In England, social care has long been a source of contention, with challenges in providing adequate services to the elderly and those with disabilities. The recent review of social care in England has sparked debates about how to address the long-standing issues that plague the system, such as high demand, limited resources, and an overburdened workforce. However, in the midst of this, a single council in London has shown that a different approach might be the answer. Hammersmith and Fulham, one of the most forward-thinking councils in the country, has been offering free personal care to those in need for the past decade. This model could provide a blueprint for tackling the crisis that has gripped England’s social care system.
Florence Mahon, a 67-year-old former House of Lords housekeeper, serves as a prime example of how access to free personal care can drastically improve the lives of elderly individuals. In her youth, Florence ran around attending to various tasks in the House of Lords, and her retirement, though early, allowed her to enjoy some peace and solitude. However, arthritis and other health conditions made it increasingly difficult for her to live independently. For several years, she was confined to her flat, unable to walk to the shops or meet friends, and simple tasks like making her bed became monumental challenges.
Before being granted access to free care, Mahon’s life was severely limited. She was unable to do anything without significant pain and effort, and her isolation grew. But with the introduction of daily home care services—something that was not available in most of England—Mahon’s life has been transformed. The personal care package, which includes assistance with tasks such as showering, dressing, and having breakfast, has given her back a sense of independence. The care workers, who provide her with 45 minutes of support each day, have enabled her to make simple yet vital improvements to her daily life.
Moreover, Hammersmith and Fulham’s decision to provide free personal care has had wider benefits, not just for residents like Mahon but also for the healthcare system at large. Studies have shown that the borough’s health outcomes are far better than the national average, particularly in terms of hospital admissions. The number of people in residential care in Hammersmith and Fulham has decreased dramatically, by about half over the past decade. At the same time, the borough has seen a marked increase in the number of people receiving home care, with nearly double the London average.
The benefits of free personal care in this borough extend beyond the individual to the wider community. One of the most notable effects of the scheme is a reduction in unnecessary hospital admissions and readmissions. As Florence Mahon attests, the home care service makes it easier for her to manage her health condition, which in turn reduces her need for extended stays in hospitals. In a system that is often overwhelmed by admissions and emergency department queues, Hammersmith and Fulham’s approach has helped prevent unnecessary hospitalizations by enabling patients to remain in the comfort of their own homes while still receiving vital care. The effect of this initiative is not just seen in terms of patient outcomes but also in the resources it saves the NHS. This model has alleviated pressure on the healthcare system, which in turn allows resources to be directed where they are most needed.
The long-term data backing the borough’s approach demonstrates its effectiveness. In 2023, the number of people receiving home care in Hammersmith and Fulham was significantly higher than in most other parts of London, with 7.5 people per 1,000 residents compared to the London average of 4.2. More importantly, the number of patients who were able to remain at home for at least 91 days after being discharged from the hospital was 95.7%, well above the 85% national average. This is a testament to the positive effects of early intervention and support, which help individuals avoid becoming more frail or needing more intensive care.
While the success of this initiative is evident in the borough’s outcomes, the broader question remains whether this approach can be replicated across the country. The ongoing review of social care by Baroness Casey, commissioned by the government, aims to investigate potential reforms to adult social care. However, reforming care has been on the agenda for many years without any real progress. The division between healthcare and social care, which dates back to the 1948 National Assistance Act, has created a fragmented system in which access to care is determined by both need and financial status.
Under the current system, the elderly and disabled individuals must navigate a complicated and often restrictive means-test, which prevents many from receiving the care they need. People with assets above £23,250 are excluded from receiving free care, leaving them to pay for their own services. This creates a disparity between those who can afford care and those who cannot. In fact, the average cost of home care can run up to £10,000 per year, making it unaffordable for many families. Many individuals are forced to make difficult choices between paying for care or other necessities, such as housing. This financial strain has led to an over-reliance on unpaid carers, often family members who give up work to provide care for their loved ones.
The system is also suffering from a severe workforce shortage, with over 130,000 vacancies in the social care sector and long waiting lists for assessments and care. Many carers work long hours for low pay, leading to high turnover rates and a lack of continuity for patients. This contributes to a sense of frustration among both carers and those in need of care, making the overall experience of social care a stressful and unsatisfactory one.
Hammersmith and Fulham’s model, which includes free personal care for all residents, presents a potential solution to these issues. The borough’s leaders argue that the cost of providing free care is outweighed by the benefits to the individual and to the NHS. However, for other councils in England, the costs of implementing such a model are daunting. Funding for local authorities has been drastically cut in recent years, leaving many struggling to provide even basic services. Some councils may question whether they can afford to implement free home care when their budgets have already been slashed.
The question of who pays for social care remains one of the most contentious issues in the debate over reform. Some have proposed a more generous means-test, others suggest a lifetime cap on care costs, while some advocate for an NHS-style system where care is provided free at the point of need. These proposals have been on the table for years, but political resistance and financial constraints have stalled progress. As Sir David Pearson, former director of social services for Nottinghamshire County, suggests, the key issue is not the lack of proposals but the unwillingness to act on them. The question of political will and funding has long been a barrier to meaningful change.
Simon Bottery of the King’s Fund outlines several potential models for reform, including a social insurance system where everyone has access to publicly funded care but contributes to the cost, as seen in countries like Germany and Japan. However, these proposals would require substantial changes to the current system and significant investment in care services.
For the people of Hammersmith and Fulham, the results of free home care have been overwhelmingly positive. The reduction in hospital admissions, increased quality of life, and greater independence for those receiving care all point to a more efficient, compassionate system that prioritizes the needs of individuals over financial considerations. As more councils consider how to reform social care, Hammersmith and Fulham’s model offers a promising solution, but its wider adoption will require overcoming significant political and financial obstacles. The government must act with determination and courage if it is to address the social care crisis that continues to affect millions across the country.
In conclusion, the current state of social care in England is unsustainable, and reform is urgently needed. Hammersmith and Fulham’s approach to free personal care offers a glimpse of a better system—one that prioritizes the needs of the most vulnerable and empowers them to live their lives with dignity and independence. It is now up to the government and local authorities to take the bold steps necessary to create a more equitable and sustainable system for all.