01
Care Association Alliance
Building a National Care Service
A Programme for Reform
Paper01

Adult Social Care
Funding Reform

The case for a national funding settlement.
Authors
Melanie Weatherley MBECo-Chair, Care Association Alliance
Damian GreenSenior Policy Adviser
William WalterLead Author
Tom ZundelSenior Author & Head of Research
Published May 2026
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The Alliance

The national voice for social care providers.

The Care Association Alliance brings together care associations from across England, representing the full breadth of the adult social care sector: residential care, nursing care, home care, and supported living.

9,000
Member organisations across England
All
Major care sectors represented: residential, nursing, home care and supported living
One
Unified voice to Government, Parliament and the Casey Commission

The campaign is supported by the Rt Hon Damian Green MP, former First Secretary of State and de facto Deputy Prime Minister, who held direct responsibility for social care policy in Government.

01
The problem

A model built for a country that no longer exists.

Social care for older people is financed through a model that distributes a national demographic risk across 153 local authority budgets that were never designed to bear it. The result is instability, rationing, and a postcode lottery of access.

153 local authorities. One national risk, split 153 ways, each with different capacity to bear it.
0×
The over-85 population is projected to double within twenty years.
OBR
0.0%
of older people now receive local-authority-funded long-term care.
King’s Fund
£0
Upper capital limit, frozen in cash terms since 2010/11.
Social Care 360
0 in 0
people aged 65 face lifetime care costs above £100,000, with no way to insure.
HoC Committee
02
The evidence

The gap is structural, not temporary.

Meeting demand needs real-terms growth of 3.1% a year. It has had 0.7%. By 2032/33 the shortfall reaches £8.3 billion a year, the cost of simply standing still.

Fig 1LA spending vs the spending needed to meet demand, 2010/11–2032/33
£18£21£24£27£30£3310/1114/1518/1922/2326/2730/3132/33projected£0.0bn (2023/24)£0.0bn needed£0.0bn£0.0bn gap
Sources: Health Foundation REAL Centre; OBR; King’s Fund. Real-terms; projections illustrative.
Fig 2The frozen means test: cash value vs inflation-adjusted
£20k£25k£30k£35k10/1114/1518/1922/2326/27£0 frozen£0 if uprated
Upper capital limit, 2010/11–2026/27. Sources: Social Care 360; IFS.
Fig 4Homecare: what councils pay vs the sustainable minimum
£0£6£12£18£24£30£36Average fee councils pay£0.00/hrMinimum sustainable price£0.00/hr£0.00/hr shortfall
2025/26. Only 1% of contracts meet the minimum. Source: Homecare Association.
03
A postcode lottery

Spend per adult runs from £400 to £940.

Across mainland England, gross spend per resident adult ranges more than two-to-one between authorities under the same statutory framework, and the widest variation is within regions, not between them.

The two extremesThe highest and lowest spend per adult in England
ENGLAND £633£0WarringtonNorth West · lowest£0KnowsleyNorth West · highest0.00× per adult
Both Warrington and Knowsley sit in the North West: the disparity is not a simple north-south or rich-poor divide.
Spend per adult · every English upper-tier authority, 2024/25
01 / 05
153 authorities

One framework, 153 budgets

Every English upper-tier authority, shaded by spend per adult. Brighter means higher, from £400 to £940.

Spend per adult
£400£940
The regional picture

Widest within regions; narrow between them.

Fig A.2The widest variation is within regions, not between them
£400£500£600£700£800£900England avg £633North West£400£940WarringtonKnowsleySouth East£525£888London£478£796East of England£416£708North East£567£832East Midlands£465£722Yorks & Humber£546£776South West£544£761West Midlands£558£721
Each bar runs from the lowest to the highest-spending authority in the region; the dot is the population-weighted average. The North West alone spans the entire mainland range. Isles of Scilly excluded.
Fig A.3Between regions, the gap is modest: just £111
£0£180£360£540£720£0NW£0NE£0SW£0Y&H£0EoE£0WM£0SE£0EM£0LdnEngland £633
Population-weighted regional averages, 2024/25. The North West (£686) and London (£575) are the extremes, a fraction of the £540 gap between individual authorities.
The hidden bill
Unpaid carers provide support valued at £184 billion a year. Equivalent to a second NHS.
£0bn
Value of unpaid care, a year
0%
Self-funder cross-subsidy
£0.00bn
Delayed-discharge cost to the NHS
04
What we propose

A national funding settlement.

Not a free NHS-style service. Not the absorption of care into the NHS. Not the end of local delivery. A national framework, built on three principles, within which local care can finally work.

Pool the risk

National pooling of financial risk

Demographic change is a national phenomenon. Its fiscal consequences should be managed centrally, not spread across 153 budgets of wildly varying capacity.

Guarantee the right

Statutory entitlement triggered by need

Meet a nationally defined eligibility threshold and you have a legal right to support, wherever you live.

Keep delivery local

Local delivery within a national framework

Care stays commissioned and managed locally, inside a national funding, eligibility and pricing structure. A framework, not a takeover.

To be clear

What this proposal is not.

Free care on NHS lines
Absorbing care into the NHS
Abolishing local government
Removing personal contribution
Centralised care delivery
05
What we are calling for

Ten recommendations.

A blueprint for the Casey Commission.

Tap any recommendation to read it in full
06
What reform costs

Affordable, and cheaper than inaction.

The Health Foundation models three levels of ambition. Even the most modest, simply meeting demand, runs to billions a year. The cost of delay rises faster than the cost of reform.

Fig 3Additional annual funding required by 2032/33, three scenarios
£0bn£4bn£8bn£12bn£16bn£0.0bnMeet demandstanding still£0.0bnImprove access≈1.1m packages£0.0bnCover provider costsfair cost of care
Source: Health Foundation REAL Centre, above baseline.
It has been done before · five countries, one lesson
01 / 05
Scotland

A cautionary tale

Free personal care without a sustained funding settlement proved unstable. Entitlement alone is not enough.

07
An invitation

Your role in Parliament.

We are forming a cross-party working group of MPs and Peers to drive the national care funding agenda from within Parliament, chaired by a Member of Parliament ready to lead one of the most consequential domestic policy campaigns of this Parliament.

Tap each role to read more

This is a genuine opportunity to build a national profile on a domestic policy question that will define social care for a generation.

The call to action

The case for action is clear. The cost of delay is rising. The opportunity to act is now.

The Casey Commission has a clear mandate and the most complete evidence base in a generation. The Care Association Alliance intends to be the voice that speaks from direct experience of what the system actually requires.

Paper One · Care Association Alliance · May 2026
About the Alliance

The Care Association Alliance.

The CAA is the national umbrella body for local care associations in England — a member-led organisation with no paid officers. All its functions are carried out by its member associations, which collectively represent over 10,000 independent care providers across every English region.

50+
Local Care Associations
10,000+
Independent Care Providers across England
One
Unified national voice to Government, Parliament and the press

The CAA works locally, regionally and nationally — partnering with government, commissioners and health bodies to advocate for a sustainable, properly funded adult social care system. It is a founding participant in the Care Provider Alliance, which unites the ten main national associations representing independent and voluntary adult social care providers in England.

Globe House, Park Lane, Halesowen, B63 2RA  ·  info@caa.care  ·  www.caa.care