Delivering Adult Social Care in Challenging Times

Delivering Adult Social Care in Challenging Times examines the growing pressures facing adult social care in county areas of England. The report argues that the current system is unsustainable due to a “perfect storm” of rising demand, declining government funding and increasing public expectations. Counties are particularly affected as they have the largest and fastest‑growing older populations, more rural geographies and more complex health economies.

Since 2010, councils have experienced around a 40% reduction in core government funding, while adult social care now accounts for over 40% of county council service spending. Demand continues to rise as people live longer and require more complex care, even though fewer people overall receive services. Funding measures such as the social care precept and Better Care Fund have largely been absorbed by cost pressures, especially the National Living Wage, leaving significant shortfalls.

The report highlights severe strain on local care markets, with providers facing recruitment challenges, financial instability and, in some cases, exiting the market altogether. These pressures contribute to increased delayed hospital discharges, particularly in county areas. Despite this, service users in counties report high satisfaction and quality of life from the care they receive.

The report calls for urgent government action, including fairer funding settlements, earlier access to additional resources, and reforms to support sustainable, integrated health and social care. Without this, it warns that adult social care in county areas risks reaching crisis point.

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