I recently chaired a roundtable discussion, hosted by The Access Group, and led by William Laing (Founder and Executive Chair of LaingBuisson) and Kat Hall (Director Bay Care Group and Co-founder of Providers Unite).
These roundtables are bringing together leaders in the care sector to share best practice and support each other in understanding how to improve the quality of care being delivered.
Since the roundtable in May, we have published a paper summarising the key challenges the industry faces and how best can these issues be addressed.
I publish it here in full. It's not too long!
Addressing challenges and charting the future
The Access Group: Care Perspectives Roundtable Discussion of 20 May 2025
Introduction: The care sector faces urgent challenges, from funding constraints to staffing shortages and market fragmentation. Despite an ageing population, demand for care home placements hasremained flat due to many factors, contrary to many people’s expectations. At a roundtable discussion led by William Laing (Founder and Executive Chair of LaingBuisson) and Kat Hall (Director Bay Care Group and Co-founder of Providers Unite), sponsored by The AccessGroup (Care), key stakeholders deliberated on the future of care in the UK, highlighting critical systemic issues and potential solutions.
Here we summarise the roundtable discussions and aims to provoke dialogue and action among policymakers, providers, care sector leaders, and the wider care community.
Key challenges facing the care sector
1. Flat demand and fragmented markets
- Local authority and NHS placements account for 55% of care home placements, yet private payers contribute the bulk of financial support.
- The home care market lacks comprehensive data, making fee benchmarking and compensation standardisation difficult. The top four providers in the working-age adult part of the care community hold only 8% market share, suggesting a fragmented landscape.
- Domiciliary care is gradually becoming the default first-line intervention, even for needs previously reserved for residential settings. This trend will likely accelerate under any model resembling the Fabian Society’s National Care Service vision.
2. Funding and regulation concerns
- Fee rates have stagnated, with Integrated Care Boards (ICBs) failing to address funding discrepancies. Some providers have been forced to close services in economically disadvantaged areas due to financial strain.
- Institutional self-protectionism has become the norm. There is a perceived reluctance to share best practice or collaborate in order to realise efficiencies in the long-term. If ICBs,local authorities and providers were able to design a better system together, there could begreater efficiencies and better service, however people are increasingly retreating into their own pressurised, financial silos.
3. Workforce and retention crisis
- Some providers report a staggering 40% turnover rate in care workers within their first year of employment, which threatens sustainability.
- Other providers at the table reported much lower rates due to enhanced business practices, and it is clear that it is a mixed picture. Overseas worker policies are impacting recruitment, exacerbating staffing shortages.
- Ethical dilemmas arise when care providers are unable to maintain services in underprivileged regions due to low fees being paid by local authorities and the lack of private payers in these areas.
4. Collaborative behaviour
- Organisations are increasingly retreating into their own financial silos.
- The lack of a trust-based, system-wide sharing platform.
- An integrated care system based on mutual trust has not developed, and the reality of the ICS structures has in many cases diminished rather than enhanced trust, giving rise to inefficiencies and poorer outcomes. It would be of such benefit if there were truly a trust-based, system-wide collaboration that transcended narrow budgetary lines.
Strategies for sector transformation
1. Improved collaboration and representation, especially in cost savings and efficiency
- Stronger, more unified leadership of the care sector is essential to unify providers and amplify their voices.
- The Providers Unite initiative has successfully mobilised care professionals, and there needs to be a full discussion about how it maintains its ability to influence change.
2. Regulatory reforms and funding strategies
- Is there any suggestion that the financial proposals from Andrew Dilnot’s 2011 recommendations could be the most viable solution to mobilise funds for care?
- The Fabian Society's June 2023 report outlines a National Care Service proposal with significant funding and structural reforms, yet its adoption remains unclear. The Government needs to define what a National Care Service actually means. Once they do so, the clarification will go some way to defining how they see social care’s role in an integrated health and care system.
3. Technology integration in care delivery
- AI and digital tools present opportunities for efficiency gains but must complement human-driven care.
- Strategic implementation of technology should balance automation with personalised service.
The future of care: the key questions to address
As in any good process the heated discussion led to other pressing questions which need resolution and answers from the Government.
- Will the Government implement a new funding system, maybe based on the Dilnot proposals of 2011, to ensure a fairer long-term care funding model? (It was noted that the Dilnot proposals have very little effect on the funding of care for working age adults).
- How will overseas staffing policies impact care service sustainability? Will the new initiatives such as the Fair Pay agreement lead to better provision of care services for people who draw on care and support?
- Is the National Care Service vision aligned with the Fabian Society’s proposals, and is the intention (as reported at the roundtable) for direct payments to become the predominant funding method? One roundtable delegate stated that a local authority senior official had said that they were being told to aim for 70% of all social care money being disbursed via direct payments.
- How can care providers effectively unify their advocacy to influence government policy?
- How can Integrated Care Services renew trust and collaboration across agencies and systems for the benefit of all?
The UK care sector is at a crossroads. Effective collaboration, financial stability, workforce sustainability, and technological innovation will shape its future. Stakeholders must form a united front to push for systemic reform, ensuring that care remains accessible, ethical, and economically viable. They must be assured of what their place is in any health and care future planning.
So where do we go from here?
Our next Care Perspectives Roundtable in September will drill down on some of these issues. It will be shortly after the publication of the 10-Year Health Plan, which is promised in mid-2025.
We will take these questions forward and continue to strive for the answers with Kathryn Smith, CEO of the Social Care Institute for Excellence (SCIE) and Gary Fee, CEO of City and County Healthcare.
The 10-Year Health Plan will be based on the three headline shifts:
- From hospital to community: Greater investment in local and home-based care, with integrated neighbourhood teams.
- From analogue to digital: Expanding use of tech like remote monitoring, interoperable records, and other digital tools.
- From sickness to prevention: Targeting upstream drivers of ill health, with emphasis on mental health, early intervention, and social determinants.
- Integrated neighbourhood teams (comprising GPs, social care, mental health, etc.) delivering joined-up support closer to home.
- Strengthened place-based leadership: With ICSs coordinating across health and care systems.
- Digital maturity: Support for local areas lagging behind on data sharing, infrastructure, or standards like DSCR compliance.
- Workforce reforms: Career progression pathways, retention investment, and potentially care worker registration.
- Capital investment: For community hubs, diagnostic centres, and tech-enablement, particularly in under-served areas.
- Health inequalities tackled by population health approaches.
So, what might be the implications for care providers?
- Care providers may see more outsourcing of health services to community partners, but with stronger accountability on outcomes.
- Commissioners will need to align strategies with neighbourhood and ICS-level metrics, prioritising impact across sectors.
- There's likely to be renewed pressure for data interoperability, so tech suppliers and providers will need to meet digital standards.
Interested to hear your views Ben Allen Nitesh Somani 💚 Avnish Goyal CBE 💚 Jeremy Richardson James Tugendhat Fraser Myles Rickatson Palvi Dodhia Ian Smith Andy Wilkins Michael Bell Sam Raffell Rob Martin Chris Poole Emma Crabtree Paul Tennant Daniel Casson💚Nadra Ahmed CBE DL 💚Sanjeev Kaushal Martin Jones MBE Dan Archer Amrit Sumal Manjinder Joshi Ashish Goyal Nicky Barnes Sarah Tarnowski Brian D. Vivienne McVey Vishal Shah, CFA James Maynard Ian Smith
Great to see this thinking well articulated. I wonder if there might be one other option to factor into this discussion - the idea of "re-abling care". I appreciate that older people are not the only ones receiving care, but we know from trials in several countries, that we can reduce the overall need for care by older people (so at least we could help that group). We also know that enabling more ability for longer doesn't materially affect life expectancy. That means we potentially create more capacity in the system (as opposed to simply time-shifting the problem). It's also the case that keeping abilities for longer can materially reduce healthcare costs. The evidence is good - the challenge people experience with this approach (across 5 countries), is the existing business models don't work. Perhaps now is the time to consider radical approaches like using staff supported by evidence-based simple reablement support systems, to find business models that allow a new way of working to be introduced? Obviously as a supplier of digitally delivered reablement support for older people, we have a vested interest - but it doesn't mean this approach can't solve some of our challenges (which have been brewing for 20 yrs).
Thank you Daniel Casson💚 for a clear paper which outlines where we are and what questions are important to consider for the future. The direct payment statement was interesting. I see some LAs making a strategic shift in that direction, but other LAs actively avoiding it. I don't see a national shift. I agree on the need for greater collaboration and financial pressures having an adverse impact. Regional care associations and organisations like Providers Unite have been more effective at supporting collaboration than the better funded ICB/Cs. How do we steer central funding into these grass roots organisations to e.g. ensure whole country coverage of Regional Care Provider Associations? (We don't have one for our NE branch as an example). For me, cost effectiveness (I purposely use effectiveness rather than efficiency) is highly dependent on new models of commissioning. Time and Task delivery only considers the short-term and fails as a result. All the improvements are underpinned by tech (as you know, my passion!).
Appreciate Daniel Casson💚and Katrina Hall 💚 for leading the conversations for this round table event. Valid points raised, regarding the current climate and challenges, with a view of potential proposals to bolster funding, technological innovation, and a NCS driven to produce better outcomes in the community whilst offering sustainability to the sector.
Thoughtful post, thanks Daniel Casson💚