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Patients face unequal access to social care across England, new report finds
A new report shows that social care needs to coordinate with the NHS and other services, particularly as integrated care boards and local authorities undergo structural changes.
Patients with similar care needs can experience significantly different waiting times, assessment processes and levels of support depending on where they live, according to new research commissioned by the Casey Commission on Adult Social Care.
The report Governance in social care: Lessons for reform, produced by the Nuffield Trust and the Institute for Government, reveals persistent inequalities in access to publicly funded care, alongside fragmented leadership and accountability across England’s social care system.
There is also a lack of clear stewardship, vision, and accountability, particularly within government departments such as the Department of Health and Social Care (DHSC). Responsibility is split between DHSC (policy) and the Ministry of Housing, Communities and Local Government (funding), creating coordination challenges.
The researchers warn that reform must take account of the relationship between social care and the NHS, particularly as local authorities and integrated care boards restructure.
The findings raise important questions about how health and social care services can collaborate to provide consistent support for older people and for patients with complex or long-term care needs.
Sector dominated by private providers
In a speech at the National Children and Adult Services Conference in Liverpool today, Baroness Casey said that England’s social care system was never deliberately designed like the NHS was in the 1940s. Instead, it was built in increments and accidents, resulting in a sector dominated by private providers, as the research describes it, “largely uncontrolled and unintended”.
The report also shows that two people with the same condition have different experiences depending on where they live: different assessment processes, waiting times, and levels of support. In addition, people paying for their own care are, on average, charged 40% more for the same service than those whose care is arranged by their council.
Workforce challenges were also highlighted, including data gaps, high vacancy rates, low pay, and complex employer landscapes, all of which make effective planning and retention more difficult. Despite the sector having over 1.5 million social care workers across around 19,000 employers, England remains the only UK country without a mandatory register of care workers or a long-term national workforce strategy.
The report is part of a series of research reports on England’s adult social care sector that the Commission will publish. The research informs the Commission’s work, which will culminate in final recommendations to government in summer 2027.
Turning point for social care
Gerard Crofton-Martin, Interim Chief Executive of the Social Care Institute for Excellence (SCIE), said: “One of the biggest lessons from the past is that reform cannot simply be legislated into existence. The report makes clear that national infrastructure is needed to make lasting improvements.
“The Casey Commission offers a genuine opportunity to change course. But building a National Care Service will take more than a bold vision and a sustainable funding settlement. It will require a serious, long-term commitment to helping a complex and fragmented sector deliver better, more equitable social care which will improve people’s lives.
“We’re at a turning point for social care, and reinforcing the foundations for lasting improvement must be at the heart of the government’s plans. SCIE stands ready to play its part in driving this ambition forward. Our work developing national standards of care, which will establish greater consistency and fairness as part of a National Care Service, shows that we need not wait for policy reforms to begin tackling the care system’s myriad challenges, such as inequitable access to care.
