Public to be asked who should pay for social care as part of major review

New Delhi, India Jul 7, 2026 ALN: The public will be asked who should receive social care and how it should be paid for as part of a review into the system.

Baroness Louise Casey, who is leading a commission into adult social care in England, described the system to the BBC's Radio Four Today programme as "impossible" to navigate and called for a "reckoning" into how people are cared for. This statement underscores the growing concern regarding the accessibility and effectiveness of social care services, particularly as the population ages and the demand for care increases.

Social care in England encompasses a range of services designed to support individuals who are elderly, disabled, or otherwise unable to care for themselves. This includes assistance with daily activities such as bathing, dressing, and eating, as well as more specialized care for those with chronic illnesses or disabilities. The complexity of the system, combined with a patchwork of funding sources and eligibility criteria, has led many to feel overwhelmed and confused when seeking care for themselves or their loved ones.

Baroness Casey stated that "challenging" conversations need to be had to determine how social care should function in a country with an aging population. As demographic trends indicate a significant increase in the number of elderly individuals—predicted to reach 23 million by 2040—there is an urgent need to rethink the current social care framework. These conversations will not only address who should receive care but also how it is funded, reflecting a broader societal debate about the responsibilities of government, families, and individuals in providing care.

The government had scrapped plans for a cap on the amount anyone would need to spend on their support at home or in care homes over a lifetime and commissioned a review of funding instead. This decision has sparked criticism from various stakeholders, who argue that the absence of a spending cap places an undue financial burden on families and individuals, potentially leading to catastrophic costs for those requiring long-term care. The lack of a clear funding mechanism further complicates the situation, leaving many unsure of what financial assistance, if any, they may qualify for.

Conversations with the public will focus on older people "too often ignored or overlooked" as well as young people "who are already losing faith that they will get anything back from the state in return for paying in." This sentiment reflects a growing disillusionment with the social contract in which individuals contribute to the state through taxes and national insurance, only to find that the support they receive in return is inadequate or inaccessible. Baroness Casey is expected to elaborate on these points at the Local Government Association's (LGA) annual conference on Tuesday, emphasizing the need for a more inclusive dialogue about social care.

She will say her team, starting this month, will begin "testing the views of hundreds of thousands of members of the public to get under the skin of where the public are" in terms of adult social care, including how it should be paid for and what their role should be in caring for family members. This large-scale engagement initiative aims to gather a diverse range of perspectives, ensuring that the voices of those directly affected by the social care system are heard and considered in the review process.

The public will also be asked what role the NHS should play in social care moving forward, with Baroness Casey telling the Today programme it has "withdrawn more and more from communities and into hospitals" in recent years. This shift has raised questions about the integration of health and social care services, which many experts argue is essential for delivering comprehensive care. The NHS, originally designed to provide universal healthcare, has increasingly focused on acute medical care, often at the expense of preventative and community-based services that are crucial for supporting individuals with long-term care needs.

Suggestions that families alone should be expected to care for their aging and ill loved ones are "simply not sustainable," she added. This assertion highlights the reality faced by many families who are thrust into caregiving roles without adequate support or resources. The emotional and physical toll of caregiving can be immense, leading to burnout and health issues for family members, which in turn can exacerbate the challenges faced by those requiring care.

When asked if she hopes to deliver a publicly funded "National Care Service" similar to one proposed by Prime Minister Sir Keir Starmer's likely successor Andy Burnham, Baroness Casey said "everything is on the table." This openness to exploring various funding models reflects the complexity of the issue and the need for innovative solutions that can address the diverse needs of the population. A National Care Service, akin to the National Health Service, could potentially provide a more unified and equitable approach to social care, ensuring that all individuals have access to the support they need regardless of their financial situation.

"I am of the view that we need a National Health and Care Service; the public don't see the difference and I don't," she said. This perspective aligns with calls for a more integrated approach to health and social care, recognizing that individuals often require a combination of medical and social support to thrive. The historical separation of health and social care services has created barriers to effective communication and coordination, leading to fragmented care experiences for individuals.

"Over time what has happened is the National Health Service has pulled more and more and more in what they think is medical and only medical and we have left basically everybody else to worry about what they think care is." This observation points to a critical challenge in the current system: the need for a paradigm shift that prioritizes holistic care over narrowly defined medical interventions. Such a shift would require a reevaluation of how care is delivered, funded, and perceived by both providers and recipients.

Previously, she has described the care system as fragile and divided, with drawn-out discussions over who pays for what, making it anxiety-laden and confusing for those who need support. This characterization resonates with many individuals and families who navigate the complexities of the care system, often feeling overwhelmed by bureaucratic hurdles and unclear eligibility criteria. The emotional toll of this confusion can exacerbate the stress associated with caregiving and seeking support.

Her independent commission started work last summer. It has been examining the problems facing the care system in England and is due to produce a report this year with a plan for how to create a National Care Service. The findings of this report will be crucial in shaping the future of social care in England, as they will provide a roadmap for addressing the systemic issues that have long plagued the sector.

Phase two, which will look at how social care is funded in the longer term, is not due to report until 2028. This extended timeline underscores the complexity of the issues at hand and the need for thorough analysis and stakeholder engagement. The outcomes of these reviews will have significant implications for policy and funding, potentially reshaping the landscape of social care in England for years to come.