Who cares? The need for real reform for social care in England

Successive Governments have promised to 'fix social care' in England. However, the Government's recent changes are inadequate to meet the growing needs of the population. Additional funding and structural reform are required to improve the system in a way that makes it work for generations to come.

In our report, 'Who Cares? The need for real reform for social care in England', we outline the underlying problems that have led to the current crisis; discuss the consequences of these problems on staffing, individuals in need of social care support, and clinical practice; and set out four key actions that are needed to improve social care.

BMA key asks for social care

To improve the social care system in the long term, we propose that the Government must: 

1. Increase long term funding

Additional funding is required beyond the Health and Social Care Levy to maintain the social care system in the long term.

We have estimated that a further £7.9bn a year in social care funding is needed by 2024/25 to keep up with cost pressures and demand, and to pay social care staff the national living wage, on top of the recent measures announced by the Government.

2. Provide free personal care at the point of need

The only way to ensure that social care can be accessed by all those who need it is to abolish means testing and to make social care free at the point of need.

This will improve the lives of those who need care, simplify the provision of care, and help reduce pressure on the NHS by reducing delays in finding care packages for vulnerable patients.

3. Ensure social care workers are paid the Real Living Wage as a minimum

To improve the status of care workers and curb the current high rate of turnover in the sector, basic pay for care workers must be increased such that all care workers are paid the Real Living Wage as a minimum.

The Real Living Wage is set at £11.05 per hour in London and £9.90 in the rest of the UK.29 In addition, we believe that wages should also be increased for experienced social care workers.

4. Introduce a standard work contract and improved training opportunities for social care staff 

To improve the working conditions for the social care workforce in the long term, the sector must move away from a predominantly zero-hour contract model.

We propose that the Government introduce a standard employment contract for care work with the option for every care worker to move onto this new contract.

This new contract should include contracted hours, pay for all hours on duty, sick pay, travel time, and employer contributed pensions.