It was reported in June that that Andy Burnham had indicated that he would make serious changes to England’s social care system this year if he was to become Prime Minister. It was further noted that Keir Starmer had begun work on updating the social care system but that Burnham had ” suggested he would seek more radical and urgent change.”
Similar claims have been made in the past 15 years, with numerous government ministers and prime ministers saying that they would fix what is seen as a broken social care system.
Indeed, in January 2025 the government announced that Louise Casey would chair an independent Commission into adult social care, while the government set out immediate reforms and investment to improve social care, support the workforce, and deliver the government’s plan for change.
The government intended to help people live at home independently for longer and keep them out of the hospital while thousands more disabled people were to have their homes adapted with the introduction of new technology and data sharing.
A blueprint for radical reform
It is against this background that Brian Fisher, writing for Compass has come up with a blueprint for radical reform of social care.
The social model of disability
It has been written that It was disabled people themselves who first developed the social model of disability. This model describes people as being disabled not through any difference or impairment but through barriers in society.
It is argued that:
“if modern life was set up in a way that was accessible for disabled people, then we would not be excluded or restricted”.
Fisher argues that for the broken system to be repaired means taking on board what is described as a “liberating “social model” of disability”. In this way, individuals would be treated as equal citizens with inherent rights, rather than “mere bundles of physical needs to be managed”, before adding, “to achieve this, seven interconnected legislative and structural changes must be enacted”
Social care and human rights
In January 2025, the United Nations assembled an analysis of the standard of human rights throughout the world in relation to care.
The United Nations also stated that “care and support are the basis for well-being of all people, societies, economies and ecosystems. For too long, we’ve relied on women and girls, including those with disabilities and older women, to provide care and support. Excess workload for unpaid care work, domestic work, and support depletes time and resources for women and girls to access education, work, social life and rest. Women, including migrant women, also dominate paid care and support work that often lack decent working conditions. At the same time, persons with disabilities, children and older people are seen merely as passive receivers of care and their autonomy and choices are denied. When they require care and support, they tend to be confined at home or in care institutions and hospitals, isolated from the community.”.
In response to this, Brian Fisher argues that the UN Convention on the Rights of Disabled People should be fully adopted into English law to guarantee, dignity, choice, and personal control. He also maintains that the state must provide a statutory duty to provide a NaCSILS , a National Care, Support and Living Service.
A fully funded and free service
It was argued in the House of Lords in June 2019 that it was unfair that social care is means tested and that it should be available free like the NHS.
Backing this up, it has also been argued that social care is undervalued in relation to healthcare and that this has resulted in “approximately half of all people formally receiving social care”, using private finance to find at least part of their care ” and this figure has been growing”.
Brian Fisher also argues that social care should be free maintaining that, the service progressive taxation must fund the care service and that it must remain “entirely free at the point of need for everyone living in the country”., in order to mirror the NHS
A publicly provided and accountable service
Accountability in social care is another area which has been on the minds of parliamentarians in recent years. Infeed it was noted in 2024 that it was “far from clear if Integrated Care Systems are making a demonstratable difference to adult social care delivery”. The report also highlighted uncertainty about funding and concerns about whether social care funding was giving value for money. Meanwhile it as also argued that linking social care with health services was not being done efficiently enough.
Fisher argues that care should be de-commodified and “the service must be publicly provided and strictly not-for-profit, prioritizing a clear strategy for de-institutionalisation and community-based living”.
A nationally mandated, locally delivered service
There has long been a debate about how much social care should be a national concern and how far it should be a local concern. Furthermore, it has also been argued that there should be a balance between local and national provision, with a service which takes the best from both cales of provision.
Fisher agrees with this, in his discussion paper on Compass, stating that service design and execution should happen locally through partnerships led by service users, carers, and local authorities, while quality standards must be mandated nationally, : The system must structurally acknowledge and support family and friends who provide unpaid care, giving people appropriate choice and flexibility to live their own lives fully, while at the same time “quality standards must be mandated nationally”,
Sufficient support for informal carers and a fit for purpose workforce strategy
Fisher also tackles the issue of informal carers such as friends and families and believes that there must be sufficient support for them to do their job properly. This can be part of another of Fisher’s aims for a better social care service, which has been argued for in the Lancet , Science Direct and by the organisation Skills for Care. The aim would be a better qualified and more respected social care workforce, which would also be able to better support informal carers and end the era of rock bottom wages.
An independent living taskforce
Independent living should be the goal for many people currently in the social care system and consequently Fisher maintains that “a user-led taskforce must be given meaningful legislative influence, ensuring that ongoing reform is guided by those with the greatest expertise: the users themselves”.
This could include ensuring that housing is modified sufficiently to enable people to live independent lives and aspects of this can also be seen in Andy Burnham’s strategy for council housing in Manchester .
Sound principles to follow
All these principles and ideas do seem straightforward enough to be followed through as policies. Andy Burnham has made it clear that finally sorting out social care will be a priority. Which principles for a better social care system will he follow?
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