Headline evidence · Adult social care · England · older people at home 2024 · council care 2014–15 to 2024–25

One in four older people at home lacked help with at least one everyday task.

About one in four people aged 65 and over living at home needed help with at least one personal task, such as washing or dressing, and got none last month. Help from family counts. It is a survey answer, not a count of people refused care.

Proposed outcome: Provide reliable care that helps people live independently without leaving families to fill the gaps. What could change →

Geography
England
Evidence period
2024
Evidence status
Survey-based
Editorial review
Reviewed 3 October 2026

The short version

Three key measures

  • Survey-based evidence
    Health Survey for England 2024Fieldwork: 2024A household survey of adults and children in England; estimates have sampling uncertainty.

    How many older people at home lacked help with an everyday task?

    24%of adults aged 65+

    Older people living at home who needed help with at least one personal task and got no help with that task in the previous month. Some of them did get help with other tasks.

    England · 2024 · Survey-based

    Definition, limits and source: How many older people at home lacked help with an everyday task?

    Needed help with at least one personal task such as bathing, dressing or getting in and out of bed but had received no help with it in the last month (27% of women, 21% of men). People aged 65+ in private households; hospitals and care homes are not sampled. Help from anyone counts.

    Survey-based · NHS England, Health Survey for England 2024: social care for older adults

    Unmet need in detail →

  • Will the care system cope with an ageing population?

    +24%more people over 65 by 2040

    England will have about a quarter more people aged 65 and over by 2040. Councils already spend more and still overspend. Ageing explains only part of the cost, as working-age adults need care too.

    England · 2026 to 2040 (projection); 2025–26 spending

    Definition, limits and source: Will the care system cope with an ageing population?

    England’s population aged 65 and over is projected to grow from 11.4 million in 2026 to 14.1 million in 2040, and those aged 90 and over from 550,000 to 990,000. Councils spent 44% more on adult social care in cash terms in 2025–26 than in 2021–22 and still overspent by £715 million, according to a survey of council care directors. Ageing is only part of the cost: working-age adults are a little over 40% of people receiving council-funded long-term care.

    Forecast (modelled) · ONS, Subnational population projections for England: 2022-based (24 June 2025), England, persons aged 65+ and 90+, mid-2026 and mid-2040

    Ageing and the funding gap →

  • How many adults receive long-term care from councils?

    672,000people

    Adults receiving long-term care arranged by councils. This does not include everyone paying privately or needing help.

    England · 31 March 2025

    Definition, limits and source: How many adults receive long-term care from councils?

    On 31 March 2025, against 657,000 in 2014–15 and a low of 613,000 in 2021–22. 396,000 were aged 65 or over.

    Published statistics · DHSC, Adult social care activity report, England: 2024 to 2025, Commentary and data tables (Tables 8, 9, 12, 60)

    Access and eligibility →
Who feels this most?

On Census Day 2021, 4.7 million people in England looked after someone because of illness, disability or old age, 1.4 million of them for 50 hours a week or more, and about 120,000 were aged 5 to 17. Women (10.3%) were more likely to care than men (7.6%), and people in the most deprived areas (10.1%) more than those in the least deprived (8.1%).

Budget 2026 · 28 October 2026

What the Budget means for social care

1

Budget measure on this topic

£0

No net effect, 2026–27

£0

No net effect, 2029–30

Biggest single-year effect of each measure · red costs money, teal saves or raises it

  • Carer’s Allowance2031–32−£80m
The Budget in 2 minutes →Is it being delivered? →

Treasury costings certified by the OBR, not measured results. Topic links are UK Facts’ classification.

The evidence

An older population, and a funding gap

By 2040 England will have about a quarter more people aged 65 and over, and nearly 80% more aged 90 and over. These are the people who need care most. Councils are already stretched: they spend about 40% more on adult social care in cash terms than four years ago, still overspent by £715m last year, and more than 400,000 people were waiting for an assessment, care, a direct payment or a review. Ageing is only part of the story: working-age adults are a little over 40% of people receiving council-funded care. Our pensions page shows the same ageing trend from the pensions side.

People aged 65 and over, England (millions)

+24%. Office for National Statistics 2022-based projections: they assume recent trends continue and are not forecasts.

  • 202611.4m
  • 2040 (projected)14.1m

People aged 90 and over, England (thousands)

+80%. The oldest group needs the most care.

  • 2026550k
  • 2040 (projected)990k

Councils’ adult social care spending, net of fees and income, England, cash terms: +44%, or about +19% after inflation. Councils still overspent by £715m in 2025–26 (ADASS survey) and more than 400,000 people were waiting for an assessment, care, a direct payment or a review.

  • 2021–22£19.0bn
  • 2025–26£27.4bn

How big is the funding gap?

There is no single official figure for the gap. The Health Foundation estimates how much more would be needed under three scenarios. We show them beside the government’s planned increase, not netted off against it. In 2024 the government dropped the cost cap planned for 2025. In July and September 2026 it announced free personal care in a National Care Service, introduced in phases in the next Parliament, with a commission reporting in summer 2027. Costs are not appraised here. Health Foundation analysis and DHSC priorities.

Extra spending a year England’s adult social care would need, 2024-25 prices, Health Foundation scenarios. Secondary: reported figures, primary page not read.

  • Keep up with demand and costs: by 2028–29£3.4bn
  • Keep up with demand and costs: by 2034–35£9.1bn
  • …and give more people care: by 2028–29£6.4bn
  • …and give more people care: by 2034–35£12.7bn
  • …and raise pay to at least the NHS entry band: by 2028–29£8.7bn
  • …and raise pay to at least the NHS entry band: by 2034–35£15.4bn

For comparison, the government says funding for councils will be about £4.6bn higher in 2028–29 than in 2025–26. The government's £4.6bn is local-authority funding for England; the Health Foundation scenarios are extra annual need. They are not like-for-like, so one is not 'the gap closed' by the other.

What older people report

Survey-based evidence
Health Survey for England 2024Fieldwork: January 2024–February 2025Adults aged 65+ in private households · self-reported unmet need

In the Health Survey for England 2024, 24% of adults aged 65+ in private households reported some unmet need for help with personal tasks. They could still receive help with other tasks. This measures experience, not satisfaction with services or eligibility for council-funded care.

Questions, sample and limits

Participants rated their ability to perform each task: independently, with difficulty, with help, or not at all. Difficulty managing alone counts as need. A follow-up asks whether anyone helped during the last month, including family. The published questionnaire asks, for example: “Have you received help from anyone with getting in out of bed on your own, in the last month?”

Table 3 has an unweighted base of 3,143 older adults (1,493 men and 1,650 women); the whole survey interviewed 9,220 adults. Interviews ran January 2024–February 2025, face to face, using a stratified random household sample. Weights adjust selection and non-response. The household response rate was 35%. Hospitals and care homes are outside the sample.

Table 3 does not give an interval for the 24% estimate; none is invented here. Recall, non-response and sampling error remain. Routing changed in 2013; 2021 used remote interviews and is not comparable. There is no complete 1996–2026 annual series. The documentation linked by the 2024 release retains a 2022 questionnaire header, so its version label is ambiguous; the 2024 report separately confirms the question sequence and unmet-need definition.

Sources: NHS England, HSE 2024 social care report (27 January 2026); Table 3; Methods, pp.6–7 and 31–41; questionnaire, PDF pp.56–57.

Annual data: Council-arranged long-term care

Comparable coverage starts in March 2015. Earlier community-care definitions differ, so 1996–2014 is left blank. The 2024–25 source switches from SALT to client-level data; DHSC regards long-term support as comparable, but announced further corrections on 7 October 2026. 2026 is not yet supplied. A dash means no comparable observation is supplied; it is not zero. England, adults aged 18+; council-provided or arranged support, excluding prison, wholly self-funded care and unpaid care.

1996–2026; people on 31 March. No change is calculated across definition or assessment breaks.

Council-arranged long-term care; people on 31 March
YearAdults
1996–2014No comparable observations supplied
2015656,500
2016652,295
2017654,765
2018641,710
2019636,495
2020630,065
2021615,980
2022613,360
2023628,900
2024649,915
2025672,025
2026No comparable observations supplied

Data notice, 7 October 2026: DHSC plans to correct some council submissions alongside its next annual release. It says the impact on England totals is minimal; current published values remain shown. Read the correction notice.

Help arranged by councils

Is council-arranged long-term care reaching more people?

Long-term care for over-65s fell for years and is now rising again; care for working-age adults has grown

England · 2014–15 to 2024–25

1996–2026 · recorded figures. Shading marks years without figures: this series starts in 2015.

Thousands of peopleSeries starts 20150k200k400k200020102020396k276k

More adults now receive long-term council care than at the recent low. These counts leave out people paying for their own care and people whose needs are unmet.

England · 2014–15 to 2024–25 · Official statistics in development

Show the workings — Long-term care for over-65s fell for years and is now rising again; care for working-age adults has grown

People receiving long-term support provided or arranged by councils on 31 March, by age, England, 2014–15 to 2024–25, thousands. All care settings except prison.

396,000 people aged 65 and over were receiving council-arranged long-term care in March 2025, against 409,000 in 2014–15; the number fell to 360,000 in 2021–22 and has risen since. Working-age adults rose from 247,000 to 276,000. These counts show who councils support, not how many need care: they do not count self-funders or people who were turned away.

Geography:
England — Adults receiving council-arranged long-term care (community, residential and nursing)
Measure:
Thousands of people
Period:
2014–15 to 2024–25
Status:
Official statistics in development
Calculation:
As published, divided by 1,000. Plotted at the year-end date.
Compare with:
2014–15, the first year of the SALT return
Not included / breaks:
Excludes people who arrange and pay for their own care without council involvement, and all unpaid care. 2024–25 comes from client-level data rather than SALT; DHSC says long-term support remains directly comparable. Earlier years are excluded because community care was counted differently before 2014–15. DHSC announced further corrections on 7 October 2026, mainly at council level; it describes the England-level impact as minimal.

Source: DHSC, Adult social care activity report, England: 2024 to 2025, Table 60 (released 23 October 2025; tables corrected 16 June 2026; further correction notice 7 October 2026).

View the data as a table
YearAged 18–64Aged 65+Total
2014–15247,445409,055656,500
2015–16247,070405,225652,295
2016–17254,500400,265654,765
2017–18253,810387,900641,710
2018–19255,115381,380636,495
2019–20254,375375,690630,065
2020–21256,110359,870615,980
2021–22253,625359,735613,360
2022–23258,850370,050628,900
2023–24264,465385,450649,915
2024–25275,825396,200672,025

Scroll the table sideways to see every column.

Separate measures, separate sources

These count different things over different periods. They are not steps in one funnel and should not be divided into each other.

  • 2.02m

    Requests for support from people new to social care

    2024–25; 1.39m people (some ask more than once) · DHSC activity report

  • 6%

    Requests leading to long-term support

    130,000 requests; 19% led to short-term support · DHSC activity report

  • 24%

    Over-65s at home reporting unmet need for personal care

    2024; help from anyone, paid or unpaid · Health Survey for England

  • 4.7m

    Unpaid carers

    Census day 2021; 1.4m care 50+ hours a week · ONS Census 2021

The number of needs assessments is not shown: DHSC’s 2024–25 report, now built from client-level records, does not publish it, and earlier figures are not comparable.

Social care helps older and disabled adults with everyday tasks such as washing, dressing and living safely. Councils arrange care for those who qualify after checks on needs and finances. People paying privately are usually absent from council figures.

Councils supported 672,000 people in long-term care in March 2025, against 657,000 in March 2015, after a dip to 613,000 in 2021–22. Of 2.02 million requests from people new to care in 2024–25, 17% came at the point of hospital discharge. 24% of over-65s living at home report some unmet need for personal care — help from anyone, paid or unpaid.

Why it is happening

Who funds and arranges what

Responsibilities and sequence, not measured effects

  1. 1

    Hospital (NHS trust)

    Treats the patient and decides when they no longer need a hospital bed. Funded by the NHS through integrated care boards.

    More on this step
  2. 2

    Discharge planning (NHS and council)

    Hospital and council staff agree what support is needed. Short-term reablement after discharge is free for up to six weeks under the Care Act.

    More on this step
  3. 3

    Council assessment and means test

    Councils with adult social services responsibilities assess eligibility against national criteria and assess finances. People above the means-test limit usually pay for their own care.

    More on this step
  4. 4

    Care providers

    Mostly private and voluntary home-care agencies and care homes, registered with the Care Quality Commission. Paid by councils, by people themselves, or both.

    More on this step
  5. 5

    Home, housing and family

    Adaptations come from housing authorities (Disabled Facilities Grant); day-to-day care also comes from unpaid family and friends (4.7 million carers in England at the 2021 Census).

    More on this step

On an average day in Sep 2026 about 13,647 patients in England’s hospitals no longer met the criteria to stay. Some were waiting for social care; others for NHS community services, assessments or transport. The hospital total alone does not identify how many beds additional social care would free. CQC’s March 2025 breakdown covers a narrower group: people in acute hospitals for at least 14 days. It attributes 23% of their discharge delays to social-care capacity or transfer-plan delays; that share must not be applied to this broader current total. Details: why hospitals cannot move patients through.

Who is affected most

Who feels this most?

Women and people in deprived areas are more likely to be unpaid carers

Usual residents aged 5 and over providing unpaid care, age-standardised per cent, England, Census 2021.

Per cent providing unpaid care
  • Women10.3%
  • Men7.6%
  • Most deprived areas10.1%
  • Least deprived areas8.1%
  • All, England8.9%

Source: ONS, Unpaid care by age, sex and deprivation, England and Wales: Census 2021 (13 February 2023). Self-reported; taken during the pandemic.

Unmet need is also higher for women (27% against 21% of men aged 65+) and, according to the Health Survey for England, more common in more deprived areas. More in who cares unpaid.

What could change

Proposals to consider. The bodies named below would need to agree to deliver them; responsibility is not a recorded commitment. Follow the links for costs and evidence.

  • Help older people stay safe at home

    Help older people stay safe at home through suitable home adaptations.

    Who could deliver it: Councils, housing providers and health/care commissioners.

    Main trade-off and delivery needs

    Scarce therapists; displacement of ongoing care; incorrect targeting.

    Separate budgets and cohorts; arrange risk assessment, therapists, installers and care staff; compare reablement outcomes.

    Cost: The extra cost is not yet known.

    Costs, drawbacks and evidence →

  • A costed social-care capacity plan

    Set out the care services needed, who will provide them and how much they will cost.

    Who could deliver it: the health department, Treasury, councils and care providers; devolved systems separately.

    Main trade-off and delivery needs

    Major workforce constraint; service displacement; eligibility and quality trade-offs.

    Model unmet need; specify pay, recruitment, training and commissioning; support unpaid carers; agree recurring funding.

    Cost: The extra cost is not yet known.

    Costs, drawbacks and evidence →

  • Targeted loneliness support

    Test organised social support for a defined group, checking whether it reduces loneliness compared with similar people without it.

    Who could deliver it: councils, public health and voluntary-sector partners.

    Main trade-off and delivery needs

    The main risks still need to be assessed.

    Specify cohort and intervention; cost facilitators, venues, accessible transport and sustained participation. Measure loneliness, exclusion and wellbeing. Proposed owners: councils, public health and voluntary-sector partners.

    Cost: The extra cost is not yet known.

    Costs, drawbacks and evidence →

  • Make heat protection operational in vulnerable settings

    Check homes and care settings for overheating, then provide suitable cooling, shade and response plans.

    Who could deliver it: Health/care providers, councils and landlords with public-health advice..

    Main trade-off and delivery needs

    Energy costs, unsuitable retrofits and staff workload.

    Cost a local risk-led plan before the next warm season, prioritising people unable to protect themselves. Use risk-based standards; a mild summer is not proof the intervention worked.

    Cost: The extra cost is not yet known.

    Costs, drawbacks and evidence →

See all options and what is still unknown →

Some problems have no assessed solution yet: see coverage and gaps.

Domain SWOT

Recorded

Show the findings
Strengths · 2 findings

  • The law already makes short-term help free: councils must not charge for reablement or intermediate care for the first six weeks, or for aids and minor adaptations costing £1,000 or less.

    England · Regulations made October 2014, in force

  • There is a dedicated grant for home adaptations: £723m of Disabled Facilities Grant in 2026–27, inside a £9,154m Better Care Fund that pools NHS and council money.

    England · 2026–27

Weaknesses · 7 findings

  • Councils overspent their adult social care budgets by about £715 million in 2025-26 and more than 400,000 people were waiting for an assessment, care, a direct payment or a review. This is a sector survey of directors, not an official statistic, and the page does not state a response rate.

    England · 2025-26

  • CQC identifies shortages in homecare and reablement, alongside providers returning council contracts because of costs. Its March 2025 breakdown attributes 23% of discharge delays among acute-hospital patients staying at least 14 days to social-care capacity or transfer-plan delays. This is a defined subgroup, not 23% of all occupied beds.

    England · CQC State of Care 2024–25, published October 2025

  • 24% of people aged 65 and over living at home reported some unmet need for help with personal tasks such as washing or dressing (27% of women, 21% of men).

    England (private households) · 2024

  • Only 5.7% of people aged 65 and over discharged from hospital were provided reablement.

    England · 2024–25

  • About 111,000 care posts were vacant (7.0%) and 23.1% of staff left their job in a year.

    England · 2024–25

  • Falls led to 221,600 emergency hospital admissions of people aged 65 and over in 2024/25 — 1,958 per 100,000, below the 2,256 of 2019/20 but about 600 admissions a day.

    England · 2019/20 to 2024/25

  • Care homes had more heat-associated deaths than any other setting in summer 2025 — an estimated 677 (95% CI 406–949), 9% above the expected level — and there is no routinely collected data on overheating or adaptation in care homes.

    England · Summer 2025

Opportunities · 2 findings

  • Targeted social and psychological support can alleviate loneliness. The DCMS review finds promising approaches, but variable designs, populations and follow-up limit transfer to a new service. Local delivery should remove barriers to participation and test sustained outcomes.

    Depends on: Define the target population and service, fund evaluation and test persistence of any improvement.

    OECD intervention studies; application to local UK services requires testing · our synthesis

  • Targeting home-hazard checks at people at higher risk of falling, where trials show fewer falls, and reablement at people likely to regain independence puts scarce therapists where the evidence is strongest.

    Depends on: Occupational-therapist capacity and adaptation waits are measured and funded, and extra reablement is evaluated against a comparison rather than counted in episodes.

    our synthesis

Threats · 2 findings

  • The first Fair Pay Agreement is due in April 2028; £500m is the maximum agreed for councils in its first year and the recurring cost depends on the pay agreed, so council budgets for extra capacity could be squeezed.

    risk

  • The national reablement outcome measure changed in 2024–25 and cannot be compared with earlier years, and 13 councils are missing from it, so national progress will be hard to judge for several years.

    risk

See the whole-UK SWOT →

Domain action plan

Proposed

Possible steps for government and the bodies responsible. These describe the order of work, not promised dates: starting an action and seeing results take different amounts of time.

  1. Short term · prepare

    Identify unmet needs and pressure on staff and unpaid carers.

  2. Medium term · deliver

    Assess the linked care, home-adaptation and prevention options.

  3. Long term · judge results

    Track independence, care quality and the demands on families.

Delivery steps and owners (6)
  1. Prerequisite: Publish adaptation waiting times and name the reablement cohort and comparison · Housing authorities and councils with integrated care boards · proposed
  2. Decision: Allocate staff and money in the local Better Care Fund plan · Health and Wellbeing Boards · proposed
  3. Delivery: Run OT hazard checks with a fast adaptation route; extend reablement at discharge · Councils with NHS falls and community services · proposed
  4. Result: Falls admissions among people adapted, and people at home 91 days after discharge, each against a comparison · Councils with an independent evaluator · proposed
  5. Decision: Publish the workforce plan with pay, vacancy and capacity costs before Fair Pay Agreement negotiations · DHSC with HM Treasury · proposed
  6. Delivery: Assess overheating in a sample of care homes and pilot building-specific measures · DHSC with UKHSA and providers · proposed

Sources, method and changes

Sources and methods (7)

Method notes

  • England only: social care is devolved, and Scotland, Wales and Northern Ireland run separate systems with their own statistics.
  • Adult social care only. Children’s social care and childcare are separate services and are not included.
  • Council activity data cover care councils provide or arrange. People who arrange and pay for care entirely themselves, and unpaid care by family and friends, are not counted.
  • Request and reablement statistics for 2024–25 come from new client-level data and cannot be compared with earlier years; long-term support can.