Social care in England

We look at the structure of social care in England, who it's for, how it's funded, issues, pressures on the workforce and the BMA's view.
Location: England
Audience: All doctors
Updated: Friday 3 April 2020
NHS Structure Article Illustration

The Care Act 2014 provides rights for people who need social care.

It ensures local authorities arrange services that help prevent people developing needs for care and support, or delays people deteriorating such that they would need ongoing care and support.


Who receives social care?

  • During 2015/16 there were over 1.8 million new requests for support.
  • 28% of these were from people aged 18-64, with the remaining 72% from people aged 65 and over.

Short-term care

  • Social care can be provided on a short-term basis with the intention to maximise the independence of clients.
  • During 2015/16 there were 209,000 instances of this type of care for new clients.
  • Over half of these were following a discharge from hospital.
  • During the same year there were 36,000 instances of this type of care for existing recipients of care, with 41% of these then moving on to long term care.

Long-term care

  • Long-term care is allocated on the basis of eligibility criteria, and subject to regular review.
  • 873,000 people received long-term support during 2015/16.
  • 652,000 were still accessing long-term support at year-end.
  • 482,000 had been accessing long-term support for more than 12 months.
  • The most common reason for needing long-term social care for clients aged 18-64 was learning disability support and for people aged 65 and over it was physical support. 


How social care is structured

Funding for local authorities is provided by the The Ministry of Housing, Communities and Local Government. Publicly funded social care is commissioned by local authorities and funded through their budgets.

The Care Act 2014 set out a framework of local authority duties for the funding and arrangement of social care.

Health and wellbeing boards are part of local authorities. They aim to bring together councillors, CCGs (clinical commissioning groups) and local communities to ensure patients and the public experience more joined up health and care services.


Paying for social care

  • Social care is not free for everyone.
  • Local authorities assess a person's income levels, including tax credits, some benefits, savings and property.
  • Local authorities won't contribute to the cost of care if a person has more than £23,250 in savings and property.


Pressures on social care

Social care, like healthcare, is facing unprecedented pressures. These pressures are coming from increasing demand, funding and workforce constraints.

Increasing demand

  • Between 2001 and 2011 the number of adults aged over 65 increased by 11%.

  • The number of adults aged over 85 increased by 24%.

  • There are now over 11.6 million people over the age of 65, and more than 1.53 million people over the age of 85 living in the UK.

  • By 2040, nearly one in four people in the UK will be aged 65 or over.

  • Annual costs of health and social care are significantly greater for older people and the number of elective and non-elective hospital admissions has also increased.

  • It is predicted that the number of older people with care needs will rise by more than 60% over the next 20 years.

Funding constraints

  • Public spending by local authorities on adult social care fell for six consecutive years, with funding falling in real terms by an average of 2.2% a year between 2009/10 and 2014/15.
  • Over 400,000 fewer older people were able to access publicly funded social care in 2014/15 compared to 2009/10 – a drop of 26%.
  • Nine in 10 NHS trust finance directors have said that cuts to local authority social care budgets are adversely affecting NHS services. 

Cost pressures

  • Approximately 75% of care employees are paid at or close to the national living wage.
  • This rose to £7.50 an hour in April 2017, causing an increase in costs for social care providers.
  • The Local Government Association estimates the living wage will add £970 million to the yearly cost of publicly funded social care in England.

Social care workforce

  • There are huge challenges with recruiting and retaining social care professionals.
  • There is an estimated vacancy rate of 5.4%, which rises to 7.7% in domiciliary care services.
  • High turnover is also an issue, with an overall turnover rate of 25.4%; around 300,000 workers leave the profession each year.
  • One in five of the adult social care workforce in England were born outside of the UK.
  • In 2015, 6% of those working in adult social care were from other EU countries, equating to nearly 80,000 jobs.
  • As a result of the UK leaving the EU there are now uncertainties in the future of EU care workers’ status in the UK, which could lead to further reduction in the social care workforce. 


The BMA's view

Social care is an increasing area of concern for the BMA. The BMA believes that the current crisis in social care is a direct result of inadequate funding. We have called for government to provide appropriate funding and resourcing.

The BMA supports a holistic approach to care, where there is collaboration between health and social care systems to deliver a joined up service for the patient.  

The funding of long term social care needs to be done without jeopardising the principles of the NHS. For example, moves towards pooled budgets such as the Better Care Fund, should not divert healthcare funding to plug holes in social care budgets. 

The BMA has called for a national framework for how NHS, public health and social care will be funded, commissioned and organised in the future to meet the needs of the population.