A study examining how having a registered carer affects adult health and social care utilisation and costs across care settings.
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This study challenges common assumptions about the role of informal (unpaid) carers in health and social care systems. Rather than reducing service use, the presence of a carer is associated with higher costs and increased access across care settings, particularly within social care.
The findings suggest that carers play an enabling role, acting as advocates and coordinators who help individuals navigate complex systems and access support. In this sense, carers often address unmet needs rather than replacing professional care.
From a care equity perspective, the study raises concerns about individuals without carers. Lower service use among this group may reflect barriers to access rather than lower need, pointing to potential inequities in how support is reached and received.
The evidence highlights the need for policy approaches that recognise carers as part of the wider care system while also addressing gaps for people without informal support. Better integration, support and identification of caring relationships may help reduce inequities in access, experience and outcomes.
Economic analysis examining the costs and benefits of improving digital skills and reducing digital exclusion in the UK, including implications for public services such as health and care.
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This report provides an economic assessment of digital inclusion in the UK, focusing on the potential benefits of improving digital skills across the population. The analysis frames digital inclusion as a key component of economic participation, with implications for productivity, employment and the use of public services.
The findings suggest that improving digital skills could also generate savings for the NHS, partly through increased use of online services and reduced demand for in-person appointments. This reflects the growing role of digital channels in accessing health information, services and administrative processes.
From a care equity perspective, the report highlights the risk that digitalisation of services may disadvantage people without access to digital skills, devices or connectivity. Older adults and individuals with lower digital literacy are projected to make up a significant proportion of those who remain digitally excluded in the future. Without targeted support, these groups may face increasing barriers to accessing health and social care services that are delivered or coordinated through digital systems.
Overall, the analysis reinforces the argument that digital inclusion should be treated as a core public infrastructure issue. Investments in digital skills, connectivity and support services may help reduce exclusion from digital health and care services while improving the efficiency of public service delivery.
An analysis of how austerity-driven funding reductions have affected the capacity, accessibility and delivery of mental health services in the UK.
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This paper examines how austerity policies have reshaped the provision of mental health services in the UK. It shows that reductions in funding have constrained service capacity at a time when demand for mental health support has continued to rise. These pressures have resulted in stricter eligibility thresholds and greater reliance on crisis-based care.
The findings highlight how financial decisions affect the balance between preventative and reactive services. Cuts to early intervention and community support mean that individuals often receive help later, when needs have become more severe. This shift places additional pressure on hospital services and emergency care pathways.
Workforce shortages and reduced investment in community-based support further contribute to this pattern. When services are under-resourced, staff capacity declines and waiting times increase, reinforcing a system that responds to acute crises rather than preventing deterioration in mental health.
In relation to care equity, the study demonstrates how austerity measures can widen existing inequities in access to mental health support. Communities already experiencing socioeconomic disadvantage are more likely to face barriers to timely care, leading to greater reliance on emergency services and poorer long-term outcomes. These dynamics highlight how financial policy decisions can shape not only service availability but also the distribution of care across different populations.
Overall, the paper argues that sustained investment in mental health services, particularly in community-based and preventative approaches, is essential to avoid deepening inequities in access and outcomes.
A cross-sectional study examining whether social care funding for people with intellectual disabilities is distributed equitably across English local authorities.
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This study identifies a clear equity issue in the distribution of social care funding for people with intellectual disabilities. Local authorities with higher levels of deprivation support more individuals with intellectual disabilities but do not receive or allocate proportionately greater resources. This mismatch between need and funding creates a structural disadvantage for people living in more deprived areas.
From a care equity perspective, this finding is particularly significant. When funding does not reflect population need, local authorities face constraints in service availability, workforce capacity and quality of provision. Over time, this risks entrenching place-based inequities, where access to adequate support depends on where a person lives rather than their level of need.
The absence of effects related to rurality or political leadership suggests that these inequities are systemic rather than incidental. This points towards national funding mechanisms that insufficiently weight deprivation and prevalence, rather than local decision-making alone. As a result, local authorities with the greatest challenges may be least able to respond effectively.
For people with intellectual disabilities, these structural funding gaps can translate into reduced access to personalised support, longer waiting times and greater pressure on families and unpaid carers. Without adjustment, funding arrangements risk reproducing inequality rather than mitigating it.
Addressing these inequities requires a shift towards needs-based resource allocation that explicitly recognises socioeconomic context. Ensuring equitable access to social care for people with intellectual disabilities depends not only on local practice, but on national systems that distribute resources in line with demand and complexity of need.
A policy analysis exploring the potential benefits and challenges of introducing a universal system of social care that is free at the point of need in England.
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This report examines the policy case for making social care free at the point of need, drawing comparisons with the NHS model of universal access. It argues that the current means-tested system places significant financial responsibility on individuals and families, often requiring people to use personal savings or assets to pay for care.
The analysis suggests that removing financial barriers could improve access to care and reduce uncertainty for people seeking support. By shifting toward a universal model, the system could become simpler and more transparent, with fewer administrative hurdles related to financial assessments.
The report also considers the potential impact on wider public services. Earlier access to social care may reduce the likelihood of hospital admissions and delayed discharges by ensuring people receive support before needs escalate.
From a care inequities perspective, the report highlights how the existing means-tested system distributes financial risk unevenly. People with moderate assets may face significant care costs while others receive publicly funded support, creating uneven financial burdens across the population. A universal system could reduce these inequities by ensuring that access to care is based on need rather than financial means.
Overall, the report contributes to debates about how social care should be funded in England. While acknowledging the scale of investment required, it argues that universal provision could improve fairness in access to care and reduce financial inequities within the current system.
A policy analysis examining the financial pressures facing local authority-funded social care for older people in England and the consequences for access, workforce stability and service sustainability.
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This report examines how sustained reductions in local authority funding have reshaped the availability of social care for older people in England. It documents a widening gap between rising demand for care and the resources available to meet it, resulting in tighter eligibility thresholds and reduced service provision.
The analysis also highlights the interconnected nature of the health and care system. As access to social care becomes more limited, pressures shift to other services, particularly hospitals and community health teams. These dynamics demonstrate how financial decisions in one part of the system can generate costs and challenges elsewhere.
Financial pressures also affect workforce stability and the viability of care providers. Low pay and constrained funding limit providers’ ability to recruit and retain staff, while thin financial margins increase the risk of service closures or provider failure.
In terms of care equity, the report highlights how funding reductions can produce uneven access to support across different areas. Local authorities with greater financial constraints may restrict services more sharply, meaning older people in some communities face greater barriers to care than others. These patterns risk widening inequalities in who receives support, the quality of services available and the degree to which individuals must rely on informal care networks.
Overall, the report shows that financial sustainability is closely tied to fairness in access to care. Without stable funding for local authority social care, pressures on families, providers and the wider health system are likely to increase, reinforcing existing inequalities in support for older people.
An analysis of trends in social care demand and access in England, highlighting the relationship between increasing requests for support and financial eligibility thresholds.
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The Social Care 360 analysis provides insight into trends in requests for adult social care support across England. The data show a continued rise in demand, with both working-age adults and older people seeking support in greater numbers.
While requests for support have increased, the report notes that the financial eligibility thresholds used in the means-testing system have not been updated to reflect inflation. As living costs rise, this can affect the number of people who qualify for publicly funded care.
The findings suggest that individuals whose financial circumstances fall just above the eligibility threshold may face increasing costs if they require care. For some households, this may lead to greater reliance on privately funded care or unpaid support from family members.
From a care equity perspective, the interaction between rising demand and static means-test thresholds may widen differences in access to care. Individuals with modest assets may not qualify for state support yet may struggle to afford private care, potentially leading to unmet needs. Adjusting financial eligibility rules to reflect economic conditions could help reduce these inequities and improve access to support based on need.
Overall, the report highlights the importance of aligning financial eligibility criteria with broader economic trends. Without periodic review, means-testing arrangements may become increasingly misaligned with the financial realities faced by people seeking social care.
A parliamentary inquiry examining the health and social care challenges faced by rural communities in England, including access barriers, workforce shortages and funding pressures.
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This parliamentary inquiry highlights the challenges faced by people living in rural communities when accessing health and social care services. Around 9.7 million people live in rural areas in England, many in small villages and isolated communities where services are more spread out.
Distance is one of the main barriers. People in rural areas often have to travel further to reach hospitals, GP services or social care support. Public transport options are often limited, meaning access to care may depend on having a car or support from family members. These barriers can be particularly difficult for older people, people with disabilities and unpaid carers.
Workforce shortages also contribute to care inequities in rural areas. Health and social care providers often find it harder to recruit and retain staff in rural locations. Staff may need to travel long distances between patients, and smaller local services may struggle to maintain stable teams.
Funding arrangements can reinforce these inequities. Delivering services across large rural areas is often more expensive, but existing funding systems do not always account for these additional costs. As a result, services in rural areas may receive fewer resources relative to the challenges they face.
Another issue highlighted in the report is that rural disadvantage is often less visible in national statistics. Because poverty and health needs are more dispersed across rural communities, they may not appear clearly in standard deprivation measures. This can make it harder for policymakers to identify where support is needed.
Overall, the inquiry argues that addressing rural care inequities requires policies that recognise the specific challenges of rural areas. Improvements in funding, workforce support, transport and community-based services are needed to ensure that people living in rural communities can access health and social care on fair terms.
A study examining how austerity policies affected English city governments and how reductions in local authority funding were passed on to poorer communities through changes to services and public spending.
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This study examines how austerity policies affected local government services in English cities and how these financial pressures ultimately affected poorer communities. The research combines national financial data with detailed case studies of several English local authorities to understand how funding reductions translated into changes in services.
Between 2010 and 2015, English local authorities experienced significant reductions in their spending power. The study shows that these reductions were not evenly distributed. Councils serving more deprived populations tended to lose a greater share of their funding because they relied more heavily on central government grants. When these grants were reduced, the financial impact was larger for poorer areas.
One important finding is the erosion of the historic principle of equalisation in local government finance. This principle aimed to compensate poorer councils for the higher levels of social need they faced. As austerity policies reduced this funding premium, poorer councils became less able to provide services at levels comparable with more affluent areas.
The research also highlights how the structure of local government spending affects how cuts are experienced. Many services provided by local authorities are used more frequently by lower-income households. Because these services make up a large share of council spending, it becomes difficult for councils to protect them completely when budgets are reduced.
Even services used by all residents can affect disadvantaged communities more strongly when they are reduced. For example, cuts to libraries, parks or neighbourhood maintenance may have greater consequences for households with fewer private resources or alternatives.
From a health and social care equity perspective, the study demonstrates how funding decisions made at national level can influence the distribution of services at local level. When deprived cities lose more resources, their ability to support vulnerable populations may decline.
Overall, the study shows that austerity policies can produce uneven impacts across places and populations. Without mechanisms that account for differences in local need, reductions in local government funding risk reinforcing existing social and geographical inequities.
A study examining why social care reform has progressed unevenly across England, Scotland, Wales and Northern Ireland, highlighting the political and institutional factors that shape policy change.
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This study explores why social care reform has progressed unevenly across the four nations of the UK. Despite widespread recognition that the current system needs reform, many proposed changes have been delayed or only partially implemented.
The authors use the concept of policy drift to explain this pattern. Policy drift occurs when existing policies remain in place even though social needs and pressures have changed. In the context of social care, demographic ageing and rising care needs have increased pressure on systems that were not originally designed to cope with these demands.
The research compares England, Scotland, Wales and Northern Ireland, each of which has responsibility for its own social care system following devolution. Although these systems share common origins, they have developed in different ways over the past two decades.
Scotland has taken the most significant steps towards reform. In 2002 it introduced free personal care for older adults, a policy that later expanded to include working-age disabled people. This approach represents a form of “risk pooling”, where the costs of care are shared across society rather than falling mainly on individuals.
England has experienced greater delays in reform. Although legislation introduced in 2014 proposed a cap on the amount individuals would have to pay for care, the policy was repeatedly postponed due to financial and political concerns. Wales and Northern Ireland have made some changes to funding arrangements but have also faced institutional and political barriers.
The study identifies several factors that can lead to policy drift. These include the high cost of reform, political disagreements between parties, the complexity of the social care system and competing policy priorities. In England, these factors have combined to slow progress more than in the other UK nations.
From a health and social care equity perspective, the findings show how differences in political systems and policy decisions can lead to uneven social care arrangements across the UK. People living in different nations may face different rules around care funding and access to services.
Overall, the study highlights how institutional and political factors shape the pace of social care reform. Without sustained political commitment and agreement on funding solutions, policy drift may continue to delay reforms designed to protect people from the high costs of care.
