With demand rising, councils under strain and care inequalities deepening, the Autumn Budget offers a critical chance to secure sustainable investment and recognise adult social care as essential national infrastructure, writes Jess McGregor, President of the Association of Directors of Adult Social Services (ADASS) and Director of Adults and Health at Camden Council.

As directors of adult social services, we see the human cost of inaction every day. People going without care, without enough care, or without the right care. And the inequalities are stark. If you live in a poorer area, you're twice as likely to need help with everyday tasks like washing or dressing. Older women are three times more likely than younger men to have unmet care needs. If you are older than 65 and Black, Black British, Asian or Asian British, you are more likely to need support. These disparities should shock us into action. Care must work for everyone, not just those who can afford to wait.

The Chancellor's Autumn Budget on November 26 presents a critical opportunity to change this trajectory. Without meaningful investment in adult social care, we risk condemning millions more people to lives diminished by unmet need.

Adult social care as a growth sector

More than 1.6 million people work in adult social care across 21,100 organisations, contributing £68.1bn in gross value added to the UK economy. It's a major local employer, and any expansion means new businesses, new job opportunities, increased tax contributions, and significant net contribution to local and regional economies.

Adult social care must be seen as an enabler—not only in supporting people to live independent lives, but also in enabling health reform, preventing ill health, supporting higher employment rates and growing the economy. When people receive the right care at the right time, they can work, their families can work, and they can participate fully in their communities. This is economic growth from the ground up.

Yet an unreformed and underfunded system is failing to deliver value for money and, more importantly, is leading to growing levels of unmet need. This undermines adult social care's preventative potential as an early intervention that reduces the need for more intensive—and expensive—interventions like acute elective care or urgent admissions later on.

The scale of the challenge

The numbers tell a stark story. In 2023/24, local authorities received more than two million requests for support from people new to our services—658,000 from working-age adults and 1.43 million from older people. Working-age adult demand has surged by 19.6% since 2018/19, while older people presenting with needs has risen by 4.6%.

The Nuffield Trust calculates that less than half of older people with support needs are accessing any kind of help. Age UK puts the figure at around two million people aged 65 and over living with unmet care needs. Healthwatch suggests up to 1.5 million disabled adults in England could be eligible for support but aren't receiving it.

These aren't just statistics. These are our parents, our neighbours, people in our communities struggling alone when they shouldn't have to. The unpaid carers holding things together.

The inequality is profound. If you live in a deprived neighbourhood, you're twice as likely to need help with daily activities. Older women face three times the risk of unmet need compared to younger men—48% of women aged 80 or over have unmet needs, compared to 16% of men aged 65-69. This compounds existing disadvantage and deepens social inequality.

More complex care

The care needs we're seeing are becoming increasingly complex. Our autumn survey found that 63% of council areas reported that the average size of care packages for people being discharged from hospital had increased over the past year. Meanwhile, 75% reported more people presenting who previously would have been eligible for Continuing Healthcare—costs being shifted from health to social care.

We're also seeing sharp increases in people presenting with mental ill health (73% of councils reporting rises), rough sleeping (60%), and safeguarding concerns (55%). The breadth of need we're expected to meet is expanding, even as resources contract.

Councils on the brink

Thirty local authorities are receiving Exceptional Financial Support from Government this year—an unprecedented situation that illustrates the depth of the crisis. The Government itself acknowledges ‘a local government sector on its knees—councils pushed to the financial brink, facing rising demand.’

Our spring survey revealed that 80% of directors of adult social care reported overspends in 2024/25, totalling £774m nationally. We're planning £932m in savings for 2025/26—the highest since 2016/17—yet only 16% of us are confident we can deliver them.

This financial distress has real consequences. Looking at Care Quality Commission (CQC) assessments, local authorities under Section 114 measures or receiving Exceptional Financial Support almost always have poor ratings. When councils can't cope financially, people go without the care they need.

The Spending Review effectively signalled a standstill position. The additional £4bn designated for social care by 2028/29 will be reliant on increases in council tax and the Better Care Fund and will be entirely swallowed up by baked-in workforce cost increases. In real terms, this means no extra capacity to improve services or expand support.

A perfect storm for reform

The limited predictability offered by multi-year settlements has been overwhelmed by simultaneous upheaval across the system. The Better Care Fund is under review, with 98% of directors believing it now underpins core services. Any refocusing, however strategic, could leave budget gaps impossible to fill.

Our relationships with health partners—operationally, strategically, and financially crucial—are severely disrupted as integrated care boards (ICBs) merge, reducing from 42 to 26 while making 50% cuts to running costs. As the King's Fund warned, ‘Previous experience shows that a focus on cutting costs stretches ICB leadership and makes collaboration—key to strategic commissioning—harder.’

Meanwhile, local government faces its biggest shake-up in a generation. The move from two-tier to unitary authorities presents formidable challenges for adult social care: ordinary residence disputes, contract complications, questions over how to maintain small but essential specialist teams. Savings, if deliverable at all, will be long-term. Costs and disruption will be immediate.

The workforce gap

We don't have enough people working in adult social care today, and we're going to need significantly more tomorrow. Care workers remain among the lowest paid in our economy. The Government's commitment to a Fair Pay Agreement (FPA) is welcome and essential—it can deliver fair pay, better terms and conditions, and contribute to local economic growth.

The £500m announced is an important first step, but early analysis suggests this will deliver only a modest rise in hourly pay—nowhere near enough to close the gap with sectors like the NHS or retail. The real concern is uncertainty. We don't yet know the final design, and there's no guarantee that Government will cover the full cost for publicly funded care. Without a clear commitment that FPA costs will be met separately from existing funding streams, we risk robbing Peter to pay Paul, cutting services to fund better wages.

The FPA won't come into force until at least 2028, leaving a worrying gap. Meanwhile, care providers face new restrictions on recruiting international workers. With 111,000 vacancies still unfilled and no clear national plan for recruitment and retention, the pressure on the workforce—and on people needing care—will only intensify.

What this budget must deliver

If Government is serious about adult social care as a driver of economic growth, immediate steps must be taken:

- Guarantee separate funding for the Fair Pay Agreement so care workers receive fair wages without sacrificing services. Develop a clear, funded workforce plan to recruit, train and retain the care workers, social workers and therapists we need.

- Support prevention and innovation—complete the Disabled Facilities Grant review and build on the £100m Innovation Fund with test-and-learn approaches.

- Enable data sharing with guidance and infrastructure for integrated care across health, social care and housing.

These incremental steps lay foundations for fundamental reform—reform that recognises adult social care as essential infrastructure for a growing economy. We know that prevention works: for every £1 spent on early support, £3.17 can be saved later on. Yet councils can only afford to focus on people with the most urgent needs. Nearly three-quarters of directors are unsure their budgets will stretch to meet even basic wellbeing responsibilities.

Adult social care at its best transforms lives. It enables millions to live where we want, how we want, in safety and dignity. We stand ready to act quickly and collaboratively—with health colleagues, housing providers, the voluntary sector, technology innovators, and most importantly, people who draw on care and support—to create solutions. But we cannot do this without the resources to match the ambition.

Care can't wait. The people we serve can't wait. This Budget must deliver for them.