Government's aim to shift health and care from hospital to community thrown into doubt by new social care report

1​5 July 2025

D​ownload ADASS Spring Survey 2025

Warm words for adult social care must be matched by action to meet Government’s health shifts and support more people to stay at home, say care leaders

Councils are being forced to cut back on early care and support to prevent people’s health and wellbeing deteriorating, as they struggle to meet the rising cost of more complex and expensive social care, according to a new survey from the Association of Directors of Adult Social Services.

The annual survey of social care leaders in local authorities across the country shows that despite a government focus on neighbourhood health and prevention, overstretched budgets mean care leaders have reduced spending on the latter by more than 10 per cent this year (1) as they are forced to prioritise immediate needs and people in crisis. This could throw the Government’s ambition into jeopardy.

The ADASS annual survey estimates that collectively Directors were left with little choice but to overspend on their budgets by £774mn (2) last year to meet their legal duty to provide care and support, the highest the overspends have been in a decade. This is likely to result in councils further tightening the eligibility criteria for social care, so they can deliver their legal obligations leaving very little left for preventative measures that would likely save the state money in the longer-term and most importantly, improve outcomes for people.

Spending pressures include an increase in the size of people’s care packages (3), indicating the growing cost of providing complex care as people live longer but often with multiple illnesses, conditions and disabilities. For example, this could mean people are requiring multiple visits per day, sometimes with more than one carer or adaptations to their home.

Three quarters of Directors continue to see increasing numbers of people with some of the most complex care needs approaching their councils for support (4), who would have previously had their care funded free of charge through an NHS budget called Continuing Healthcare (CHC). Data shows a postcode lottery for CHC funding, with people less likely to be successful in obtaining CHC support according to where they live in the country (5).

The trend of care workers increasingly being asked to carry out health tasks that would normally have been covered by NHS staff continues despite this often being unfunded, and a staggering 100% of those Directors surveyed believe increased pressure on the NHS will in turn increase pressures for adult social care into next year (6).

Jess McGregor, ADASS President and Director of Adult Social Care in Camden, said:“The maths simply doesn’t add up – more people are coming to councils for help and their care is complex and costly, which means we don’t have funds left to provide the early support and prevention that would stop people’s health from deteriorating and help them avoid spiralling into crisis, where they frequently end up in hospital.”

The increase in costs has not been accounted for by the Government in the latest Spending Review. It saw social care receiving up to £4bn additional funding by 2028/29 (compared to 2025/26). But uncertainty remains around what this amount covers, including the potential for it to need to be used to pay for measures like a much needed but costly Fair Pay Agreement for care workers. It comes after costly increases in employers’ national insurance contributions and the national living wage, plus inflation, which have pushed the cost of care up. It also assumes that every council will increase council tax by 5% to fund that additional spending.

Ms McGregor added: “We shouldn’t have to choose between helping people with complex needs now and preventing others from getting unwell – we need to support people at both ends of the social care spectrum. But without more investment to keep people well and independent at home, we risk undermining the shift towards prevention and neighbourhood health that Wes Streeting, the NHS and this Government are rightly championing."

Ms McGregor believes the survey results, the only of its kind in England, prove the shift from hospital to community will be hard to obtain unless adult social care is prioritised: “It’s vital that adult social care leaders who are well versed in delivering support at the community level are meaningfully involved in decisions about where and how resources for neighbourhood health and care are spent. After all, acute hospitals are not best placed to deliver social care at the neighbourhood level – but councils are.”

Example of prevention in social care - Somerset Adult Social Care - Independent Living Centres

Somerset Adult Social Care have Independent Living Centres to help people in Somerset who need advice about and support with living independently.

They offer a chance to talk to a Social Care Occupational Therapy-led team and try equipment and technology to make daily life easier.

The support can include equipment for the bathroom, kitchen and general moving around the home as well as specific technology to help people with their caring role.

See some of the support the centre offers Are you or someone you know struggling at home with daily living tasks? - YouTube

1. ADASS Spring Survey, Slide 20
2. ADASS Spring Survey, Slide 5
3. ADASS Spring Survey, Slide 15
4. ADASS Spring Survey, Slide 17
5. Continuing Healthcare, including regional comparisons https://e-sd.org/TJUQD/
6. ADASS Spring Survey, Slide 22
7. Adult social care is a vital statutory service, a key responsibility for local authorities, and the largest area of local authority expenditure. It is key to the government’s missions to build an NHS fit for the future, to shift care from hospitals to communities, and from treatment to prevention.' p29 The Fair Funding Review 2.0