The latest ADASS Spring Survey 2026 contains plenty of alarming statistics: a £715 million overspend across adult social care, growing waiting lists, widening concerns about safeguarding, and increasing doubts about the long-term sustainability of care markets. But the most important finding isn’t about social care finances at all. It is about where risk now sits in our public services.
Across England, local authorities are increasingly carrying responsibilities that once sat elsewhere in the system. Responsibility is moving from hospitals into communities, from the NHS into local government and, in many cases, from public services to families themselves. The question is no longer whether costs are rising. It is who picks them up when they do.
The survey paints a picture of a sector under growing strain. Adult social care overspent by £715 million nationally in 2025/26, and councils are expected to deliver a further £909 million of savings next year. Only 15% of Directors of Adult Social Services are fully confident those savings can be achieved.
Those numbers matter. But they are symptoms rather than causes. The bigger story is what is driving demand.
For years, the dominant narrative in adult social care has been population ageing.
Older people. Frailty. Dementia. Hospital discharge delays.
Those issues remain important, but this year’s survey suggests that the real pressures are increasingly being driven elsewhere. Directors report their greatest concerns are now linked to working-age adults with complex needs, transitions from children’s services, mental health demand, Section 117 aftercare responsibilities and the growing number of people who previously may have received NHS-funded support through Continuing Healthcare.
Almost every council leader will recognise these trends.
The challenge facing local authorities today is not simply that more people need support. It is that the support required is becoming more specialist, more intensive and significantly more expensive.
The survey highlights growing complexity among adults aged 18-64, increasing numbers of young people transitioning into adult services and rising mental health needs across communities. Directors identify complexity as the single biggest financial pressure facing adult social care budgets.
This is not a short-term fluctuation. It increasingly looks like the new demand profile for adult social care.
I strongly support the ambition behind neighbourhood health.
Supporting people closer to home is almost always the right thing to do. Few people want unnecessary time in hospital. Prevention, integration and community-based care remain the right direction of travel.
But the ADASS survey highlights an uncomfortable paradox.
If responsibility moves from hospitals into communities without a corresponding movement of resources, the pressure does not disappear.
It simply relocates.
Eighty-six per cent of Directors believe NHS pressures will lead adult social care to assume greater responsibility for services previously delivered by health partners. Seventy-two per cent believe social care staff are increasingly undertaking tasks that were once delivered by NHS professionals. Almost half report that the wider policy shift towards supporting more people closer to home is already increasing local demand.
That should give us pause.
Neighbourhood health cannot be delivered through structural reform alone. It needs workforce, capacity and sustainable investment in community support. Otherwise, neighbourhood care risks becoming little more than decentralised crisis management.
Anyone working at the interface between councils and the NHS will recognise the growing tension around Continuing Healthcare (CHC) and Section 117 funding arrangements.
The survey provides some of the clearest national evidence yet that these tensions are becoming systemic. Fifty-four per cent of Directors report fewer people qualifying for CHC. Seventy-five per cent report increasing numbers of people presenting to social care who would previously have qualified. Seventy-seven per cent report overspends linked to tighter CHC eligibility decisions.
Alongside this, a quarter of councils report NHS disinvestment in Section 117 aftercare and increasing disputes around funding responsibilities. Forty-three per cent report increased overspends linked to insufficient NHS funding for Section 117 support.
The issue here is not organisational conflict.
It is what that conflict tells us.
When systems are financially healthy, conversations focus on outcomes for people.
When systems are financially stretched, conversations increasingly focus on organisational boundaries and who pays.
That is not a criticism of any one organisation. It is a predictable consequence of scarcity.
But it is also a warning sign.
Perhaps the most revealing statistic in the entire report concerns prevention.
Government policy is increasingly framed around prevention. The NHS Ten Year Plan places it at the heart of future reform. Most leaders agree that supporting people earlier is preferable to responding when needs escalate.
Yet the proportion of adult social care budgets spent on preventative services has now fallen to just 5% — the lowest level recorded by ADASS. Only 20% of Directors are fully confident they can meet their prevention and wellbeing duties.
The irony is hard to miss.
The more pressure systems face, the less able they become to invest in the activities most likely to reduce future pressure.
It is a classic public sector trap.
And one we have been walking into for years.
For those of us working in place-based partnerships, the survey reinforces something many of us already know.
No organisation can solve these challenges alone.
The growth in complexity spans health, social care, housing, education, mental health, employment and community safety. The solutions must therefore be equally connected.
What struck me most about this year’s survey was not the scale of the financial challenge. We have almost become numb to those numbers.
It was the continued evidence that complexity, rather than volume, is now the defining issue.
The report describes rising need among people experiencing poor mental health, homelessness, poverty and multiple disadvantage. It highlights increasing safeguarding concerns, growing waiting lists and mounting pressures in the care market. What links all of these issues is that they cut across organisational boundaries.
And that points towards a bigger challenge for reform.
The question should not be whether costs sit with the NHS or local government.
The question should be what support helps people live well.
That sounds obvious.
Yet too often we continue to organise ourselves around institutions rather than people.
If neighbourhood health, prevention and integration are genuinely going to succeed, they must be accompanied by a meaningful shift of power, responsibility and resource into communities.
Otherwise adult social care will continue to function as the system’s shock absorber.
Always adapting.
Always responding.
Always filling the gaps.
But never quite receiving the investment needed to fulfil its full potential.
Adult social care overspent by £715 million last year.
That’s the headline from this week’s ADASS Spring Survey 2026. But I don’t think that’s the real story.
What struck me most wasn’t the size of the overspend, the growing waiting lists, or even the increasing concerns about safeguarding and market sustainability.
It was the evidence of a much bigger shift taking place across public services. Responsibility is moving from hospitals into communities. Risk is moving from the NHS into local government. And increasingly, adult social care is becoming the system’s safety net.
The survey highlights:
• Growing complexity among working-age adults.
• Rising mental health demand.
• Increasing pressures from transitions.
• More disputes around CHC and Section 117 funding.
• Falling investment in prevention despite universal agreement on its importance.
The question isn’t whether costs are increasing. The question is who picks them up when they do.
I’ve written a new Substack article exploring what I call “The Great Cost Shift” and why this matters for neighbourhood health, prevention, integration and the future of public service reform.
I’d be interested in whether others working across health, local government and the voluntary sector are seeing the same trends.
Read the full article here: [insert Substack link]
#SocialCare #NHS #LocalGovernment #Prevention #NeighbourhoodHealth #PublicServiceReform #HealthAndCare #Integration #Leadership #ADASS
Comments
Nothing yet. Say the first thing.
Sign in to join the conversation.