This book is about ‘adult social care’ in England – the term commonly used to refer to personal care and practical support for older people and adults with physical disabilities, learning disabilities or mental health issues, as well as support for those caring for them informally. Much of the debate about adult social care tends to concentrate on the situation of older people, even though social care expenditure on adults of working age and older people is roughly equal in size. The focus is also on England. Although all parts of the UK have followed the same policy trajectory to some extent, this has become less so in the wake of devolution. While reference will be made to variations across the UK, this is not a comparative policy analysis. The terms ‘personal care’ and ‘practical support’ are also significant: the former is narrower than the latter, and both are restrictive compared to a wider concept such as ‘well-being’. All of these definitions and their implications will be explored.

It is also a sector of considerable economic significance, enormous policy complexity and seeming political impenetrability. In terms of size, one recent estimate (IFC Consulting, 2018) put the total economic value of the sector at almost £50 billion. The workforce is estimated to be around 1.5 million – a massive source of employment. Moreover, it is estimated that if the adult social care workforce grows proportionally to the projected number of people aged 65 and over in the population, then the number of adult social care jobs will increase to around 2.2 million jobs by 2035 (Skills for Care, 2019). Better healthcare has also improved the life expectancy of people with physical and learning disabilities, meaning that more working-age adults are now in need of social care support. These adults are also less likely than older adults to have financial assets that disqualify them from receiving publicly funded care (NHS Digital, 2019b).

Political and policy responses to a sector of such significance have been contradictory. On the one hand, it has been subjected to massive ideological change in the way support is commissioned and delivered; on the other hand, the long-running debate around funding long-term care has been inconclusive.