In 2010, the former Prime Minister published a review of adult social care in which the Health Services Management Centre (HSMC) argued that the system was fundamentally broken:

‘In the early twenty-first century, a number of commentators have essentially argued that the current adult social care system is fundamentally broken... This is not the fault of the people working in adult social care, nor of the people making social care policy (either now or under previous governments). It simply seems to be the case of a system designed with 1940s’ assumptions and principles in mind that are now no longer fit for purpose in the early twenty-first century’ (Glasby et al., 2010, p. 4).

A year on and very little has changed to alter our pessimistic assessment. Indeed in recent weeks, this diagnosis has been reconfirmed by a number of inter-related developments, including:

  • High profile financial problems in Southern Cross, the UK's largest provider of care homes for older people and subsequent debates about the role of private equity in the care sector. Against this backdrop, HSMC has published a national guide to good practice when supporting older people during residential care home closures, highlighting ways in which negative impacts can be minimised and, on some occasions, even improving outcomes (Glasby et al., 2011).
  • Concerns from the Equality and Human Rights Commission about the neglect of older people receiving home care.
  • Widespread budget reductions in local government and a judicial review to test the legality of some of the social care cuts.
  • Related concerns in the NHS about the quality of care provided to older people expressed by the Care Quality Commission and the NHS Ombudsman, as well as shocking footage filmed by Panorama at Winterbourne View.

In July, we expect the outcome of the Dilnot Commission established by the Coalition Government to explore options for the future funding of care and support ( This is crucial as HSMC’s research suggests that, if we do nothing, the real cost of adult social care will double in 20 years (and this was before the massive cuts which councils currently face).

Ultimately, what is at stake is a personal and philosophical debate about how much we value older and disabled people in our society, what sort of life we want together, how much we’re all prepared to say – and whether we really mean it when we say it. For too long adult social care has been under-funded, low status and poorly understood – and the results of this collective neglect are here for all to see. While there will be no easy answers, the Dilnot Commission is a chance to have these difficult debates openly with each other – and we’ll be letting older people, disabled people and ourselves down if we don’t take this opportunity.

Professor Jon Glasby

Professor of Health and Social Care and Director of the Health Services Management Centre, University of Birmingham


  • Glasby, J., Ham, C., Littlechild, R. and McKay, S. (2010) The case for social care reform – the wider economic and social benefits (for the Department of Health/Downing Street). Birmingham, Health Services Management Centre/Institute of Applied Social Studies
  • Glasby, J., Robinson, S. and Allen, K. (2011) Achieving closure: good practice in supporting older people during residential care closures. Birmingham, Health Services Management Centre (HSMC)/Association of Directors of Adult Social Services in association with the Social Care Institute for Excellence

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