Shifting health and care from hospital to community in jeopardy after new report

Efforts to move healthcare out of hospitals and into community settings are under serious threat, according to a new report from the Association of Directors of Adult Social Services (ADASS).

Local authority leaders warn that unless urgent action is taken, the Government’s aim to support more people to live independently at home could collapse under growing financial pressures.

The annual ADASS survey of adult social care directors reveals that councils are being forced to scale back early intervention and preventative support services—vital tools for maintaining health and wellbeing in the community. Instead, overstretched budgets are being redirected to meet the rising cost of crisis care and support for those with the most urgent needs.

This shift away from prevention undermines the Government’s stated focus on neighbourhood-based care and population health. According to the report, local authorities have cut spending on preventative services by more than 10% in the past year alone.

Jess McGregor (pictured), ADASS President and Director of Adult Social Care in Camden, said “the maths simply doesn’t add up”.

“More people are coming to councils for help and their care is complex and costly, which means we don’t have funds left to provide the early support and prevention that would stop people’s health from deteriorating and help them avoid spiralling into crisis, where they frequently end up in hospital.”

Directors estimate that councils overspent their adult social care budgets by a staggering £774 million last year—the highest overspend in a decade—as they struggled to fulfil their legal duties. With no additional funding in sight, many councils are now expected to tighten eligibility criteria, leaving even less room for investment in services that could save money in the long run and deliver better outcomes for people.

Among the biggest financial pressures cited in the report are increasingly complex care needs. As people live longer with multiple health conditions, care packages have become more intensive—often requiring multiple daily visits, support from more than one carer, or significant home adaptations.

The increase in costs has not been accounted for by the Government in the latest Spending Review. It saw social care receiving up to £4bn additional funding by 2028/29 (compared to 2025/26). But uncertainty remains around what this amount covers, including the potential for it to need to be used to pay for measures like a much needed but costly Fair Pay Agreement for care workers. It comes after costly increases in employers’ national insurance contributions and the national living wage, plus inflation, which have pushed the cost of care up. It also assumes that every council will increase council tax by 5% to fund that additional spending.

“We shouldn’t have to choose between helping people with complex needs now and preventing others from getting unwell – we need to support people at both ends of the social care spectrum,” Ms McGregor added. “But without more investment to keep people well and independent at home, we risk undermining the shift towards prevention and neighbourhood health that Wes Streeting, the NHS and this Government are rightly championing.”

Compounding the strain, three-quarters of Directors report a continued rise in the number of people approaching councils for support with complex needs that would previously have been met through NHS Continuing Healthcare (CHC) funding. The report highlights a postcode lottery in CHC decisions, with people’s access to free care varying significantly by region.

The blurred lines between health and social care are also raising concern. Care workers are increasingly being asked to perform tasks traditionally carried out by NHS staff—often without appropriate training or funding. Worryingly, 100% of Directors surveyed believe that pressures on the NHS will further intensify demand on social care services over the next year.

In response, ADASS is calling for immediate investment and a long-term funding solution to ensure councils can both meet urgent needs and rebuild the early support services essential to preventing ill health and reducing hospital admissions.