I can think of few problems as important and urgent as how we provide care for adults who are unable to care for themselves through physical and mental impairment.
It’s a problem that hits harder the older I get and experience first-hand the impact that age-related decline can have on the life quality of family members. It’s also a problem of immense scale. The Association of Directors of Adult Social Services says that 4 in 5 of us will need adult social care in our lifetime, whilst the government’s latest data reveals that two million people aged 65+ and 1.5 million people of working age are not getting the care they need.
A resilient care system for a resilient economy?
I’m lucky that I have parents who still enjoy relatively good health into their 80s. However, I’ve also witnessed many elderly relatives grow increasingly frustrated with a world that simply does not seem interested in the needs of people who find it hard or even impossible to navigate the food, financial, health and mobility services on which they rely without first having to master technology, automation and the lack of empathy that seems to be designed into services targeted at the elderly.
Given the scale of the problem and the inability of successive governments to respond it’s no surprise that some 1.5 million unpaid carers effectively put their lives on hold to care for loved ones and in so doing, are often forced to leave paid work. These carers typically experience worse health outcomes than non-carers.
No functioning system
How we care for an ageing population is not a new problem. In the last decade, David Cameron (2010 – ‘The Dilnot Report’), Theresa May (2017 – ‘the Dementia Tax’), Boris Johnson (2019 – ‘once and for all’), Keir Starmer (2025 – ‘national consensus’) and now Andy Burnham (2026 – ‘a national care service’) have all promised a comprehensive plan for adult social care. It could not be more urgent.
Speaking at the June 2026 Local Government Association Conference in Bournemouth, Baroness Louise Casey of Blackstock, who is leading the Government’s review into adult social care, explained that England ‘does not currently have a functioning ‘system’ of adult social care’ whilst referring to the failure of successive governments to ‘secure the public consent for the tough choices involved’.
Tough choices? Or is it really just about the money?
So, what are these tough choices? Baroness Casey refers to the need to define who social care is for, the balance between state and families, and the somewhat vague what we should all contribute. The BBC is more direct, going to the source of the problem by highlighting that the public will be asked to decide who should pay for social care.
As the Local Government Association rightly identifies, the perennially thorny issue of how to pay for social care may partly explain why the momentum behind countless commissions, reviews and inquiries into the future of adult social care have stalled before any change could take hold and why associated policy papers now litter the long grass.
The cost of care…unsustainable pressure, or economic illiteracy?
In May 2025, a House of Commons Health & Social Care Committee report on the cost of social care described the annual cost of £32bn as an unsustainable pressure for local authorities, saying:
‘Due to the current funding model, local authorities’ budgets are buckling under the pressure of adult social care, with more councils seeking emergency funding and increasing proportions of budgets being spent on adult social care’
The same report laid the blame for a failure to act firmly at the door of government, which chose instead to focus on the so-called ‘£22bn black hole’ and then later, to ‘manage down fiscal pressures’. Which, of course, is economic illiteracy.
It also explains why the report focused on the cost of inaction rather than getting to grips with the accounting reality of government finances as the true solution to the social care crisis. In short, there is no shortage of money.
Carer of first resort vs. funder of last resort
It’s arguable that attempts to reform social care fail because central government seems unable or unwilling to grasp its critical role as the issuer of its own currency. It is the ‘funder’ of last resort because it can always create the money required to meet any financial commitment or obligation denominated in the currency that only it can create. For the avoidance of doubt: The UK government is the monopoly issuer of the pound.
And yet by placing more of the financial cost of social care onto Local Councils, who are currency users, central government has created a completely artificial financial constraint. That’s not to say that Local Government should not be providing social care. In fact, the LGA also finds that people want care delivered by local councils because they value the democratic legitimacy, local knowledge, and place-based solutions that only local government can deliver.
However, as currency users, local councils can raise income only from ratepayers or through grants from central government. Local councils facing a growing demand for care are invariably forced to make binary trade-offs between vulnerable groups. The problem is compounded by the fact that towns or regions with the greatest need for care often have the lowest council tax bases.
Funding social care in a resilient economy
Social care funding is never unaffordable to a state which creates its own currency. If the public is to be asked how social care is to be funded, it is vital that the public is told the truth about government money.
Of course, there are constraints…not least the availability of a highly skilled and compassionate workforce, physical equipment and medicines, and the broader integration into the wider healthcare system.
National Care Service: From systemic problem to systemic opportunity
But these real resource constraints can all be managed with planning, training, education and a system-wide strategy. All of which can be funded with newly created government money.
And yes, there is a risk of inflation if money seeks to purchase resources that do not exist. However, as the government’s June 2026 ‘young people and work – interim report’ reveals, 1 million 16–24-year-olds are not in education, employment, or training. 60% are economically inactive. 84% of them said they want a job and training.
In total, 1.7m people are unemployed and 9.1m are economically inactive (many of whom may already be unpaid carers) in the UK, chasing just 700,000 vacancies. As the employer of last resort, only the state has the financial muscle to employ and train anyone who wants to work as part of a ‘national care service’.
Doing so at a socially inclusive wage would not only solve the social care crisis, but also raise incomes, living standards (especially for those effectively providing care for free), aggregate demand, and ultimately GDP. Every £1 invested yields £1.75 in economic return.
Adult social care is a huge opportunity to offer personal dignity, societal resilience and economic renewal to an ageing population. How we pay for it really should be the least of our worries.
