Extract/synopsis from this excellent report
The King’s Fund has published an updated version of Fixing Social Care: The Six Key Problems and How to Tackle Them by Simon Bottery (originally written in 2019 and revised in October 2025). The report is summarised by BCOP Welcome to BCOP
Broadening Choices for Older People
Supporting older people in the West Midlands since 1946. It provides a clear and detailed look at what’s still wrong with England’s adult social care system — and what needs to happen to make it fair, sustainable, and fit for the future.
The report is especially timely as the Casey Commission on Adult Social Care, led by Baroness Louise Casey, begins its work to define a “fair and affordable social care system.” The King’s Fund analysis contributes to that national conversation — one that BCOP has been directly involved in, through the National Care Forum (NCF) and its policy work on social care reform and parity between health and care sectors.
1. Access and funding inequality
Bottery highlights how social care in England is means tested, unlike the NHS, which is free at the point of use. This means only people with very high needs and very low assets receive state-funded support — often forcing others to sell their homes to pay for care.
The King’s Fund notes that 2 million older people are not getting the care they need. Options discussed include raising the means-test threshold, introducing a lifetime cap on care costs, or moving to an NHS-style system of free care — though all would require significant investment.
2. Quality of care
Quality issues range from 15-minute home visits to untrained staff and inconsistent oversight. The King’s Fund calls for stronger regulation, fairer commissioning that values quality as well as price, and better support for care providers. It emphasises the need for a culture of person-centred care that gives people greater choice and control.
3. Workforce pay and conditions
The care workforce remains underpaid and overstretched, with around 111,000 vacancies at any one time. Many staff are on zero-hours contracts, and career progression is limited. The King’s Fund supports the creation of a Fair Pay Agreement for social care, to be negotiated nationally by 2026, but warns that reforms must be properly funded and linked to improved training and public perception of care work.
4. Market fragility
Many care providers are struggling to stay in business, particularly as local authority fees have not kept pace with rising costs. The King’s Fund recommends fairer funding for providers, more stable fee-setting, and stronger local commissioning. Some areas may need to bring services back in-house or strengthen voluntary sector delivery to maintain access to care.
5. Disjointed health and care systems
Despite progress in Integrated Care Systems (ICSs), the divide between the NHS (free) and social care (means-tested) continues to cause inefficiency and delay. The King’s Fund argues that better integration is “essential to improving people’s outcomes and experiences,” especially for those living with multiple long-term conditions. A review of NHS Continuing Healthcare is also urged to reduce inconsistencies between local areas.
6. The postcode lottery
Access to care varies dramatically across the country — depending on where you live, how well your council is funded, and local decision-making. The King’s Fund calls for a fairer national funding formula, better data on local performance, and potentially a national system for assessing eligibility to ensure consistency and equity.
Paying for it: a national conversation
Bottery concludes that sustainable reform requires a new “social contract” between individuals and the state. The King’s Fund supports a model in which the state shoulders most of the financial responsibility but individuals contribute if they can afford to — moving towards a system that pools risk and reduces catastrophic personal costs.
BCOP’s Role in the conversation about the future of social care
As a proud member of the National Care Forum (NCF), BCOP is part of the national conversation about how to build a fairer, more sustainable social care system. Working alongside other not-for-profit providers, BCOP contributes evidence, insight and experience from the front line of care — helping to inform research and policy initiatives such as the Casey Commission on Adult Social Care.
The NCF’s recent response to the government’s NHS 10-Year Plan reflects many of the same themes highlighted in the King’s Fund report. It calls for adult social care to be “baked into plans from the outset” and for care providers to be recognised as equal partners with the NHS in neighbourhood health and wellbeing delivery.
Through this collaboration, BCOP continues to advocate for reform that truly puts people before profit — a system that values care staff, supports prevention and community connections, and ensures older people can live the best possible life in later years.
Interviewed by Matt Bailey at 7.10am on 29th July about NESCHA views on imminent Andy Burnham announcement later that morning. I was greatly encouraged by his feedback ( he said it was interesting and ran over time!) and wrote the paper attached.
I never dreamt that one day I would be living the system!.
Sadly Robert my co-author , died when I was in hospital some years ago but my wife visited daily and then she lived with a diagnosois mixed dementia for over four years, was admitted to hospital last October and, following a rapid discharge to a care home, died peacefully in December .
Despite a professional background in social work and years spent working on improving health and care systems, nothing fully prepares you for living that experience. It brought into sharp focus both the compassion of frontline staff and the frustrations families can face when services are not as joined-up or consistent as they should be.
NHS de-frazzle new book and brilliant review