Health and Social Care in Counties: Funding, Demand and Cost Pressures

This report examines funding, demand, and cost pressures facing health and social care services in English county areas. It finds that counties experience a “perfect storm” of rising demand, rapid population ageing, and comparatively lower funding than other authority types.

Our report finds that funding for adult social care in county councils has fallen significantly, with reductions of around 23% between 2013 and 2016—higher than elsewhere. Counties also receive substantially less funding per older resident than the national average, alongside lower allocations for public health, NHS services, and the Better Care Fund. Overall, county areas receive markedly less combined health and social care funding despite serving large populations.

At the same time, demand is increasing faster in counties than elsewhere. Growing numbers of older people, higher rates of long-term illness, and increased referrals to social care are driving costs upward. This has contributed to rising delays in hospital discharges, indicating insufficient social care capacity and added pressure on the NHS.

The report argues that current funding formulas fail to reflect these pressures and risk embedding historical inequalities. It calls for urgent reform, including a fairer funding distribution based on need, increased and frontloaded investment, and stronger integration between health and social care. Without these changes, services risk becoming financially unsustainable.

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