Why social care reform must tackle more than cost

A Which? survey in May found that 55% of retired respondents were concerned about being able to afford care in the future, up from 46% in 2024. These findings aren't surprising; the existing social care system exposes people to unpredictable and potentially very high costs. Financial means can determine people's ability to make choices and decisions about their own care and support. The human impact is far-reaching and not felt evenly. It can affect whether people can access the right care and support at the right time, the quality of the care and support they receive, and the knock-on effect for their families and loved ones.SCIE's recently published ‘How care inequities shape social care experiences' research found that people who had the means to draw on private funding alongside, or instead of, publicly funded care reported greater flexibility, continuity and personalisation. In other words, they were better able to choose who supported them, when support was provided and how care fitted around their routines and preferences. In contrast, people dependent on public funding often felt constrained by limited flexibility and had to adapt their lives around their care rather than the other way around. Others felt caught between two systems: ineligible for additional public support, but unable to sustain privately funded care without depleting savings or assets. This is not simply a divide between public and private care. Wider funding, workforce and market challenges constrain the flexibility available within publicly funded support. The challenge is ensuring choice, control and personalisation do not depend on someone's ability to pay. National standards alone, however, can't resolve social care's structural challenges. Workforce shortages, market sustainability, and the financial pressures on local authorities require wider reform and investment. Financial inequity also doesn't exist in isolation. SCIE's research found that financial means interact with other factors such as geography, ethnicity, age, health conditions and gender. When these factors come together, people can have less agency and fewer routes to support. For example, a person without the financial means to tailor their support may find it harder to find carers who share a language and understand cultural or religious needs. Inequity in social care is, therefore, the cumulative and compounding result of factors that interact throughout people's experiences of care. People can encounter barriers as they move into and through care, including difficulties accessing appropriate information, navigating complex systems, and securing timely assessments. This can leave some people having to do considerably more work to secure appropriate support. They may have to repeatedly explain their circumstances to different professionals, challenge decisions, and coordinate their own care and support. The stress, frustration and fatigue this causes can lead to people accepting unsuitable support, relying on unpaid care, or going without support altogether. Improving equity can't, therefore, be about addressing individual factors. It requires a holistic approach that considers all of the barriers people encounter. This will mean clear information, designated points of contact, consistent relationships, proactive communication, culturally responsive support, and closer collaboration with trusted community organisations. Looking ahead, the Government's vision for social care reform creates an opportunity to tackle the deep-rooted and systemic challenges that allow inequities to accumulate and compound. National standards of care, which will underpin this government's National Care Service, could play an important part of that response. SCIE's ‘Towards a National Care Service: raising national standards of care' shows how well-designed national standards of care can could reduce unwanted variation by creating a clearer, more consistent expectation of good care, regardless of postcode, provider or funding route, while protecting flexibility in how outcomes are achieved locally. National standards alone, however, can't resolve social care's structural challenges. Workforce shortages, market sustainability, and the financial pressures on local authorities require wider reform and investment. The acceleration of Baroness Casey's Independent Commission on Adult Social Care presents an opportunity to create a solid foundation for a National Care Service, underpinned by national standards of care, that supports everyone to live the lives they want to live. Future reform should ease people's concerns about being able to afford care and support, but it should also address the wider inequities that shape people's experiences and outcomes, so that choice, control and personalisation don't depend on someone's income, circumstances or postcode. Gerard Crofton-Martin is interim chief executive at the Social Care Institute for Excellence (SCIE)

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SOCIAL CARE

Why social care reform must tackle more than cost

By Gerard Crofton-Martin | 02 September 2026

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