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Reform of adult social care: vanishing over the horizon


In November 2019, we identified the eight key problems in adult social care that the incoming government – then led by Boris Johnson – would need to address if it were serious about ‘fixing’ social care.

Initially, the government advanced towards addressing these with a series of proposed reforms, including the introduction of a cap on lifetime care costs, changes to the means test and a White Paper on wider reforms. We welcomed these changes, though said they did not go nearly far enough.

However in recent months – and following two changes of prime minister – reform has entirely stalled. In its November 2022 Autumn Statement, the government announced that the cap and means test reforms would be postponed until October 2025. With a general election to be held no later than January 2025, there is therefore a significant risk that these reforms are never implemented.

Now, following publication of its ‘next steps’ document on 4 April 2023, many of the remaining measures from the White Paper have been cut back or even abandoned. Most notably, a key promise of at least £500 million to be spent on workforce training, qualifications and wellbeing has been cut to £250 million, and a promised £300 million to transform housing options has been replaced by £102 million for smaller in-home adaptations. Spending on innovation and improvement has also been cut back, though investment in digital has emerged largely untouched and there are very small pots for carer support, international recruitment and volunteers.

This reduction in spending is particularly disappointing because it comes at a time when all the trends on adult social care are going in the wrong direction: more people are asking for support but fewer are getting it; workforce vacancies are at an all-time high and public satisfaction with social care is at its lowest ever.

Here, sadly, we update our initial assessment of the government’s reform programme.

Means testing

Catastrophic costs

Unmet need

Quality of care

Postcode lottery


Market fragility

Disjointed care