Adult social care in England is nearing collapse, with a “crisis unfolding in real time,” according to an alarming report released on Tuesday, as we went to press.
A survey of 200 care providers conducted by Care England and the disability charity Hft revealed that 90% cited workforce costs as one of their top three financial pressures. Of those, an overwhelming 95% identified Labour’s proposed increase in the National Living Wage as their most pressing concern.
The charities warned that shortfalls in fee increases from local authorities mean most care organisations will be forced to absorb the additional costs themselves. Already, 30% of providers have closed parts of their operations or handed back contracts to local authorities. Alarmingly, a third are considering exiting the market entirely, potentially leaving hundreds of thousands of vulnerable people without essential support.
The survey also found that nearly 40% of providers have curtailed investment in building future care capacity. Adding to these challenges, impending increases in employer National Insurance contributions are expected to further strain the sector.
This comes after Labour announced that a long-overdue overhaul of the social care system will be postponed until 2028. In the meantime, an independent commission, led by Baroness Casey of Blackstock, a respected Whitehall figure known for addressing social issues such as homelessness and anti-social behaviour, will work to build a “national consensus” on reform.
The first phase, focusing on medium-term challenges, will commence in April 2024 and conclude by mid-2026. The second phase will address long-term structural issues and deliver its final report in 2028.
As this step has invited criticism and support from various actors of the society, we understand what the problem actually is, practicality of the approach and how social care affects ethnic minorities.
Problems facing the social care sector
The social care sector has been brought “to its knees” with severe staffing shortages, rising waiting lists, and uncertain finances.
According to Caroline Abrahams, Charity Director at Age UK, “As a result, there isn't enough social care to go round and the quality is highly variable, so securing social care is something of a postcode lottery. As a result, families often end up having to pick up the pieces by providing care themselves. Many do so willingly, but it's a lot to take on without any support. A further drawback is that if you have to pay for your own care, as increasing numbers do, it can be very expensive, quickly wiping out most people's savings. The average cost of a week in a care home has recently been calculated at £1,600.”
Bernie Suresparan, the Chief Executive Officer at We Care Group also shared his opinion on the problem areas. He said, "The previous government's decision to restrict dependents from accompanying overseas workers has significantly impacted the social care sector. Initially, there were 156,000 vacancies, which had been reduced to 131,000, largely due to contributions from overseas workers and local staff.
“However, this progress is at risk of being undone as the restrictions disproportionately limit the availability of overseas workers. Furthermore, the sector's low pay rates fail to attract young people to careers in social care, further worsening the workforce shortage."
He also highlighted the plight of caregivers sharing that millions of caregivers have received minimal support from the Government. “Although the introduction of an extra week of holiday offers some relief, the government falls short of addressing their financial challenges”, he said.
Abrahams also stressed that social care needs a complete overhaul, a commitment from the politicians to fund the shortfall in investment that has built up over the years, and measures to make being a paid carer a more attractive career, including better pay and conditions.
She said, “There are lots of vacancies in the social care workforce so we would like to see the Government take action during 2025 to give care workers a pay rise. This would be fair recognition of the difficult and crucial job these people do and should also help to reduce the turnover of staff in home care and care homes.”
Previously, Lord Darzi of Denham’s Independent Investigation of the NHS in England, published on September 12, 2024, described the state of social care as "dire." The report revealed that 13% of NHS beds were occupied by patients who could have been discharged from the hospital.
While not all delayed discharges are directly linked to issues within the social care sector, other contributing factors include waiting for patient transport, delays in receiving medications, or families expressing concerns about a patient’s readiness to return home.
Lord Darzi’s report outlined the repercussions of delayed discharges on NHS operations, stating that they result in a 7% reduction in daily outpatient appointments per consultant, 12% less surgical activity per surgeon, and an 18% decline in activity per clinician working in emergency medicine.
To address these challenges, the report recommended “hardwiring” funding into a multidisciplinary model of care services. It called for better integration of care systems and an increased focus on preventative community-based interventions.
Need for social care support and understanding of ethnic minorities
According to, Dr Karan Jutlla, Head of Centre for Applied & Inclusive Health Research & Dementia Lead at University of Wolverhampton, Consultant in dementia care and inclusion, the issue of underfunding affects people universally, regardless of their background. However, for individuals from South Asian communities or those whose first language isn’t English, the impact is even more significant—a kind of double jeopardy. Historically, there hasn’t been enough funding or resources to cater to these communities and address their specific needs.
She explained her perspective stating, “For instance, when people from such backgrounds approach care providers, they often find that there’s no culturally appropriate information or resources available, let alone materials in their native language. This creates an immediate barrier. Most care providers acknowledge this but argue that they lack the funds to translate materials or make services culturally inclusive.
“Now, with even less funding available, the gap between communities and care providers is set to widen further. Previously, organisations barely managed to provide good-quality dementia care, let alone invest in making that care culturally and linguistically appropriate. The current funding cuts will exacerbate these disparities, leaving already underserved communities at an even greater disadvantage in accessing adequate care.”
She further highlighted that to make meaningful progress, it is needed that communities missing out on support are identified. “Ethnic minority communities, particularly South Asian communities, are expected to see the steepest increase in dementia cases. These communities also have higher risk factors compared to others. Given this, there’s an urgent need for government initiatives that drive attention and resources toward addressing these disparities. However, for such efforts to be effective, they must be properly resourced”, Dr Jutlla said.
Is the independent review a practical approach?
Reactions to the social care review are largely mixed, with many welcoming the long-awaited focus on the system's issues, particularly funding and workforce shortages, but expressing concerns about the lack of concrete details and potential for insufficient action, especially regarding the proposed funding mechanisms and workforce improvements needed to address the growing demand for social care services.
Bernie Suresparan feels that while reviewing the social care system in its entirety is a positive step, but waiting until 2028 is far too long. He said, “The sector is already on its last legs, and such a delay will only worsen the situation. More care homes will likely close, bed availability will decrease, and unnecessary pressure will be placed on the NHS. Smaller care providers, in particular, will struggle, as they lack the financial reserves to sustain themselves until 2028.”
Offering her perspective, Caroline Abrahams said, “The reality is that the Government doesn't really have a plan to reform social care - if they did then Age UK and many others would be pressing them to put it into practice straight away. Instead, they have asked Baroness Louise Casey to lead an independent commission into how social care should change. Baroness Casey is highly respected as a reformer who gets things done, but the timescale the Government has set for her review is too relaxed as they have said she won't report until 2028.
“This won't help older people receiving social care now, and their families, so we and many others are urging the Government to speed the review up. What's more, the Government has said it would like to secure cross party agreement to the changes she recommends, but that will be difficult in 2028 as a General Election will be just around the corner. For these reasons we'd like the timetable to be much more rapid, so some constructive changes can get underway before the next Election.”
Dr Jutlla, shared her perspective on how social care affects Dementia patients stating, “From my understanding, the focus now is on targeting previously underserved areas and developing better post-diagnostic support for dementia care. Currently, there is a significant gap following a dementia diagnosis—there’s no immediate follow-up support. Most people only enter the system when they’ve reached a crisis point. Recognising this, the aim is to address the gap by providing more comprehensive post-diagnostic support. Additionally, there’s an intent to provide greater support to younger individuals affected by dementia.
“What remains unclear is how deeply the review will examine health inequalities among different communities affected by dementia. Will it truly address these disparities, or will it take a blanket approach? While it’s positive to see more focus on post-diagnostic support, my concern—both personally and professionally—is whether there will be a substantial effort to understand and tackle the health inequalities that exist in dementia care.”
