Financial inequities
What are 'financial equities'?
This theme explores financial inequities in social care, focusing on how economic factors influence access, quality, and sustainability of services. It examines the impact of funding disparities, variations in care costs, and the financial burden placed on individuals and families. Means testing, the role of self-funders, and differences in public versus private funding models all contribute to unequal experiences of care.
Financial barriers can limit access to essential services, particularly for those in low-income households who may struggle to afford care but do not qualify for state support. Regional cost variations and workforce pay inequalities further affect service availability and quality. This theme aims to highlight the structural financial challenges in social care and explore potential solutions for a more equitable system.
Key Statistics
The King's Fund (2025)
LSE (2021)
RSN (2022)
Reference
Humphries et al. (2016). Social care for older people: Home truths. The King’s Fund, London.
Key Messages
- Local authority funding for social care has declined in real terms, leading to reduced service availability despite increasing demand.
- Financial sustainability of local authorities is at risk, raising concerns about their ability to meet statutory social care responsibilities.
- Workforce pressures, including recruitment and retention difficulties, are exacerbated by low wages and the introduction of the National Living Wage.
- Social care market instability is growing, with increasing risks of provider failure affecting service continuity.
- Reduced access to social care is placing additional pressure on the NHS, particularly in primary care, community nursing, and acute hospital services.
- Older people are experiencing declining quality and availability of care, leading to unmet needs and greater reliance on informal carers.
Commentary
This report provides a detailed analysis of the growing pressures on local authority-funded social care for older people, highlighting significant inequities in service availability and financial sustainability. The findings illustrate that cuts to social care funding have not been matched by a reduction in demand, leading to rationing of services and increased reliance on unpaid carers.
The report also raises concerns about the social care workforce, as recruitment and retention challenges are compounded by low pay and the impact of the National Living Wage. These pressures increase the likelihood of provider failures, particularly in more deprived areas where margins are lower.
There is also a clear link between reductions in social care provision and increased strain on the NHS. Limited access to domiciliary and residential care has contributed to rising hospital admissions, delayed discharges, and greater pressure on community services. This highlights a wider issue of social care inequity—those in lower-income areas may experience greater service reductions, leading to poorer health outcomes.
A key gap in this analysis is the long-term impact of these pressures on social care system resilience. While the report effectively outlines short-term financial constraints and immediate risks, further research is needed to assess the long-term consequences for service provision and workforce sustainability.
Reference
Cummins (2018). The impact of austerity on mental health service provision: A UK perspective. International Journal of Environmental Research and Public Health, 15(6), 1145.
Key Messages
- Austerity-driven funding cuts have significantly reduced mental health service capacity across the UK.
- Disparities in access to mental health support have widened, particularly affecting low-income and marginalised communities.
- Service rationing has led to higher thresholds for accessing care, leaving many with unmet mental health needs.
- Workforce pressures and reduced investment in community-based mental health services have contributed to increased hospital admissions and crisis interventions.
- Financial constraints have disproportionately affected early intervention and preventative services, limiting their effectiveness.
Commentary
This study highlights the impact of austerity on mental health services, showing how funding cuts have deepened existing inequities in care provision. The shift towards crisis-driven models, rather than preventative and early intervention approaches, has led to worsening mental health outcomes, particularly for disadvantaged groups. The findings suggest that service rationing and higher access thresholds have disproportionately affected those already at greater risk of poor mental health, including individuals in low-income areas and minority communities. Workforce shortages and reductions in community mental health support have also increased pressure on emergency services, reinforcing a reactive rather than preventative approach to care. A key issue raised by this research is the long-term sustainability of mental health services under continued financial constraints. While the report effectively outlines immediate impacts, further research is needed to explore how austerity-driven reductions in mental health funding will shape service provision in the coming years. Addressing these inequities will require targeted investment in community-based support and a shift away from crisis-led models of care.
Reference
Dowling (2022). The care crisis: What caused it and how can we end it? Verso Books.
Key Messages
- The care crisis is a direct result of how public expenditure is distributed across health care, education, housing, and transport.
- Inequalities in social care access are driven by wider economic and policy decisions, rather than individual needs alone.
- Marketisation and privatisation of care services have exacerbated inequities, reducing accountability and public control.
- Gender and class disparities are central to the crisis, as unpaid and low-paid care work continues to be undervalued.
- Achieving a fairer care system requires systemic policy change, not just increased funding.
Commentary
Dowling’s analysis places the care crisis within the broader context of public policy, showing how decisions on public spending in health, education, housing, and transport directly shape inequalities in social care. The book argues that the crisis is not simply about funding shortfalls but about how care is structured and who bears the costs—typically women and low-income workers. A key strength of this work is its critique of market-driven care provision. It highlights how privatisation has led to fragmented services, workforce exploitation, and a lack of accountability in service delivery. This is particularly relevant in the UK, where social care has increasingly shifted towards private providers, raising concerns about quality, accessibility, and workforce conditions. The book also contributes to discussions on care inequity by linking social care access to broader economic structures. It highlights how underinvestment in housing, transport, and education exacerbates care inequalities, particularly for those in precarious employment or poor-quality housing. While Dowling provides a compelling argument for systemic reform, the book does not offer detailed policy recommendations on how to transition away from marketised care. Further research is needed to explore viable models for publicly funded, equitable care systems that address these structural challenges.
Reference
Anderson et al. (2021). Securing a sustainable and fit-for-purpose UK health and care workforce. The Lancet, 397(10288), 1992-2011.
Key Messages
- Workforce shortages in health and social care are a major threat to the sustainability of services.
- Recruitment and retention challenges are exacerbated by low pay, poor working conditions, and lack of career progression opportunities.
- There is a critical need for a long-term workforce strategy that integrates health and social care planning.
- International recruitment remains a key pillar of workforce planning, but reliance on overseas workers raises ethical and sustainability concerns.
- Without urgent policy intervention, workforce gaps will continue to widen, impacting service quality and patient outcomes.
Commentary
This study provides a comprehensive analysis of the workforce crisis in UK health and social care, highlighting structural issues in recruitment, retention, and planning. Workforce shortages are not a new issue, but the pressures of covid-19 and chronic underinvestment have exacerbated existing problems. The findings highlight how workforce challenges disproportionately affect the social care sector, where low wages, job insecurity, and high turnover rates contribute to long-standing inequities. Unlike the NHS, social care lacks a national workforce strategy, leading to fragmented and inconsistent approaches to staffing. This has significant implications for equity, as those in deprived areas are more likely to experience workforce shortages and service disruptions. The report also raises concerns about the UK’s reliance on international recruitment to fill workforce gaps. While overseas workers play a vital role in health and social care, dependence on this strategy without addressing domestic workforce planning raises sustainability and ethical concerns. A key gap in this analysis is the role of unpaid carers in workforce sustainability. With workforce shortages increasing, there is a growing reliance on informal carers, who often receive little support. Addressing these inequities will require a workforce strategy that not only tackles pay and conditions but also integrates support for unpaid carers and community-based care models.
Reference
Jones & Burns (2021). Unit costs of health and social care 2021.
Key Messages
- The cost of providing social care services continues to rise, with significant regional and sectoral variations.
- Workforce costs are a key driver of financial pressures, particularly in residential and domiciliary care.
- Low pay and poor conditions in social care contribute to recruitment and retention challenges, affecting service sustainability.
- Public funding for social care has not kept pace with rising costs, increasing the financial strain on local authorities and providers.
- Accurate cost data is essential for policy planning, ensuring funding allocations reflect real service delivery costs.
Commentary
This report provides a detailed breakdown of the unit costs of health and social care services, offering valuable insight into the financial pressures affecting the sector. It highlights how rising workforce costs, combined with limited public funding, are making it increasingly difficult for providers to maintain service quality and financial viability. One of the key challenges identified is the impact of workforce pay on the sustainability of social care provision. Low wages and poor working conditions contribute to high staff turnover, making it harder to maintain consistent and high-quality care. This is particularly concerning for domiciliary care, where recruitment challenges are exacerbated by travel costs and insecure contracts. The findings also highlight regional disparities in care costs and funding allocation. Areas with lower funding per capita face greater financial pressures, often leading to reduced service provision or higher fees for self-funders. This raises important questions about social care equity, as those in more deprived areas may have less access to affordable, high-quality care. A limitation of this report is its focus on cost analysis without a detailed examination of the impact on care outcomes. While it provides essential data for financial planning, further research is needed to explore how cost pressures affect service quality and accessibility, particularly for marginalised groups.
Reference
Mayhew (2017). Means testing adult social care in England. The Geneva Papers on Risk and Insurance-Issues and Practice, 42, 500-529.
Mayhew (2016). Means testing social care in England.
Key Messages
- Means testing in adult social care creates financial barriers for individuals, limiting access to necessary services.
- The current system disproportionately affects middle-income individuals, who may not qualify for support but struggle to afford care.
- Regional disparities exist in how means testing is applied, leading to inconsistencies in access to publicly funded care.
- The financial thresholds and complexity of the means-testing process can deter people from seeking support.
- Alternative funding models, including insurance-based approaches and personal savings incentives, could improve financial sustainability and equity.
Commentary
Mayhew’s work provides a critical analysis of means testing in England’s adult social care system, highlighting the inequities and financial challenges it creates. The research shows that means testing disproportionately impacts those with moderate assets, who often face high care costs without financial support. This raises important concerns about fairness, particularly as wealthier individuals may have the resources to self-fund care while those with lower incomes receive state support. The findings also point to regional inconsistencies in how means testing is applied, contributing to postcode lotteries in social care access. Individuals in areas with higher care costs may find themselves financially disadvantaged compared to those in regions where services are more affordable. A key issue raised is the deterrent effect of means testing, as some individuals avoid seeking care due to uncertainty over costs. This can lead to unmet care needs, worsening health outcomes, and greater pressure on informal carers. The research suggests alternative funding models, such as insurance-based schemes or incentivised savings, could help create a more sustainable and equitable system. While the research provides a strong economic perspective on social care funding, further work is needed to examine the lived experiences of those navigating means testing. Understanding the practical challenges faced by individuals and families could help shape reforms that balance financial sustainability with equitable access to care.
Reference
IPPR (2019). Social care: free at the point of need.
Key Messages
- Introducing free social care at the point of need would remove financial barriers and improve access for all individuals, particularly those on low incomes.
- The current means-tested system creates inequalities, where many people face significant financial hardship when accessing care.
- A fully publicly funded model would require significant investment but could lead to long-term savings by reducing hospital admissions and reliance on crisis care.
- International comparisons show that universal free social care models can deliver better outcomes, but sustainability depends on adequate government funding.
- Policy reform would need to balance financial sustainability with the goal of equitable access to care.
Commentary
This report examines the feasibility of making social care free at the point of need, drawing comparisons with the NHS model. The analysis highlights the inequities of the current means-tested system, where many individuals must deplete their savings to access care while others receive publicly funded support. The findings suggest that a universal social care system could improve equity by removing financial barriers and ensuring that all individuals, regardless of income, can access necessary care. However, the report also acknowledges the substantial financial implications of such a policy shift, requiring sustained public investment and potential tax reforms. A key strength of the analysis is its consideration of international examples, demonstrating that free social care can be successfully implemented with the right funding structures. However, the research does not fully explore the potential workforce implications, particularly the impact on recruitment and retention in a publicly funded care system. Further research is needed to assess the long-term economic and social benefits of a universal care model, particularly its potential to reduce hospital admissions and reliance on unpaid carers. Addressing these questions will be essential for policymakers considering major social care reforms.
Reference
Mayblin & James (2019). Asylum and refugee support in the UK: civil society filling the gaps? Journal of Ethnic and Migration Studies, 45(3), 375-394.
Key Messages
- Asylum seekers in the UK are excluded from the labour market and rely on welfare support, which is significantly below standard poverty thresholds.
- Civil society organisations, including charities and community groups, play a key role in providing essential support, filling gaps left by inadequate government provision.
- The current policy framework creates extreme poverty among asylum seekers, leading to breaches of fundamental human rights.
- The third sector response varies geographically, leading to disparities in support depending on location and available resources.
- Without structural policy changes, civil society will continue to carry a disproportionate burden in mitigating the effects of restrictive asylum policies.
Commentary
This research highlights the structural inequities in the UK’s asylum and refugee support system, showing how restrictive policies create poverty and social exclusion. The inability of asylum seekers to work legally forces them into dependency on minimal welfare payments, which are set well below the standard poverty line. A key contribution of this study is its mapping of civil society responses to these gaps, illustrating how charities and local organisations provide critical support that the state does not. However, this reliance on third sector provision creates further inequities, as support availability depends on local capacity rather than consistent government policy. The findings raise serious concerns about the human rights implications of current asylum policies. By creating conditions of extreme poverty, the system effectively limits access to adequate social care and basic services, leading to long-term social and health inequalities. While the research effectively critiques the gaps in state provision, further work is needed to explore the long-term sustainability of civil society-led support. Without systemic policy change, these organisations will continue to bear an increasing burden, further entrenching social care inequities for asylum seekers and refugees.
Reference
Gray, M., & Barford, A. (2018) The depths of the cuts: the uneven geography of local government austerity. Cambridge Journal of Regions, Economy and Society, 11(3), 541-563.
Key Messages
- Austerity measures have led to significant disparities in local government funding and resources across Britain.
- Central-local government relations have been reshaped, reducing the capacity and autonomy of local authorities.
- Regional disparities have been exacerbated, with deprived areas facing more severe service reductions.
Commentary
This study highlights the pressing need to reevaluate funding strategies for local governments, particularly concerning social care services. The disproportionate impact of austerity on already disadvantaged regions has intensified social care inequities, leaving vulnerable populations with reduced access to essential support. To promote social care equity, it is imperative that policymakers address these geographical disparities and allocate resources in a manner that reflects the specific needs of each community.
Reference
Giebel et al. (2024). Socioeconomic determinants of access to dementia care in Europe: A systematic review. International Journal for Equity in Health, 23(1), 2245.
Key Messages
- Socioeconomic status significantly influences access to dementia care services, with lower-income individuals facing greater barriers.
- Financial constraints limit the ability to afford private care options, leading to reliance on often under-resourced public services.
- Educational disparities affect awareness and utilisation of available dementia care services.
- Policy interventions are needed to reduce socioeconomic inequalities and improve access to dementia care across Europe.
Commentary
This systematic review highlights the significant impact of socioeconomic factors on access to dementia care services across Europe. Individuals from lower socioeconomic backgrounds face substantial barriers, including financial constraints and limited awareness of available services, leading to disparities in care utilisation. The findings underscore the need for policy interventions aimed at reducing these inequalities, such as subsidising care costs and enhancing public awareness campaigns. Addressing these socioeconomic disparities is essential for ensuring equitable access to dementia care and improving health outcomes for all individuals, regardless of their economic status.
Reference
The King's Fund (2025). Social Care 360: Access.
Chart
Key Messages
- The number of new requests for social care support in England increased from 2.0 million in 2022/23 to 2.1 million in 2023/24.
- Requests from working-age adults rose by 8% (from 612,000 to 658,000), while requests from older people increased by 3% (from 1.39 million to 1.43 million).
- Despite the rising demand, the report indicates that the financial means test thresholds for social care has not been adjusted in line with inflation, potentially limiting access to publicly funded care.
Commentary
The increase in requests for social care support highlights growing demand within the sector. However, the report suggests that financial eligibility thresholds may not have been adjusted to reflect inflationary pressures. This stagnation could result in fewer individuals qualifying for publicly funded care, thereby increasing out-of-pocket expenses for those in need. Such a scenario may exacerbate existing inequities in access to social care services, particularly affecting low-income individuals who are unable to afford private care options. To promote equity, it is essential to regularly review and adjust financial eligibility criteria in line with economic changes, ensuring that access to necessary care services is based on need rather than financial capability.
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