Queen Elizabeth I’s motto, ‘Semper Eadem’ (‘Always the same’), sums up the experience of social care over the last 30 years. We are constantly seen as second-class citizens compared to the NHS; we are consistently subjected to inadequate funding settlements; our workforce is portrayed as low skilled and low status; we are misrepresented in the media; and we constantly have to fight for recognition from the public.
I sadly predict that 2026 will not see any change to this approach. The coming year will, however, see several significant issues that will have a direct impact on social care and, as a sector, we must be prepared for them. Many of these changes will not be positive and it will be up to us to navigate them and make the best of an imperfect world.
Money talks
One of the first things is the Employment Rights Act. This will affect all employers and impose substantial costs on the delivery of care. The development of a fair pay agreement (FPA) will see social care as the test bed for a policy to be rolled out across the economy. How interesting that social care was singled out for this piece of legislation and what a pity we never see Government singling us out for positive things.
However, it could be argued that the FPA could significantly improve pay rates and working conditions. This is, to an extent, true, but it depends on how much money Government is prepared to put behind this new initiative. To date, it has committed £500m, which is a drop in the ocean compared with the £4.5bn funding gap in social care. Even this will be reduced by things like the freezing of personal allowance thresholds, which will see some people going into a different tax regime, and Government will claw some money back from the very people it claims will benefit.
We have heard from the Chancellor and Prime Minister that we have a challenging financial position, and that is certainly true, but it did not stop Government putting £30bn extra into the NHS, money which seems to have evaporated. We now have the NHS whingeing about the fact it cannot deliver and has not got enough money. If Government was committed to issues like the FPA, it could have put £10bn of that extra funding into social care. This would have been transformational – bridging the gap and giving enough money for the FPA to be correctly implemented.
Shift the dial
Yet another system reorganisation awaits in 2026, when NHS England will be abolished and moved back into the Department of Health and Social Care. We are also seeing the reconfiguration of integrated care systems (ICSs) and local authority changes. How many times have we been through this process? What Government fails to understand is that structural reorganisation costs money but does not necessarily deliver outcomes. We have so much evidence of this from the last 30 years.
The challenge is not the structure; it is the culture of organisations that defines how they deliver, and the public sector needs to develop a much more outcome-focused culture. We need to see a collaborative approach to working with the independent sector and we need to see money flow to where it will deliver the best outcomes, rather than being constantly locked into organisations. The current system is based on organisations and processes. We need to shift the dial in 2026 so people and outcomes define public services. Until we achieve that, we will never get better services that deliver better outcomes for citizens and greater efficiency for taxpayers.
Plan, then communicate
The NHS reorganisation plan also highlights another political problem. In the past, being in opposition was not only about offering a different view from Government’s but also about crafting your vision for the future and working through plans. Hence, the opposition adopted a coherent approach upon assuming office. Sadly, this Government seems to have spent 14 years in opposition creating soundbites, with no proper approach to delivery.
The NHS reorganisation, which appeared with very little thought and next to no consultation, did not have a proper costed implementation plan behind it. It seems to come as a shock to Government that it would have to fund things like redundancy payments, when it was moving people out of their jobs to other organisations, early retirement or redundancy. No commercial organisation would ever begin a massive reorganisation without clearly understanding what it was trying to achieve; what the route map to the reorganisation was; what the timelines were going to be; how much it was going to cost; and where the money was going to come from. These basic principles for running a service seem to be largely absent from the public sector.
There was also a real challenge in how this was communicated; it seemed to have been leaked by No. 10 before it was officially announced in Parliament. Over the years, we have seen an increase in leaking of Government information and important decisions, which undermines a managed approach to change and development. In a world where communication is instant, it seems to be accepted that everything must be announced on social media before being properly thought through. I urge all politicians to go back to, first, planning the change and, second, communicating it effectively and in a timely way, rather than rushing out a series of social media posts. Give us a formal announcement that tells us exactly what is going to happen, what it will achieve and how it will be delivered.
Update on reform
2026 will also see the first part of Baroness Louise Casey‘s report on a National Care Service. This review is taking far too long and Baroness Casey is largely absent in discussions, debates with various key stakeholders, roundtables and initiatives. I am concerned that this review will be a rerun of what we saw with Lord Sutherland’s and Sir Andrew Dilnot’s, both of whom were very able and also very visible and engaged as they wrote their reviews, but ultimately failed to convince Government to implement their recommendations. Both Lord Sutherland and Sir Andrew led many consultation events. They were also very prominent in the media, discussing their reviews and how they would deliver a long-term future for social care.
Baroness Casey, on the other hand, has been nearly invisible. Despite having more time to complete the review, it is important that she not only engages with stakeholders but is visible to them, as their lives will be changed if her review is implemented. The challenge for us all is that, just as with the Sutherland and Dilnot Reviews, there is no commitment from the Government to implement the outcome of these deliberations. When Baroness Casey finally delivers her report in 2028, we will be on the eve of a general election and I am confident this will be pushed into the long grass. We will probably repeat the cycle if there is a change of Government. Social care faces serious issues that must be addressed now and sticking-plaster budgets or piecemeal reorganisations cannot address them.
Accountability and transparency
This year, we will also see the Care Quality Commission (CQC) embedding its new structure and revised single assessment framework. Whilst I support this and have confidence in the senior team at CQC, I am concerned about the pace of this change. One of the biggest challenges in the public sector is that, during a reorganisation, some people seem to think their core activities should be suspended or services reduced because they are going through a reorganisation. In the real world, reorganisation happens alongside business as usual and its pace is set within a realistic timeframe.
I want to remind the public sector that organisations like X not only changed ownership, but also reduced its headcount by 40%. It was also required to undergo a rebranding process, which was completed within six months. As a platform, it never went down because business-as-usual continued. This is a lesson the public sector must learn. We expect them to continue with their primary work, even during reorganisation.
We will also see endless discussion in 2026 about accountability and transparency and this needs to apply to the public sector as well. I want to know why the senior management team at CQC was not held responsible for wasting £92m of our money on an unworkable IT system. Despite messing up the regulation, the entire Board and CQC senior team walked away without any accountability for the chaos caused or the money wasted. These individuals were responsible for undermining public trust in the health and care system. Yet, they have been allowed to leave without any consequences. Sadly, I think 2026 may see more of this regarding the NHS and ICB and other restructurings.
2026 will be another tough year for the care sector. Queen Elizabeth I’s motto was ‘Always the same’ but what is also always the same is the commitment of the care sector to the people we support and, whatever the challenges, I know that in 2026 this sector will do its best in very difficult circumstances.
What do you think is the greatest challenge care providers will face in 2026? Comment on this column or join the conversation to share your thoughts.
Professor Martin Green OBE is Chief Executive at Care England. Email: [email protected] X: @ProfMartinGreen