A Lost Decade? Adult Social Care Reform in England

This blog is based on an article in the Journal of Social Policy. Click here to access the article.

As the pandemic has progressed, adult social care has moved from the margins to centre stage, with the situation in care homes in particular increasingly recognised as a national scandal. However, adult social care is much more than just the services provided in care homes – it includes a range of support provided to disabled people, people with learning difficulties, people with mental health problems, older people and family carers to help with activities of daily living such as getting up, getting washed and dressed, eating and drinking, going to the toilet, and keeping safe and well during the day. Ideally, it shouldn’t just be about ‘services’ but about ‘having a life’ – although funding and service pressures mean that even maintaining services is difficult.

Of course, the challenges faced by adult social care pre-date covid-19, with the virus highlighting and exacerbating long-term policy neglect, lack of understanding, fragmentation and under-funding. In 2010, we worked with Downing Street and the Department of Health to review the costs of adult social care and the different options available to government in terms of reform. This concluded that the system was “broken” and that, with no action, the costs of adult social care could double within two decades.

This would be the case for current services (which had already been strongly criticised for failing to fully and appropriately meet need), leading to significantly higher costs with no improvement. We were adamant that doing nothing was not an option. Our analysis was part of the government’s 2010 White Paper, with pledges to create a new ‘National Care Service’ (with much greater similarities to the NHS than to the previous highly targeted, discretionary and poorly funded adult social care system).

Not only were these warnings not heeded – but the situation has since got worse. Adult social care has always been organised differently and funded less generously than health care, but the period since 2010 brought this into even greater relief. The 2010 reforms were instantly dropped by the new government, and the austerity agenda led to a decade of spending cuts, service pressures and a growing sense of crisis. In our article we describe this as ‘a lost decade’ in which previous reforms and investment stalled and, in many cases, began to go backwards.

Predictably, the result has been greater unmet need, more self-funding, lower quality care, a crisis among care providers, and much greater pressure on staff, families and partner agencies. Cuts have also fallen heaviest on older people, with services for working age people less affected. Despite the legitimate needs of other groups, it is hard to interpret this other than as (at least in part) the product of ageist attitudes and assumptions about the role and needs of older people. Put simply, it seems services for older people can be cut in ways unimaginable (and which would certainly be even more vehemently challenged) if they occurred in other service settings.

While the situation is urgent, the human misery caused by this ‘lost decade’ is not as visible as financial pressures on more prominent, popular and better understood services, such as hospitals or schools. When social care is cut to the bone, lives are blighted, distress and pressure increase, and the resilience of individuals and their families is ground down. Yet this happens slowly – day by day, week by week, and month by month. It is not sudden, dramatic or hi-tech in the way a crisis in an A&E department may be, and tends to attract less media, political and popular attention. With yet more urgency than in 2010 we warn again: doing nothing is NOT an option.


About the authors

Jon Glasby is Professor of Health and Social Care at the University of Birmingham

Yanan Zhang is Research Fellow at the University of Birmingham

Matthew Bennett is Senior Lecturer in Social Policy at the University of Birmingham

Patrick Hall is Research Fellow at the University of Birmingham

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