Decades of stalled reform, rising costs and demand, and an overstretched workforce have created instability that will only intensify without significant action to deliver a more sustainable care system.
Good social care can be transformative, enabling people to live with dignity, maximise independence, and enjoy a better quality of life.
However the care sector is under severe and mounting pressure. Rising demand, increasingly complex needs, persistent workforce shortages, and financial strains have created fragility across both adult and children’s social care. Services are struggling to meet needs, with growing reliance on unpaid carers. Many of the challenges in adult and children’s social care highlighted during Sixth Senedd scrutiny persist today.
The costs of care for those who need it can be extremely high and unpredictable. The problems with the current funding model have been recognised for decades. As the Welsh Government acknowledged in 2009, “the current system of paying for care is complicated, unfair, and unsustainable in the long term”.
Despite multiple reviews and commissions by both UK and Welsh governments, major reforms have repeatedly stalled. Nuffield Trust describes “thirty years of inaction” in England, which has had clear consequences for progress in Wales.
What’s happened in England and Wales?
In 2011, the Dilnot Commission recommended reforms including a lifetime cap on care costs, warning that adult social care funding had been ignored for too long, and without action the problems would worsen and harm the most vulnerable. The UK Government initially planned to implement a version of these reforms in England (with consequential funding for Wales), but this was repeatedly delayed by subsequent governments and eventually cancelled by the current UK Government in 2024 as part of wider public spending reductions. In 2025 it established a new independent commission, chaired by Baroness Casey, to “build a national consensus around a new national care service” and “finally grasp the nettle on social care reform”.
The Welsh Government briefly considered increasing income tax to fund social care, following Professor Holtham’s (2018) proposal for an enhanced social insurance model, funded by a levy. This approach - requiring people to contribute a portion of their income into a future care fund - was later ruled out before the 2021 Senedd election.
The UK Parliament’s Health and Social Care (HSC) Committee (2025) observed that governments have repeatedly stepped back from adult social care reform when faced with the cost, without considering the human and financial cost of inaction. It highlighted evidence that every £1 invested in social care could return £1.75 to the wider economy.
What’s the current state of adult social care in Wales?
The Welsh Local Government Association (WLGA) stress that social services face acute and widening financial challenges, with more than 81,000 people relying on care and support. In March 2026, councils reported a £69m in-year overspend in social care, driven by rising demand and increasingly complex cases.
Care Forum Wales says the sector is under immense strain, grappling with persistent workforce pressures, unsustainable fee rates, and increasing employer costs. Fee rates set by local authorities often do not cover the full cost of care and vary significantly across Wales. Evidence to the Sixth Senedd’s Local Government and Housing Committee shows that fees for nursing care can differ by as much as £9,000 a year between neighbouring authorities.
For those who fully fund their own care (‘self-funders’), average weekly costs are around £1,156 for residential care, and £1,394 for nursing care. The Older People’s Commissioner highlights how funding pressures fall unfairly on service users, with inequitable fee structures and top-up fees leaving many selffunders effectively subsidising publicly funded care home placements.
Workforce pressures
Staffing pressures remain a major concern, with chronic vacancies and ongoing recruitment and retention difficulties, despite the introduction of the Real Living Wage for social care workers. More than a quarter of domiciliary care workers are on zero-hours contracts. Social Care Wales’ latest workforce survey (2025) found that one in five social care employees aim to leave the sector within around 14 months, citing low pay, poor conditions and limited progression.
Growing delays and waiting lists
The Welsh Government doesn’t currently publish data on waiting times for social care services but stakeholders report long and growing delays.
- The WLGA highlights increasing waits for assessments, care packages, equipment and occupational therapy.
- Age Cymru’s 2024 research found that nearly one in four older people were waiting more than 30 days for a care assessment, and one in six were waiting more than 30 days for care to be put in place.
- The Association of Directors of Social Services (ADSS) Cymru found that most areas have waiting lists for carer’s assessments, “which prevents carers having the support they need”.
Pressure on unpaid carers
The value of unpaid care in Wales was estimated (in 2023) at around £10.6bn per year, yet many carers are at “breaking point”. The sixth Senedd’s Health and Social Care Committee reported widespread unmet need, with carers experiencing financial hardship, deteriorating physical and mental health, and exhaustion.
The UK Health and Social Care Committee concluded that unpaid carers bear the greatest cost of the failure to reform adult social care, and recommended that the Casey Commission establish a dedicated workstream on reducing pressure on carers.
How could adult social care be funded differently?
There are various options for alternative funding models that could replace the existing means-tested system, such as:
- Social insurance: Everyone pays into a fund during their lifetime and receives support if they develop care needs. Social insurance models operate in a number of countries including Germany, Japan, and Austria.
- Free personal care: Support with daily living tasks (e.g. washing and dressing) is free, but residential care remains means-tested, as in Scotland.
- An NHS-style system: Comprehensive social care would be free at the point of need, similar to Denmark’s model. The Welsh Government’s 2021 Co-operation Agreement with Plaid Cymru, set out a shared ambition for a National Care Service based on this principle.
The path to a National Care Service
The previous Welsh Government convened an expert group to advise on developing a National Care Service which recommended a phased approach to charging reform. The Welsh Government has since launched the National Office for Care and Support, and published a Stage 1 implementation plan, followed by an update report and proposed Stage 2 plan at the close of the Sixth Senedd.
The latest update says further research is required to assess funding options, starting with modelling the impacts of making non-residential care free at the point of need, and then extending free care (excluding accommodation costs) to residential settings.
Significant questions remain about how a National Care Service could be funded, and when this might become a reality. A recent report by the Chartered Institute of Public Finance and Accountancy (CIPFA) and Local Government Information Unit (LGiU) cites stakeholders’ criticism that although the Welsh Government’s initial implementation plan and National Office give the appearance of progress, they have not been translated into tangible outcomes.
The expert group recommended a ‘national conversation’ on the level of funding needed, and whether the public are willing to pay for it. It also highlighted the need to consider whether social care can be prioritised over other areas of spending and, if not, whether mechanisms such as devolved income tax powers should be considered. Without new funding, it warned, existing deficiencies will intensify.
What lies ahead in adult social care?
This year the Casey Commission plans to release its first report and launch a national conversation on the future of adult social care in England, with a final report expected in 2028. The previous Welsh Government’s proposed Stage 2 implementation plan (2026-28) includes plans to consult on national design principles for a National Care and Support Service.
Wales now faces a critical moment for adult social care. While the previous Welsh Government set out a long-term vision for a National Care Service, meaningful progress with reforms will depend on confronting fundamental questions about funding, political will, and public consensus.
Will action be taken in the Seventh Senedd to build a fairer, more sustainable and resilient care system — one that most of us are likely to rely on at some point in our lives?
Article by Amy Clifton, Senedd Research, Welsh Parliament
