Significant disparities in access to adult social care in England have been exposed by a coalition of charities, revealing a "brutal postcode lottery" where residents in some areas are three times more likely to be denied support than in others. The Care and Support Alliance (CSA) analysis of official data shows stark differences in outcomes for individuals seeking assistance with services such as home help or care home placements, depending on their location.
In the 2024/25 period, the East Midlands and South East regions recorded the highest rates of applications resulting in no support, at 75 percent. Conversely, the West Midlands had the lowest rate, with just under two-thirds (62 percent) of requests not leading to formal care, according to figures from the Department of Health and Social Care. These regional variations, however, mask even more dramatic differences within specific areas.
For instance, in London, the proportion of requests denied support ranged from 30 percent in the borough of Bexley to 91 percent in Lambeth. This means individuals with similar care needs, living a short distance apart, can experience vastly different outcomes when seeking help. Even in the North East, where the gap between council areas was narrowest, the rate of requests not leading to support still varied from 46 percent to 76 percent.
Nationally, Portsmouth reported the highest proportion of requests not leading to care, at 93 percent, while Bexley recorded the lowest at 30 percent. The CSA acknowledges that some variations may occur due to factors like a person's death before support is provided or if a council offers assistance but refuses funding based on an individual's assets. However, the coalition stated that the scale of the differences revealed by the data "raises serious questions about fairness."
In a letter to council leaders, the CSA highlighted that these challenges are not isolated to specific areas 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," the alliance stated. "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."
The CSA co-chairs, Caroline Abrahams, Emily Holzhausen, and Jackie O'Sullivan, described the situation as a daily challenge for councils trying to balance rising demand, complex needs, and increasing costs against insufficient budgets. They emphasized that local authorities cannot solve this problem alone and that decades of underinvestment require national action with sustainable funding.
The coalition welcomed Prime Minister Andy Burnham's call for a cross-party approach to fixing social care and his initiative to build consensus through a public survey on expected standards for a modern care system. Burnham has previously stated that addressing the social care crisis could save the National Health Service billions annually and has described the failure to act as a "major dereliction of public duty."
Baroness Louise Casey's review of social care is expected to release its findings in phases, with a final report anticipated next year. A spokesperson for the Local Government Association commented that the current funding model for adult social care "has fully outgrown itself and needs reform." The Department of Health and Social Care acknowledged that the current system "broken" and has expressed a determination to fix it.