Key points
- In England, Wales and Scotland, local authorities are responsible for adult social care and this duty is set in law. Funding comes from central grants, which can be subject to squeezes from central government, and from local revenue-raising mechanisms (such as council tax).
- In Northern Ireland, health and social care trusts have this responsibility due to the integrated nature of their health and social care system.
England
152 local authorities1 have responsibility for social care in their localities. They organise and fund support and care for those with moderate or high needs who are unable to fund it themselves. They can also organise care services for self-funding individuals who may require assistance to do so.
Local authorities fund social care through a combination of a grant from central government via the Department of Levelling Up, Housing and Communities (DLUHC), and local revenue-raising mechanisms, such as council tax, the specific social care precept and business rates. The local NHS is also mandated to transfer a set amount to a local authority via the Better Care Fund (BCF).2 The BCF is a national programme that pools together budgets from the NHS, the Disabled Facilities Grant, and the improved Better Care Fund (iBCF) (a local authority grant).3 The Better Care Fund framework for 2022/23 has set out increases in NHS contribution by 5.66%, and an overall increase in the improved Better Care Fund grant by £63 million.4
Social care funding is not usually ringfenced, which means that local authorities can decide how much of their overall budget they allocate to care. In addition, where an individual is assessed as eligible for NHS funding for care5 under the Continuing Health Care scheme, this funding will also cover their associated social care needs (see ‘Support for health needs’).
However, the 2022 Autumn Statement announced additional central government funding via the social care grant (for children’s and adult social care) and a ringfenced adult social care grant. The adult social care grant is attached to spending conditions under the Market Sustainability and Improvement Fund, which will mandate local authorities to deliver improvements under four key priorities (capacity, sustainability, workforce, and waiting times).6
Local authorities were also given greater revenue-raising powers, through the ability to increase council tax by up to 3% and the social care precept by up to 2%.7
Local authorities are responsible for the organisation of care and support plans and personal budgets (see ‘Offer and eligibility’). The Care Act 2014 set out a national minimum threshold for eligibility to which all local authorities must comply. However, local authorities have discretion to provide services to individuals outside of the eligibility threshold.8
Wales
The Welsh Assembly receives a block grant from general taxation gathered at an UK level, distributed to the devolved administrations via the Barnett Formula, based on current and historical population size.9 Spending decisions by the UK government (for instance, via an increase in health spending or a new grant for social care) will impact on the size of the block grant passed on to the devolved administrations.
Local authorities receive grants from the Welsh Assembly via the revenue support grant, which are supplemented by local revenue raising to form the total spending budget. Local taxes are devolved to the Assembly10, which means that the local revenue-raising powers in Wales are subject to different legislation than in England, such as over business rates.1112 In Wales, the social care precept does not apply. Local authority revenue is also supplemented by NHS Wales funding through local health boards under the Continuing Health Care scheme (see ‘Support for health needs’).13
Local authorities are responsible for the format of care and support plans (see ‘Offer and eligibility’), and are required to be consistent across the country with the use of the national eligibility criteria.14
Seven statutory regional partnerships boards were established in April 2016 to encourage closer integration with the health care sector.15 Regional partnership boards assemble local authorities, health boards and third sector organisations to provide care and support to those residing in their area.16 However, it remains the responsibility of Wales’s 22 single-tier local authorities to organise and deliver care for those unable to fund it themselves, whether that be directly or through the commissioning of services.17
The creation of a national office to drive progress and strengthen work in the regional partnership boards via a national framework for commissioning was announced in the rebalancing care and support white paper in 2021.18
Scotland
The Scottish government receives a block grant from general taxation gathered at an UK level, distributed to the devolved administrations via the Barnett Formula, based on current and historical population size.19 Spending decisions by the UK government (for instance, via an increase in health spending or a new grant for social care) will impact on the size of the block grant passed on to the devolved administrations.
Scottish local authorities fund social care through a combination of a grant from the Scottish government (General Revenue Funding of Local Authorities) and local taxes to form the total spending budget.20 In Scotland, local taxes are devolved, which means that the local revenue-raising powers are subject to different legislation from England.21 There are different council tax rates22 and the social care precept does not apply as it does in England. Local authority revenue is also supplemented by NHS Scotland funding through NHS health boards23, under the Hospital Based Complex Clinical Care scheme (see ‘Support for health needs’).24
The Public Bodies (Joint Working) (Scotland) Act 2014 was established to integrate health and social care. There are 31 health and social care partnerships in Scotland that are responsible for the commissioning of social care services via integration authorities.25 Scotland’s 32 local authorities are responsible for the procurement and contracting of care from providers for those unable to fund it themselves. They are also able to organise care services for self-funders who may require assistance to do so.
Local authorities are responsible for the format of self-directed support plans (see ‘Offer and eligibility’). Each local authority has their own eligibility criteria to determine whether an individual will be able to access social care, which must be compatible with the national eligibility framework.26 National eligibility applies for service users with a need for personal care, under which those with a critical or substantial risk must receive services within six weeks of assessment.
Plans to introduce a National Care Service by 2026 would remove responsibility for arranging social care from local authorities and place this with Scottish ministers, with delivery through local care boards.27
Northern Ireland
The Northern Ireland Executive receives a block grant from general taxation gathered at an UK level, distributed to the devolved administrations via the Barnett Formula, based on current and historical population size.28 Spending decisions by the UK government (for instance, via an increase in health spending or a new grant for social care) will impact on the size of the block grant passed on to the devolved administrations.
In Northern Ireland, social care is integrated with health care under five health and social care trusts. These manage their own budget allocated by the Northern Ireland Executive through the Department of Health (NI). As health and social care services in Northern Ireland are integrated, provision of Continuing Health Care is organised directly by the health and social care trust and thus does not represent an additional source of revenue (see ‘Support for health needs’). The newly formed Strategic Planning and Performance Group, accountable to the Minister for Health, is responsible for the planning, improvement, oversight, and delivery of health and social care services at a regional level across Northern Ireland.29
Health and social care trusts are responsible for the format of self-directed support plans (see ‘Offer and eligibility’). The Northern Ireland single assessment tool is designed to ensure a consistency of assessment across different trusts and different professionals, whether undertaken by a nurse or a social worker. However, trusts have discretion to determine at what level of need an individual is entitled to social care support.
Suggested citation
Dodsworth E and Oung C (2023) 'Who organises and funds social care?', in Adult social care in the four countries of the UK. Explainer series, Nuffield Trust.
Adult social care in the four countries of the UK
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