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Barry Cooper
Barry Cooper was a bureaucrat, a transport planner, an academic, self-employed and retired in 2002. He lives in the long lost Kingdom of Ergyng and thinks a lot about all sorts of things, from the bottom up.He is the author of How to find our way into the future.
The modern care home system in the UK is a highly centralised, industrial solution to a profoundly human need: the care of older people and those with physical or learning disabilities.
While it provides security, staffing, and specialised facilities, it comes at a staggering financial cost to both individuals and the state. In contrast, localism offers a more humane, flexible, and financially sustainable alternative.
In 2024, the NHS and local authorities spent approximately £11 billion supporting around 200,000 people in residential care and nursing homes. This sum is not only immense; it is also inefficiently deployed.
A large proportion of it goes not to hands-on nursing and care but to cover the cost of property, profits, administration, and debt repayments incurred by commercial and other care home providers.
A breakdown of average care home costs reveals the issue starkly. Only about 50–60% of fees go towards actual staff wages and day-to-day care. The rest includes building maintenance, loan repayments, insurance, utilities, profit margins, and administrative costs.
In many private care homes, particularly those owned by private equity, debt repayment alone can account for 10–20% of total care fees. This is public money, not used to improve lives but to finance commercial borrowing.
Now consider an alternative grounded in localism. If those currently in care homes could instead be cared for in their own homes or by relatives, supported by modest state allowances, training, respite provision, and community networks,
Estimates suggest that shifting all care home residents to family based care, with appropriate state support, would cost between £0.5 billion and £3 billion per year. That represents a potential annual saving of £7–10 billion, or 70–90% of current government expenditure on institutional care.
These figures assume varying degrees of state assistance to family carers, including direct payments, carer's allowance, or access to local informal respite networks.
As the national economy shrinks, less state funding for care will be available, and local economies will develop, with surpluses for care and other community services.
Not every individual can be cared for at home. Some families will be unable or unwilling to take on the burden.
Localism will not require all-or-nothing solutions. Instead, it favours flexibility, community involvement, and a local mix of care options: small group homes, intergenerational living arrangements, local voluntary networks, and accessible respite centres. These can operate at a fraction of the cost of institutional care and without the drag of servicing commercial debt.
In a shrinking economy, where public funds are under strain, shifting from centralised to localist care models is not just desirable - it is necessary.
The care sector, in its current structure, is unaffordable and unsustainable.
By contrast, localism will support a reweaving of human interdependence, where families, neighbours, and communities are empowered and trusted to care.
Read more on Chatting about Localism.