Key statistics 

• the study draws on 65 semi-structured interviews with policy stakeholders across the UK between 2019 and 2021, alongside analysis of 31 policy documents relating to social care reform 

• interview participants included stakeholders across government, local authorities, care providers, NHS organisations and third sector groups in England (22), Wales (17), Scotland (13) and Northern Ireland (13) 

• Scotland introduced free personal care for people aged 65 and over in 2002, later extending it to working-age disabled people in 2019 

• England legislated for a cap on social care costs through the Care Act 2014, but implementation was repeatedly delayed due to financial and political pressures 

Key messages 

• social care reform in the UK has been slow and uneven despite widespread agreement that reform is necessary 

• policy “drift” occurs when policies remain unchanged even as social needs increase or circumstances change 

• Scotland has progressed further in social care funding reform than the other UK nations, particularly through free personal care 

• England has experienced the greatest delays due to factors such as political disagreement, financial pressures and institutional complexity 

• Wales and Northern Ireland have introduced some policy changes but have also faced barriers including institutional capacity and political instability 

Policy implications 

• social care reform requires long-term political commitment and cross-party agreement 

• funding reforms should address the balance between public funding and individual contributions to care costs 

• policymakers should consider how institutional structures and political systems affect the ability to implement reforms 

• greater policy coordination across UK nations may help identify effective reform approaches 

• sustained policy attention is needed to avoid continued delays in addressing long-term care funding challenges 

Gaps 

• the research focuses on national-level policymaking and does not examine how reforms are implemented locally 

• the study relies on interviews with policy stakeholders and does not include direct perspectives from service users or carers 

• the analysis primarily examines funding reform rather than broader aspects of social care quality or workforce issues 

• further research is needed to understand how different funding models affect access to care and financial risk for individuals 

Commentary 

This study explores why social care reform has progressed unevenly across the four nations of the UK. Despite widespread recognition that the current system needs reform, many proposed changes have been delayed or only partially implemented. 

The authors use the concept of policy drift to explain this pattern. Policy drift occurs when existing policies remain in place even though social needs and pressures have changed. In the context of social care, demographic ageing and rising care needs have increased pressure on systems that were not originally designed to cope with these demands. 

The research compares England, Scotland, Wales and Northern Ireland, each of which has responsibility for its own social care system following devolution. Although these systems share common origins, they have developed in different ways over the past two decades. 

Scotland has taken the most significant steps towards reform. In 2002 it introduced free personal care for older adults, a policy that later expanded to include working-age disabled people. This approach represents a form of “risk pooling”, where the costs of care are shared across society rather than falling mainly on individuals. 

England has experienced greater delays in reform. Although legislation introduced in 2014 proposed a cap on the amount individuals would have to pay for care, the policy was repeatedly postponed due to financial and political concerns. Wales and Northern Ireland have made some changes to funding arrangements but have also faced institutional and political barriers. 

The study identifies several factors that can lead to policy drift. These include the high cost of reform, political disagreements between parties, the complexity of the social care system and competing policy priorities. In England, these factors have combined to slow progress more than in the other UK nations. 

From a health and social care equity perspective, the findings show how differences in political systems and policy decisions can lead to uneven social care arrangements across the UK. People living in different nations may face different rules around care funding and access to services. 

Overall, the study highlights how institutional and political factors shape the pace of social care reform. Without sustained political commitment and agreement on funding solutions, policy drift may continue to delay reforms designed to protect people from the high costs of care.