The Kings Fund Social Care 360 Review

The Social Care 360 review by The King's Fund has been released and as always, offers an in-depth analysis of the current state of social care, highlighting key issues and areas for improvement.

I thought I would dive right in and summarise the findings:

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Funding Challenges

The report starts by exploring the pressing issue of the the funding crisis within social care which is impacting care providers and is leading to a reduction in the number of people receiving social care support.

Access to Care

After a fall in 2020/21 during the Covid-19 pandemic, when requests from older people fell sharply, requests have returned to the general trend seen since 2015/16 of increasing demand for social care services.??

Around 4 in 5 requests originate from the community and 1 in 5 from hospital discharge . The total number of new requests for social care support in England rose in 2023/24, particularly from working-age adults.

The total number of new requests for social care support in England rose in 2023/24, particularly from working-age adults and whilst the number of people receiving support is starting to increase, financial eligibility criteria continue to tighten. This means that many individuals who need care are unable to access it due to financial constraints.

Expenditure

Spending on social care is on the rise, driven primarily by higher provider costs, especially staffing costs. This increase in expenditure is necessary to maintain the quality of care but poses a significant challenge for local authorities and care providers.

For working-age adults, nearly two-thirds of money was spent on community-based care, whereas for older adults, nearly two-thirds was spent on care homes

Workforce and Carers

The review highlights a mixed picture for the social care workforce. On the positive side, vacancies have decreased due to an increase in overseas staff. However, care worker pay remains low compared to other jobs, which affects recruitment and retention.

It is good to read that the social care vacancy rate in England is falling but remains higher than the overall unemployment rate. At 8.1%, the vacancy rate in the independent sector of adult social care was still the third highest it has been since Skills for Care began collecting data in 2012/13.?

Whilst it was mainly good news for paid carers in the sector, it is a different story for unpaid carers, with fewer receiving direct support. Looking at the second graph below in this section, this highlights the support being offered and whilst the increased lack of direct support does not surprise me based on what I see and hear everyday, in 2025, this should absolutely not be the case and unpaid carers are the backbone of Health and Social Care, propping them both up from falling over. Data in this report shows that Unpaid carers – usually, but not always, family members – contribute the equivalent of four million paid care workers to the social care system.

Quality of Care

Ratings have been relatively stable since 2018 when the initial programme of inspections under a new ratings framework was completed, though there has been a small overall improvement, with the percentage of inspected services rated good or outstanding increasing from 80.9% in April 2018 to 83.2% in April 2023.

I was surprised to see the report was not transparent about the failures of the CQC and the decline in the overall number of inspections that are taking place as this is a huge factor affecting the sector, across Health and Social Care services. For members of the public reading this report who may not be aware, this is something that I feel should have been included.

Direct Payments

The number of people in England receiving direct payments has stabilised since the fall in numbers. The number of people using direct payments increased slightly from 117,000 in 2021/22 to 117,500 in 2022/23. However, the proportion of people receiving long-term care who used direct payments fell from 27% to 26%.

There is likely to be more than one reason for this. Opting for a direct payment requires more involvement and responsibility than simply receiving a service, and people may need support to manage one. Equally, if there is limited choice of local services on which to spend a direct payment, people may wonder whether it is worth the extra work.

Recommendations

The Social Care 360 review makes several key recommendations to address the challenges facing the sector:

• It is crucial for the government to avoid repeating past funding mistakes. Fully reimbursing the costs of new measures is essential to prevent a return to reduced care provision.
• Establishing a sustainable funding model for social care is vital to ensure that everyone who needs care can access it.
• Improving pay and conditions for care workers is necessary to attract and retain a skilled workforce.

You can read the full report here