Social care 'postcode lottery' shows huge variation in support across England
Official figures on requests to local authorities for social care support for adults showed a stark difference depending on where someone lived
A “postcode lottery” in social care underlines the need for long-term national reform, a coalition of charities has said as analysis suggested the likelihood of not getting support can triple depending on which area of England someone lives in.
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With Prime Minister Andy Burnham having vowed to “put everything I’ve got” into tackling difficult issues such as fixing adult social care, the Care and Support Alliance (CSA) said the opportunity for lasting reform is available and told council leaders they “must not let it pass”.
The CSA said its analysis of official figures on requests to local authorities for social care support for adults showed a stark difference depending on where someone lived.
The East Midlands and South East had the highest rate of applications ending in no support being provided, at 75%, according to the CSA analysis of Department for Health and Social Care data between the beginning of April 2024 and the end of March 2025.
The lowest regional rate was in the West Midlands, with just under two thirds (62%) of requests ending in this way on average.
But the CSA said the rates also differed within regions, varying greatly between different council areas.
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Results for London showed the proportion of requests not leading to formal care and support ranged from 30% in one borough to 91% in another, which the CSA said meant two people with similar care needs living just a few miles apart “can face vastly different experiences when they ask for help”.
While the gap in support between council areas was narrowest in the North East, it still ranged from 46% to 76% depending on where in that region someone lived, the CSA said.
In some cases a request might be withdrawn or end in no provision of support because the person has died.
But while the coalition accepted there will generally be some variation between councils in terms of support requests being met – reflecting differences in local communities and patterns of demand – “the scale of the differences revealed by the data raises serious questions about fairness”.
The CSA has written to councils stating: “These challenges are not unique to your area and are reflected across England. Too many people are left without the care and support they need, while others face very different charges depending on where they live.
“This postcode lottery is unfair for the people who rely on care and support and unpaid carers, and underlines the need for long-term national reform.”
Caroline Abrahams, Emily Holzhausen and Jackie O’Sullivan, CSA co-chairs, said councils are facing a daily challenge of “trying to balance rising demand, increasingly complex needs and growing costs against budgets that simply have not kept pace”.
They added: “But this is not a problem councils can solve on their own. Local leaders cannot be expected to overcome decades of underinvestment or fix a fundamentally unsustainable system one council at a time.
“That is why we are writing to council leaders across England and asking them to join us in making the case for change. The only way to end this unfairness is through national action, backed by sustainable funding that enables every council to provide the care and support its community needs.”
They welcomed Mr Burnham’s emphasis on a cross-party approach being necessary to fix social care, and the launch of a public survey “to build consensus about what people should be able to expect from a modern care and support system before decisions are made about how it should be funded”.
The CSA said: “Council leaders have a vital role to play. They see these challenges every day and have an important voice within local government and across the political spectrum.
“We hope they will help encourage local people, unpaid carers and community organisations to take part in the Big Conversation, while continuing to make the case for the sustainable national settlement that adult social care has needed for far too long.
“The opportunity for lasting reform is here. We must not let it pass.”
Last month, Mr Burnham – during a visit to a care home – said “difficult, difficult decisions” could be needed on tax but insisted fixing the current problems in social care in England could save the NHS billions of pounds a year.
The PM said it was a “major dereliction of public duty” that successive governments had failed to address the crisis in social care.
Baroness Louise Casey’s review of social care is expected to publish a phase one report in autumn and a final report next year, with recommendations for reform.
A spokesperson for the Local Government Association, which represents local councils, said most variation in care “stems from factors such as different levels of affluence or deprivation in the local population, differences in how healthcare is delivered, and how local care providers operate”.
They added: “The funding model for adult social care has fully outgrown itself and needs reform. We believe the Government should make the case to the public for a comprehensive funding solution for adult social care, ensuring any National Care Service strengthens appropriate consistency, not replacing local democratic leadership.
“Local government and its convening powers are essential to making adult social care reform work and stick. We look forward to working closely with government and Baroness Casey’s independent commission exploring all options for system reform.
“Successful reform of adult social care will require a new partnership between national government, local government and the public. It will ultimately be judged by whether people who draw on care and support are better able to remain connected to the people, places and passions that matter most in their lives.”
A Department of Health and Social Care spokesperson said: “The Prime Minister has convened political leaders to build a consensus for reform, and Baroness Casey’s Big Conversation on Care is inviting the public to put forward their own experiences and ideas on what a National Care Service should deliver.
“In the interim, we have made over £4.6 billion additional funding available for adult social care in 2028-29, we are establishing the first ever fair pay agreement for care workers, and we have published a cross-government unpaid carers’ action plan to better recognise those looking after loved ones, and give them the support they need.”