How does adult social care in England work? The system explained as Andy Burnham promises to deliver ‘urgent’ reforms

How does adult social care in England work? The system explained as Andy Burnham promises to deliver ‘urgent’ reforms Andy Burnham will host a summit with Tory leader Kemi Badenoch and Lib Dem leader Sir Ed Davey to discuss social care reforms - Bookmark - CommentsGo to comments Prime Minister Andy Burnham has made much of his pledge to reform the adult social care system in England, having vowed to “grasp the nettle”. The new Labour prime minister is set to hold a summit in Downing Street on Wednesday with Tory leader Kemi Badenoch and Lib Dem leader Sir Ed Davey to begin the process of thrashing out a way to deliver social care before it collapses the NHS. Ahead of a speech he is set to deliver at a care home in north London on Wednesday morning, Mr Burnham said: “Last week I said we needed a different kind of politics: problem-solving, not point-scoring. Nowhere is that more urgent than social care. “For decades, governments have kicked this issue down the road because they’ve seen it as too risky, too difficult, and too complicated. “Politicians might have different views but I’m serious about fixing this issue and to do that, we have to find common ground and listen to others to find a way forward. “It’s time to draw a line under people playing politics when the human cost of that means carers struggling, families paying the price and our NHS buckling under the strain.” We take a look at the state of play in the sector currently. How does adult social care work in England? Unlike NHS care, social care is not free at the point of use and high costs sometimes mean people are forced to sell their homes to pay for what they need. People with savings worth more than £23,250 are not entitled to help with the cost of care from their local council. Recent analysis by the Nuffield Trust think tank found England is one of few systems where access to any public funding for care is restricted by how much money people have. The Health Foundation said total net expenditure on adult social care in England was £28.7 billion in 2024/25. The NHS budget was around £200 billion. However, polling has shown a lack of awareness about how the system works, with Ipsos UK research for the Health Foundation in May 2025 suggesting that around a third of people believe the NHS provides the majority of social care services for older people, and a similar proportion think social care services are generally free at the point of need. How does it work elsewhere? England has one of the least generous adult social care systems in the UK and beyond, according to Camille Oung from the Nuffield Trust. The organisation’s analysis of 11 other countries or regions, including the three other UK nations, found England “stands out from the pack, in that people must also pass a financial test to be considered for any state-funded support at all”. “Most of the other systems have some level of universal entitlement,” Ms Oung told the Press Association. “It might not be that everybody gets the same thing. There are some systems where those who are better off get less. But it’s actually one of the few where there’s a hard cut-off based on how much money people have. “I’d even say that if you compare it to other UK countries, it’s probably the least generous. Northern Ireland has free domiciliary care. Wales has higher means tests. Scotland has free personal care.” While England’s approach of concentrating resources on those with the highest needs and the lowest means “can be justifiable”, she said the risk many face is they “end up with nothing” due to the £23,250 threshold to qualify for state support. “You either don’t get the right level of care, depend on unpaid carers, or end up on your own,” she added. The Nuffield Trust analysis found Denmark to have the most generous system, with anyone over 65 assessed as needing care able to access it for free – aside from the cost of accommodation in residential care – regardless of their financial circumstances. How many people use the social care system in England? There were 889,000 people receiving publicly funded long-term care in the year to March 2025, according to analysis published earlier this year by the King’s Fund health charity. This was made up of 576,000 over-65s and 313,000 people aged 18–64. The King’s Fund said local authorities spent similar proportions of money on long-term support for working-age adults (£11.5 billion) and older people (£12.0 billion) in 2024/25. The most recent estimates published by the Office for National Statistics (ONS) suggested there were 279,916 people using community care services in England in the year to the end of February 2023 who were state-funded, while 23.0 per cent (83,844) were self-funders. ONS data for care homes estimates just over a third (37.0 per cent or 137,480) of care home residents in England were self-funders. What about those waiting for care? As of the end of March this year, 408,985 people were awaiting an assessment of their needs, for care and support or their direct payment to start, or a review of their care plan, according to the annual report from the Association of Directors of Adult Social Services (Adass). According to King’s Fund analysis, there were two million new requests for adult social care support in England in the year to March 2025. These requests related to 1.4 million people – more than one request can be made per person – of which almost two thirds (868,000 or 64 per cent) were for people aged 65 and over while 490,000 (36 per cent) were for working-age adults aged 18–64. While the majority (around four in five) of requests for care came from the community, almost a fifth (17 per cent) were made because a person was ready to be discharged from hospital. Age UK said an estimated 1.9 million older people in England – those aged 65 and over – currently have an unmet need, which can include difficulty getting in and out of bed, bathing or showering or dressing. How well-staffed is the adult social care sector in England? Vacancy levels in adult social care remain around three times higher than the wider economy. A report from Skills for Care, published in June, said there were around 96,000 vacancies on any given day. However, in some good news for the sector, this vacancy rate of 6.2 per cent in 2025/26 was the lowest in a decade, with the number of vacancies down 10.5% on the previous year. While there were 22,000 more filled posts than the previous year, the organisation said this was the slowest growth rate in four years. Baroness Louise Casey, who is leading a review into the sector, said the current system “relies on someone filling the gaps”. According to the 2021 Census, there were an estimated five million unpaid carers across England and Wales. What might reforms cost? The Health Foundation think tank has estimated that if the state covered the costs of everyone currently receiving adult social care services in England, an NHS-style social care system would cost £18.5 billion extra a year by 2035 – on top of the current costs. This is described as a “broad estimate” and assumes everyone who currently funds their own care would be eligible for publicly funded care but does not include likely additional costs of people with unmet care needs, who come forward because of the policy change. Introducing a Scottish-style system of free personal care – where the state covers costs for people aged 65 years and older for help with tasks such as eating, bathing and using the toilet and contributes towards personal care costs for people in care homes – is estimated at £7.5 billion a year extra by 2035/36. A so-called care cap of £86,000 on the amount anyone in England would need to spend on their personal care over their lifetime – previously accepted but delayed by the Conservatives and then scrapped by Labour as not “deliverable” in the time frame – could cost an estimated £4 billion a year extra by 2035/36. Join our commenting forum Join thought-provoking conversations, follow other Independent readers and see their replies Comments