Warning issued over ‘precarious’ state of long-term adult social care in England

England’s adult social care system is struggling with a record number of individuals receiving long-term support, pushing council budgets to breaking point and creating a “precarious” financial situation, a new report has warned.

According to the King’s Fund, while this increase in provision has improved the quality of life for thousands of people, it has “come at a huge cost to local authority budgets and is ultimately unsustainable”.

The independent health charity’s annual review found 890,000 people had accessed long-term care by March 2025.

This represents an increase of 53,000 from 2022/23 and the highest figure since comparable records began in 2015/16.

The report said home care provider fees rose by 5 per cent in real terms and 6 per cent more people received publicly funded long-term care from 2022/23 to 2024/25, beginning a trend of increased spending power allowing local authorities to raise fees and provide more long-term care.

But the charity added that while more people were receiving care, councils still did not have the resources to meet all demands and their overall financial situation was “deteriorating”.

The report stated that for the latest year 2024/25, the average weekly wage paid by local authorities in England for care home places for working-age adults increased by 3.6% in real terms to £1,823, while the average weekly wage for aged care home places increased by 3.3% to £1,019.

Councils’ total spending on adult social care in 2024/25 rises to £34.5bn; This was an increase of 7.9% in cash terms and 4.1% in real terms compared to 2023/24.

The report said: “As a result, local authorities are increasing fees below the cost increases faced by social care providers.

“This has potential impacts on market stability, quality, and especially on private pay clients who are charged much more for their care so providers can balance their books.”

In March, the chair of a major review into adult social care in England called for a “moment of reckoning” in a sector “riddled with anxiety” for vulnerable people and their families.

Baroness Louise Casey currently leads an independent commission into adult social care; This commission was announced nearly a year ago, at the beginning of January 2025, and officially started a few months later in April.

A report on the first phase is expected to be published later this year, but the second phase, which includes long-term recommendations for the sector, is not expected to be reported until 2028.

He insisted there needed to be “an honest conversation directly with the public” about what they want the NHS and the national care service promised by Labor to look like, including who should pay for care and where the line should be drawn.

He said: “I think we need a mandate from people who pay for health and social care through tax and national insurance but don’t even know what that is.

“It needs to be more than whether or not people should sell their homes. There are really tough questions like who can benefit from the system? Where do we draw the line?”

“What should we expect from families? What is the responsibility of the state? What contribution should be made, when and how?

“We now need to work with the people to create a system suitable for the nation we are today.”

The King’s Fund report, published on Wednesday, said its commission faces “significant pressure” to put forward “consistent recommendations” for sector reform.

It concluded: “The picture for social care remains precarious, with significant pressure on the government to stabilize the sector in the medium term and on the Casey Commission to set out coherent recommendations for reform in the longer term.”

Simon Bottery, author of the report and senior fellow for social care at The King’s Fund, said: “Local authorities have gone to great lengths to meet their legal obligations over the past year.

“They have spent more on social care, an investment not just in increasing provider fees but also in increasing the number of people receiving care.

“This will improve the quality of life for thousands of people currently receiving care and should be welcomed given the difficult financial circumstances.

“But this has come at a huge cost to local government budgets and is ultimately not sustainable.

“We are long overdue for a national debate about how to properly reform social care to organize and fund the support people need in a way that does not compromise other local authority services and their overall financial health.”