By James Watson-O'Neill | July 21, 2026
Last Updated on July 21, 2026
A new Prime Minister always brings renewed expectations for reform. For adult social care, those expectations are particularly high, writes James Watson-O’Neill, Chief Executive at Sense.
Andy Burnham MP has a long history with social care reform. As health secretary in 2009, he proposed radical reform to create a single, unified National Care Service in England. The proposals aimed to eliminate the mean-tested social care system and move to a more equitable and accessible care system. As Mayor of Greater Manchester, he built one of the country’s most ambitious experiments in devolved, integrated health and social care, demonstrating what can be achieved when services work together around people and operate beyond organisational boundaries.
I saw him speak at a disabled people’s organisations event at the People’s History Museum in Manchester in 2022 and he convinced me of his commitment to disability rights by the passion with which he spoke and the relationships he had already built with the people in the room. If Greater Manchester has shown us anything, it is that reform is not simply about moving budgets or redesigning structures. Integration is a means, not an end. The real question is whether it gives people more control over their own lives.
As the new Prime Minister begins setting their priorities, we have an opportunity to rethink not just how adult social care is funded or structured, but what it is designed to achieve. At Sense, we believe the answer is simple. Social care should enable people to live the lives they choose. It should remove barriers, create opportunities and give disabled people greater choice, control and independence. That is why the success of any reform should be judged by one measure above all others: does it shift power away from systems and back to the people who rely on support?
Challenges with the current system
Every day, 1.6 million disabled people with complex needs across the UK face barriers that limit their ability to participate fully in society. Our research found that 95% rely on high-quality, consistent care and support to overcome those barriers. Yet too many are still unable to access the support they need; our research shows over a quarter (27%) of disabled people with complex needs are living with unmet care needs.
Providers already know what good support looks like. Every day, they deliver creative, personalised care despite growing financial pressures and workforce shortages. Yet too often they find themselves defending packages of care that enable independence because commissioning increasingly funds only the minimum. The result is a system that manages crisis instead of preventing it. Good social care is not simply about helping a person through the day. It is about helping them build the life they want and choose.
How a National Care Service could drive a power shift
A National Care Service offers a rare opportunity to rethink not just how social care is delivered, but what it is for. At its best, it could reshape the system around choice, control and independence, placing power firmly in the hands of disabled people, rather than the systems that serve them.
Working alongside disabled people with complex needs and their families, Sense has developed a five-point plan for achieving this shift:
- Support should be genuinely person-led: Disabled people should shape the support they receive around their own ambitions, relationships and goals, rather than fitting into services designed around organisational boundaries.
- Personalised budgets should become genuinely personal: Too many people remain caught between fragmented health and social care systems, repeating their stories and navigating unnecessary bureaucracy. Bringing funding together around the individual would reduce complexity while giving people greater control.
- We must invest in the specialist social care workforce: None of this is possible without skilled professionals who are recognised for the expertise they bring. Better training, clearer career pathways and greater parity with NHS colleagues are essential if we are to recruit and retain the workforce the future demands. We welcome the implementation of the first Fair Pay Agreement for social care workers as a key step towards recognition for a long undervalued and underpaid workforce. However, we are concerned that the £500m allocated for the first settlement will be spread too thinly and no social care worker will see the real benefit until 2028. Sense would like to see a fully funded workforce plan to be tied into wider social care and health system reform.
- Assistive technology should become a core part of modern care: Used well, it can transform communication, increase independence and expand what is possible. It should no longer be viewed as an optional extra.
- Housing must become central to the conversation: Too often, disabled people are placed in settings that reflect the limitations of systems rather than their own aspirations. At Sense, we are increasingly supporting people in their own homes because this gives them genuine legal control over where they live, who they live with and who provides their support. Having your own front door is about much more than housing. It is about dignity, independence and belonging.
Moving from words to action
Andy Burnham has already stated publicly that he wants the Casey review to conclude by the end of this year rather than 2028. This pace of change is ambitious. Key to turning words into reality will be to harness the Civil Society Covenant, to build stronger partnerships between Government, the NHS, local authorities and the voluntary sector. Charities like Sense bring decades of specialist expertise, trusted relationships with disabled people and their families, and deep roots in local communities. We are not simply providers of services; we are partners in prevention, innovation and community connection.
Andy Burnham has often spoken about devolving power away from Westminster. The same principle should guide adult social care reform. The measure of success should not simply be whether systems become more efficient or organisations become better integrated. Instead, we should ask different questions. Are disabled people exercising greater choice and control over their lives? Are people more connected to their communities?
If the answer is yes, then reform will have succeeded, because ultimately, the purpose of social care is not to sustain systems. It is to enable people to live well.
James Watson-O’Neill, Chief Executive at Sense.