England’s two tier care system deepens social care inequalities

In July 2024, the UK government abandoned long awaited reforms to address England’s two tier care system, in which people with care needs either self-fund or receive state support if their assets fall below £23 250. For care homes—residential facilities licensed to deliver personal care and support, which may include nursing care—this two tier system has created wide care inequalities, with state funded residents experiencing worse quality care, while many others have unmet needs or rely heavily on unpaid family carers. These inequalities are not just costly for local authorities, which fund social care, but also create substantial downstream costs for the NHS.1Although most countries have elements of two tier funding in their care systems, England’s sharp wealth threshold has created a system in which care home providers focus on richer areas with a higher concentration of self-funders, with low incentive for homes to open and operate in poorer, high…