Recommendation 1

HM Government Accepted

We recognise that people face challenges in accessing adult social care, with many going without the care they need or grappling with a complicated system. Lord Darzi’s report highlighted a growing gap between requests for social care support and those receiving publicly funded social care; and there is a long-term trend of declining access to publicly funded adult social care, despite an ageing population. We are aware of a range of published estimates on the scale of unmet need, including the estimates regularly published by NHS England using the Health Survey for England (HSE). There are, however, substantial limitations to existing data and significant challenges and complexities in defining and assessing care needs, for instance to take account of eligibility thresholds. For those reasons, it would be challenging to publish an annual assessment of the level of unmet care needs, as recommended by the committee. Research by the Adult Social Care Policy Research Unit in 2021, funded by the National Institute for Health and Care Research (NIHR), estimated that 1% to 2% of older adults (65 and over) are likely to have eligible social care needs but receive no care or support, based on HSE samples and controlling for care need eligibility. The research did not cover younger adults. The NIHR supports an ongoing programme of research to further understand the impact of unmet need. Under the Care Act 2014, local authorities are responsible for assessing individuals’ care and support needs and, where eligible, for meeting those needs. Where individuals do not meet the eligibility threshold, they can get support from local authorities in making their own arrangements for care services. However, a thriving social care system extends beyond statutory services. Families and friends, communities, and the voluntary and charitable sector provide vital support to meet individuals’ needs and help people remain independent. These organisations are also well placed to respond flexibly to people’s needs given their deep roots in communities, including practical help with daily living, maintaining social connections, and joining up services across a variety of needs such as health, housing and financial support. Care Quality Commission (CQC) local authority assessments consider the delivery of Care Act duties, including the timeliness of assessing care needs. If CQC identifies a local authority has failed or is failing to carry out its functions to an acceptable standard, the Secretary of State for Health and Social Care has powers to intervene. The CQC has published over 30 local authority assessments as of May 2025. These have identified a number of common challenges, developing helpful learning for the sector as a whole. These include: • lack of support for unpaid carers • long waiting times for assessment and occupational therapy • challenges arising from an increase in demand for adult social care Another emerging theme is how local authorities need to do more to ensure equity in people’s experiences and outcomes in social care. CQC has found this is done well when local authorities work with voluntary organisations to build relationships with communities, in order to understand and meet the diverse needs of their local population. CQC is currently assessing all 153 local authorities, identifying strengths and areas for improvement, helping us target this support where it is most needed. DHSC funds a support programme to help local authorities address issues identified by CQC and improve services, including how they ensure equity in people’s experiences and outcomes.