England's social care reform: ownership, funding and the push for a national care service

Summary

The Conversation examines Labour's Andy Burnham pledge to reform England's social care system by steering away from profit-driven provision and pursuing a national, more person-centred care service. It weighs two reform paths—funding reforms (taxation or social insurance) and ownership reforms (not-for-profit models, social enterprises, or state provision)—and highlights evidence that for-profit care can worsen access, quality, and inequality. The article also notes Wales' 2014 and 2025 moves toward banning for-profit provision in social care and discusses political challenges, including market disruption and the need for political capital to enact change. The author underscores that lasting reform must address both funding and ownership to improve outcomes for residents in England, with ongoing scrutiny of profiteering incentives.

• Burnham aims to legislate a national care service within two years
• For-profit care homes are linked to poorer quality and greater inequality
• Two reform routes: funding reform or ownership reform, with Wales as a reference
• Action now is argued to avoid care deserts and safety risks

Introduction

The article discusses Prime Minister Andy Burnham's commitment to improving England’s social care system, including plans to legislate a national care service within two years. It argues that reforms must tackle who owns care services, not just how they are funded, to create a system that is more person-centred and aligned with the NHS while removing profiteering from care.

Why ownership matters in social care

Evidence cited suggests for-profit ownership correlates with less available, lower-quality care and greater inequalities. Studies on local care delivery show ownership type as a key determinant of quality and responsiveness, with non-profit and publicly owned providers often delivering better outcomes. The debate thus extends beyond principles of public versus private to the incentives that corporate ownership creates in care provision. Acknowledgement from leaders like Baroness Louise Casey and the Prime Minister that commercial incentives play a pivotal role is noted, while the piece emphasizes the need to distinguish ownership from funding as separate levers for reform.

Two broad reform options

The article outlines two main avenues. The first is funding reform, such as new taxation or social insurance, which could maintain current service models while expanding state coverage and reducing the burden on individuals. This pathway could mitigate the two-tier system where some individuals access higher-quality care through private payment while others rely on state-supported, lower-quality options. The second approach is ownership reform, aimed at shifting provision toward not-for-profit models. This could involve legal steps to prioritize ethical ownership—councils, charities, cooperatives, or locally run enterprises—either through procurement policies or by converting existing private providers into social enterprises or public entities. A Welsh example is cited to illustrate a phased, state-led approach to banning for-profit provision in children’s social care, with private providers given time to convert before being replaced by non-profit care homes.

Practical pathways to change

Two concrete options for changing ownership are discussed. One is a market rebalancing that prioritises not-for-profit providers in commissioning decisions, a model Burnham previously advocated to counter creeping NHS privatization. The other is a phased legal requirement for providers to convert to forms of social enterprise or registered societies, with a ban on new for-profit entrants where no non-profit options exist. Wales’ 2025 reform is highlighted as a gradual, phased process designed to minimize disruption while expanding non-profit provision. Both paths imply significant political capital and resistance from market actors, but proponents argue that inaction risks safety failures, care deserts, and evictions from rising fees.

Context and challenges

Pro-profit providers in England are described as tending to serve the healthiest and wealthiest areas, thereby widening access inequalities. In contrast, non-profit and council-run facilities are presented as more responsive to local needs and better in quality, even when funding sources vary. The piece stresses that ownership reforms must accompany funding changes to have a meaningful impact on accessibility, quality, and equity. It also notes potential threats to market stability, including provider market exits and disruption, and underscores the political will required to overcome lobbying from profitable providers and to implement substantial reform.

Conclusion

The article argues that the Labour government should pursue a dual strategy: reform funding to reduce the burden on individuals, and reform ownership to ensure care provision aligns with ethical, non-profit models. Only by combining these approaches can reforms deliver consistent, high-quality, and equitable social care across England.