The Prime Minister is right to put social care at the heart of his government’s agenda. After decades of delay, there is finally a chance to build a National Care Service that matches the scale of the challenge. However, if reform focuses only on who pays for care, it risks overlooking an equally pressing question: where will that care actually be delivered?
Analysis by Unity Trust Bank suggests that more than one hundred parliamentary constituencies would need the equivalent of at least five additional care homes simply to reach today’s national average level of provision. Twenty-four constituencies would need the equivalent of ten new care homes. These are not isolated local shortages. They point to a growing mismatch between where older people live and where residential care capacity exists.
The pattern is particularly striking in rural and coastal England. Constituencies including South Devon, North Dorset, Richmond and Northallerton, Waveney Valley and St Ives combine some of England’s oldest populations with some of the weakest care home provision.
These places attract retirees, offering them a quieter pace of life and strong local communities. Consequently, many are ageing faster than the country as a whole while the infrastructure needed to support people in later life has failed to keep pace.
The result is the emergence of what our report describes as “care deserts”, communities where residential care capacity is increasingly disconnected from demographic need. Left unaddressed, they risk becoming “care traps”, places where people can enjoy many years of retirement but later struggle to find appropriate care close to family, friends and the communities they know best.
This is not a challenge that can be solved overnight. New care homes require planning permission, suitable sites, skilled staff and crucially, access to long-term investment. Even where demand is obvious, creating new capacity takes years. Delaying investment today simply stores up greater pressures for tomorrow.
England’s ageing population is no surprise. We have understood its trajectory for decades. Yet investment too often follows short-term market conditions rather than long-term demographic trends.
The consequences extend well beyond social care. Residential care is as much a part of Britain’s national infrastructure as housing, transport or energy. We cannot build a National Care Service on foundations that are already running short of capacity.
That is why residential care should increasingly be viewed through the same lens as other forms of essential infrastructure.
Britain rightly recognises the strategic importance of investment in housing, transport and energy. Care deserves similar attention. Communities cannot thrive if one of the services people are most likely to need during their lifetime becomes progressively harder to access.
Planning reform has an important role to play but so does investment policy. Our report recommends targeted Care Investment Zones in those parts of the country facing the greatest demographic pressures. Streamlined planning, combined with investment incentives, could encourage new care capacity before shortages become entrenched.
Alongside that, providers need access to patient capital. Long-term lenders have an important role to play alongside government and care providers. Access to stable finance allows well-run organisations to modernise facilities, expand capacity and invest with confidence. Our ageing population is not a short-term phenomenon and the financial framework supporting care should recognise that.
The Prime Miniter’s recent announcement marks the clearest commitment to social care reform for many years. He has promised to fast-track Louise Casey’s review, build cross-party consensus and create a National Care Service that finally tackles one of Britain’s longest-running policy failures. That ambition deserves broad support.
If reform is to succeed, it must address whether the country is investing in enough places to deliver it where people need it most. Funding reform and capital investment are two sides of the same coin. Without sufficient places to deliver care, even the best-designed funding system will struggle to meet people’s needs.
For too long, social care has been treated as a recurring funding problem. It is also an investment challenge. A National Care Service cannot exist on paper alone; it requires buildings, beds, skilled staff and long-term capital. If the Prime Minister’s reforms are to leave a lasting legacy, they must ensure Britain is investing not only in paying for care but in creating the capacity to provide it.
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