Analysis: The Key Problems Facing Social Care

In 2019 the King’s Fund discussed eight key problems facing social care and called for reforms to address them. They’ve now re-visited these topics in the shadow of Covid-19. Their analysis is, as ever, very insightful and, for anyone wanting more information on the challenges facing care in the UK, it’s a useful starting point. We’ve published their intro directly below, with links to the full report on their website.


Now, the Covid-19 pandemic has shone an uncompromising light on the sector, its staff and the people of all ages who use its services. As the sector emerges slowly into a new normal, fearful of a second wave while still trying to make sense of the first, it’s time to take stock. Analysis is difficult because of a lack of up-to-date, quantitative data and the ongoing nature of the pandemic. Nonetheless, in six of those eight areas, Covid-19 has brought significant change and, if anything, exacerbated these challenges.

Last year we listed the key problems as:

  • means testing: social care is not free at point of use like the NHS
  • catastrophic costs: some people end up paying large amounts and even selling their homes to pay for care
  • unmet need: many people go without the care and support they need
  • quality of care: a wide spectrum of concerns, from 15-minute care visits to neglect and lack of choice and control
  • workforce pay and conditions: staff are underpaid, leading to high vacancy rates and turnover
  • market fragility: care providers go out of business or hand back contracts
  • disjointed care: health and care is not integrated around the individual and causes issues such as delayed transfers of care from hospital
  • the ‘postcode lottery’: there is unwarranted variation between places in access to care and its quality.

In this long read we revisit these eight problems in the light of the Covid-19 pandemic. The emphasis on them has shifted – the first two issues have barely been mentioned during the past few months. Instead, the public focus has rightly been, first, on quality of care, as Covid-19 wrought a terrible death toll and, in many places, fundamentally changed the way care was being delivered. Second, there has also been some, though arguably not enough, focus on unmet need, as Covid-19 both created more need and made it more difficult to meet existing need. A third key area during the pandemic ­– though one that has had less attention – has been the difference in the ways local care systems have dealt with the pandemic and the potential consequences for the existing postcode lottery of access and provision. Two more areas that have been highlighted during the pandemic have been the sector’s workforce, which has received more recognition than ever before, and to its providers, where the pandemic has exacerbated market fragility. And finally, the relationships between services – which even under normal circumstances can lead to disjointed care – have been to the fore during Covid-19, most obviously in the ongoing dispute about discharge from hospital during the early stages of the pandemic.

Read the full report here

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