England's adult social care system is grappling with a record number of individuals receiving long-term support which is pushing council budgets to breaking point and creating a "precarious" financial situation, a new report has warned.
While this surge in provision has enhanced the quality of life for thousands, it has "come at great cost to local authority budgets and ultimately is not sustainable," according to the King's Fund.
The independent health charity's annual review revealed that 890,000 people accessed long-term care in the year to March 2025.
This figure marks an increase of 53,000 from 2022/23 and represents the highest number since comparable records began in 2015/16.
Provider fees for homecare rose by 5% in real terms, and 6% more people received publicly funded long-term care from 2022/23 – when the trend of increased spending power allowing local authorities to raise fees and provide more long-term care began – to 2024/25, the report said.
But while more people are getting care, councils still do not have the resources to meet all the demands and their overall financial position is “worsening”, the charity added.
For the latest year 2024/25, the average weekly fee paid by local authorities in England for care home places for working age adults rose by 3.6% in real terms to £1,823, the report said, while for older people’s care home places the average weekly fee rose 3.3% to £1,019.
In 2024/25, total expenditure by councils on adult social care rose to £34.5 billion, which was a rise of 7.9% in cash terms and 4.1% in real terms from 2023/24.
The report said: “As a result, local authorities are increasing fees below the increase in costs faced by social care providers.
“This has potential implications for market stability, quality, and particularly private-paying clients, who are being charged much more for their care so that providers can balance their books.”
In March, the head of a major review into adult social care in England called for a “moment of reckoning” in a sector which is “anxiety laden” for the vulnerable and their families.
Baroness Louise Casey is currently leading an independent commission on adult social care, which was announced just over a year ago, in early January 2025, and formally began a few months later in April.
It is expected a report on is first phase will be published later this year but the second, making long-term recommendations for the sector, might not report until 2028.
She insisted there must be an “honest conversation with the public directly” about what they want their NHS and Labour’s promised national care service to look like, including who should pay for care and where to draw the line.
She said: “I think we need a mandate from the people who pay for health and social care through their taxes and national insurance, but might not even know what it is.
“It needs to be about more than just whether people should have to sell their home or not. It’s really tough questions like who should be able to draw from the system? Where do we draw the line?
“What should we expect from families? What lies with the state? What contribution should be made, when and how?
“We now need to work with the public to create a system fit for the nation that we are today.”
The King’s Fund report, published on Wednesday, said her commission faces “significant pressure” to come up with “coherent proposals” to reform the sector.
It concluded: “The picture for social care remains precarious, then, with significant pressure on the government to ensure stability in the sector in the medium term, and on the Casey Commission to identify coherent proposals for reform in the long term.”
Simon Bottery, report author and senior fellow for social care at The King’s Fund, said: “Local authorities have gone to great lengths over the past year to fulfil their statutory obligations.
“They have spent more money on social care, with that investment not just going towards the increase in provider fees but also expanding the number of people receiving care.
“This will have improved the quality of life for the thousands of additional people now in receipt of care and given the challenging financial backdrop should be welcomed.
“However, it has come at great cost to local authority budgets and ultimately is not sustainable.
“We are long overdue a national conversation about how to properly reform social care so that it provides the support people need organised and funded in a way that does not put at risk other local authority services and their overall financial health.”
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