Policy briefing
Adult social care reform in England: the policy landscape explained
Adult social care in England has been in a state of perpetual reform discussion for decades. This briefing explains what the sector is, why it is in crisis, who the key decision-makers are, and where the policy debate currently stands.
What adult social care is
Adult social care encompasses the support provided to adults who need help with daily living because of age, disability, or long-term health conditions. It is distinct from NHS healthcare, which is funded centrally and free at the point of use. Social care is means-tested: those with assets above a capital threshold (currently £23,250 in England) are expected to fund their own care.
The sector covers three main types of provision:
- Domiciliary care (home care)— support workers visiting people in their own homes to assist with personal care, medication, and daily tasks. The largest part of the sector by number of people supported.
- Residential care— care homes providing 24-hour staffed accommodation for people who can no longer manage at home, typically older adults or adults with learning disabilities.
- Nursing homes— registered care homes with nursing staff on-site, providing care for people with complex medical needs alongside social care.
The sector is predominantly delivered by independent providers — private companies and charities — commissioned by local authorities and, in some cases, directly purchased by individuals using local authority personal budgets or their own funds.
The funding crisis
Adult social care in England faces a structural funding crisis driven by three converging pressures: demographic demand (an ageing population with increasingly complex needs), constrained local authority budgets, and a workforce that is chronically underpaid relative to comparable NHS roles.
Local authority social care funding is met partly from central government grants and partly from council tax, including the social care precept introduced in 2016. Neither has kept pace with demand or cost inflation. The result is a sector in which many providers operate on margins that make investment in quality and workforce extremely difficult.
The Dilnot proposals and the abandoned cap
The Dilnot Commission, reporting in 2011, proposed a cap on the lifetime amount any individual would have to contribute to their care costs, combined with a raised means-testing threshold. The principle was to protect people from catastrophic care costs while retaining some personal contribution.
The then-Conservative government legislated for a version of Dilnot’s cap — set at £86,000 in the Health and Care Act 2022 — to come into force in October 2023. In July 2023, with implementation imminent, it was postponed to 2025. The 2024 general election returned a Labour government that has not committed to implementing the cap in the form legislated, and the policy position remains unresolved.
The repeated delay reflects both the fiscal cost of the cap (estimated at several billion pounds per year at full rollout) and the political difficulty of reforming a system that simultaneously requires people to deplete their assets to fund care while the state struggles to fund the baseline.
Key stakeholders
Understanding who holds influence in adult social care policy requires mapping a complex ecosystem:
Care Quality Commission (CQC)
The independent regulator for health and social care in England. CQC registers, inspects, and rates providers. Its inspection methodology and rating system significantly shape provider behaviour and market confidence.
NHS England and Integrated Care Boards
Integrated Care Boards (ICBs) commission some social care services and lead the integration agenda in their areas. The NHS–social care boundary is a persistent flashpoint in the system.
Local authorities
Upper-tier and unitary councils are the statutory commissioners of adult social care. They set fee rates, determine eligibility thresholds, and manage the local care market. The Association of Directors of Adult Social Services (ADASS) represents their leadership.
NCF and Skills for Care
The National Care Forum represents not-for-profit providers. Skills for Care is the workforce development body for adult social care in England, publishing annual data on the workforce and training needs.
Current government position
The Labour government elected in July 2024 committed to a National Care Service as a long-term objective but has not set a timetable or published a funding framework. In the short term, it has prioritised the NHS Long Term Workforce Plan and early NHS reform over social care structural reform.
The immediate pressure points being debated include the impact of the National Living Wage increase on provider viability (social care is heavily reliant on minimum-wage staff), the pace of CQC reform following the Dash Review which identified significant concerns about CQC’s regulatory capacity, and the future of NHS-social care integration under the Integrated Care System architecture.
Select Committee inquiries into social care funding and workforce have been recurring features of recent Parliamentary sessions, and the sector continues to generate significant policy debate in both the Commons Health and Social Care Committee and the Lords.
The Better Care Fund
The Better Care Fund (BCF) is a pooled budget between NHS England and local government, designed to fund integrated health and social care at a local level. It is one of the main structural mechanisms through which NHS and local authority resources are brought together to support integrated commissioning.
For a detailed explanation of how the BCF works and how health and care organisations can engage with it, see our guide to the Better Care Fund.
Bridgehead’s social care practice
Bridgehead is a specialist communications and public affairs agency with deep experience in adult social care. We work with care providers, sector bodies, and technology companies operating in the care market — helping them communicate credibly with media, policymakers, and commissioning bodies.
