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Adult social care

Social care is a fundamental part of the care and support system in the UK. The close relationship between health and social care means it is vital that both services work effectively to deliver high quality care for all. It is important to understand the different structures across the UK and how they interact with healthcare.

  • What is adult social care?

    Adult social care describes the activities, services and relationships that help people live independent, healthy, active and inclusive lives. It covers a great variety of services, delivered by many different providers, in a selection of settings. For example, adult social care can include domiciliary (home) care, residential care, nursing care, day care opportunities, short respite breaks and the provision of equipment.

    There is significant cross over between health and social care, and there are areas where healthcare is largely provided in a social care setting, for example care for dementia, Parkinson's and end of life care.

    Where an individual is assessed as having ‘primary healthcare needs’ they are eligible for NHS Continuing Healthcare. This is "a package of ongoing care that is arranged and funded solely by the NHS where an individual has been found to have a ‘primary health care need’'".[i] The package can include accommodation if that is part of the overall need, such as in a nursing home, a hospice or in an individual’s own home.

    There is however no legal definition of a ‘primary health need’, this has led to disparities in how it is interpreted and as a result the number of people who receive NHS Continuing Healthcare. For example in England at the end of quarter 2 in 2013/14 59,000 people were eligible for NHS Continuing Healthcare, where as in Northern Ireland between 2006 and 2013 only 17 people had been assessed as eligible.[ii]

    The Dilnot Commission for England in 2011 emphasised the importance of seeing social care as part of a wider care and support system. The Commission emphasised the importance of people receiving a coherent package of support shaped around their needs not funding streams.

    "Social care supports people of all ages with certain physical, cognitive or age-related conditions in carrying out personal care or domestic routines. It helps people to sustain employment in paid or unpaid work, education, learning, leisure and other social support systems. It supports people in building social relationships and participating fully in society.

    Social care is part of a wider care and support system, which includes social care, the NHS, the social security system, housing support and public health services. It also includes the services provided by third-sector organisations, and the invaluable contribution made by carers and volunteers. The state pension and private financial products also provide income that is used for care and support needs."

    Dilnot Commission

    [i] Department of Health (2012) The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (Revised) DoH: London

    [ii] Age NI (2014) The denial of NHS continuing healthcare in Northern Ireland Age NI: Belfast

  • What is the BMA’s policy position?

    Social care is an increasing area of concern for the BMA. We believe that the significant pressures in social care is a direct result of inadequate resourcing. To look after individuals well, doctors need social care to be sufficiently funded and adequately staffed.

    In addition improved integration between health and social care services is needed to ensure patients move between the two services easily.

  • What is the BMA doing to support care workers?

    The BMA recognises the need for more carers in the community and is exploring how as an organisation we can help identify solutions to address the significant pressures in social care.

    In particular, we have been actively supportive in helping to create more capacity in the sector by giving care workers NHS-style terms and conditions to encourage more people into those careers.

    The BMA’s CCC (committee on community care) is liaising with relevant stakeholders, including UNISON, which represent care workers to support the work they are undertaking to improve the conditions for care workers across the UK. 

    UNISON’s ‘save care now’ campaign encourages councils to sign up to its Ethical Care Charter. This charter establishes a minimum baseline for the safety, quality and dignity of care to ensure the recruitment and retention of more stable workforce through more sustainable pay, conditions and training levels. CCC will continue to raise awareness of these issues with stakeholders to ensure that vulnerable patients receive safe and dignified standards of care.
  • Adult social care across the UK

    Social care, like healthcare, is facing unprecedented pressures across the UK. These pressures are coming from increasing demand, funding and workforce constraints.

    How adult social care is structured and functions differs across the UK. Read more about how adult social care works in each nation.



    Adult social care, like health, is an important policy area for the UK Government. In 2014 the Care Act was passed into law and from 2015 it provided new rights for people in England who need social care. It aimed to improve people’s independence and wellbeing and made it clear that local authorities must provide or arrange services that help prevent people developing needs for care and support or delay people deteriorating such that they would need ongoing care and support.

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    Northern Ireland

    Health and social care in Northern Ireland has been structurally integrated since 1973 and this makes it distinct from the other three systems in the UK. Despite longstanding structural integration, it is widely acknowledged that patients don’t always experience an integrated service. As a result, successive governments have looked to improve and reform the adult social care system.

    The system is currently undergoing a three stage phase of reform. The second and current stage was started in October 2016 following the Health Minister’s reform proposals in response the publication of the Bengoa expert panel report. This stage has focused on evaluating the reform proposals through a public consultation and by an expert panel.

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    Over the past decade social care has undergone significant reform in terms of the strategic approach to adult social care, the structure and how services are delivered. An important theme has been a move towards greater integration between health and social care, as seen with the creation of IJBs (integrated joint boards). Another distinguishing characteristic of the Scottish system is the entitlement to free personal care for those aged 65 years and over.

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    Adult social care, like health, is an important policy area for the Welsh Government. In recent years there have been important shifts in how and where services are provided. The Social Services and Well-being (Wales) Act 2014 was a significant milestone in the development of adult social care services in Wales. The Act changed the way that people’s needs were assessed and the way services are delivered, it also gave people more say over the care and support that they receive.

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