Adult social care in the four countries of the UK

With reform of England's social care system still some way off amid wider uncertainty, we’ve been looking at England's nearest neighbours, where 20 years of devolution have led to important differences, to assess how each country operates and what each might learn from the others. This explainer series kicks off looking at key themes around funding, eligibility and ‘offer’ in each of the four UK countries, while considering the direction of current reform efforts.

Comment series

Published: 18/03/2020

It is more or less clear to people that, when they have a health need, they can easily access the NHS via their GP or A&E or other direct access clinics (such as a walk-in clinic or minor injuries unit). And, when health care is needed, it is also well understood across the whole of the UK that there will be no charge.

The same clarity is not so evident when an adult has a care need – such as when they need help dressing, bathing or preparing food. Not only is social care an entirely different system from health, organised and with mostly separate funding to the NHS, there are also a number of differences between what a citizen can expect from social care across each of the four countries in the UK.

Legislative and demographic differences have existed between the different countries’ social care systems for many years, but since formal devolution settlements in the late 1990s, Scotland, Wales and Northern Ireland have assumed greater administrative and legislative powers. The pace at which these powers have been devolved has varied between countries – in Scotland and Northern Ireland social care has been (progressively more) administratively and legislatively devolved since 1998, and in Wales legislatively since 2006. The result of 15 to 20 years of devolution is that the social care systems in each of these countries have developed in different ways. As England continues to await long-promised social care reform, the other three countries of the UK offer learning that policy-makers should heed.

In this series of explainers, we describe the social care system in each of the UK countries, and shed light on where the systems diverge and the direction that each country is now taking.

The sections below look at funding, who receives help, other types of support, and the processes of reform in the different countries. They are accompanied by an article that draws out some key lessons that England may wish to take from the other countries.

Further explainers on the workforce, staff and carers, and the provider market will be published here in the coming weeks.

We thank all the stakeholders across England, Wales, Scotland and Northern Ireland – from registration and regulation bodies to policy think tanks and academia – who advised on this project.