What health and care need from the next government: #2 – Adult social care

With an election approaching, the Nuffield Trust's briefing series challenges the NHS and social care manifesto commitments of UK political parties in advance of the vote. The second in our series looks at adult social care: a vital public service supporting people of all ages to live with dignity and independence but one that has been left with insecure funding, variable access, catastrophic costs for those in need, and high staff turnover. Reform is long overdue, and we set out the criteria we believe would need to be met for getting social care on the right footing.

The NHS and social care in England are struggling. A combination of the sudden shocks from the Covid-19 pandemic and high inflation, and the longer-term pressures of poor workforce planning, morale problems, failure to deliver promised efficiency savings, and decades of delay to social care reform are all taking their toll. Strain and dysfunction are deeply rooted and will not immediately improve, and the public sees this clearly: satisfaction with both services is at historic lows. Credible long-term plans to improve this situation are vital for any political leader who wants to gain the support of the British people.

Our series of general election briefings, produced with funding from the Nuffield Foundation, looks at a set of key issues where we believe a government taking or returning to office in the next year must act in order to meaningfully improve health and care. The second in that series looks at adult social care – a vital public service, supporting people of all ages in England to live with dignity, independence and wellbeing. Yet it has been left to languish for decades with insecure funding, variable access to support, high workforce turnover, heavy reliance on unpaid carers and catastrophic costs falling on people in need. Despite much excellent high-quality care being successfully delivered every day, hundreds of thousands of people who need support with their daily lives simply get none.

Both government and opposition leaders recognise that reform of this ailing system is overdue, but fear that taking action will bring more blame than credit because of low awareness among voters, and tight finances. This has been a terrible failing of British public policy, and public dissatisfaction has gradually continued to rise.

This briefing sets out the criteria we believe would need to be met for a long-term social care reform which would support this sector as a vital pillar of social and economic infrastructure, and a visible political success rather than a source of increasing public disapproval. It is based in part on our in-depth research into other countries, such as Germany and Japan, which have carried out comprehensive and politically successful reforms.

Test 1: Set out a plan for cohesive reform that offers clear benefits and grants social care policy parity with the NHS

There is a need to tackle low awareness of social care by articulating the clear benefits of investing in the system and building a case for the future. To date, reform has been piecemeal and limited. To transform the system, there needs to be a coherent plan that recognises the interconnectedness of different elements.

Test 2: Introduce a credible mechanism to fund adult social care sustainably

To ensure public support for contributions, revenue should be raised through easily understood established taxation routes that are as fair as possible, and pooled nationally to spread the risk of high costs across the whole population. Any approach should put an end to the uncertain, sporadic injections of money and boost overall funding.

Test 3: Introduce greater consistency in, and expand, access to publicly funded care

Diminishing and inconsistent access to care and support, determined by where someone lives, has been a feature of social care in recent years. Expanding the offer and ensuring people have consistent access to services needs to underpin a clear eligibility process.

Test 4: Ensure that people who need social care have choice and control and can access personalised support

While consistency of eligibility criteria for public funding is crucial, this needs to be balanced with flexibility to design care and support to ensure that people who need social care have choice and control and can access personalised support. The next government should not seek to define a national package of care for all and instead consider notional budgets to be used flexibly to suit an individual’s needs and preferences.

Test 5: Set out a clear long-term strategy for the social care workforce that ensures staff are valued and want to stay in social care

Rising vacancies and turnover have undermined continuity and quality and been challenging for providers. A strategy would need to address issues of low pay, poor terms and conditions and training and development. It should consider all parts of the workforce, including registered professions, managers and personal assistants and consider skills needed for the long term.

Test 6: Bring stability, growth and steady improvement to the organisations that deliver care 

A strong market development strategy should include ensuring fair fees are paid to providers to enable investment; setting clear rules of financial behaviour for all providers; and supporting councils to commission innovatively and strategically. 

Test 7: Set out plans for supporting England’s unpaid carers 

Although the preceding reforms should create a system where there is less reliance on unpaid carers, they will still be an important feature and should be both included in plans and given adequate, tangible support to help them balance caring with their own wellbeing, work and other activities.

Test 8: Ensure social care reform works alongside other services, in particular the NHS

Social care needs to be seen as an equal partner at integrated care system level and people interacting with both services should experience a seamless journey. Where there are mutual benefits, such as in workforce planning and investment in innovations, social care and the NHS should work collaboratively for the benefit of their local communities and to avoid undermining long-term planning in both services.

Read the full briefing

View the summary slides


We are grateful to the Nuffield Foundation for contributing funding to this work through their General Election Analysis and Briefing Fund.

The Nuffield Foundation is an independent charitable trust with a mission to advance social well-being. It funds research that informs social policy, primarily in education, welfare, and justice. The Nuffield Foundation is the founder and co-funder of the Nuffield Council on Bioethics, the Ada Lovelace Institute and the Nuffield Family Justice Observatory. The Foundation has funded this project, but the views expressed are those of the authors and not necessarily the Foundation. 

Suggested citation

Curry N, Oung C, Crellin N and Dodsworth E (2024) What health and care need from the next government: #2 – Adult social care.  General election briefing series, Nuffield Trust.