Fragmentation of responsibility for social care in England has led to a lack of accountability, harming those needing and providing care. In Whitehall, policy responsibility sits with the Secretary of State for Health and Social Care and the Minister of State for Care. Yet their attention remains focused on the NHS. The Ministry of Housing, Communities and Local Government manages the social care budget as part of local government finance. His Majesty’s Treasury controls the purse strings.
In England, 153 local authorities hold statutory responsibility for meeting social care needs, making independent spending decisions. In 2024/25, adult social care accounted for over 40% of all local authority service spending. The Local Government Association projects a cumulative funding shortfall of £6.2bn over the next two years. Care delivery costs are rising fast and council fee rates are not keeping pace. Further employment cost inflation is adding pressure. Many councils risk budget deficits and are holding fee rates down. When providers complain about low fee rates, the Government and local councils blame each other. Everyone blames the Treasury.
This blame-shifting cycle has created a governance vacuum with severe consequences. Homecare Association research revealed only 1% of public sector contracts paid our calculated Minimum Price for Homecare in 2024/25 (£28.53 per hour). Indeed, 6% of contracts failed to cover direct employment costs at the national minimum wage (NMW). For 2025/26, our calculated minimum price is £32.14 per hour. Some councils are paying as little as £18.06 per hour; providers need £22.71 to cover direct staff costs at the NMW, before including other running costs.
The new Employment Rights Bill seeks to ensure fair employment and end labour exploitation. The Homecare Association supports this and wants the Government to aid care sector compliance. A potential solution lies in establishing a National Contract for Care Services. This would define minimum tariffs for care services, with a legal obligation on local authorities to meet these terms. Central to this proposal is adequate central Government funding to councils. Strengthened regulation would complement the National Contract through the new Fair Work Agency. With enough resource, regulators could enforce fair wages and safe working conditions.
It is vital the CQC recovers its operations with minimal delay. Poor-performing commissioners and providers are not being held accountable. Quality, ethical providers are being squeezed out of the market in a ‘lowest bidder wins’ race to the bottom. Cash-strapped councils rely on cheap care and turn a blind eye to unsafe services and labour exploitation. Citizens face confusion and inequality because of arbitrary decisions about NHS or local authority care funding. A single, needs-based budget would simplify support and cut red tape. Care funding in Australia is based on individual needs, not means or location. The Government allocates agreed national subsidies for each level of need. There is one route of access via Australia’s central portal for aged care services, My Aged Care, simplifying navigation of the care system for citizens.
Adding a Secretary of State for Social Care, as some have suggested, would likely perpetuate, rather than solve, the fragmented accountability. We need a system with clear accountability and enough funding. The current approach makes it hard for providers to be financially stable and compliant with regulations. No more passing the buck. Care recipients and caregivers deserve a system that respects them and their importance in society.
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Dr Jane Townson OBE is Chief Executive Officer at the Homecare Association.
Email: [email protected] X: @homecareassn