Councils across England are grappling with unprecedented demand and rising costs in adult social care, with sector leaders warning that meaningful reform cannot come soon enough. As political attention turns to leadership and future policy direction, hopes are growing that renewed commitments at the top of government could finally translate into long-promised structural change.
The latest annual survey from the Association of Directors of Adult Social Services, published today, reveals that local authorities overspent on adult social care by £715 million last year. This marks the fourth consecutive year of escalating costs, driven by increasing demand and growing complexity of care needs.
Rising demand and increasing complexity
According to the survey, councils are supporting more individuals with highly complex conditions than ever before. This includes people whose care would historically have been funded through NHS Continuing Healthcare, but who are now increasingly turning to local authorities for support.
In addition, there has been a notable rise in safeguarding concerns, as well as mounting pressures linked to younger adults entering the system with significant mental health needs.
The report highlights a system struggling to keep pace with demand, where both financial constraints and organisational fragmentation are placing strain on frontline services.
Phil Holmes, President of ADASS, said:
“ADASS’ latest survey highlights the disconnect between government ambitions for adult social care and the funding provided to deliver them. Councils continue to be placed under huge financial pressure, with no signs of this abating. Behind every number there is person needing support, a family struggling or an unpaid carer taking on huge responsibility.
“There are areas that need particularly urgent attention. The ongoing reduction in the number of people receiving NHS Continuing Healthcare flies in the face of our ageing population. Increasingly frequent funding disputes are leaving people and families facing uncertainty about whether they will get the care they need, or whether their existing care will continue to be possible. This year’s ADASS survey provides even more evidence that NHS Continuing Healthcare urgently needs national reform.
“This must be just the start. A new Prime Minister is about to take the helm and Baroness Casey is saying that adult social care needs fundamental reform and sustainable investment with no more ‘sticking plasters’. We must make sure that our government uses this momentum so that next year’s ADASS national survey signals positive change rather than more of the same.”
Continuing Healthcare and system tensions
The findings reveal growing concern around NHS Continuing Healthcare eligibility and access. Three-quarters of directors reported an increase in individuals approaching councils who would previously have qualified for CHC, raising questions about cost-shifting across the system.
This tension is compounded by disputes over funding responsibilities, which stakeholders say detract from a focus on patient care.
Integrated Care Boards under scrutiny
Despite increasing demand, many councils report insufficient investment from Integrated Care Boards in key community services. This includes CHC, section 117 aftercare funding for mental health, and jointly funded care packages.
Local leaders argue that without coordinated, system-wide planning and funding, pressure will continue to fall disproportionately on local government.
Mental health demand continues to rise
The survey paints a stark picture of increasing mental health need across communities:
- 86% of directors reported a rise in mental health demand between 2025 and 2026
- 77% saw an increase in younger people presenting with mental health needs
Despite this, gaps in NHS funding are hindering councils’ ability to respond effectively, reinforcing calls for more integrated approaches to service planning and delivery.
Growing costs among younger adults
Councils are also supporting a growing number of young people aged 18–24, many of whom have highly complex needs, including trauma-related mental health conditions and severe physical or learning disabilities.
These individuals often have prior involvement with children’s services, underscoring the need for better transition planning and stronger integration between children’s and adult social care systems.
Waiting lists and unmet need
More than 400,000 people are currently waiting for assessments, care packages, direct payments or reviews. ADASS warns that delays at this scale risk leaving individuals with unmet or inadequately met needs, potentially impacting independence and long-term wellbeing.
Safeguarding concerns
Over half of directors expressed limited confidence in their ability to meet safeguarding duties fully. With many key partners, including councils, ICBs and police, undergoing structural changes, there are fears that disruption could weaken multi-agency coordination.
Pressure on unpaid carers
The report also highlights a worrying decline in investment in unpaid carers, despite rising demand:
- Only 35% of councils plan to increase spending on carers in 2026/27 (down from 39% in 2025/26)
- 73% of directors reported an increase in unpaid carers needing support
At the same time, waiting times for carers’ assessments – covering young carers and parent carers – have risen significantly.
A pivotal moment for reform
With demand continuing to rise and funding pressures intensifying, the ADASS survey underscores the urgency of meaningful reform in adult social care. Sector leaders are clear: without sustained investment, system-wide integration, and clarity around NHS and local authority responsibilities, the challenges facing councils will only deepen.
As national leadership priorities take shape, local government will be watching closely to see whether this moment translates into lasting change – or another year of mounting pressures.
Image credit: iStock
