Why social care can’t wait – a guest blog by Adam Crampsie, Everyturn CEO

“If I were Prime Minister, I would spend my political capital on social care too.

Andy Burnham has put social care reform near the top of his agenda and made clear that he is willing to take on the difficult choices needed to fix it. Good. So he should.

Governments have spent decades acknowledging the problem through review after review, only to step back when the choices became difficult. Meanwhile, the crisis has continued to grow.

This issue cuts right across my day job and my NHS board roles.

At Everyturn, we run specialist community bed services supporting older people, including people living with dementia, alongside bed based services for people with serious mental illness. These are commissioned by the NHS and local authorities.

I also sit on the boards of two acute NHS trusts, chairing the Quality Committee at one and the Finance and Performance Committee at the other.

So I see the same problem from both ends.

I see people who could remain independent with the right support, but who reach crisis because that help was not available early enough. I also see hospitals struggling to admit people who need treatment, while people who are ready to leave wait for the right support and somewhere that can safely meet their needs.

That pressure fills emergency departments and leaves ambulances queuing outside hospitals. It also means longer ambulance waits for people in the community.

Many of those waiting have not yet been assessed or diagnosed, so the clinical risk is unknown. Their condition may deteriorate before an ambulance reaches them. Families can be left trying to manage a crisis without support.

The scale of the social care problem is huge.

In England, an estimated two million people aged over 65 are living with some unmet need for care and support. Among people aged over 80, more than one in four are struggling without all the help they need. This includes people who need help to wash, dress, eat or get out of bed. These are basic parts of daily life, yet people are going without support and families are being left to fill the gaps.

And this is wider than older people. Social care also supports working age adults who may need lifelong or specialist help. Any reform has to work for them too.

The workforce remains under huge pressure. There were around 111,000 vacant adult social care posts in 2024/25. The vacancy rate was three times that of the wider economy, while almost one in four staff in the independent sector left their role during the year. Care staff are doing incredibly difficult work, often for low pay and with limited opportunities to develop. We cannot build a reliable care system without giving the people who deliver it a reason to stay.

Then we see the impact in hospitals.

In April 2026, an average of 13,612 people were in hospital every day despite no longer meeting the clinical criteria to remain there. That is around one in every ten general and acute hospital beds in England.

The estimated cost of delayed hospital discharges reached almost £2.7 billion in 2025/26.

Delayed discharge has several causes. Some arise from hospital processes. Others reflect slow assessments or insufficient support outside hospital. But capacity is a major part of it. In March 2025, it was the single largest recorded reason for delays among people who had been in hospital for at least 14 days. This covered a lack of social care and wider community services, including rehabilitation.

We know what happens next. When someone cannot leave hospital for support at home or appropriate community care, they have no safe route out. While they wait, another person waits in an emergency department or for an ambulance to reach them at home.

Pressure on beds leads to cancelled operations and slower ambulance handovers. Corridor care becomes more common as staff try to manage demand without the capacity they need.

Remaining in hospital can also make someone less independent. Older people lose strength quickly during extended stays, increasing the risk of delirium and falls. Someone admitted from their own home can leave needing considerably more support than they would have needed if they had been discharged promptly.

It is a pretty expensive cycle. We limit lower cost support in people’s homes and communities, then spend far more when they deteriorate or remain in an acute hospital bed.

Most beds released through better social care would quickly be used by patients already waiting. Hospitals could treat more people and cancel fewer operations. Staff would have a better chance of delivering safe and dignified care.

But social care should never be viewed only through the lens of what it can do for the NHS. Its first purpose is to help people retain independence and control over their lives. The NHS benefits when we do that well.

So, if I had political capital to spend, where would I spend it?

• I would start by being honest with the public about what a fair social care system costs and how we are going to pay for it. People need clarity about what support they can expect and how that promise will be funded.
• I would protect people from catastrophic care costs. A diagnosis of dementia should not result in someone losing their life savings or their home to pay for essential care.
• I would create a proper national workforce settlement. Pay and conditions should reflect the value of care work, with genuine opportunities to build a career and develop professionally. Without the workforce, everything else is just a policy document.
• I would invest in community services that can step in earlier and support people at home. Every area also needs enough rehabilitation and specialist bed capacity to help people leave hospital as soon as they are ready.
• I would require commissioners to pay the true cost of providing good care and offer longer term contracts. Providers cannot build sustainable capacity around short term funding pots and fee rates that do not cover delivery.
• I would make the NHS and local government jointly accountable for outcomes, backed by genuinely pooled funding. For people needing support, clear responsibility matters far more than which budget pays for their care.
• I would put legislation before Parliament within this term, supported by a funded implementation timetable and public reporting on progress. We have already spent decades describing the problem.

A National Care Service could set consistent rights and standards across the country. Its success would depend on strengthening local delivery and avoiding another layer of bureaucracy.

Andy Burnham is right that fixing social care will require political capital. It will also require honesty about the scale of the commitment and investment sustained beyond one Parliament. That means building a genuine cross party consensus. If the weekend’s exchange between Andy Burnham and Ed Davey is anything to go by, they have at least managed the first step: having a cordial discussion via tweets.

If we get it right, more people will be supported to live independently and the NHS will regain much needed capacity.

So that’s the back door sorted. Then we can turn to the front door, with the primary care and prevention reforms needed to stop people needing hospital in the first place and keep them thriving in their communities.”