Why the UK still can’t fix social care – and what four other countries got right

Overview

Original article by The Conversation examines why the UK still can’t fix social care and what four other countries have done differently. It highlights that the problem extends beyond money to policy design, political sensitivities around housing wealth, and the separation between health and social care. The piece then outlines four international examples and four practical lessons for reform.

• The UK faces persistent reform gridlock fueled by cost pressures and conflicting political incentives around wealth and care funding.
• Japan, Sweden, Germany and Denmark show divergent but instructive approaches to funding and delivering care, particularly at home.
• Four core lessons emerge: care is a shared social risk, incentives must be aligned across budgets, investing in home-based care reduces hospital use, and a clear funding decision is needed on who bears the risk.
• The author urges bold action, with Casey Commission recommendations to2027 as a potential catalyst.

Introduction

The Conversation article, published on August 3, 2026, argues that the United Kingdom remains unable to fix its social care system due to a combination of cost pressures, political sensitivities around housing wealth, and a long history of unfulfilled commissions and promised reforms. It frames social care as a fundamental social risk that has not been adequately pooled or funded, contributing to delayed discharges and hospital congestion.

The scale of the UK problem

On an average day in England, around one in ten hospital beds are occupied by someone medically fit to leave but still in hospital because adequate care at home is not available. This problem carries a substantial fiscal cost, estimated at about £2.7 billion per year for delayed discharges. The article also notes that approximately 3.5 million people are not receiving adequate home care, increasing risks such as falls, malnutrition, dehydration, infections, and the need for hospital admission. The Independent Commission on Adult Social Care, chaired by Baroness Louise Casey, has described the system as cobbled together, underfunded, and reliant on low-paid workers, with a persistent health/social care split that undermines accountability and efficiency.

Historical context and policy fragility

The piece traces a cycle of reports and promises since 1997, with significant milestones including a royal commission in 1999 advocating funding personal care through general taxation, the Dilnot inquiry in 2011 proposing caps on care costs, and 2014 legislation that was delayed and ultimately shelved. Subsequent moves—such as a health and social care levy in 2021, its abolition in 2022, and the cap cancellation in 2024—illustrate the political sensitivities surrounding who should pay and how much wealth should be tapped for care. The article emphasizes that the tug-of-war between taxpayers and homeowners helps explain why reform stalls at the policy level.

What four other countries got right

The author turns to four international examples to highlight possible avenues out of the UK’s reform cycle. In Japan, the 2000 introduction of compulsory long-term care insurance shifted responsibility from families to society as a whole, with providers paid under a national fee schedule and pricing safeguards that prevent price competition from eroding access. Sweden faced its own crisis of delayed discharges in the 1980s and, through the 1992 Ädel reforms, restructured funding so municipalities became financially responsible for patients medically fit for discharge, leading to a reduction in delayed discharges. Germany’s 1995 cross-party agreement established compulsory long-term care insurance funded by payroll contributions shared between workers and employers, addressing the affordability and fairness of long-term care. Denmark’s approach from 1987 moved away from building traditional nursing homes in favour of self-contained housing with tax-funded at‑home support and preventive home visits introduced in 1996, illustrating a strong emphasis on prevention and community-based care. The article argues that these reforms reflect an acknowledgment that care is a shared social risk and should be pooled across the population rather than treated as individual misfortune tied to private wealth.

The four lessons for the UK

From these cases, four lessons emerge. First, money is not the only determinant of success; the UK spends around 2.6% of GDP on long-term care—more than Japan and Germany but less than Denmark and Sweden—yet still struggles with outcomes. Second, maintaining separate health and social care budgets undermines alignment of incentives and can hamper reform efforts. Third, investing in care at home reduces the need for hospital-based care later, potentially easing NHS pressures. Fourth, a clear, sustained decision about who bears the risk—through insurance-like contributions or taxation—has to endure across changes of government. The article also notes the political difficulty in persuading voters to accept wealth tied to housing as a funding source for care, a tension dating back to right-to-buy policies in the 1980s and the debates around a National Care Service.

A way forward: concrete implications for policy

The author suggests that reform could gain traction if the UK adopts a more explicit, cross-party framework that pools risk and aligns incentives, possibly by following international models that combine insurance-like funding with home-based care and preventative services. The piece calls for leadership from Andy Burnham and forward movement on Casey Commission recommendations to 2027 as a potential inflection point. It also argues that the UK must decide what social care is for, who should pay, and how the system should protect vulnerable populations as demographics shift.

Conclusion

Ultimately the article advocates treating social care as a shared societal responsibility rather than a private problem, and learning from international models that successfully balance risk, funding, and delivery. It contends that the UK can escape the current cycle of crisis only by a frank, durable commitment to reform that reconciles the political economy of housing wealth with the needs of a growing aging population.