The invisible role of self-funders
One of the starkest realities Sinclair raises is the contribution of people who pay entirely out of pocket for their care. “Self-funders are effectively propping up the system,” he says. Around 40 per cent of care home residents fall into this group, with even higher proportions in wealthier parts of the country.
Their role, Sinclair stresses, goes far beyond paying their own bills. “In many cases, they’re cross-subsidising the whole market,” he explains. Local authorities, under long-term financial pressure, often pay significantly less than the fees charged to private individuals. “If we didn’t have that cross-subsidy, many homes simply wouldn’t survive.”
Despite this, the contribution of self-funders is rarely acknowledged in public debate. “It’s as if policymakers don’t want to admit how reliant the whole system is on people selling their homes or draining their savings,” Sinclair reflects. The absence of recognition, he argues, makes it easier for governments to defer reform. “We talk about sustainability all the time but the truth is, we’re sustaining social care on the backs of families. That’s not fair and it’s not sustainable.”
Delays and uncertainty
Families, Sinclair notes, often wait until crisis point before making decisions, unsure about how much care will cost or how long their savings will last. “People are terrified of the lottery of care costs,” he says. “They don’t know what they’ll be asked to pay, or for how long.”
The rules are stark: anyone with assets above £23,250 must pay for their own care, sometimes meaning the sale of their home. Unlike the NHS, which offers treatment without financial risk, social care leaves families exposed to both illness and uncertainty. “It’s a system that creates stress rather than relieving it,” Sinclair observes.
He points to the long-promised cap on care costs as a clear example of political hesitation. Announced and delayed repeatedly, it remains out of reach. “Successive governments have known this system is broken, but they’ve lacked the courage to fix it,” he argues. The consequences, he stresses, are not abstract. “Every time reform is pushed back, it means more families selling homes, more people living their final years with that constant worry.”
For Sinclair, the real obstacle is political toxicity. “It’s become safer for governments to do nothing,” he says. “But that choice has devastating consequences for families.” The backlash to the so-called “dementia tax” in 2017 and “death tax” in 2010 showed how easily reforms can be weaponised.
Workforce, innovation and the human touch
For Sinclair, reform cannot ignore the workforce. With vacancies in the sector running into the hundreds of thousands, turnover remains high and recruitment a constant challenge. “Unless we make care work a job people want to stay in, everything else will crumble,” he says.
We’re sustaining social care on the backs of families. That’s not fair and it’s not sustainable
Self-funders play a role here too, as their higher fees can indirectly support better pay. But Sinclair stresses this is no long-term solution. “We can’t build a sustainable care system on cross-subsidy,” he warns.
He sees technology as an important part of the answer, though never a replacement for people. “It’s not about robots replacing carers,” he explains, “it’s about tools that can reduce admin or spot risks early, so staff can spend more time on the human side of care.”
The ILC has explored examples such as acoustic monitoring in care homes and AI tools that can flag issues like dehydration or infection. These interventions, he notes, show real potential. But the problem is scale. “We’re very good at pilots in the UK,” Sinclair reflects, “but very bad at rolling them out. Until we fix that, technology will stay an untapped opportunity.”
A call for honesty and courage
What Sinclair wants most is a reset in how policymakers talk about social care. “We can’t go on pretending that the system will somehow fix itself,” he says. Without an open acknowledgement of the role self-funders play, and the inequities this creates, reform will remain out of reach.
He stresses that the issue is not only about finance but also about the fundamentals of people’s lives. For him, it comes down to “dignity, trust and peace of mind.” Families should be able to make plans for later life with confidence rather than anxiety, and care workers should be properly valued and paid.
Sinclair also warns against political point-scoring. “Unless we stop using care as a political football, nothing will ever change,” he argues. That tendency, he suggests, has repeatedly blocked serious reform.
Looking ahead, he is clear about the stakes. “We talk about people living longer as if it’s a problem,” he says. “It’s not. It’s a triumph. But if we don’t help people live those extra years well, then it becomes a crisis.”
Despite the challenges, he remains cautiously hopeful. The solutions, from intermediate care beds that relieve pressure on hospitals, to workforce reforms and smarter technology, already exist. “The knowledge is there. The ideas are there. The public support is there,” Sinclair concludes. “What we need now is the political leadership to join it all up.”
