London School of Hygiene & Tropical Medicine

On 29 July 2026, UK Prime Minister Andy Burnham announced his ambition to reform the adult social care system in England. As his first steps, he announced ‘cross-party talks’ with the leaders of the Conservative and Liberal Democrats, and prioritising reforms for improving the social care workforce.

The Prime Minister also confirmed that he will bring forward the government report on social care to 2027. This would aim to establish a ‘National Care Service’, which would make social care free at the point-of-delivery for everyone, along the same principles as the NHS.

Experts at the London School of Hygiene & Tropical Medicine (LSHTM), including those working with The Centre for Care Research and Policy (C-CARE) group and the NIHR Policy Innovation and Evaluation Research Unit (PIRU), outline the challenges with the current system and reflect on what needs to be done next for any reform of social care in England to be successful.

Dr Mirza Lalani, Assistant Professor at LSHTM from C-CARE and PIRU, said: “Adult social care is fragmented, as different regions vary considerably in how they provide care. Who can ultimately be held accountable for success or problems is also fragmented: the authority that determines funding sits at a different level to the regulators, or the companies that deliver social care. The fact that England’s social care is a mixed economy, where the system is partly run by the public and private sectors, complicates the issue further.

“Implementing social care reforms means you have to navigate many different organisations, each with different structures and pressures. Reforms that are popular and seem coherent at a national level can encounter very different realities on the ground, and in different regions.”

As part of plans for wider social care reforms, the Government has launched the Big Conversation on Care: a national project to allow people to give their views on the future of adult social care and the big questions that underpin its reform. However, Dr Shereen Hussein, Professor of Health and Social Care Policy at LSHTM, stresses the importance of prioritising engagement with those working on the frontline of social work, as well as individuals using social care services.

She said: "Previous studies, such as the Adult Social Care Staff Evaluation of Reforms to Training (ASSERT) study, sought the views of policymakers and national sector leaders, which captured organisational positions more than individual experience.

"To get on-the ground sentiment, a deliberate targeted engagement campaign is needed prioritising frontline workers and people using social care services, not just a public open invitation for conversation."

Dr Josephine Exley, Assistant Professor at LSHTM and PIRU, said: "While there is clearly a growing need for social care, our work with the general public highlights that there is poor understanding of how the social care system works: what social care involves, who receives social care, how it is paid for and how much recipients are expected to pay themselves.

"The limited understanding of the social care system among the general public negatively impacts the level and quality of public debate possible and raises questions about whether policy makers should be asking the public to help resolve the issue."

Dr Hussein said: “To meet this challenge, the government cannot rehash outdated analysis: it needs to engage with the current problems the social care sector faces. We need to have the best evidence and frameworks at our disposal for effective, evidenced-based reforms”.

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