Gathered for a roundtable hosted by Healthcare Management, three of the sector's most prominent voices – Professor Martin Green, chief executive of Care England; Nadra Ahmed, executive chair of the National Care Association and Mike Padgham, chair of the Independent Care Group – delivered a candid assessment of the proposal, warning that without funding, strategic alignment and urgency, it risks becoming another well-meaning soundbite lost in the political churn.

The promise and the pitfall

Labour's Fair Pay Agreement, positioned as a solution to chronic recruitment and retention problems, represents the party's most significant policy commitment to social care so far. But for the leaders at the table, it's a promise that currently lacks substance.

‘We do need a much more coherent approach to how we remunerate and support our workforce,' said Professor Green. ‘But this policy is completely unfunded. With only £500m on the table, when the funding gap is over £4bn, it won't touch the sides.'

Green warned that segmenting the funding only to publicly funded care risks deepening disparities between services that already operate on tight margins. ‘Providers with mixed client bases are being asked to find the extra money themselves. It's disingenuous,' he said.

Padgham agreed. ‘We've been calling for attention to pay for over three decades. This feels like too little, too late—and it's not even starting until 2028. We have a recruitment crisis now,' he commented.

Ahmed echoed the urgency. ‘As a manifesto commitment, it may go forward, but we're not expecting impact until the tail end of the next Parliament. That's destabilising. And if it's not funded, it's not fair—to workers or to providers.'

A sector left out again

Underlying the debate is a growing frustration with the systemic sidelining of social care in broader healthcare policy. The recent 10-Year Health Plan largely excluded social care and the Government's Casey Commission on reform will not produce its first findings until 2026.

‘All of us in this room have spent years trying to raise social care's profile,' Ahmed said. ‘We're not seen as partners at the table. We're just an independent sector that's done onto. But without us, none of the ambitions in that health plan are deliverable.'

Professor Green went further. ‘The NHS is spending about £100,000 a minute on training. None of that is available to social care, despite constant rhetoric around integration. The ICBs, meant to bridge this gap, have delivered next to nothing. Another soundbite without substance.'

A workforce in crisis

Recruitment and retention dominate the social care agenda. With 120,000 vacancies and tightening restrictions on overseas workers, providers are at breaking point.

‘Every day we get emails from members struggling to recruit,' Ahmed said. ‘Home care staff are being verbally abused because of the immigration narrative. We've conflated skilled migration with illegal immigration, and the sector's paying the price.'

Padgham, who runs five care homes in North Yorkshire, illustrated the point: ‘Over a quarter of my staff are from overseas. Without them, our nursing homes would have to close. We've tried every method to recruit locally and it doesn't work. The talent isn't there, or it won't stay.'

Green highlighted the long-standing nature of the issue. ‘Nadra raised the red flag 15 years ago when she was vice chair of Skills for Care. Nobody listened. Now, we're in a workforce emergency.'

And the impact of this crisis extends well beyond the care sector.

Collateral damage: The NHS

The knock-on effects for the NHS are clear. Padgham painted a stark picture: ‘In York and Scarborough, we've got 100 people medically fit for discharge stuck in hospital because we don't have the staff to take them. That's just one area.'

Ahmed confirmed this is a nationwide issue. ‘Some trusts have over 400 people waiting. And then we're blamed for bed blocking. But we're not going to take people out of hospital if we're not funded to support them properly.'

For Green, the problem lies in an outdated funding structure. ‘There's £230 billion going into the NHS and less than £28 billion into social care. Yet we're doing the heavy lifting with long-term conditions. The NHS won't spend outside its walls, even though it's the only way to relieve pressure on hospitals.'

A broken model – and a path forward?

Each of the panelists stressed the need for a complete reimagining of how social care is positioned and supported.

‘The issue isn't that social care is broken—it's that it's underfunded,' Ahmed said. ‘We're running what are essentially small hospitals, often more efficiently than the NHS. Yet we're treated like second-class providers.'

Green added: ‘We need a national strategy—like the NHS has—with career pathways, protected pay differentials, access to training budgets. And we need a funding model based on outcomes, not just organisational survival.'

Padgham proposed another practical step: ‘If we're going to raise minimum pay, we also need a minimum price for care, so local authorities aren't constantly driving costs down while expectations go up.'

All three agreed that real progress will require bold political leadership—and honesty with the public.

‘No politician wants to tell voters they'll need to pay more for care,' said Green. ‘But we're past the point where silence is sustainable. We need a national conversation.'

The final word: from crisis to crossroads

Despite their shared frustration, the leaders remain united in their desire to be part of the solution.

‘We're not adversaries—we want to help whichever Government is in power,' said Padgham. ‘But they have to start listening. They need our expertise at the policy table.'

Ahmed added: ‘This isn't about us protecting our businesses. It's about supporting the people who rely on us—and ensuring the staff who care for them are treated with the dignity they deserve.'

For Green, the challenge is clear: ‘If we stop focusing on systems and start focusing on people, we might finally build a care system that works.'