Last Updated on October 14, 2026
The King's Fund, an independent charity, has published new analysis that reveals wide local variations in access to long-term care. The analysis highlights how 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' (councils with similar social and economic profiles).
The King's Fund analysed the statistical model used by the Ministry of Housing, Communities & Local Government (MHCLG) that lists local authorities' nearest statistical neighbours, considering factors including deprivation, disability prevalence and median income. The analysis found that 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 for working age and/or older adults.
The King's Fund argues that the extent of these difference shows that social care reform should include an 'equal access' national assessment to eliminate the risk of a postcode lottery.
The King's Fund is advocating for further major reforms, including:
- 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 King's Fund analysis found variation between statistically similar councils varies up to 101% for working-age adults and up to 60% for people over 65. For example, in Thurrock, 7,860 older people per 100,000 accessed long-term care. In contrast, its nearest statistical neighbour, Medway, had only 4,810. This is a difference of 60% despite the two areas being demographically and economically similar. However, for working age adults, Thurrock had 10% fewer people access care than Medway.
More standout differences were found throughout the analysis, 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. Another standout case was Salford and Southampton, were the access rate for older adults stood at 52% higher in Salford than Southampton and 20% higher in working-age adults.
The King's Fund argues that meaningful comparison between local authorities must happen between those that have a similar socio-economic profile. The organisation 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.
The think-tank also 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.
Commenting on the analysis, Simon Bottery, 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. […]
'What The King's Fund has set out [...] 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 had been promised.'
Gerard Crofton-Martin, Interim Chief Executive at the Social Care Institute for Excellence (SCIE), said, 'Inequalities in adult social care are profound and persistent, and they demand urgent action. One of the core values of a caring society is fairness; it is indefensible that the availability and quality of people's care and support are still inextricably linked to where they live, their socioeconomic circumstances, ethnicity, disability or gender.
'SCIE's research on care equity find that these factors interact and accumulate across people's care journeys, with each creating barriers that make it harder for them to find, access and sustain care around their individual circumstances and aspirations.
'SCIE's research supports the King's Fund's recommendation for clearer entitlements, which would clarify people's rights and responsibilities, help them to understand and navigate the system more easily and, ultimately, give them greater choice and control.'
Martin Walker, Head of Practice Improvement (Self-Directed Support) at Think Local Act Personal (TLAP), said, 'The King's Fund's proposals, including clearer entitlements to support, a more permissive approach to direct payments and a greater focus on person-centred care planning, recognise the need to make choice and control a reality for more people who draw on care and support.
'People shouldn't have to fit into whatever services exist in their area. They should be able to decide how they live, who supports them and how their care is arranged. This is a right that is enshrined in law but not upheld or protected in practice.'
Dr Jane Townson OBE, Chief Executive at the Homecare Association, said, 'The care you receive should depend on what you need, not here you live or what our council can afford. Today, too often, it does not. […]
'We support national consistency in assessment, fairer national funding and clear entitlements. But an entitlement to care is meaningless if nobody is funded to deliver it. Reform must pay the true cost of care, move beyond time-and-task commissioning and give people genuine control over support that helps them live well at home.'
The King’s Fund analysis can be seen here. A map of local authorities showing the percentage difference in access rates can be seen here, and a dot plot data visualisation showing the spread of variation can be accessed here.
In other news, Dame Esther Rantzen, the first host of the Markel 3rd Sector Care Awards, has died at the age of 86.