How do you reform social care? Reversing drift in the four nations of the UK

10 May 2021

Professor Catherine Needham, University of Birmingham and Patrick Hall, University of Birmingham and University of Sheffield


In this presentation, we will focus on the question of how to make progress on social care reform in the UK. The social care crisis in the UK is often portrayed as an example of a reform deficit or policy drift: a long awaited and much needed reform that has not yet been delivered. Drawing on documentary analysis and interviews in the four nations of the UK, we find that there are different degrees of drift in the four nations of the UK.

Scotland has gone furthest on care reform, introducing free personal care, although not addressing the issue of how to bring more money into the care system. Wales has shifted the means-test and introduced a maximum weekly charge for home-based services but abandoned its legislative commitment to an overall spending cap. England has made no progress on care funding reform and in fact could be seen as going backwards, due to the lack of inflationary uplift in the means test thresholds. Northern Ireland has a de facto free personal care system but like Scotland has not addressed the issue of bringing more care monies into the system.

Looking across these cases allows us to identify the factors that can reverse policy drift. We argue that the more incremental approach taken in Scotland has been more successful than the failed ‘big bang’ efforts in England. This provides insights into how England might more effectively more towards reform.

Speakers' biographies

Patrick Hall

Patrick Hall is a Research Fellow on the ESRC Sustainable Care Programme and is based at the Health Services Management Centre, University of Birmingham and the University of Sheffield: Centre for International Research into Care, Labour and Equalities. He is the lead researcher on the Care in the Four Nations strand of the Sustainable Care Programme.

Professor Catherine Needham

Catherine Needham is Professor of Public Policy and Public Management at the Health Services Management Centre, University of Birmingham. She has undertaken research on a wide range of issues relating to adult social care including system design, markets and funding mechanisms, and is a Co-Investigator on the ESRC Sustainable Care Programme.

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