Social Care 360: April 2026 — Full Digest

The King’s Fund Social Care 360 is a large, multi-section online report. 

The eighth edition of the King’s Fund’s annual 360-degree review of adult social care in England, has just been published on 8 April 2026. 

Its overarching warning is stark: spending has increased and more people are receiving care, but councils are financially hollowing themselves out to achieve it. 

The 2026 report, whilst published in April 2026, draws primarily on data from 2023/24 and in some areas 2022/23. 

Several of the risks it identifies — notably the impact of the April 2025 rise in employers’ National Insurance contributions and the anticipated Fair Pay Agreement — were, at the time of writing, prospective concerns. This reflects the NHS/DHSC data collection and publication cycle, which typically runs 12–18 months behind the financial year in question.

Those developments have since occurred or are in train, meaning the report’s warnings should now be read as a baseline against which emerging outcomes can be assessed, rather than as predictions about an uncertain future. Any assessment of their actual impact on access, expenditure, provider stability or workforce will only become visible in the 2027 edition, when 2025/26 data becomes available.

The core argument of the 2026 edition is clear :

• The “doom loop” warning is front and centre: Loading unfunded costs onto providers leads to rationing — this happened 2015/16–2021/22 and must not recur.
• The immediate threat: Employers’ NI contribution rises and the proposed Fair Pay Agreement will significantly increase provider costs in 2024/25.
• The government’s own impact assessment acknowledges Fair Pay Agreement costs will fall on local authorities — yet without full central government reimbursement, councils will be forced to ration care again.
• Fee increases already paid: Between 2015/16 and 2023/24, LAs increased fees for older people’s care homes by 33% in real terms, home care by 18%, and working-age adult care homes by 13%.

Section 1 — Requests for Support

Headline: Requests keep rising — 5,700 every single day.

• In 2023/24, new requests reached 2.1 million, up from 2.0 million in 2022/23
• Requests from working-age adults rose 8% (612,000 → 658,000); from older people 3% (1.39m → 1.43m)
• Since 2015/16, working-age adult requests are up 31%, older people’s requests up 9% — reflecting growing disability rates (23% of working-age adults in 2022/23 vs 16% in 2012/13)
• Around 4 in 5 requests come from the community; 1 in 5 from hospital discharge

Section 2 — Access (Receipt of Care)

Headline: More people are receiving care — but still fewer than in 2015/16.

• In 2023/24, 859,000 people received publicly funded long-term care, up from 835,000 in 2022/23
• This is still below the 873,000 receiving care in 2015/16, and when adjusted for population growth, the fall is even starker: from 6.0% of over-65s in 2015/16 to just 5.2% in 2023/24
• Working-age adults receiving long-term care rose modestly (293,000 → 300,000); older people rose more (543,000 → 559,000)
• Short-term care to maximise independence (ST-Max) increased 12% to 252,000 — the largest year-on-year rise since records began
• Provisional 2024/25 data shows a continued increase: 673,000 in long-term support at end of September 2024, up from 656,000 in March 2024

Section 3 — Financial Eligibility

Headline: The means test keeps getting meaner.

• The upper asset threshold has been frozen at £23,250 since 2010/11
• Had it risen with inflation it would now be £32,375 — meaning in practice more people are excluded than Parliament originally intended
• The threshold will remain unchanged in 2025/26
• The previous government’s plan to raise the threshold to £100,000 and introduce an £86,000 lifetime cap was cancelled by the incoming Labour government in October 2024
• The Minimum Income Guarantee (the income floor for people receiving care at home) has increased in line with inflation since 2021/22, and will continue to rise in 2025/26

Section 4 — Expenditure

Headline: Spending is up sharply — but councils are going into the red to fund it.

• Total expenditure on adult social care in 2023/24 reached £32.0 billion — up 6.3% in real terms from 2022/23
• Gross current expenditure (excluding NHS income) rose to £27.2 billion, up 8.1% in real terms
• In real terms, this is £4.6 billion more than in 2010/11

How the money was spent (gross current expenditure):

Category	Spend
Long-term support: older people	£11.0bn
Long-term support: working-age adults	£10.4bn
Learning disability (working-age)	£7.1bn
Physical support (older people)	£7.7bn
Memory/cognition (older people)	£2.1bn
Physical support (working-age)	£2.0bn
Mental health (working-age)	£1.3bn
Social work, assessment, safeguarding	£2.3bn
Commissioning and service delivery	£1.4bn

• 81% of councils expected to overspend their adult social care budgets in 2024/25, up from 72% in 2023/24, with an estimated total overspend of £564 million
• For 2025/26, the government made available £5.9 billion via the social care grant — an increase of £880 million on 2024/25

English councils drew on usable reserves and increased external debt in 2024/25 in order to meet their statutory duties under the Care Act 2014. This is not financial mismanagement: local authorities are legally obliged to meet eligible needs, and where grant funding and council tax revenue are insufficient to cover the full cost of doing so, drawing on reserves is not merely permissible — it is the legally correct response to avoid breaching statutory duty. 

CIPFA data cited in the report shows usable reserves fell by 4% and external debt rose by 10% across English councils as a direct consequence of honouring those obligations. 

The concern the report raises is not that councils acted wrongly, but that the structural gap between statutory duty and central government funding is now so wide that reserves — which can only be spent once — are being eroded at an unsustainable rate, with half of councils indicating they may need to apply for exceptional financial support within three years.

Section 5 — Cost of Commissioning

Headline: Fees to providers are rising, but still below sustainable levels.

• In 2023/24, average weekly fees paid by LAs rose: +3.8% (working-age adults) to £1,696/week; +6.5% (older people) to £951/week; +0.9% (home care) to £22.03/hour
• Since 2015/16: older people’s care home fees up 33% in real terms; home care up 18%; working-age adult care homes up 13%
• Staff costs account for ~60% of residential/nursing home costs and ~70% of home care costs — these are the primary driver of fee increases
• Despite rising fees, self-funders still pay around 40% more than council-funded clients in care homes, effectively cross-subsidising the public system
• Provider profitability is not a factor — no clear trend of increased profits for the largest residential providers between 2015–2023; home care profits fell from a peak of 10.8% (2012) to 7.6% (2023)
• The Nuffield Trust estimated the 2024 Autumn Budget NI rise will cost social care providers over £900 million

Section 6 — Care Home Places

Headline: The total number of care home places is slowly declining.

• In 2023/24: 456,000 care home places (up marginally from 455,000) — but places per 100 people aged over 75 fell from 8.8 to 8.6
• Since 2012: a net 8,000 fall in total places (14,000 decline in residential, offset by 6,000 increase in nursing home places)
• In 2012, there were 6.1 residential and 5.2 nursing home places per 100 over-75s; by 2024 this had fallen to 4.4 and 4.2 respectively
• Regional variation is stark: nursing home places up 12% in South East and West Midlands since 2014, but down 9% in North East and down 21% in Yorkshire and the Humber
• The average care home size has grown: average residential home went from 19 to 22 places since 2012; nursing homes from 46 to 52

Section 7 — Vacancies

Headline: Vacancies have fallen — but only because of overseas recruitment, which is now drying up.

• Vacancy rate fell from 9.9% (2022/23) to 8.3% (2023/24); total vacancies fell from 152,000 to 131,000
• The fall was driven entirely by 185,000 overseas workers arriving in the UK between March 2022 and March 2024 following February 2022 visa rule changes
• Meanwhile, 70,000 UK domestic workers left social care over the same period
• Domiciliary care has the highest vacancy rate (11.5%); personal assistants (11.0%); residential care much lower (5.2%)
• Changes to visa rules in December 2023 have drastically curtailed overseas recruitment: only 8,000 arrived April–June 2024 compared to an average of 26,000 per quarter in 2023/24
• The Fair Pay Agreement Bill was published October 2024 but an agreement is unlikely before 2026

Section 8 — Pay

Headline: Pay is rising but social care workers are now earning no more than shop workers.

• Median care worker pay in March 2024: £11.00/hour (independent sector) — a 5.4% real terms increase on 2022/23
• Since 2015/16, median pay has risen 17% in real terms — but in 2012/13 care workers earned more than retail assistants; by 2023/24 they earned the same
• Care workers earn 67p/hour less than newly employed NHS healthcare assistants
• The National Living Wage rose to £11.44 in April 2024 (9.8% increase); rises to £12.21 in April 2025 (+6.7%) — over two-thirds of care workers (estimated 605,000) were earning below £11.44 and entitled to a rise
• Pay progression has collapsed: experienced care workers now earn just 10p/hour more (mean) than those with under one year’s experience — down from 33p more in 2016

Section 9 — Unpaid Carers

Headline: Fewer carers receive support than a decade ago, despite more needing it.

• In 2023/24, 308,000 carers received direct support — up from 295,000 in 2022/23 but still below 314,000 in 2015/16
• Respite care provision has fallen dramatically: from 57,000 in 2015/16 to 36,000 in 2023/24
• Unpaid carers contribute the equivalent of four million paid care workers to the system
• An estimated 1.4 million people in England provide more than 50 hours of unpaid care per week
• Claims for Carer’s Allowance have risen from 1.2 million (February 2016) to 1.4 million (February 2024) — suggesting actual demand is rising, not falling
• Only 36.7% of carers reported being extremely or very satisfied with services in 2023/24, down from 39% in 2016/17

Section 10 — Quality Ratings

Headline: Quality is broadly stable — but the CQC is struggling to do its job.

The Quality section of Social Care 360 2026 is concerned exclusively with the CQC’s registration and inspection of care providers — care homes, nursing homes, and domiciliary care agencies — not with the CQC’s separate assurance assessments of local authorities. The data it reports relates entirely to registered care services, and the criticism of the CQC’s reduced inspection throughput — 4,447 ratings in 2023/24 versus 13,505 in 2019/20 — relates to provider inspections under the CQC’s Single Assessment Framework.

This should not be confused with the CQC’s separate and more recently introduced function of assessing local authorities’ own delivery of their statutory duties under Part 1 of the Care Act 2014 — a function conferred by the Health and Care Act 2022 and operative from April 2023. That local authority assurance programme generates its own distinct reports and ratings on councils, and is not covered in the Social Care 360 Quality section.

• April 2024 ratings: 4% outstanding, 78% good, 16% requires improvement, 1% inadequate — almost identical to April 2023
• Good/outstanding services have improved marginally from 80.9% (2018) to 82.4% (2024)
• 1 in 6 services remains below standard; 3% of care homes have never been rated better than “requires improvement”
• An independent review (October 2024) found the CQC had caused a “stark” reduction in inspections, a backlog in new registrations, delays in re-inspection, and serious problems with its new Single Assessment Framework
• Only 4,447 ratings published in 2023/24 — compared to 13,505 in 2019/20

Section 11 — Direct Payments

Headline: Direct payments are stagnating, especially for older people.

• 118,000 people used direct payments in 2023/24, up marginally from 117,000 — but this represents only 25% of all people in long-term care, down from 28% in 2015/16
• Working-age adults use direct payments much more (37%) than older people (14%)
• PA vacancy rate stands at 11.0% — the highest of any role in social care
• Once recruited, PAs have far lower turnover (18.2%) than care workers generally (29.9%)

Section 12 — User Satisfaction

Headline: Service users are broadly satisfied — but the public and carers are not.

• 65.4% of service users said they were extremely or very satisfied in 2023/24, up slightly from 64.4%
• Working-age adults (69%) more satisfied than older people (63%)
• However, only 13% of the public say they are satisfied with adult social care in 2024 — a striking contrast
• The 2023 British Social Attitudes Survey found 64% of those who had contact with social care were dissatisfied with it — 15 percentage points higher than those with no contact

Public Attitudes

Headline: Social care has virtually zero public priority.

• In February 2026, literally 0 out of 1,000 people surveyed by Ipsos said social care was THE top national priority; only 2% said it was among the top priorities
• This is in the context of the King’s Fund’s companion report Not My Priority: How The Public Sees Social Care

The Report’s Conclusion

The report’s own summary is: “The outlook for social care remains precarious”. Increased spending and more people receiving care have come at the direct cost of councils’ financial stability — raiding reserves, cutting other services, and with half of councils saying they may need emergency government support within the next three years. The structural problems — the frozen means test, low pay, declining overseas recruitment, an overstretched CQC, and near-zero public prioritisation — remain unresolved.

The Report’s approach to Baroness Casey’s commission

The report references the Independent Commission on the Future of Adult Social Care, chaired by Baroness Louise Casey, which was announced by the Labour government in late 2024 as part of its longer-term reform agenda for social care.

The King’s Fund’s assessment is cautiously supportive but urgently pressing. Its key points are:

• Phase 1 must address the doom loop: The report explicitly urges the Commission to treat the risk of cost increases being passed down to providers and triggering care rationing as a Phase 1 priority — not something to defer to longer-term structural reform
• The NI rise and Fair Pay Agreement cannot wait: Because the Commission’s work will take time, the report argues the government must act now to fully fund the NI contribution rise and the Fair Pay Agreement for care workers — without waiting for the Commission’s recommendations — to prevent a fresh collapse in access
• The frozen means test is another immediate ask: The King’s Fund argues the Commission should address the £23,250 upper capital threshold as a matter of priority, since it has eroded significantly in real terms since 2010/11 and is already set to remain frozen in 2025/26
• Structural reform must go further than funding alone: The report implicitly signals that without reform to workforce pay, overseas recruitment, the CQC’s inspection regime, and the direct payments framework, any additional money will be absorbed without improving outcomes

In essence, the King’s Fund is telling the Casey Commission: the building is on fire right now — and you need to fix the immediate financial emergency before designing the new architecture, Which the Baroness does not have authority to do. However, the report does not critique the Commission’s terms of reference or composition directly, but uses its existence as a hook to press for specific, urgent interventions that fall within its scope.

The King’s Fund is not briefing an incoming commission. It is applying pressure to an active one, arguing that the National Insurance contribution rise and the Fair Pay Agreement costs are already landing on providers and councils in 2025/26 — financial year data for which will not appear until the 2027 edition — and that the Commission cannot afford to treat these as background context to be addressed in a longer-term reform package. It is essentially saying:

“The Casey Commission is the right vehicle for long-term reform — but it must not become an excuse for inaction on immediate financial threats that are unfolding faster than the Commission can report.”

In other words, the King’s Fund is trying to prevent the Commission from being used — deliberately or inadvertently — as a reason to defer decisions about the NI rise reimbursement and Fair Pay Agreement funding that the government could and should make now, independently of whatever the Commission eventually recommends.

The Specific Funding Asks

Social Care 360 is a data and trends report, not a policy recommendations document. It does not contain a formal list of numbered recommendations in the way that, say, a Select Committee report or a government review would. What it does instead is make strongly implied calls to action embedded within its analysis — and these are directed squarely at government.

Its statistical backbone reflects a world of 2023/24 — before the NI rise, before the Fair Pay Agreement Bill, before the Casey Commission existed. Its narrative and policy commentary is written in early 2026 and addresses those developments directly. Readers need to hold both timelines simultaneously: the data tells us where social care was; the commentary tells us what was being anticipated at the moment of publication. Neither section should be read as telling us where social care actually is today, in April 2026 — that picture will only emerge in the 2027 edition.

In spite of that that tension, the funding-related calls the report makes, explicitly or very clearly implicitly, are:

• Fully fund the NI contribution rise: The government must reimburse local authorities and providers in full for the cost of the April 2025 increase in employers’ National Insurance contributions, which the Nuffield Trust estimated will cost providers over £900 million. The report is explicit that loading this cost onto providers without full compensation will trigger the doom loop
• Fully fund the Fair Pay Agreement: When implemented (expected from 2026/27 onwards), the Fair Pay Agreement for care workers must be accompanied by ring-fenced central funding to local authorities — not absorbed from existing budgets
• Unfreeze the means test: The upper capital threshold of £23,250, frozen since 2010/11, should be uprated — the report notes it would stand at £32,375 had it kept pace with inflation. It flags the government’s own confirmation that it will remain frozen again in 2025/26 as a missed opportunity
• Maintain and grow the Social Care Grant: The grant rose from £3.9bn (2023/24) to £5.0bn (2024/25) to £5.9bn (2025/26) — the report treats this trajectory as necessary but not sufficient, given that 81% of councils still expect to overspend their adult social care budgets, with a combined projected overspend of £564 million
• Stop councils raiding reserves: The report warns this is fiscally unsustainable — half of councils have indicated they may need emergency government support within three years
• Address the Better Care Fund reform: Given the government’s own December 2024 framework consolidating multiple grants from 2026/27, the report implicitly presses for this to increase — not simply rationalise — the money reaching social care.

In the press release announcing the publication of this report, Simon Bottery, Senior Fellow for Social Care, The King’s Fund, and co-author of the report 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 is organised and is funded in a way that does not put at risk other local authority services and their overall financial health.’