Crisis in social care: who should look after Britain’s elderly?

Worrying about how to care for our elderly relatives – indeed, worrying who will care for us as we reach old age – has become a national preoccupation. That’s why the crisis of Britain’s social-care system really matters, and why Andy Burnham’s proposal for a national care service on a par with the NHS has cut through. It’s why there’s high hopes for the findings of the government’s Independent Commission on Adult Social Care chaired by Baroness Louise Casey. Can it solve the problems of an ageing population: more complex care needs, staff shortages and years of underfunding that has left councils struggling to provide consistent, quality care. Britain has become a postcode lottery, where the quality and availability of care can depend on where you live, make a national service seem especially attractive. But who will pay and will the public buy proposed reforms?

Burnham’s social-care reforms follow on from previous Labour and Conservative governments, who tried to implement major changes in social-care funding that were quickly shut down. Theresa May’s ‘dementia tax’ is famously said to have cost the Tories their parliamentary majority in the 2017 general election. Labour’s previous proposal for a national care service 16 years ago, championed by the then health secretary – one Andy Burnham – was labelled by the Conservatives as a ‘death tax’ in the run-up to the May 2010 election – which Labour lost. Will these similar proposals prove more popular in 2026?

One problem: can or should a state-run national care service ever replace families or community support? On the one hand, the decline of traditional family structures means we are coming to accept that there are increasingly elements of care that require outsourcing. While estimates suggest relatives still provide between £57bn and £100bn of unpaid care per year, organise professional support and make decisions about where loved ones are cared for, the system where care was solely rooted in the home has broken down.

But when women, who previously provided care and emotional labour free of charge, now have the opportunity to work outside the home, do we need to stop being so sensitive about the fact that we will need to pay for our care? It is because care was provided free of charge – not evaluated through its economic value, but its necessity to the community and the family – that we are stuck in a system with predominantly female workers on low wages, with poor working conditions. The sector has staff shortages three times that of the national average, despite increased dependence on overseas workers.

So, what should social care look like? Should it primarily be the responsibility of the state, the family or the market? Is there a danger that aspiring to outsource the care associated with intimate relationships is too great a burden to socialise? And when care is essential for the infirm, why do we continue to treat it as something with little economic value? Would putting more responsibility in the hands of the state solve the crisis?