King’s Fund calls for six changes to England’s social care

King’s Fund sets out six proposals to tackle unequal access to support and chronic staff shortages, as ministers prepare for long-awaited reform.

England’s adult social care system needs a fundamental overhaul after decades of piecemeal tinkering have left it struggling to meet people’s needs, the health thinktank has warned.

In a report published on Monday, the King’s Fund set out six proposals to address longstanding problems in the sector, including unequal access to care, chronic staff shortages and a lack of control over the support available to people.

Recommendations include capping lifetime care costs, introducing a national funding system and replacing the 153 separate local authority assessment systems with a single process.

The report said the current system relied on restricting access to care and expecting unpaid family carers to fill the gaps. About 22,000 people with care needs receive no state support.

Under the proposed reforms, people would contribute towards the cost of their care according to their income and assets. Clearer entitlements and personal budgets would also give people greater choice over the support they receive.

Councils, meanwhile, would move away from acting primarily as gatekeepers to funding, with a greater emphasis on care planning and safeguarding.

The cost of reform would depend on how much people were expected to contribute. A model involving higher co-payments could cost about £4bn by 2036, while a universal system providing free care with low or no co-payments could cost £18.5bn, according to the report.

Proposals come as the government pledges to establish a national care service, with the Casey commission on adult social care due to report in summer 2027.

The King’s Fund said the combination of political commitments and the commission offered a chance to address problems successive governments failed to resolve.

‘After more than 25 years of expectation and disappointment, there is a cautious optimism that long-awaited change may happen this time,’ the report said.

Gerard Crofton-Martin, interim chief executive at the Social Care Institute for Excellence (SCIE), said the inequalities facing people who needed care were ‘profound and persistent’.

‘It is indefensible that the availability and quality of people’s care and support are still inextricably linked to where they live, their socioeconomic circumstances, ethnicity, disability, or gender,’ he said.

Crofton-Martin also welcomed the recommendation for clearer entitlements, saying they’d help people understand their rights, but warned reform would require an ‘honest conversation about funding.’ 

‘There are no easy answers, and difficult trade-offs will be unavoidable,’ he added. ‘Building greater public understanding of the value of social care and consensus through the Casey commission will be essential; without taking the public with it, the government will struggle to put forward a more generous settlement.

Martin Walker, head of practice improvement for self-directed support at Think Local Act Personal (TLAP), also welcomed proposals. He said: ‘People shouldn’t have to fit into whatever services exist in their area. They should be able to decide how they live, who supports them, and how their care is arranged.’

Image: Artem Labunsky/UnSplash

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