The Kings Fund - Social care in a nutshell

Eligibility for publicly funded social care

Social care is not free at the point of use. Anyone who requests publicly funded social care must undergo a needs assessment and a means test, and only those with the highest needs and the lowest financial assets are likely to receive support. Anyone with assets of more than £23,250 must pay for all social care themselves. Below this threshold, contributions are made by the person needing care and the government on a sliding scale. If the individuals requesting care have long-term complex health needs, the NHS may also contribute to funding.

In 2022/23, there were more than two million requests for adult social care support. Demand for care is growing, driven by changes in demographics. Demand from working-age adults, in particular, has increased by 22% since 2015/16 ‒ partly due to the increase in the number of adults with disabilities as more people with severe disabilities survive childhood. There are also more older people as a result of the post-war ‘baby boom', and until recently, life expectancy had been increasing.

Expenditure

In 2022/23, total expenditure by local government on adult social care was £28billion. The majority of this money was spent in two areas: learning disability support for working-age adults, and physical support for older adults. Most of this expenditure goes on long-term care, which is ongoing service or support with the aim of maintaining quality of life. The remaining expenditure is spent on short-term care, which aims to maximise independence and reduce the need for ongoing support.

Unmet need

There is significant unmet need for social care. Nuffield Trust estimated that fewer than half of older people with care needs were receiving support (including support from unpaid carers). Long-running cuts to local authority budgets have meant that funding has failed to keep pace with demographic pressures. Currently, nearly one-third of requests for local government funding result in no support. Unmet need puts pressure on the five million self-identified unpaid carers in England and Wales (a figure that may be a huge underestimate - research from Carers UK found that there could be as many as 10.6 million unpaid carers in the UK) to provide support for their families and friends, and demand is unlikely to be met without significant funding increases.

Costs of care

For individuals not eligible for full public funding, the total costs across the person's lifetime will vary depending on their level of need. The government estimates that one in seven adults aged 65 face lifetime care costs of more than £100,000. Even within the publicly funded sector, service user contributions to social care have been increasing. This is due to restrictions on public funding and the increasing costs of care. In 2022/23, those eligible for publicly funded care contributed £3.5 billion towards their own care (note, this figure does not include people who have to fund their social care privately).

The current position

Government action to address the pressures on social care has largely been rolled back. A White Paper published in December 2021 announced reforms to address the ‘catastrophic' care costs that some individuals face in their lifetime. But in the November 2022 Autumn Statement, the government announced that some of these reforms would be postponed until October 2025.

Although there was no additional money for local government in the 2023 Autumn Statement, in January 2024 the government announced an additional £600 million for local authorities in 2024/25 , of which £500 million was for children's and adults' social care. Nonetheless, in February 2024, the cross-party House of Commons Levelling Up, Housing and Communities Committee noted that ‘local authorities are increasingly reporting concerns about their financial positions and their ability to maintain delivery of their services' and said that ‘the Government must act now if local authorities are to survive the severe crisis and financial distress that they face'.