SCIE chair and former shadow health secretary calls for adult social care reform to put practical measures in place to avoid just "restating ambition" that doesn't deliver change.
England’s adult social care system will only become sustainable if reform moves beyond high‑level ambition and confronts a series of practical design choices on entitlement, funding and responsibility, according to a new intervention from the Social Care Institute for Excellence (SCIE).
Writing this week, chair of SCIE and former shadow health secretary Paul Burstow, argues that while there is broad consensus on what social care should achieve, the system continues to fall short because expectations are not translated into arrangements that work consistently in practice.
Burstow points to the Care Act as providing a clear ambition for wellbeing, independence and individual rights, but says that in reality, access to care remains shaped by eligibility thresholds, local interpretation and available resources.
This uncertainty, he warns, leaves many people navigating complex systems at moments of stress or crisis.
Central to reform, he argues, is greater coherence on what support is guaranteed and where responsibility sits between the state, individuals and families. Different models exist, ranging from more collective approaches that pool risk across society to systems that place greater emphasis on individual responsibility, but Mr Burstow says reform cannot avoid making the implications of these choices explicit.
The paper also highlights the mixed economy of adult social care, where public funding, private contributions and unpaid care combine to meet need.
Mr Burstow’s contribution to the debate comes after the King’s Fund earlier this week called for reform to address a fragmented system that leaves people who need care and their families left in a ‘no-man’s land’ between the NHS and social care providers.
Dame Louise Casey is currently chairing an independent commission on adult social care, which is expected to pave the way towards a National Care Service when it reports next year.
Mr Burstow concludes that reform will depend on making trade‑offs transparent and aligning responsibilities in ways that can be delivered, understood by the public and sustained over time.
