Explainer: Adult social care in local government

Introduction

Adult social care is provided to adults who need help and support to live as independently as possible. Although separate from health care, the boundary is often blurred, since social care can include health-related needs and support. Demand for adult social care has grown significantly in recent years, placing increased pressure on local government budgets.

At a glance:

What this explainer covers	Adult social care in the UK and Ireland. How the models work and where responsibilities for service delivery lie. The pressures and challenges they face.
Who is it for	This resource offers an overview of adult social services, making it useful for anyone who is new to the topic, whether a newly elected councillor or newly appointed officer, or someone moving into social services from elsewhere in local government. It will also be useful for anyone seeking a broader overview of the range of local government services.
Why it matters	Well-delivered adult social care can improve the wellbeing of both individuals and communities. However, the cost of adult social care is increasing, creating a heavy financial burden which must be balanced with other services.

Why adult social care matters for local government

Adult social care is one of the core functions of upper-tier and unitary local authorities in England, Scotland and Wales. The statutory duty to provide care services specifies minimum standards, but for many local authorities, strategically delivered services can support the wider council ambition and vision, for example, by improving wellbeing, supporting communities, and developing voluntary and community groups.

In both the UK and Ireland, financial sustainability of care services is a challenge. While Northern Ireland and Ireland have centralised systems without local government delivery, in England, Scotland, and Wales, this financial burden has fallen on local authorities. Although financial reform has been on the agenda of national governments for many years, little has changed. In the UK, there is consensus that adult social care is one of the, if not the, major pressure on local government finance.

This has often meant that social care impacts the full range of council service delivery. Many councils have cut discretionary services to support their statutory duties in social care. Others have attempted to make a virtue of necessity and developed programmes that mean their social care spending benefits more than just the individual entitled to care. However, inevitably, the pressures have been a key factor in council tax increases, and there is evidence that social care is behind increased external debt and decreased reserves in the sector.

What is adult social care?

In broad terms, adult social care is the support, excluding healthcare, needed for an adult to live a full life. Those needs can be a result of physical or mental health needs, learning disabilities, and autism, frailty or dementia, as well as the needs of carers supporting others. This can cover a wide range of activities, such as practical help and support, like adaptations or part-time carers to enable someone to live independently, or supported living or residential and nursing homes. Changes in preferences, often driven by personal budget decisions, has increased the diversity of social care schemes, to include things like activity-based sessions and community groups.

How is adult social care need assessed?

How is adult social care delivered?

Across the UK and Ireland, the public sector has increasingly taken on a commissioning role, meaning that much adult social care is delivered by the private sector. The amount delivered in the public sector or by the voluntary sector differs between the nations and local authorities. In Northern Ireland and Ireland, with centralised systems and larger economies of scale, there tends to be more public sector delivery. While in Scotland and Wales, national policy has supported the growth of the voluntary sector as a provider.

There is also a significant level of social care bought directly by users, either through personal budget systems, which gives them freedom to spend as they wish to meet their needs, or through self-funding. Although this tends to be spent in the private sector, it will often be directed to smaller providers.

Finally, unpaid carers provide a significant amount of care. Research by the Health Foundation in the UK found that one-in-six adults had provided some unpaid care, and that more than one-in-five of those provided more than 35 hours a week of unpaid care.

How is adult social care funded?

Funding is a critical issue for social care. The UK, in particular, has seen a decrease in healthy life expectancy while life expectancy has generally remained unchanged, increasing the duration for which care is needed. Throughout adult life, improvements in healthcare have increased the number of people who survive illness and accidents, but sometimes with additional needs. 

Across the UK and Ireland, there is a general presumption that, unlike healthcare, the service user will fund or contribute to their care unless they cannot afford it. Scotland differs the most, offering free personal care, although some costs, such as accommodation, are not included in this.

Typically, a means test assesses the level of assets a person has. There will be the expectation that these assets will be used to fund care until they fall below the minimum level.

For those whose care is paid for by the state, the funding comes through general taxation and, in England, Wales and Scotland, an element of council tax. Since 2016, councils have been able to levy a social care precept in addition to council tax, to cover the cost of social care.

What are the financial issues?

Social care is expensive, and the costs are rising. The nature of the need means that even if the assessed need is low, it’s long-lasting and can have a considerable lifetime cost. Typically, the revenue cost only goes up, as most people’s needs increase as they age. The requirement to self-fund offers the public sector only limited protection from the costs, since the ability to self-fund typically ends when the expenditure is approaching its highest.

There are concerns about cost-shunting. The issue of delayed discharges, where people are unable to leave hospital because of a lack of social care, is often highlighted. However, in practice, because health and social care are closely related, those costs can go both ways. A particular area is in prevention, where the costs are largely borne by social care and local authorities more broadly, while the benefits accrue to the health sector.

A further issue, which is difficult to quantify, are the opportunity costs associated with social care. This can include the inability of informal and unpaid carers to contribute to the community and economy, or the lost opportunities for those not receiving adequate care to partake in normal life.

How do adult social care services interface with children’s services?

Although there are differences between each nation, rather than a hard boundary at 18, the line between children’s and adult care services tends to be blurred. If a young person is likely to need adult care services, planning for the transition usually should start well before they reach adulthood, often in their mid-teens. The aim of providing a smooth transition can mean a transfer either before or after an 18th birthday, if appropriate.

There is also a shift of emphasis, with children’s services tending to be more heavily focused on areas like safeguarding, family support, and the child’s development, while adult services focus more on individual support, promoting independence, and meeting assessed needs. 

What are the issues for users?

There is a significant body of evidence that most people do not think about their possible social care needs or understand how the system works until they are approaching the system.

For those in the system, the public finance issues can create particular issues. For working-age recipients, the limits on assets act to disincentivise long-term planning, with saving or homeownership ‘punished’ by the removal of support. Another issue for people initially self-funding is that the council’s need to consider long-term costs, should they become unable to self-fund, can create tension if they have to choose more expensive options.

What are the issues for carers?

While carers are often celebrated, there is often little support in place for them despite the various duties in place to consider their needs. Caring is a full-time job for many, but without the perks of a salary, pension, or holidays. There is also evidence that carers are more likely than the general population to have their own unmet health and care needs.

However, the role of carers is critical, and most people in social care would agree that, without them, the system would quickly collapse. England, Scotland, and Wales all have requirements to consider the needs of carers, provide support, and promote their well-being.

What are the issues for providers?

The social care market is fragile. Many providers struggle to balance a service that is highly regulated and expensive to deliver with a market that has limited resources and in which there are, effectively, local monopsonies. Cost of care exercises undertaken as part of the previous UK Conservative government’s reforms found that there was wide variance in the fees paid to providers and, often, the fees were below the cost of many residential settings. This meant self-funders were subsidising publicly funded residents (and therefore making it more likely they would become publicly funded themselves).

There are also significant workforce issues. Although there have been attempts to increase the profile and perception of care work, it remains a lowly paid and regarded profession, especially when compared to healthcare. A significant proportion of social care staff work at or close to minimum wage levels, even after several years of experience. Additionally, a large proportion of the workforce is from overseas, creating a risk when immigration policies change.

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What reforms are proposed?

Scotland, England and Wales have all proposed the creation of a National Care Service, although relatively little progress has been made. In England, the Casey Commission is tasked with developing plans for the creation of a National Care Service, within current financial limits, for implementation over a ten-year period. The commission’s first report, which should include these plans, is due in 2026.

In Wales, the intent, since 2022, has been to introduce a National Care Service over a ten-year period. Progress towards this has been criticised as being slow, although elements, like the National Office for Care and Support, have been put in place as part of the implementation scheme.

A Scottish National Care Service became government policy following the 2021 Scottish Parliament elections. The plans, which included a transfer of social care services to a central service, met with some criticism. Council leaders left negotiations on the plans in 2024, and at the beginning of 2025, the plan was abandoned in favour of a national advisory board on social care.

What impact will England’s NHS reforms have?

Although The 10 Year Plan for Healthcare makes much of the shift to local provision, prevention, and integration in neighbourhood health centres, for many areas this will only be an evolution of existing local partnerships between health and social care. In practice, changes elsewhere in the NHS system are likely to have a larger impact.

The sudden abolition of NHS England and requirement to halve the number of Integrated Care Boards is likely to transform the way health and care interact. Aside from the short-term disruption caused by a rushed reform, the larger ICBs will have to be more strategic, with more operational management – and a bigger share of the Better Care Fund – moving to local authority level. This will provide an opportunity at place level and potentially give local authorities more influence on the associated Integrated Care System partnerships because of the importance of social care delivery. The caveat is that the recommendations of the Casey Commission and subsequent moves towards a National Care Service may upend everything again.

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Roles and responsibilities

In England, Scotland, and Wales, local government is the main commissioner of social care. This gives it a set of roles that its counterparts on the island of Ireland do not have.

How it works across the UK & Ireland

Funding & resources at a glance

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Current challenges and pressures

Financial sustainability

The fundamental challenge for adult social care is, ironically, the consequence of success in healthcare and prevention. Increased lifespans can mean more people with frailty who need support at home or in residential care. Across the lifespan, better healthcare increases the survivability of many conditions and accidents, but at the cost of lifelong social care needs afterwards.

The long-term outlook, under current systems, is bleak. Funded by general and local taxation, along with user contributions, demographic change is creating pressure. There are competing pressures from governments and providers on pricing, but the simple fact that there is more need and fewer resources means margins in the sector are tight, resulting in fragility that occasionally creates severe pressure when providers fail.

Many people do not know how the social care system works, with around a third believing it’s free and largely delivered by the NHS. For many, this can create a financial shock they cannot easily absorb when they enter the care system. And pressures elsewhere, such as the cost-of-living crisis and rising house prices may, in turn, reduce the asset base of future generations and their ability to self-fund.

Workforce difficulties

The social care sector tends to have a high vacancy rate and a high turnover of staff. Salaries tend to be low, despite often being a skilled role with high emotional and physical demands. In England, Scotland, and Wales, there has been a reliance on migrant labour, initially from Eastern Europe, then, post-Brexit, elsewhere in the world, making them sensitive to immigration changes.

There has been a trend of professionalisation in the sector. Scotland and Wales have introduced registration requirements, and sector organisations like Skills for Care are filling a gap and creating workforce plans and career progression. However, the low pay when compared to the NHS means that there is little incentive to upskill and remain in the care sector.

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What does this mean for councillors and officers?

The following advice is relevant to councillors in the UK, and the role of councillors in Ireland and Northern Ireland is significantly different. In Ireland, although there is no statutory role in social care delivery, councillors can still be involved in decisions relevant to social care, such as housing and the wider health ecosystem, through advocacy and representation of citizens’ views. 

What should councillors and officers be aware of?

The financial challenges of adult social care in relevant councils are impossible to escape. Even services with no direct involvement in social care can be affected, whether it’s making cuts to discretionary services or considering how their own service can contribute to the adult social care duty. This is likely to be the defining context for both councillors and officers. Key issues that both will want to consider, from their respective angles, are:

• Meeting statutory duties, and the quality of service provided.
• The financial sustainability of services.
• The local social care landscape, both demand and supply.
• Ensuring prevention work provides value for the system and benefits to service users.
• The effectiveness of partnership working.

In England, councillors and officers should also be prepared for the first report of the Casey Commission, which will have implications for social care.

The role of councillors

Councillors are highly likely to have to make decisions about budgets and savings. In many cases, officers may need a clear steer because all options have drawbacks and risks.

Service pressures may require councillors to scrutinise or make decisions on things like service redesigns or changes to commissioning, and partnerships with the public, private and voluntary sectors. In the event of market failures, such as the collapse of a care provider, councillors may need to authorise the response.

An important task of councillors is understanding how the decisions they make affect residents in practice. Social care users are often among the most vulnerable in any community. While data-rich reports and scrutinising officers can provide a lot of quantitative information, it’s important to triangulate this with qualitative information. These may include listening events and forums, service visits, discussions with service users or Healthwatch members, complaints analysis, or through resident casework. Councillors should also be aware that there may be many who need social care, but who are not yet accessing services for various reasons.

Executive members will be more involved in care services. Those in that position will need to ensure they understand their service’s budget, including the likely cost and demand pressures in the future. They should also ensure they have a good understanding of the wider risks, which will include the stability of the provider market, issues within the local workforce and any performance issues.

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Key questions to ask

• What are the biggest drivers of demand locally? What is driving cost increases?
• What are the workforce issues the council is facing? What are the vacancy and turnover rates? Are there any skills gaps?
• How well is the system working at its interfaces? With health services? With children’s services?
• How do we ensure we are reaching all those who need social care? How accessible are our services? What do we do to help those who have difficulty accessing services?
• How sustainable are our services? What are the pressure points in one year? In five years?
• How reliable is the data? What are they telling us? Are there areas where we don’t have good data?
• How and where can additional capacity in the system be created? Do we fully engage the private and voluntary sector?

Common pitfalls

Some problems often encountered in social care include:

• Focusing on the now. Although there is the temptation to focus on meeting immediate statutory duties, investing in prevention, even when not required by the national frameworks, can help reduce long-term costs.
• Only measuring outputs. Good social care should also consider the outcomes for users and their families and carers.
• Poor data quality. Good data is critical to understanding the social care landscape, and will inform the development and delivery of services, planning, and understanding and shaping of the local social care market.
• Neglecting partner relationships. Partnerships are not just structural and depend on good working relationships at every level, especially where the boundaries, for example, between children’s and adult care, or between health and care, can be blurred.
• Not getting user and carer feedback. Ultimately, social care comes down to the support given to individuals. Being able to understand what that care means to individuals can be critical, especially for councillors and more senior officers who are not at the care frontline.

Where does local leadership make a difference?

Good social care is typically more than a transactional service. By empowering people to lead more productive lives for longer, social care can play a key role in place-shaping strategies. Councils can use their commissioning role to support local business development, create employment, and develop skills and training. Voluntary sector and community strategies can be used to increase capacity in the sector, offering opportunities and building community.

Good leadership will mean difficult decisions. Almost all councils have been forced to reduce, or even entirely remove, discretionary services to meet their budgets. While these may be painful decisions, without them, they may not have been able to meet statutory duties.

Conversely, some areas have managed to increase capacity by empowering staff, utilising the community and voluntary sector, and offering practical support to carers. Good leadership can provide the psychological safety needed for social care teams to innovate and improve their services.

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Further reading and LGIU support

General

• The LGIU
• Skills for Care
• The King’s Fund
• The Health Foundation
• The Social Care Institute for Excellence

United Kingdom

England

• Department of Health and Social Care
• UK Government social care blog
• The Casey Commission

Scotland

• The Scottish Government
• Scottish Social Services Council

Wales

• The Welsh Government
• Social Care Wales

Northern Ireland

• Department of Health
• Northern Ireland Social Care Council

Ireland

• Health Service Executive
• CORU