Last week’s government Spending Review follows a pattern with which many in the social care sector will be familiar. Social care gets a passing mention in announcements that are really about saving the politically more salient NHS. Reform of social care will be tomorrow’s business, with the Casey Commission due to make an interim report next year. Some money is promised, but with scant details and likely only enough to meet current demand rather than fund much needed reforms.
It perpetuates a sense in the sector of stasis, of waiting, of hoping that this time will be different, despite the failures thus far to even implement laws that have been passed.
Social care in complex local systems
But whilst national social care reform remains at a standstill, the reality of local social care systems – where these policies are enacted and experienced – is constant change, not stasis. French and colleagues (2023) write about dynamic complexity in local public services: ‘the churn and volatility of causal factors and their interrelationships through which outcomes emerge’. Social care is enmeshed with so many local systems and structures that it is in a constant state of flux.
This year alone, local authorities are dealing with the restructuring of local government, the planned mergers of Integrated Care Boards and the shift to Reform-led leadership in several councils. As leaders digest the implications of the Spending Review, local authorities will be planning for the boost in social housing spend and a welcome investment in children’s services. There is also a fund for ‘trailblazer neighbourhoods’ – 20 areas which will receive £20 million of investment. Demos has called this a ‘Quiet revolution in government’ and welcomed its ambition for neighbourhood transformation, but for local government leaders there is now the issue of understanding how this knits into existing partnerships and infrastructure. Investment in housing, children’s services and neighbourhoods have the potential to support wider social care ambitions, but only if leaders can think and work in whole system ways.
Complexity for care providers and workers
This complexity is not limited to local government. We can see each part of the care ecosystem as affected by the same turbulence. Care providers, the vast majority of which are for-profit and not-for-profit rather than state owned, similarly face constant shifts in landscape. The National Insurance (NI) and legal minimum pay rate rises, which local authorities cannot afford to fund fully, threatens the viability of many providers. The government has repeatedly committed to a Fair Pay Agreement for care workers, and reiterated this as part of the Spending Review announcement. However, care providers expressed concern at the lack of clarity on how this would be funded. Workforce planning is made harder by the frequent shifts in national government policy around the health and care visa. The creation of this visa route in 2020 has led to a big increase in international workers in the sector, helping to address workforce shortages. However the visa has since been modified to limit the bringing of dependents and looks likely to be removed entirely as part of the government’s commitment to limiting net migration.
Overall this creates a sense that – where national government is intervening in social care – it is doing so in a way that is not joined up and with insufficient attention to the sequencing of reforms. Placing more financial demands on the system – through the NI contributions and legal minimums, and the likely Fair Pay Agreement – can only destabilise the system if it comes ahead of sustainable funding. Similarly, on the visas, in addition to the stress and uncertainty for workers themselves, the decision to halt them has been made before a clear alternative plan on workforce sustainability has been presented. Beyond this provider perspective, this constant change adds to the stress and woes of a fragile workforce reeling from austerity, Brexit, COVID-19, and the subsequent rises in living costs. It also reaffirms the construction of migrant workers as disposable, with the stability and security of their lives an afterthought.
Complexity at the level of the individual
Similarly, for disabled people, older people, people using mental health services and carers, the reality is constant churn and anxiety rather than stasis or continuity. Carers must make up for gaps in funded care support, with Age UK estimating that 2 million older people have some level of unmet need and Healthwatch England highlighting 1.5 million people of working-age are not getting the care they need. Recent changes to the earnings limit for Carer’s Allowance are welcome but do not make up for the ways in which caring has a negative impact on people’s health and financial security. Threatened changes to Personal Independence Payments (PIP) which are on the horizon for October 2026, further add to the constant sense of precarity and threat.
And of course in a complex public service ecosystem, the impacts on individuals are also impacts on families, neighbourhoods and institutions. If reforms to PIP go through, this will reduce the contribution that disabled people will make to local authorities for their care, further straining local authority budgets. If unpaid carers aren’t adequately supported and their own health suffers, there will be higher levels of demand on formal health and care services.
Ways forward?
In complex systems, the level of emergent change is such that people often lack the headspace and capacity to make planned interventions. Perhaps there is some comfort in the fatalistic narrative of crisis and a sense that there’s no point doing much until we have the Casey Commission report.
What can be done, in the absence of national policy or funding reform, is more work at local level to get the basics right. There are a range of system, policy and practice interventions that can be taken now to reduce blockages and make the system simpler for people to navigate. Social Care Future call this the plumbing and wiring and have produced helpful resources on how to do it.
Future strategies might also involve understanding the potential benefits of AI for social care,, with an allocation of £2bn in the Spending Review for the public sector. Technological possibilities advance much more quickly than public policy reforms. However there needs to be a balance between ‘techno optimism’ and mitigation of the risks and costs it also brings. The increased onus on digital will need to navigate issues of exclusion and also public trust, particularly when in collaboration with the private sector.
When ‘big picture’ reform does come from the Casey Commission it will need to be mindful that this is not a static sector, awaiting its turn for attention. Social care is a complex and shifting interplay of family, state, market and community, inextricably entangled with health, housing, employment and migration. Successful reforms will require an understanding of this complexity as much as they will require adequate funding or the right legal frameworks.
Read our response to the 2025 Spending Review in relation to Children’s Social Care here.
About the authors
Kate Hamblin is Professor of Social Policy and Director of the Centre for Care. She joined the University of Sheffield in 2018 to work on the Sustainable Care programme. She also currently leads the Centre for Care’s Digital Care research theme and is the UK Networks and geographical lead for the North and East-Midlands in the IMProving Adult Care Together (IMPACT) evidence implementation Centre. She is also the Policy and Practice Liaison lead for the NIHR School for Social Care Research at the University of Sheffield.
Catherine Needham is Professor of Public Policy and Public Management at the Health Services Management Centre, University of Birmingham. Her research focuses on adult social care, including personalisation, co-production, personal budgets and care markets. She has published a wide range of articles, chapters and books for academic and practitioner audiences. Catherine led the Care in the Four Nations work package within the ESRC Sustainable Care team. She is now leading research on care systems as part of the ESRC Centre for Care and is also a member of IMPACT, the UK centre for evidence implementation in adult social care.
In the Centre for Care, Duncan works with Dr Liam Foster in the Care Workforce Change research group. They are currently researching care workers’ organising activities, including their role in trade unions, campaign groups and community organising. This piece introduces the study.
