The Widening Disparities in Adult Social Care

A new report from the Institute for Government, Adult Social Care Across England, reveals stark and growing inequalities in access to publicly funded adult social care, with older adults facing the greatest disparities. The report, part of the Performance Tracker Local series supported by the Nuffield Foundation, finds that care provision increasingly depends on where a person lives — not just their level of need or financial means.

Key findings include:

• Access to long-term care for older adults (65+) has halved since 2003/04 —falling from 8.2% to just 3.6% in 2023/24.
• There is wide variation in access across the country. In 2023/24, the proportion of older adults receiving long-term care ranged from 2.0% to 8.8% depending on local authority.
• Local authorities with larger older populations tend to provide care to a smaller share of those residents, indicating that care is being rationed in areas with high demand.
• Where access is lower, unpaid carers — often family members, women, and lower-income individuals — step in to fill the gap.

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Read the full report here

RSN Response: Implications for Rural Areas

While the report does not focus specifically on rural England, its findings have clear and serious implications for rural communities, where populations are older, health needs are higher, and formal services are more limited.

The Rural Services Network notes that:

• Rural areas often have a higher proportion of residents aged 65 and over, making them particularly vulnerable to the kind of service rationing highlighted in the report.
• Geography and workforce constraints can make it harder for rural local authorities to meet statutory care duties — yet the funding formula does not fully reflect these additional pressures.
• Access to care is not just about eligibility — it is also about availability. In dispersed rural settings, even eligible individuals may face long waiting times or unviable distances to access services.
• As the report shows, where formal provision declines, the burden shifts to unpaid carers. In rural areas, this often falls on neighbours, spouses, or adult children — many of whom may be older themselves or juggling work and caring responsibilities.

RSN Chief Executive Kerry Booth said: "This report reinforces what many rural councils and communities already know: that access to adult social care is being squeezed, and the effects are felt hardest in places where demand is high but funding is limited. For rural areas, where populations are older and services already thinly stretched, the need for fairer, needs-based funding is urgent. Without action, rural residents risk being left behind in a system that should provide support based on need — not postcode".