Care Association Alliance launches it's second paper on Adult Social Care Reform

This is the second paper in the Care Association Alliance’s reform programme, prepared in partnership with the Institute of Health and Social Care Management. Our first paper, Adult Social Care Funding Reform, argued that no funding model can succeed without a workforce capable of delivering it.

This paper sets out what that workforce needs. It needs a recognised professional framework built on the existing Skills for Care Care Workforce Pathway, national professional levels, and a Fair Pay Agreement that is fully funded and tied to demonstrated competency. Not a new bureaucracy, and not a single national employer, but one recognised profession operating across many.

The Institute of Health and Social Care Management (IHSCM) describes itself as the leading independent membership organisation for managers and leaders who plan, deliver and support health and care in the UK and internationally. Its members work across the NHS, social care, public health, and the private, voluntary and military sectors, at every level of management. It offers leadership training, a Health and Social Care Management Qualification, conferences, mentoring and special interest groups on topics including digital health and workforce wellbeing, and its history stretches back to 1902. Source: ihm.org.uk.

Foreword

Our first paper argued that the financial risk of growing old and needing care is a national risk, and should be
managed nationally. Nothing in that argument has changed. But in the roundtables, commissioner
conversations and official responses since, one theme has recurred more than any other. You can reform the
money, but if you cannot recruit, keep and develop the people who deliver the care, the money will not translate
into better outcomes.

Adult social care fills around 1.59 million posts, across close to 19,000 employers and, on our own count of the
CQC register, more than 30,000 locations. Few parts of the British economy match that scale, spread and
complexity. Yet it remains one of the only workforces of its size with no nationally recognised professional
framework, no consistent career ladder, and no shared understanding, in government, among the public, or
within the sector itself, of what a career in care actually looks like.

That has real consequences. A worker who has spent five years building genuine clinical and relational skill can
move employer and start again on paper, because there is no register and no common language for what they
can already do. A sector asked to take on more delegated healthcare responsibility and more complex need is
paid and progressed as though none of that had changed. And an obvious opportunity goes begging: close to a
million young people not in education, employment or training, against tens of thousands of unfilled care
vacancies, with no bridge yet built between the two.

This paper does not propose a new bureaucracy, a single national employer, or the abolition of the diversity that
makes adult social care what it is, spanning home care, residential care, supported living, learning disability and
mental health services, all organised differently, all needed. What we propose instead is what every other
recognised profession already has: shared standards, a national pathway for progression, and a mechanism
through which the Fair Pay Agreement can reward competence rather than simply raise a floor. The starting
point already exists in the Skills for Care Care Workforce Pathway; it is not yet fit for that purpose, but it would
not take a great deal to bring it up to speed.

We have held ourselves to the same standard we asked of government in our first paper: evidence over
assertion. Where we could find data to test our own arguments, including original analysis commissioned
specifically for this paper, we went and found it. Where the evidence did not fully support a claim we had
intended to make, we changed the claim.

We publish this paper as government itself has started to speak this language. In his speech on social care on 29
July 2026, the Prime Minister said the ambition should be “to lift it up, to lift it closer to NHS standards… to
integrate it more with the NHS workforce and actually to start to think about progression routes,” with care staff
recognised “in terms of pay, but also in terms of training and the wider support we give them.”1 The same week,
in Derby, he argued for “parity between academic and technical” routes into skilled work.2 We agree with both.
This paper sets out what delivering them actually requires.

England does not need a single workforce. It needs a single recognised profession. This paper sets out how to
build one.

Melanie Weatherley MBE

Co Chair Care Association Alliance