Social care postcode lottery: King’s Fund reveals wide local variations in access to long-term care as it launches radical social care reform proposals

The proportion of people accessing long-term social care varies substantially even between similar local authorities, with some areas supporting up to twice as many people per 100,000 than their nearest statistical neighbour', new analysis from The King's Fund has revealed.

The analysis found that over half (59%) of local authorities had access rates publicly funded to long-term care that were at least 20% above or below those of their nearest 'statistical neighbour' (councils with similar social and economic profiles), for working age and/or older adults. 

The extent of these differences shows that social care reform should include an equal access' national assessment to eliminate the risk of a postcode lottery, says The King's Fund.

The King's Fund will today (12^th October) set out its recommendations on how to reform the social care sector in the midst of a new drive for action by the Prime Minister, who has brought forward the reporting timetable for Baroness Casey's review to 2027 and at Labour Party Conference set out his vision of a high-quality National Care Service to give peace of mind in later life'.

Further major reforms advocated by The King's Fund include:

• universal access to publicly funded care, but with co-payments from users
• a cap on lifetime care costs
• national, rather than local, funding for social care
• clear individual entitlements to social care support

The think-tank said that together its social care reform proposals would cut unwarranted variation in access, ensure that everyone in need of social care would be entitled to at least some state-supported help, raise money more fairly for social care and give people greater freedom over how they received their support. It would also change the role of local authorities, who currently manage social care access, from gatekeepers' of public funds to organisations that help people find the care they need and join it up with health and other public services.

The public spending required for the new system and the extent of co-payments expected of people receiving services would be set every five years during projections of required long-term care expenditure.

The King's Fund analysis found variation between statistically similar councils varied up to 101% for working-age adults and up to 60% for people over 65. In Thurrock, 7,680 older people per 100,000 accessed long-term care. In contrast, its nearest 'statistical neighbour', Medway had only 4,810. This means Thurrock has 60% more older people accessing care, relative to the older population, than Medway despite being demographically and economically similar. For working age adults, however, Thurrock had 10% fewer people access care than Medway. 

There are other standout differences, such as between Torbay Council and Telford and Wrekin, with the former having a 101% higher access rate for working-age adults, and a 24% higher access rate for adults over 65. In Salford, the access rate for older adults was 52% higher than in Southampton, and 20% higher for working-age adults.

Meaningful comparison between local authorities must happen between those that have a similar socio-economic profile. A statistical model used by the Ministry of Housing, Communities & Local Government (MHCLG) lists local authorities' nearest statistical neighbours', considering factors including deprivation, disability prevalence and median income. Using this model, The King's Fund compared access to social care between statistical neighbours and found large variations in the proportion of adults accessing long-term social care support.

The King's Fund said that the reasons for variation are likely to be due to a combination of factors including different levels of need, levels of wealth, the model of provision and levels of council resource, caused by differing abilities to raise money from council tax. It said that while all councils must assess people's needs for care using national eligibility criteria, in practice there was enough subjectivity in these assessments to mean that people with the same level of need might experience different outcomes in different local authorities.

Simon Bottery, co-author of the work and Senior Fellow for Social Care at The King's Fund, said:

'A national care service, which the Prime Minister has promised, must be genuinely national and ensure that all people, wherever they live, have the same access to social care support.

Our new proposals for an equal access' national assessment would help prevent this issue of unwarranted variation and ensure that access to social care support is not decided by your postcode.

But reform must go further than that and ensure that there is universal access to at least some publicly funded support, with a cap on the cost people are expected to pay to ensure that no one faces huge lifetime care bills. Currently, one in seven people aged 65 will spend at least £100,000 in lifetime care costs.

We must also introduce fairer, national funding of social care, with greater choice and control for people and their families over how their care needs are met.

The Prime Minister and Baroness Casey's commitment to reform is clear but we are still awaiting the concrete policies that will turn this vision into a reality. To achieve that, their proposals will need to focus not just on who pays but on how the wider system operates on the ground.

What The King's Fund has set out today can begin to plug these gaps and help politicians and the public decide what type of social care system they want to see. There is still a long way to go to tackle one the great unresolved policy problems of our generation but we are at least on the road towards reform and we hope the work we have put forward will help build the fairer and more effective system that has been promised.'

ENDS

Notes to Editors:

The King's Fund analysis can be seen here. A map of local authorities showing the % difference in access rates can be seen here, and a dot plot data visualisation showing the spread of variation can be accessed here.

Notes on data: Because access rates among under-65s are lower overall, percentage differences can appear larger even where the actual numerical gap is smaller. Conversely, because access rates are higher for over-65s, absolute differences in rates are larger for this group. We therefore report on both the numerical gap and the percentage difference.

The MHCLG nearest statistical neighbours' model was developed with the ONS to complement the Local Outcomes Framework. It includes 21 indicators ranging from education rate to digital connectivity; the full list can be found here. Note that nearest statistical neighbours are not necessarily symmetrical: for example, Torby's nearest neighbour is Telford and Wrekin, but Telford and Wrekin's nearest neighbour is Sefton.

Explainer on social care: In England, 153 upper tier' and unitary' local authorities make decisions individually about whether people are entitled to state-funded care or not. These decisions are based on an assessment of both people's means their savings and assets and their needs.

Under the 2014 Care Act needs test', to identify whether people qualify for support local authorities are required to assess whether people have a physical or mental illness or a disability, whether this leaves them unable to achieve two or more outcomes (such as maintaining personal hygiene, going to the toilet, getting dressed, preparing food and maintaining relationships with friends), and whether this has a significant impact on their wellbeing.

Local authorities on average spend around 40% of their total annual budget on providing adult social care support. Most spending on adult social care comes from local authorities' own budgets, which are made up of locally raised revenues such as council tax and business rates, alongside grants from central government. Local authorities have a legal duty to balance their budgets.

Research by the Institute for Government in 2025 found lower rates of access to care in local authorities that have larger older populations, implying that local authorities ration' care when a larger proportion of the population is older.

The government has established the Casey Commission to make recommendations on social care reform. It has recently launched a Big Conversation' allowing members of the public to give their views.