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The rise in employers’ national insurance contributions (NICs), which came into force yesterday (6 April 2025), risks causing harm to people with care needs and more strain for carers, care provider leader have warned.

Sector associations have claimed that many services face closure, leaving people without much-needed care, due to employers now paying a NICs rate of 15%, up from 13.8% previously, on employee earnings above £5,000 a year, down from £9,100.

But while public sector organisations had their increased costs covered, this was not applied to the adult social care sector, with the government successfully overturning an attempt by the House of Lords to enact such an opt-out.

Cost of almost £1bn to sector

Think-tank the Nuffield Trust has calculated that the change will cost independent care providers in England an extra £940m in 2025-26, alongside a further £1.85bn from this year’s 6.7% rise in the national living wage (NLW).

Councils should meet about £2bn of the combined £2.8bn cost, said the trust, because they purchase about 70% of care provided by the independent sector.

But while the government has claimed that English councils with adult social care responsibilities will have up to an additional £3.7bn in budget in 2025-26, approximately £1.2bn of this is dedicated to adult social care.

Council fee rises lag well behind cost increases, say providers

The Homecare Association, which represents domiciliary care providers, said that its members faced an average increase in costs of 10% in 2025-26; however, council fee increases were averaging about 5%, based on data it had collected so far.

It said that some councils had frozen fees, while others offering higher percentage rises were starting from a low base.

Last year, it reported that there was a £1bn shortfall between the fees paid by councils and NHS commissioners in England and the amount home care providers needed to pay staff at least the NLW, meet other costs and make a minimum profit or surplus.

Since then, the association’s calculation of the minimum price for home care in England has risen from £28.53 to £32.14 per hour. This is mainly due to the NICs and NLW rises, though it has also uplifted its minimum profit level from 5% to 7% of costs, based on recent research.

‘Risk of harm to individuals and strain on carers’

Commenting on the impact of the increased costs, chief executive Jane Townson said: “We are likely to see an increase in non-compliance with regulations, insolvencies and provider closures.

“This risks harm to individuals; greater burdens on unpaid carers; and more pressure on NHS services. We call on the government to provide adequate funding for vital homecare services.”

Care England chief executive Martin Green offered a similar message, saying fee increases from councils did not reflect the “enormous increases” in cost that providers were facing.

“[This] will drive some services into bankruptcy, and the impact on both people who are supported, and care staff will be catastrophic,” he added.

Bridging fund proposed to mitigate impact on providers

Meanwhile, the National Care Forum (NCF), which represents not-for-profit services, has written an open letter to chancellor Rachel Reeves suggesting a way to mitigate the impact of the NICs rise on providers and prepare the sector for the government’s planned fair pay agreement.

It urged the Reeves to set up a “bridging fund”, equivalent to at least the sector’s losses from the NICs rise, to enable employers to make the transition to the fair pay agreement.

Under this, an Adult Social Care Negotiating Body would be created, to make agreements about the pay, terms and conditions of adult social care workers in England, in a move designed to raise salaries across the sector.

The bridging fund – an idea conceived of by NCF member Methodist Homes – would be allocated based on an organisation’s number of employees and could be paid direct to providers or administered by local authorities, the open letter said.

‘Not too late for government to step in to safeguard services’

NCF policy director Liz Jones said it was “not too late” for the government to address the impact of the employer NICs rise on people who needed care and support.

She added: “Without action, we are concerned that hundreds of thousands of people with learning disabilities, autistic people and older people, as well as their wider communities, will not be able to access the vital services they need to live fulfilling lives as a result of the predicted shrinkage of care and support services resulting from these measures.”

MPs have overturned an exemption for adult social care providers from the forthcoming increase in employer national insurance contributions (NICs), in what leaders have described as a “devastating blow” to the sector.

In a vote today, they rejected House of Lords amendments to the legislation introducing the NICs rise that would have exempted regulated care home and home care providers in England and Wales, along with charitable social care services and health bodies, from the rise.

From April 2025, the rate of employer NICs will rise from 13.8% to 15% and the employee salary threshold at which firms start paying the tax will drop from £9,100 to £5,000 a year.

Public sector organisations, such as councils, are receiving grants to cover the costs of the rise for them, and the Lords amendment was designed to provide similar protection for health and social care providers.

However, the House of Commons overturned peers’ main amendment to the National Insurance Contributions (Secondary Class 1 Contributions) Bill, by 307 votes to 182, today, courtesy of the Labour government’s huge majority in the elected chamber.

Cost of national insurance rise for adult social care

Think-tank the Nuffield Trust has calculated that the NICs rise will cost England’s 18,000 independent adult social care providers £940m in 2025-26.

The government has said that councils with social services responsibilities will be able to help commissioned providers meet these costs through an increase of up to £3.7bn in their funding in 2025-26. This includes an £880m increase in the social care grant, 60% of which has been spent on adults’ services historically, and licence for authorities to raise council tax by up to 5%, with up to 2% ring-fenced for adult social care.

However, this amounts to only £1.2bn in dedicated extra resource for adult social care and, in addition to the NICs rise, providers must also fund the implications for their workforce of a 6.7% increase in the national living wage (NLW) next month.

The Nuffield Trust has calculated that the two measures combined will cost providers £2.8bn in 2025-26, with £2bn relating to council-commissioned care – significantly more than the increase in dedicated resource for adult social services departments in 2025-26.

‘Devastating blow that seals fate of thousands of providers’

Provider leaders reacted angrily to today’s vote, with the Homecare Association and Care England describing it as “a devastating blow that seals the fate of thousands of care providers across our nation”.

The Homecare Association has calculated that its members face a 10% increase in their costs in 2025-26, chiefly due to the rises in employer NICs and the NLW.

Its chief executive, Jane Townson, said: “The government’s refusal to exempt care providers from the [employer NICs increases], while simultaneously failing to provide adequate funding to local authorities, threatens the existence of regulated home care services across Britain. The government is forcing home care providers to choose between breaching regulations or insolvency.”

For the National Care Forum, director of policy Liz Jones said: “In choosing to vote down the amendments that would have protected care and support providers from the devastating impact of the employer’s national insurance contribution changes, the government inflicts a devastating blow on already fragile, underfunded and undervalued essential public services which millions of people, and their families, depend on for vital support.”

‘Funding available to meet social care pressures’

Defending the government’s position in the House of Commons today, Treasury minister James Murray said it could not support the Lords amendments because they would put at risk the funding that ministers intended to raise through the employer NICs rise and put further pressure on the public finances.

“On social care, the government have provided a cash increase in core local government spending power of 6.8% in 2025-26, including £880m of new grant funding provided to social care—funding that can be used to address the range of pressures facing the adult social care sector.”

NHS fees for care homes to fund nursing services will rise by 7.7% in 2025-26, the government has announced.

The increase in NHS-funded nursing care (FNC) will benefit more than 75,000 care home residents in England, said the Department of Health and Social Care (DHSC).

FNC is designed to fund services provided to care home residents by a registered nurse involving either the provision of care, including performing procedures or administering medicines, or the planning, supervision or delegation of such care.

The latest rise, which follows a 7.4% increase last year, will take the standard rate of FNC from £235.88 to £254.06 per week from 1 April 2025. The higher rate, paid to the relatively few residents who received it when the three previous bands were merged in 2007, will increase from £324.50 to £349.50.

Independent providers’ umbrella body Care England said this was the tenth year in which it had worked with the department to ensure that FNC increases reflected the rising costs of care faced by providers.

‘Threat to sustainability of social care nursing’

However, while its chief executive, Martin Green, said that the 2025-26 increase was “a step in the direction”, he warned that the “sustainability” of nursing in social care settings was under threat.

This was as a result of the upcoming rise in employer national insurance contributions – expected to cost providers in England £940m in 2025-26 – and the “shrinking wage gap” between care home nurses and lower-paid staff, due to above-inflation rises in the national living wage.

Care England chief executive Martin Green

Green also referred to the “increasing burden of delegated healthcare tasks”, under which nurses train and supervise care workers to carry out healthcare tasks, such as injections.

He said the rise in the FNC needed to be followed by integrated care boards increasing the rates they pay social care providers for NHS continuing healthcare (CHC) by at least the same amount. CHC involves the full funding of a person’s health and social care by the NHS on the grounds that they have a “primary health need”.

Green added that, without such a rise in CHC rates, “we risk a system where providers simply cannot afford to provide nursing care, which will add to hospital discharge challenges”.

Celebrate those who’ve inspired you

Photo by Daniel Laflor/peopleimages.com/ AdobeStock

Do you have a colleague, mentor, or social work figure you can’t help but gush about?

Our My Brilliant Colleague series invites you to celebrate anyone within social work who has inspired you – whether current or former colleagues, managers, students, lecturers, mentors or prominent past or present sector figures whom you have admired from afar.

Nominate your colleague or social work inspiration by filling in our nominations form with a few paragraphs (100-250 words) explaining how and why the person has inspired you.

*Please note that, despite the need to provide your name and role, you or the nominee can be anonymous in the published entry*

If you have any questions, email our community journalist, Anastasia Koutsounia, at anastasia.koutsounia@markallengroup.com

Providers are holding a day of action in protest against the impact of the autumn Budget on adult social care.

The Providers Unite event today includes a rally at the Houses of Parliament to lobby MPs on the implications for the sector of the increases in employer national insurance contributions and the national living wage (NLW), which are due to come into force in April.

The campaign is calling on the government to review the measures, with 3,900 providers and people having signed a letter to chancellor Rachel Reeves warning that the policies risk “eroding the foundations” of adult social care services.

What are providers protesting about?

In the autumn Budget, in October 2024, Reeves announced:

• A 6.7% rise in the NLW, from £11.44 to £12.21 an hour, benefiting hundreds of thousands of care workers.
• A rise, from 13.8% and 15%, in the contribution rate for employers’ national insurance.
• A reduction in the wage threshold at which employers start paying national insurance, from £9,100 to £5,000 a year.

Estimated £2.8bn in additional costs

Think-tank the Nuffield Trust has calculated that the measures will cost independent care providers in England an extra £2.8bn in 2025-26: £940m in additional national insurance and £1.85bn in extra wage costs.

With councils purchasing an estimated 70% of the care these providers deliver, the Nuffield Trust said authorities would have to find £2bn of this bill.

The government’s finance settlement for councils includes a £880m top-up to the existing social care grant, which can be used on adults’ and children’s services. If councils allocate 60% of this to adults’ services, in line with current practice, this will yield £528m in 2025-26.

Question marks over extra resource for councils

In addition, authorities may increase council tax by up to 2% and ring-fence the proceeds of this for adult social care, raising about £650m and bringing the total amount of extra dedicated resource for the sector in 2025-26 to almost £1.2bn.

Authorities may also raise council tax by a further 3%, without putting the issue to a local referendum, and have also been given a £600m ‘recovery grant’, providing further resource that can be used on adult social care.

However, councils will also need to use much of this money to deal with other pressures, not least in children’s services, while county authorities have warned that they will be receiving very little of the recovery grant because it is distributed based on deprivation.

Social care ‘already underfunded’

Moreover, councils and providers alike have repeatedly warned that the autumn Budget measures will hit a sector that is already underfunded.

For example, last year, the Homecare Association calculated that there was a £1bn shortfall in home care fees paid by commissioners and the amount required by providers in England to pay staff the NLW, meet other costs and make a 5% profit or surplus.

Speaking ahead of the day of action, the association’s chief executive, Jane Townson, said: “Losing access to quality home care risks harm to people needing care, adds burdens to family carers, and piles pressure on an over-stretched NHS.

“Today, we stand united with homecare providers and their care workers with one message: enough is enough. The government’s refusal to exempt our sector from the latest national insurance hikes, coupled with a lack of proper funding for the minimum wage increase, risks devastating disruption of homecare provision.”

Peers vote to exempt care providers for NI increase

On the day of the rally, the House of Lords voted to exempt adult social care providers – along with NHS-commissioned healthcare providers and hospices – from the increase in national insurance contributions.

This was through an amendment to the National Insurance Contributions (Secondary Class 1 Contributions) Bill, the piece of legislation that will bring in the change.

The bill is due to be subject to a final vote in the Lords – at the third reading – before returning to the House of Commons, which will consider amendments to the legislation made by peers in order to agree a final version of the bill.

Sector representative body Care England welcomed the amendment, with chief executive Martin Green saying: “This is a huge moment for the social care sector and a testament to the relentless campaigning from care providers, local trade associations, national bodies, the Care Provider Alliance, and Providers Unite. For too long, social care has been overlooked, but yesterday’s vote proves that when we come together, our voices can no longer be ignored.”

Prospects for success

However, the government is almost certain to use its sizeable majority in the Commons to overturn the amendment on exempting care providers from the national insurance contributions increase. The House of Lords would be unlikely to press its case in relation to the amendment, in that event.

Next month, fiscal watchdog the Office for Budget Responsibility will assess whether the government is on course to meet its fiscal rules: that by 2029-30, it should only be borrowing to invest and that public sector net debt should be falling as a percentage of national income (source: Institute for Government).

The pressures on the public finances means the OBR may judge the government to be on track to miss the first of those rules unless the government takes reparatory action, such as raising taxes or cutting spending (source: Institute for Fiscal Studies).

This hugely limits the prospects for additional investment in services including social care.

Over half of carers say they require more recognition of their needs from councils, amid worsening mental health and high levels of overwhelm, driven by a lack of breaks.

Those were among findings published last week by Carers UK, taken from the charity’s latest State of Caring survey. This was carried out last summer, with responses from 12,500 people, 92% of whom were still in a caring role, with the rest former carers.

Most carers ‘overwhelmed’

Over a third (35%) of carers said they were in bad or very bad mental health, compared with 27% in the charity’s 2023 survey, while 57% said they were often or always overwhelmed.

Of those who felt overwhelmed, two-thirds (65%) attributed this to a lack of breaks; overall, 49% of survey respondents said they needed more time off from their caring role.

Fifty five per cent of respondents said they needed more recognition of their needs from their local authority, up from 46% in the 2023 survey.

Under the Care Act 2014, councils must assess carers who may have support needs, currently or in the future, and meet the needs of those who meet the eligibility threshold through a support plan that should be reviewed very 12 months. Similar rights exist in Wales under the Social Services and Well-being (Wales) Act 2014.

Long waits and lack of support following assessments

Carers UK’s found that 23% of carers had had an assessment in the previous 12 months, though only 41% had sought help from adult social services for their caring role.

Of those who had sought help, 57% said they had experienced long waits for assessments or support.

Of those who had received an assessment, 42% said they had not been supported by their council subsequently, with 31% saying they had been supported and 28% not sure.

Among the group who said they had not received support, almost half (47%) said their assessment had identified support needs, but it had not been provided

Carers surveyed reported issues such as being given a direct payment or a voucher for a sitting service, but not being able to find care workers to deliver these services.

Several said that, contrary to their expectations, they had been signposted to other services rather than offered practical support directly by their council.

Carers UK said this chimed with the national picture in England. It NHS England data for 2023-24 showing that, of 360,815 carers provided with support, or assessed, by councils, 55% were only given information or advice and 15% not directly supported at all.

‘All councils must fulfil Care Act duties’

Carers UK chief executive Helen Walker said: “An increasing demand for social care services, together with a lack of funding for social care means that, all too often, replacement care and respite services are not available when carers need them.

“Far too many carers are not receiving adequate support, resulting in poor mental health and burnout. We need to see a clear plan for long-term, sustainable funding ensuring that all local authorities can fulfil their duties to carers under the Care Act 2014 and all carers can access high-quality social care when they need it.”

The charity also called for the government to urgently invest an extra £1.5bn in breaks and respite care services in England, with equivalent resources for the devolved nations, backed by legislation giving carers a statutory right to regular and meaningful breaks.

It also urged that the government ensure that “robust cross-government support for unpaid carers” was part of the terms of reference of the Casey Commission, set up to develop plans for the long-term reform of social care in England.

Better support for carers ‘should be part of funding solution for social care’

In response to the report, the Local Government Association (LGA) linked the problems it revealed to the need for improved resource for adult social care.

Cllr David Fothergill, Chairman of the LGA’s Community Wellbeing Board said:  “Councils recognise the enormous contribution of unpaid carers who provide vital support for thousands of people every day,” said David Fothergill, chair of the LGA’s community wellbeing board.

“Helping councils to better support unpaid carers should be a crucial part of a long-term and sustainable funding solution for social care.”

The government has granted almost one in five English councils ‘exceptional financial support’ (EFS) to help them balance their books in 2025-26.

Twenty seven of the 153 authorities with social services have been granted EFS, up from 17 last year, reflecting the scale of pressures facing councils in areas including adults’ and children’s services.

The dispensation means the authorities will be able to borrow or use receipts from the sale of assets to fund day-to-day (revenue) expenditure; typically, these may only be used to fund capital projects, such as new buildings or infrastructure.

Requirement to balance books

By law, councils must balance their books each year. EFS is generally designed to prevent authorities from having to issue a so-called “section 114 notice”, declaring that they are unable to set a balanced budget, a move typically followed by deep cuts to non-statutory services, often overseen by government troubleshooters.

The 27 authorities include all six of those who have been permitted to raise council tax by more than 4.99% without having to gain the consent of local citizens through a referendum: Birmingham, Bradford, Newham, Somerset, Trafford and Windsor and Maidenhead.

Birmingham has been granted the highest level of EFS for 2025-26 (£180m), followed by Croydon (£136m) and Bradford (£127.1m).

Mixed views on generosity of council finance settlement

There are mixed views on the generosity of the government’s finance settlement for councils for 2025-26, which was confirmed earlier this month.

According to think-tank the Institute for Fiscal Studies (IFS), if all authorities increased council tax by the maximum permitted without a referendum, funding for English councils would rise by £4.3bn in 2025-26, which it described as a “substantial cash-terms increase”.

Authorities would also be able to make use of an extra £1.1bn through a new scheme designed to charge producers for their use of packaging. Excluding £470m allocated to help councils meet the costs, for their own staff, of April’s rise in employer national insurance contributions (NICs), the IFS has said this amounted to a maximum 6.4% rise in resource for authorities in 2025-26, after taking account of inflation.

However, local government leaders have said the funding was not sufficient to address pressures, particularly in social care, driven substantially by the costs of compensating care providers for the rise in employer NICs and this year’s 6.7% increase in the national living wage (NLW).

Government ‘under no illusion about state of council finances’

Announcing the exceptional financial support package today, local government minister Jim McMahon said: “We are under no illusion of the state of council finances and have been clear from the outset on our commitment to get councils back on their feet and rebuild the foundation of local government.”

He said ministers were encouraging authorities to “come in confidence where needed to seek help and be assured we will offer a relationship of partnership – not punishment”.

However, London Councils, which represents the capital’s boroughs, raised concerns about the use of EFS to shore up authorities’ finances.

Exceptional financial support ‘a misnomer’

“Exceptional financial support is a misnomer – it is no longer exceptional and it fails to provide sustainable financial support, instead forcing local authorities to borrow to maintain basic statutory services,” said London Councils chair Claire Holland. “Rather than resolve the crisis, EFS is a short-term measure that leaves us with more long-term debts to worry about.

“We desperately need a sustainable solution to the crisis in local government finance, which has been years in the making. We welcome the government’s commitment to working with local authorities to reform a funding system which is fundamentally broken and to bring long-term stability to council finances.”

The government’s planned reforms will see councils given multi-year finance settlements and more flexibility of how they use their money, and funding formulae changed to better reflect need.

While the first two measures have broad support across councils, the latter has divided opinion, with county authorities fearing they will be penalised by a shift to a more deprivation-based distribution of funding.

This has been foreshadowed in the 2025-26 settlement by a £600m ‘recovery grant’, whose distribution is based on councils’ deprivation levels.

The government has let six English councils with responsibility for social care increase council tax rates by more than national limits this year.

Birmingham, Bradford, Newham, Somerset, Trafford and Windsor and Maidenhead will be able to increase levies by more than will the other 147 social services authorities; the latter would need the approval of citizens through a local referendum to raise rates by 5% or more.

Bradford will be allowed to raise council tax by 9.99%, Newham and Windsor and Maidenhead by 8.99%, and Birmingham, Somerset and Trafford by 7.49% in April 2025 without a referendum, said deputy prime minister Angela Rayner this week.

Tax rises ‘to prevent financial distress’ for councils

The authorities had all requested “exceptional financial support” , a system by which councils can receive government aid – usually in the form of loans – to address funding pressures they consider “unmanageable”.

In a statement to parliament setting out the finalised local government finance settlement for 2025-26, Rayner said the decision was taken to help “prevent these councils falling further into financial distress” and on the basis that they had “amongst the lowest levels of council tax” in the country.

Think-tank the Institute of Fiscal Studies (IFS) said five of the six authorities had council tax rates for Band D properties that were in the lowest quarter, nationally, though Somerset’s was above average. The South West authority said it was facing a £66m funding gap in 2025-26, driven chiefly by social care pressures, and that the additional council tax increase would not fill be enough to fill this.

‘A substantial cash-terms increase’

According to the IFS, if all authorities increased council tax by the maximum permitted without a referendum, funding for English councils would rise by £4.3bn in 2025-26, which it described as a “substantial cash-terms increase”.

Authorities will also be able to make use of an extra £1.1bn through a new scheme designed to charge producers for their use of packaging. Excluding £470m allocated to help councils meet the costs, for their own staff, of April’s rise in employer national insurance contributions (NICs), the IFS said this amounted to a maximum 6.4% rise in resource for authorities in 2025-26, after taking account of inflation.

However, local government leaders said the funding was not sufficient to address pressures, particularly in social care, driven substantially by the costs of compensating care providers for the rise in employer NICs and this year’s 6.7% increase in the national living wage (NLW).

Funding ‘falls short of what is desperately needed’

Local Government Association chair Louise Gittins said: “Extra money for councils next year, including compensation for employer national insurance contributions increases, will help meet some of the cost and demand pressures they face but still falls short of what is desperately needed to cover them all.”

The settlement includes a £270m children’s social care prevention grant, to help roll out family help services and implement a new duty on councils to offer parents a family group decision making meeting whenever they are considering issuing care proceedings for a child.

It also comprises an £880m top-up for the social care grant, which covers both children’s and adults’ services, while authorities will be able to raise council tax by 2% specifically to fund adult social care.

The Association of Directors of Adult Social Services (ADASS) has calculated that these two measures combined would raise about £1.2bn extra for adults’ services in 2025-26 – well short of the £1.8bn in extra costs they have calculated that authorities are facing.

‘Substantial overspending on social care and homelessness’

In its response to the settlement, the organisation representing the capitals’ boroughs said they were facing a funding gap of £500m in 2025-26, despite the settlement, driven by social care and homelessness services.

London Councils said that boroughs were facing overspends of £180m on adult social care, £150m on children’s social care and £270m on homelessness services in 2024-25.

“We are dealing with a range of immense challenges in London, but the worsening homelessness emergency represents the biggest single risk to borough finances,” said London Councils chair Claire Holland.

“The impact of homelessness on Londoners – especially families with children – is devastating, and the costs to boroughs are utterly unsustainable.”

Mixed views on government approach to funding

The County Councils Network (CCN) said the costs of the employer NIC and NLW rises outweighed additional funding received through the settlement for the shire authorities it represents.

It also took aim at the government for redirecting money away from these areas through a £600m ‘recovery grant’, the distribution of which was based on deprivation levels, which ministers said were a proxy for population need.

In her statement, Rayner described this is the “first meaningful step” towards reforming funding based on “an up-to-date assessment of councils’ funding needs and financial resources”, which would be implemented from 2026-27.

The grant was welcomed by metropolitan councils’ body the Special Interest Group of Municipal Authorities (SIGOMA), which said it would “provide welcome relief to the most deprived areas after a decade of disproportionate cuts and increases in demand”.

However, the CCN, whose members are receiving just 3% of the recovery grant, has argued that significant areas of need are not fundamentally driven by deprivation.

Social care and SEND demand ‘key drivers of need’

“The CCN’s evidence shows that demand and market failure across adult and children’s social care and special educational needs services are the main reasons as to why councils across all four corners of the country are struggling,” said its finance spokesperson, Barry Lewis.

“If the trend of this finance settlement does continue, the government will completely understate the very real financial pressures faced by councils outside of towns and cities and it will push many county and unitary councils to the brink.”

The news comes with the government having announced its intention to replace existing two-tier (county and district) councils by unitary authorities and replace small unitaries with bigger bodies, in order to boost value for money and clarity of service responsibility for citizens.

Various groups of councils have come forward with proposals for reorganisation already and the government is planning to create some of the new unitaries during this parliamentary term.

Social workers could form part of neighbourhood-based multidisciplinary teams (MDTs) providing support for people with complex health and social care needs.

The Department of Health and Social Care (DHSC) called on NHS and local authority leaders to establish the teams in guidance on their use of the Better Care Fund (BCF), under which they are required to pool resources to tackle government priorities.

The BCF policy framework for 2025-26 said such teams were designed to provide “more integrated and proactive care for people with complex needs”, to help them “stay independent for as long as possible” and reduce the likelihood of them being admitted to hospital or care homes.

This is part of the government’s ambition to create a “neighbourhood health service”, further details of which were set out in guidance issued by NHS England this week, which said the MDTs were one of six “core components” of the approach.

NHS England said a neighbourhood service involved delivering “more care at home or closer to home” and creating “healthier communities, helping people of all ages live healthy, active and independent lives for as long as possible while improving their experience of health and social care”.

‘Too many experience fragmentation and suboptimal care’

While this required an integrated response from health and social care bodies, “too many” people experienced “fragmentation, poor communication and siloed working, resulting in delays, duplication, waste and suboptimal care”, NHS England added.

Echoing the BCF framework, it said that NHS integrated care boards (ICBs) and local authorities’ focus in 2025-26 should be on people with “complex health and social care needs who require support from multiple services and organisations”. This should include:

• adults with moderate or severe physical or cognitive frailty;
• people of all ages with palliative care or end of life care needs;
• adults with complex physical disabilities or multiple long-term health conditions;
• children and young people who need specialist paediatric expertise regarding their physical or mental health;
• people of all ages with high intensity use of emergency departments.

It said ICBs and councils should jointly draw up a plan for a neighbourhood health and care model including the six core components, which NHS England said were based on existing good practice.

Integrated teams potentially involving social workers

Along with improving population health management, general practice, community health and urgent care, this should involve establishing neighbourhood MDTs to carry out holistic assessments and reviews and plan and co-ordinate care for people with complex needs.

Best practice would be for the team to include a core group of staff responsible for complex case management, with a care co-ordinator assigned to each person, and an extended team who could be drawn upon for specialist support.

NHS England said teams could include social workers, home care staff and care home staff, as well as district nurses, GPs, occupational therapists, hospital staff and social prescribing link workers whose role is to connect people with community-based activities.

NHS England indicated that these teams would support adults, adding that guidance on neighbourhood MDTs for children and young people would be published shortly.

The final core component of the model was the provision of short-term rehabilitation, reablement and recovery services, overseen by a registered therapist, to people at home, it added.

Better Care Fund targets

The DHSC said the BCF’s aim in 2025-26 should be to support shifts in care from “sickness to prevention” – by helping people remain independent for longer and preventing escalation of need – and from “hospital to home”, by preventing hospital and long-term care home admissions and tackling delayed discharges.

These are broadly similar to this year’s objectives of “helping people stay well, safe and independent at home for longer” and “providing people with the right care, at the right place, at the right time”.

However, the DHSC has reduced the seven previous metrics that local areas will be measured against to three:

• emergency admissions to hospital for people aged over 65 per 100,000 population​;
• average length of discharge delay for all acute hospital adult patients, derived from a combination of:​
  • the proportion of adult patients discharged from acute hospitals on their discharge ready date (DRD);
  • for those adult patients not discharged on their DRD, the average number of days from the DRD to discharge;
• long-term admissions to residential and nursing homes for people aged 65 and over per 100,000 population.

Increase in NHS funding for adult social care

The DHSC has provided councils with £2.64bn in BCF funding for 2025-26, the same as in 2024-25; this must be combined with NHS resources into locally pooled funds.

ICBs must make a minimum contribution of £5.614bn to the BCF, up 1.7% on the 2024-25 level. As in previous years, some of this NHS money must be used to fund adult social care, with the DHSC stipulating that this component increase by at least 3.9% in 2025-26.

According to NHS England figures, ICB funding for adult social care through the BCF was £2.92bn in 2023-24.

The BCF also includes the disabled facilities grant (DFG), which funds housing adaptations for disabled people, and is worth £711m in 2025-26, the same level as 2024-25 following in-year increases in resource.

The DFG must be spent in accordance with an agreed BCF plan, the DHSC said.

Requirements to submit plans to NHS England

Health and wellbeing boards (HWBs) – local partnerships of health and social care leaders – must submit their plans to NHS England’s national BCF team for approval by 31 March.

These will then be reviewed, with HWBs informed by May whether their plans have been approved, approved with conditions or not approved, which applies when the plan does not meet national conditions for use of the BCF.

In the latter case, the partnership will likely receive “enhanced support and oversight”, including advice and, potentially, funded support to meet national objectives.

Staff vacancy numbers in adult social care services fell last year, early data suggests.

As of December 2024, 7% of roles in independent sector adult social care providers in England lay vacant, down from 7.6% in April 2024, according to the Skills for Care (SfC’s) figures.

The data only covers those providers that have submitted figures to SfC’s adult social care workforce data set (ASC-WDS) for the relevant time period so is not representative of the sector as a whole.

SfC’s last sector-wide assessment measured the independent sector vacancy rate at 8.1% as of March 2024, down from 9.9% in 2023 and 10.7% in 2022.

Rapid fall in level of overseas recruitment

These falls were largely driven by the recruitment of staff from abroad. However, levels of international recruitment have fallen since March 2024, when the government banned adult social care staff on new or extended health and care visas from bringing partners or children to the UK.

According to SfC’s estimates, independent providers recruited 18,000 international staff from April to September 2024, compared with 105,000 in the year to March 2024, a fall of roughly two-thirds in the quarterly average.

Nevertheless, SfC data showed that the number of filled posts in independent providers rose from 575,000 to 585,000 from April to December 2024, alongside the apparent fall in vacancies.

Possible contributors to the trends include the 9.8% rise in the national living wage (NLW), from £10.42 to £11.44 an hour, in April 2024, which will have driven up pay across hundreds of thousands of care worker roles.

Concerns over potential care and job cuts

The NLW is due to rise again in April, by 6.7%, to £12.21 an hour. However, there is widespread sector concern that the measure, in combination with the planned increase in employer national insurance contributions, will lead to cuts to both levels of care and employment.

Almost two-thirds (64%) of organisations said they would need to make staff redundant, while 57% said they would have to hand care contracts back to councils and NHS commissioners on the back of the measures, according to a survey carried out last November by the Care Provider Alliance.

Think-tank the Nuffield Trust has estimated that the measures will cost providers in England £2.8bn in 2025-26, £2bn of which would need to be met by local authorities. Separately, the Association of Directors of Adult Social Services (ADASS) has calculated that councils face £1.8bn in increased costs in adult social care in 2025-26 due to the two measures, and wider inflation.

The government has said that it is making available an extra £3.7bn for local authorities with adult social care responsibilities in 2025-26. However, only about £1.2bn of this is dedicated funding for the sector.

Council fee rises for social care providers have lagged behind increases in the national living wage (NLW) for each of the past three years, providers have reported.

The research, carried out before the government’s autumn 2024 Budget added an estimated £2.8bn to the costs of adult social care in 2025-26, revealed that services were facing increasing workforce challenges.

The latest Sector Pulse Check, carried out from August to September 2024 by representative body Care England and learning disability provider Hft, was based on data from 206 organisations responsible for the care of 128,000 older people and people with learning disabilities and/or autism.

Council fees not keeping up with wage rises

It found that 85% of providers felt that local authority fee increases were not sufficient to cover last year’s rise in the (NLW), from £10.42 to £11.44 an hour.

This replicates findings from 2023, when 79% of providers reported that fee rises did not cover the impact of that year’s rise in the NLW, and 2022 – the first year that the survey covered both learning disability and older people’s providers – when 81% of respondents reported the same.

The average care worker wage among the providers surveyed (£12.10 an hour) was 8.1% above the equivalent figure in the 2023 survey (£11.19 an hour), compared with a 9.8% rise in the NLW over the same period.

Recruitment squeeze

Alongside the reported squeeze on fees, 91% of providers listed workforce-related costs as among their top three financial pressures, up from 81% in the 2023 survey, with 86% citing pay as a key barrier to recruitment, the same proportion as in 2023.

Two-thirds of providers said they had seen a decrease or no change in the number of applications they had received from UK jobseekers in the past 12 months, down from 54% in the 2023 survey.

And while 55% reported an increase in applications from international staff over the previous 12 months, policy changes introduced in March 2024 – notably a ban on overseas social care staff on health and care visas bringing dependants to the UK – have squeezed the supply of staff from abroad.

Financial pressures easing

This year’s survey did reveal some improvements in providers’ financial position compared with 2023, including that:

• 29% of providers said they were in deficit in 2024, down from 40% in 2023.
• 26% said their surpluses had decreased, down from 31% in 2023.
• Use of agency staff fell to 7.8% in 2024, from 15.7% in 2023, despite the workforce pressures.
• 29% of providers said they had closed down parts of their organisations or handed back contracts to local authorities as a result of cost pressures, down from 43% in 2023.
• 9% said they were offering care to fewer people as a result of cost pressures in 2024, down from 17% in 2023.

Estimated £2.8bn bill from Budget

However, the survey was carried out before last year’s Budget announcement of a further 6.7% rise in the NLW and a significant increase in employer national insurance contributions (NICs), both of which will be implemented this April.

Think-tank the Nuffield Trust has estimated that these measures will cost providers an extra £2.8bn in 2025-26, with local authorities having to find £2bn of this in increased fees. The Association of Directors of Adult Social Services, meanwhile, has calculated an increased bill for local authorities of £1.8bn.

However, both the Nuffield Trust and ADASS figures far exceed the approximately £1.2bn in dedicated additional funding for adult social care that the government has allocated to councils for 2025-26.

Calls for sector funding boost and easing of migration rules

On the back of the latest Sector Pulse Check, Care England and Hft urged the government to:

• Fully fund the rise in employer or exempt care providers from the increase.
• Remove the ban on social care staff coming to the UK on health and care visas from bringing dependants.
• Introduce a multi-year funding framework for adult social care, with annual increases linked to inflation and increases in the NLW.
• Increase pay across the sector, over the long-term, in order to achieve parity with similar NHS roles.
• Introduce national standards for commissioning to tackle inconsistencies in local authority practices.

The survey results come with the government having announced the establishment of a commission, headed by Baroness (Louise) Casey, on long-term reform of adult social care, but faced sector criticism for deferring its final report until 2028 at the latest.

Delayed action ‘leaving more people without support they need’

Care England chief executive Martin Green said: “We are ready to work alongside Baroness Casey and the government to turn this commission into a catalyst for genuine change. But let’s be clear: the status quo is no longer an option. Every delay, every failure to act, pushes more care providers out of the sector and leaves more people without the support they need.”

The Local Government Association (LGA) issued a broadly similar message in response to the survey.

“Local authorities are under unprecedented financial pressure, exacerbated by inflation, rising demand, an increase in employer national insurance contributions, and workforce challenges,” said the chair of the LGA’s community wellbeing board, David Forthergill.

“We urgently need a long-term funding plan for adult social care, along with a workforce strategy that values and supports care workers. Without immediate government action, care services will remain at risk, with devastating consequences for individuals and families who rely on them.”