Social care reform: 7 practical steps to fix the UK system

The UK's social care system is facing significant challenges, from capacity shortages to quality concerns. With an ageing population and constrained public finances, the need for reform has never been more pressing. This urgency has been further underscored by Lord Darzi's recent independent investigation into the NHS in England, which emphasises the critical need to shift care delivery into communities and integrate health and social care services more effectively.

A new report titled "Ready to care: the first steps to fixing social care" co-authored by Birdie based on interview with over 20 leaders in the social care sector, outlines seven pragmatic recommendations to reform and improve social care in the short-term. These proposals aim to increase capacity, improve outcomes, and enhance financial sustainability without requiring major structural changes or significant additional funding.

1. Reduce travel times for homecare workers

One of the most significant challenges facing the social care sector is workforce recruitment and retention. The vacancy rate for care worker positions is 8.1%, nearly three times the UK average, with an annual turnover rate of 25.6%. For homecare workers, who make up 43% of the social care workforce, long travel times between clients significantly reduce their effective pay and contribute to high turnover rates.

The report recommends evaluating "neighbourhood models" of homecare commissioning. Under this approach, local authorities would divide their areas into neighbourhoods and invite provider consortiums to serve all clients in each area. This could optimise routes, reduce travel times, and improve staff retention. A similar model piloted by Leeds City Council halved the turnover rate of care workers and improved recipient satisfaction.

2. Enable real-time data sharing

Hospitals often struggle to identify available social care capacity when discharging patients, leading to unnecessary delays and bed blocking. The report proposes mandating open and accessible APIs for care management software. This would allow real-time capacity data to flow into NHS systems like Capacity Tracker, facilitating quicker discharges and enabling better system-wide planning.

A case study from Leeds Health and Care Partnership demonstrates the potential of this approach. Their 'system visibility tool', a live dashboard accessible to all system partners, has led to an 11% increase in patients discharged to home-based care and a 30% reduction in hospital bed days lost due to delayed discharges.

3. Launch a fast-track leadership programme

The social care sector faces a critical leadership shortage, with a lack of appropriate training for registered managers and limited career progression opportunities. To address this, the report proposes a Teach First-style programme to attract talent into care leadership roles.

This programme would be open to graduates, career changers, and promising current care workers. It would develop its own leadership curriculum, recognised by the CQC as appropriate for registered manager status. The proposal suggests reallocating £1 million from the existing Workforce Development Fund to establish this employer-led fast-track programme, which would become self-financing within a year.

4. Streamline CQC inspections

The Care Quality Commission (CQC) plays a crucial role in maintaining care quality, but its current inspection process has been criticised for lack of clarity, infrequent inspections, and slow registration of new providers. The report recommends reforming the CQC's assessment methodology around a small number of core quality indicators, tracked digitally from each provider in real-time.

These indicators would form the basis of new, shorter inspections designed to validate and contextualise the quantitative data. This approach could set clearer goals for providers, enable more frequent inspections, and allow the CQC to focus its resources on high-risk services.

5. Create a national online support service for unpaid carers

An estimated 5 million unpaid carers in the UK provide vital support to friends and family, with the value of this care estimated at £162 billion annually. However, many struggle to balance work and care responsibilities, with 600 people leaving the workforce daily to provide care.

The report proposes creating a national online support service for unpaid carers. This platform could increase access to high-quality information and support, save money for local governments, identify carers previously unknown to statutory services, and provide valuable data to inform policy. The report estimates that such a service could reach 2 million unpaid carers annually, 80% of whom would have never received support in their caring role before.

6. Delegate healthcare tasks to care workers

To reduce unnecessary hospital admissions and improve community care capacity, the report suggests developing delegation frameworks for key conditions. These would enable care workers to take on more healthcare tasks under clinical supervision.

The recommendation focuses on three acute conditions (UTI, pneumonia, cellulitis) and three chronic conditions (diabetes, dementia, hypertension) that often lead to unnecessary hospital admissions. By allowing care workers to optimise chronic condition management and help manage acute conditions in the community, this approach could prevent thousands of unnecessary hospital admissions.

7. Boost NHS-social care integration

Despite the creation of Integrated Care Systems (ICSs) through the 2022 Health and Care Act, many areas still see NHS organisations and social care providers operating largely independently. To address this, the report recommends introducing secondary legislation requiring Integrated Care Boards (ICBs) to include the Director of Adult Social Care from a partner local authority.

This change would prioritise social care integration with the NHS at a strategic level, fostering joint planning and promoting much-needed communication between the two sectors. Some ICBs, such as Norfolk and Waveney, have already adopted this approach with positive results.

Conclusion

These seven recommendations offer a practical roadmap for near-term social care reform in the UK. While major structural changes and increased funding will likely be necessary in the long term, these evidence-based proposals could drive meaningful improvements in capacity, quality, and sustainability in the immediate future.

The full whitepaper, authored by Harry Dunn, Rachael Crook, and Max Parmentier, provides detailed rationales and case studies for each proposal. As the UK continues to grapple with the complex challenge of social care reform, these ideas offer a valuable starting point for policymakers, sector leaders, and stakeholders to consider and potentially implement.

Download the full whitepaper at Birdie's resources centre.