Introduction to adult social care: briefing pack for elected members

Every council with responsibility for adult social care will have a director of adult social services. This is a statutory role under the Care Act 2014 and is responsible for the leadership, delivery and quality of adult social care services. There is also a statutory role for lead members for ASC. 

Further resources can be found on both the Local Government Association and Association of Directors of Adult Social Services websites. Key publications include: 

• The DASS Guide
• ADASS Autumn Survey 2025
• Must knows' for lead members for adult social care
• Get in on the Act: Health and Care Act 2022. 

Further information to understand the headline measures of health and wellbeing in your area can be found in the LG Inform report: Health and care: an overview for lead members.

What is adult social care?

We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us." (Social Care Future vision)

The Care Act 2014 is the key legislative framework for how adult social care is delivered through local authorities. Local authorities  are responsible for assessing people’s needs and, if individuals are eligible, funding their care. Care is provided by councils, voluntary and private organisations, and informal networks like family and friends. 

Adult social care supports people to  live independently, safely, and with dignity. It supports working age and older adults with health conditions, mental ill health, learning disabilities and autistic people, through practical, personal, and community-based assistance, such as help with daily tasks, home adaptations, reablement, residential care, and support for carers

At its heart, adult social care is about rights, relationships, and enabling people to live the lives they choose. At its best, it ensures that everyone can pursue the things that matter most to them, regardless of age or health conditions.

How big is adult social care?

• In 2024/25, there were 2 million new requests for adult social care, with 888,755 adults receiving long-term support and 245,495 receiving short-term care aimed at maximising independence. 
• The population is ageing, and people are living longer with complex health conditions. Healthy life expectancy has declined, and 17.3 per cent of adults have long-term conditions. 4.7 million people provide unpaid care, highlighting the essential role of informal carers. .
• Total expenditure on adult social care has risen to approximately £34.5 billion (Institute for Fiscal Studies), with funds divided almost 50/50 between the two groups: Older People (Aged 65+): Accounts for roughly £12.0 billion of long-term support. Working-Age Adults: Accounts for roughly £11.5 billion of long-term support.
• There are 1.50 million people working in adult social care. In comparison there are 1.54 million people working in the NHS. The sector is diverse: 78% female, 38 per cent from ethnic minority backgrounds, and 31 per cent non-British nationals. Most work in direct care roles, with a smaller proportion in managerial or regulated professional roles. 
• As of 2024/25 social care is provided and organised by approximately 19,000 organisations and delivered in approximately 42,000 establishments. 84 per cent of adult social care staff worked for independent sector employers, 8 per cent were employed by direct payment recipients and 8 per cent worked for local authorities.
• The two main service settings are residential and domiciliary (home-based) care, both of which employ more than 500,000 staff. By job role, 76 per cent of posts were direct care workers (people who work directly with patients).
  80 per cent of providers are running on digital systems, though up to 20 per cent of them – mainly SMEs - are still on pen and paper.
• Unlike the NHS, social care has never been free at the point of use. It is financially means-tested for most care situations and that depending on relative levels of deprivation, a large proportion of people who draw on care and support in their area may be paying for some or all their care. As such people with care and support needs are financial partners in their care and support. 

Adult social care within local government

Executive councillor

• Strategy shaper: help shape the council’s adult social care strategy to focus on the right groups and priorities.
• Story maker: with citizens and staff, create a shared narrative about the council’s adult social care strategy.
• Networker: build good relationships with partners, including health, the voluntary sector and care providers.
• Challenger: support and challenge the council’s senior officers to improve services.
• Enabler: foster a culture that encouraging innovation and co-production.
• Champion: promote adult social care as a key service for the council, for partners and the general population
• Connector: link different council departments to make services are more effective.

Source: Adult Social Care – Making a difference as an executive councillor. A Development Guide – University of Birmingham / NIHR Scholl for Social Care Research

Scrutiny councillor

• Challenger: provide constructive challenge to executive councillor responsible for adult social care
• Assessor: give feedback to help improve the performance of service providers and partnerships.
• Investigator: explore issues of concern in the community and bring things to light.
• Ally: involve people who use services and their carers in scrutiny of adult social care services.
• Innovator: propose solutions through research and credible recommendations.
• Watchdog: monitor performance and risk across the care market and raise concerns.
• Advocate: make sure that important issues for people who use services and carers are considered.

Source: Adult Social Care – Making a difference as a scrutiny councillor or committee. A Development Guide – University of Birmingham / NIHR Scholl for Social Care Research

Ward councillor

• Partner: help and support care service providers who are based in the community. 
• Caseworker: support, advise and advocate for individuals and families.
• Volunteer: help local projects that improve the health, wellbeing and independence of citizens.
• Connector: signpost people to services and opportunities
• Advocate: make sure that the needs of people using care service are reflected in service planning.
• Watchdog: raise concerns about services to the council and other organisations.
• Sensemaker: Share messages with the community about how adult social care works.

Source: Adult Social Care – Supporting residents to live a good life. A guide for ward councillors. University of Birmingham / NIHR Scholl for Social Care Research

The Care Act

The Care Act (2014) provides the framework for how councils must support adults with care and support needs, and their carers. Duties under the Act include:

• Promote individual wellbeing: all decisions must promote individual well-being, including dignity, health, independence, and participation.
• Prevent needs for care and support: provide services and interventions that reduce or delay the need for care. 
• Promote integration: work with health services and other partners to integrate care and support.
• Provide information and advice: ensure accessible, comprehensive advice for residents, carers, and self-funders.
• Promote diversity and quality in services: develop a diverse, sustainable care market offering choice and quality.
• Co-operate with partners: collaborate with other agencies to deliver joined-up care.
• Safeguard adults at risk: protect adults at risk of abuse or neglect through robust systems.

A duty to assess people’s needs and if needs assessed meet the Substantial threshold then councils have a duty to provide support to meet those needs.

The Care Act shifts adult social care from a crisis response to proactive support. It requires councils to promote wellbeing, maintain independence, and intervene early through a statutory duty to prevent, reduce and delay the need for care and support. 

To fulfil this vision, prevention is understood in three layers: 

• Primary prevention: universal information, advice, and community‑based activities that help people stay well. 
• Secondary prevention: targeted early help for people beginning to struggle, such as falls prevention or support for carers. 
• Tertiary prevention: reablement, rehabilitation and short‑term support that helps people with existing needs avoid further deterioration.

This duty applies to all adults, including those with unmet needs and carers at risk. Councils must ensure prevention is accessible, embedded in strategy and commissioning, and supported by sustained investment. 

Effective prevention relies on strong community capacity, social connection, and integrated working across health, housing, public health, and the voluntary sector. Strong partnerships ensure people experience seamless support that flows well across services. There is a key opportunity for leaders to enable more joined‑up thinking across these partners to create a shared understanding of local needs; and champion a positive, proactive vision of prevention and wellbeing. 

Other legislative duties

While the Care Act 2014 is the primary legal foundation for adult social care, councils must comply with a wider set of laws and regulations that shape how care is delivered, safeguarded, funded, and overseen. 

The Mental Health Act 2025: modernises the 1983 Act, setting out the legal framework for assessing, treating, and, when necessary, detaining people living with mental illness, to protect their safety or the safety of others

The Health and Care Act 2022: strengthens councils’ adult social care responsibilities by introducing CQC assessments of how well they deliver their Care Act duties and by driving greater integration with the NHS through statutory Integrated Care System

The Mental Capacity Act 2005: requires councils to ensure that adults who may lack capacity are properly supported to make decisions wherever possible, and that any decisions made on their behalf, follow the Act’s principles of best interests and least restriction.

NHS Continuing Healthcare (CHC): Under NHS legislation, councils must ensure that people who are eligible for NHS Continuing Healthcare are funded by the NHS, not the local authority, and must work closely with NHS partners to avoid unlawful provision of health services.

New legislation and reform

The Government’s 10 Year Health Plan for England: fit for the future seizes the opportunities provided by new technologies, medicines, and innovations to deliver better care for all patients – wherever they live and whatever they earn – and better value for taxpayers. It is making 3 big shifts to how the NHS works:

• from hospital to community: more care will be available on people’s doorsteps and in their homes
• from analogue to digital: new technology will liberate staff from admin and allow people to manage their care as easily as they bank or shop online
• from sickness to prevention: we’ll reach patients earlier and make the healthy choice the easy choice.

At heart, the plan is about building a “neighbourhood health service” that offers easier, earlier, more personalised care closer to home, rebalancing activity away from hospitals while using digital tools and data to anticipate need and improve outcomes. 

Running alongside the NHS 10‑year plan is a social care reform trajectory pointing toward a National Care Service. 

The UK government has launched an independent commission, chaired by Baroness Louise Casey, to deliver recommendations for a reformed adult social care system as a first step toward a National Care Service. The commission will work with councils, care users, NHS partners and the voluntary sector to create a long-term plan. 

The commission will consist of two phases:

• First phase (medium term report due in 2026): should set out the plan for how to implement a National Care Service, a government manifesto commitment. 
• Second phase (long-term report due 2028): should then make longer term recommendations for the transformation of adult social care.

Better Care Fund

The Better Care Fund (BCF) is a circa £10 billion programme that supports local systems to successfully deliver the integration of health, housing and social care in a way that supports person-centred care, sustainability and better outcomes and people and carers.

It represents a unique collaboration between:

• The Department of Health and Social Care
• Ministry for Housing, Communities and Local Government
• NHS England
• The Local Government Association

The four partners work closely together to help local areas plan and implement integrated health and social care services across England, in line with the vision outlined in the NHS Long Term Plan. Locally, the programme spans both the NHS and local government to join up health and care services, so that people can manage their own health and wellbeing and live independently in their communities for as long as possible.

The Government intends to reform the BCF as part of the 10‑Year Health Plan and early steps towards a National Care Service. BCF 2025–26 guidance frames the current year as a first step towards more integrated, preventative, neighbourhood‑based care, signalling the direction of travel for post‑2026 arrangements.

Health and Wellbeing Boards

• Health and Wellbeing Boards (HWBs) have been central to driving joined‑up local working since 2013, bringing together NHS, public health and local government leaders to improve population health. Their core statutory duties, producing Joint Strategic Needs Assessments (JSNAs) and Joint Local Health and Wellbeing Strategies (JLHWSs), continue to guide local commissioning and integration, including the Better Care Fund. Despite the creation of Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs) under the Health and Care Act 2022, HWBs remain the key mechanism for place‑based coordination.
• The 10‑Year Health Plan proposes reorganising ICB boundaries to align more closely with strategic authorities, meaning HWBs will need to operate within larger system footprints while ensuring the local “place” voice and community needs remain visible in broader commissioning decisions.
• The Plan also confirms the abolition of ICPs, removing their statutory footing by 2027. However, the Department of Health and Social Care has encouraged systems to retain successful partnership arrangements and design models that reflect local priorities. HWBs will therefore continue to play a central role in neighbourhood‑level health improvement, with a clear expectation that HWBs, ICBs and other partners will work closely with new Mayoral Combined Authorities on shared duties to tackle health inequalities.
   

Care Quality Commission

On April 1, 2023, the Care Quality Commission (CQC) assumed a new duty to assess local authorities’ performance in delivering of their adult social care (ASC) responsibilities under Part 1 of the Care Act 2014.  
The CQC assessment framework is grouped into four key themes, each with nine quality statements mapped to the themes. The assessment process culminates in a single performance rating for local authorities. These ratings are categorised as outstanding, good, requires improvement, or inadequate.

As this is a new responsibility for the CQC, it is establishing a baseline of completed initial assessments for all councils. CQC will complete baseline assessment of all 153 councils by December 2025 and aims to publish all assessment reports by 30 June 2026.

What comes next – after baselining: a baseline of initial assessments is intended to help develop CQC’s understanding of relative performance across local authorities. The future assessment approach has been established and the ‘roll out’ process has begun.

Care Quality Commission assessments for adult social care: Must know guide for chief executives

Key findings

The Care Quality Commission (CQC) evaluates councils against 9 quality statements across four core themes: Working with people, Providing support, Ensuring safety within the system, and Leadership. The most common shortcomings identified in published reports feature the following:

• Assessment and equipment delays
  • long waiting lists: Many authorities struggle with timely processing. In some cases, individuals are on Occupational Therapy (OT) waiting lists so long that their cases are closed because their needs changed drastically in the interim. 
  • equipment provision: Delays in providing essential adaptations at home are a recurring issue, hindering individuals' ability to live independently
• Lack of support for unpaid carers
  • hidden carers: Unpaid carers frequently report that support is difficult to access, and they do not receive the longer-term, proactive assistance needed to maintain their own wellbeing while caring for others
  • capacity burdens: Carers note feeling the strain of escalating care needs, particularly when local authority preventative resources and respite options fall short
• Transitions and complex needs
  • hospital discharge: care provision and continuity during hospital discharge remain fragmented, requiring closer cooperation between local authorities and health partners
  • younger adults: there is a notable lack of appropriate provision and supported living for working-age adults with complex needs. This negatively impacts young people transitioning out of children's services
  • inappropriate placements: some vulnerable individuals, particularly those with sensory impairments or neurodiverse needs, have been placed out-of-area or in inappropriate care settings
• Commissioning and workforce pressures
  • commissioning challenges: good commissioning of sustainable, high-quality care is crucial for outcomes but rising financial pressures have forced many care providers to hand back local contracts due to unsustainable costs. 

Section 60

• CQC’s assessment reports will make clear any areas that require improvement. Councils are best placed to lead their own improvement. Assessments will consider any improvement actions that a local authority has already put in place.
• If a council is found to be failing to perform its functions under the Care Act to an acceptable standard, CQC must inform the Secretary of State for Health and Social Care. This duty is under section 50 of The Health and Social Care Act 2008.
• Following notification, the Department of Health and Social Care will provide guidance and co-ordinate any improvement or intervention activity with the appropriate organisation (for example, NHS England, the Local Government Association, the Association of Directors of Adult Social Services).  

Adult social care intervention framework for local authorities 

Finance

Adult social care is one of the largest areas of council expenditure. In 2024/25, councils with social care responsibilities allocated around two‑thirds of their budgeted net service spend to adult and children’s social care combined (excluding education, fire and police). It is also the fastest‑growing area of spend, driven by general inflation and increases in the National Living Wage. As a result, it places significant pressure on councils’ finances, absorbing both core council tax capacity and the additional social care precept.

Funding comes from a mix of sources: council tax (including the adult social care precept), business rates, central government grants, and contributions from individuals who are assessed to pay for all or part of their own care. Additionally, the Better Care Fund encourages collaboration between the NHS and local authorities, pooling budgets to deliver integrated care.

Despite these sources, the system is under significant pressure. These pressures include an ageing population, increasing numbers of working-age adults with disabilities, and the need to maintain quality and safety in care provision. At the same time, the cost of care provision is rising, driven by inflation, workforce costs, and the need to maintain quality standards. Councils are legally required to set a balanced budget, which means difficult decisions often must be made about which services can be funded and at what level. 80 per cent of councils overspent on adult social care in 2024/25, up from 72% in 2023/24 (ADASS Spring Survey)

Safeguarding

The Care Act 2014 established legal duties for safeguarding adults at risk in England, requiring local authorities to protect those with care needs who are experiencing or at risk of abuse/neglect and unable to protect themselves. Types of abuse and neglect include physical, emotional, sexual, financial, organizational abuse, neglect, modern slavery, discrimination, and self-neglect.

Safeguarding under the Act focuses on empowering individuals, preventing harm, promoting wellbeing, and ensuring proportionate responses, involving a legal framework for enquiries, Safeguarding Adults Boards (SABs), and Safeguarding Adults Reviews (SARs) for serious cases, all rooted in principles of dignity and control. 

Safeguarding Adults Boards (SABs), which bring together key partners like the NHS, police, and voluntary sector to ensure a joined-up approach.
The Government has recently committed to establishing a National Adults Safeguarding Board.

Workforce

Key objectives for the sector include improving recruitment and retention, ensuring fair pay and conditions, developing clear career pathways, and building a workforce that reflects the diversity of the communities it serves. There is also a strong focus on professional development, wellbeing, and creating inclusive, supportive working environments.

Issues with recruitment and retention are driven by factors such as low pay, limited career progression, and high levels of stress and burnout. Many care workers are employed on zero-hours contracts, and the sector struggles to compete with other industries for talent. Vacancy rates in adult social care are significantly higher than in other sectors, including the NHS. 

Workforce shortages are compounded by an ageing population and increasing complexity of care needs, placing greater pressure on services. Councils have increasingly relied on international recruitment to fill gaps, but recent visa restrictions and concerns about ethical employment practices have raised questions about the sustainability of this approach.

Strategic workforce planning can help councils anticipate future service needs, align staffing with demand, and invest in the right skills and roles to deliver high-quality care. It supports sustainability by identifying gaps, guiding recruitment and training, and ensuring the workforce is resilient, diverse, and equipped to meet evolving challenges. 

Commissioning

Under the Care Act 2014, councils must commission adult social care services that promote wellbeing, prevent or delay the need for care, and support a diverse, high‑quality care market. Commissioning includes assessing needs, planning services, procuring providers, and monitoring outcomes to ensure people receive the right support at the right time.

Adult social care is often the largest employer within a local area, shaping thousands of jobs and the wider care economy. This scale brings a responsibility to maintain strong quality assurance, support provider resilience, manage market risks, and ensure services meet statutory duties and deliver positive outcomes.

Financial pressure remains a major challenge. Rising demand, increasingly complex needs, and limited budgets make it difficult to sustain high‑quality provision. Councils must balance affordability with paying fair rates to providers, especially amid workforce shortages and inflation.

Market fragility is also a concern, with many providers operating on thin margins, particularly in residential and domiciliary care. Councils work to shape and stabilise the market to ensure it remains diverse, sustainable, and responsive to local needs.• Integration with health, housing, and community services is increasingly important, creating opportunities for co‑designed services, shared budgets, and aligned priorities. Achieving this requires overcoming organisational differences and coordinating commissioning approaches.

Commissioning must remain person-centred and outcomes-focused, involving service users and carers in co-design and co-production and evaluation. This includes embedding continuous improvement, safeguarding, and equity in all aspects of commissioning.

Organisations

Partners in Care and Health (PCH)

Social Care Institute of Excellence (SCIE)

Think Local Act Personal (TLAP)

Skills for Care

Department of Health and Social Care (DHSC)

Care Quality Commission (CQC)

Briefings

Local Government Reorganisation (LGA)

Adult social care: key facts and figures (The King's Fund)

Councillors and care (21st Century Public Servant)

A councillors guide to the health system in England (LGA, May 2014)