What steps are currently being taken to reform social care?

This explainer analyses the main social care reform activities in each UK country.

Blog post

Published: 02/02/2023

Key points

  • Although the social care systems of each UK country are becoming increasingly different, each is experiencing significant challenges with their systems.
  • All four countries have recently embarked on reform programmes to address shared issues around access, accountability, market stability and the social care workforce.
  • Successfully embedding reform has proven a challenge across the UK, with financial pressures threatening current reform initiatives.


Here we discuss the main policy developments underway in each country in turn.


England’s white paper for reform, People at the Heart of Care, was published in December 2021. It set out the government’s vision for social care over the next 10 years as well as its plans for investment into the sector. This included £1.7 billion allocated to social care improvements up to 2024/25, which allocated £500 million for workforce support and training, £300 million for housing, £150 million for technology and digitisation, £70 million to support local authorities to commission and deliver social care, and £25 million to support unpaid carers.

The proposed reforms also introduced a cap on individuals’ lifetime care costs, set at £86,000 and an extension of the upper means test (known as the ‘floor’) from £23,250 to £100,000. Proposals also included plans to end the cross-subsidy often paid by people who fund their own care, by encouraging councils to pay higher fees to providers (known as the fair cost of care).1 These changes were due to be implemented in October 2023, although some stakeholders had raised concerns that the funding and time given to implement these were insufficient.2

The Autumn Statement in October 2022 announced a delay to the introduction of the cap and means test extension to 2025, which had been in recognition of the significant financial pressures currently faced by local authorities.3 This funding was repurposed in the form of a ringfenced fund intended to enable local authorities to make tangible improvements to adult social care, in particular to address discharge delays, waiting times, low fee rates and workforce pressures.4 The Autumn Statement also announced additional funding for social care discharge. However, stakeholders (including the Lords Social Care Committee) have raised concerns that the funding made available may allow the sector to keep pace with inflation, but will not be enough to improve or increase the level of care.5



In January 2021, Wales consulted on proposals to improve social care arrangements and strengthen partnership working in its white paper for reform, Rebalancing care and support. It set out plans for reform around three key areas: rebalancing the market for care provision, improving commissioning practices, and evolving integration with health care partners. In October 2021, the introduction of a strategic national framework for care and support was announced, alongside the establishment of a national office within the Welsh government to oversee its implementation.6

The Welsh government and Plaid Cymru have committed to delivering an implementation plan for a National Care Service, free at the point of need, by the end of 2023.7 In November 2022, the Expert Group on the National Care Service published its recommendations for the development of the implementation plan.8



The Independent Review of Adult Social Care published its report on how to reform Scottish social care in February 20219, which was followed by the Scottish government’s own consultation analysis in February 2022.10 In June 2022, primary legislation to create a National Care Service was published.11 The legislation sets out that responsibility for social care will be shifted from local government to Scottish ministers by 2026.12 At a local level, care boards will replace the existing integration authorities to shape social care in line with the vision set by the National Care Service.

However, several cross-party committees, including the Education, Children and Young People Committee13 and the Finance and Public Administration Committee14 have both expressed discontent with the limited cost information currently available to assess the potential impact of implementing a National Care Service. Councils have also called on Scottish ministers to delay its plans given current inflationary pressures (at the time of writing).15


Northern Ireland

The Department of Health in Northern Ireland published a consultation document, Reform of Adult Social Care in Northern Ireland, in January 2022. The consultation included a number of proposals to implement recommendations of the Power to People report published by the Expert Advisory Panel on Adult Care and Support in 2017.16 The Department of Health are currently analysing responses and progressing the development of social care reform.

However, the collapse of power-sharing in October 2022 has left Northern Irish policy-making in an executive deadlock. At the time of writing, a power-sharing agreement has not been reached.17 Legislation to take forward the implementation of social care reform is likely to be more difficult until power-sharing is restored in Northern Ireland.


Suggested citation

Dodsworth E and Oung C (2023) 'What steps are currently being taken to reform social care'?, in Adult social care in the four countries of the UK. Explainer series, Nuffield Trust.


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