← NHS

NHS · Social care and prevention · England · 2024–25

Why does NHS performance depend on social care and prevention?

Hospitals cannot discharge patients without care at home or in a care home, and adult social care has its own workforce and funding gap: 111,000 vacant posts in England in 2024–25 and about 470,000 more posts needed by 2040. Prevention changes demand, but slowly.

Evidence last reviewed 3 October 2026

Social care is a separate system with its own limits

This chapter covers how social care affects the NHS. For who asks for care and who gets it, unpaid carers, and what care costs, see the full adult social care section; for healthy life expectancy and preventable illness, see health.

1.60m

filled posts in adult social care

England, 2024–25 · Skills for Care estimate

7.0%

vacancy rate (111,000 posts)

down from 10.5% in 2021–22 · Skills for Care estimate

23.1%

of staff left their job in a year

about 335,000 leavers; many stay in the sector · Skills for Care estimate

How a shortage of care can hold up hospital treatment

  1. 1

    Ready to leave hospital

    Some patients no longer need a hospital bed, but still need support to leave safely.

  2. 2

    Care must be available

    A home-care package or care-home place needs staff and funding. Social care is a separate system, funded by councils and individuals.

  3. 3

    A bed becomes available

    Without that support, discharge can be delayed and beds remain occupied.

    More on this step

Vacancies have fallen since 2021–22, largely because of overseas recruitment from 2022–23. The government closed the care worker visa route to new overseas applicants on 22 July 2025, so future growth depends on recruiting and keeping staff in England, where care work is among the lowest-paid jobs. Skills for Care projects that demand alone would need about 470,000 more posts by 2040, as the population aged 65 and over grows by 27% and those aged 90 and over by 74%.

Long-term reform of how care is funded has been promised and postponed by successive governments. An independent commission on adult social care was set up in 2025 and is due to report in stages.

Prevention: changing demand, slowly

Much of the demand on the NHS comes from long-term conditions — diabetes, heart and lung disease, mental illness — that are more common, and arrive earlier in life, in poorer areas. People in England’s most deprived tenth of areas can expect about 20 fewer years in good health than those in the least deprived (women, 2022 to 2024; 19 years for men).

Public health services (smoking cessation, sexual health, drug and alcohol treatment, health visiting) are funded through councils. Evidence that prevention saves NHS money is strongest for specific interventions such as stopping smoking; for most programmes the benefits are real but arrive over years, so they do not relieve this winter’s pressure. Prevention is a reason to invest, not a reason to expect waiting lists to fall quickly.

More on health gaps between places and incomes: inequality; on people out of work through ill health: jobs and pay.

Sources and methods (3)

Method notes

  • Skills for Care figures are estimates for England built from its Adult Social Care Workforce Data Set (about half the regulated workforce) and are not official statistics.
  • The healthy life expectancy gap is the difference between the most and least deprived tenths of areas; ONS headline figures use the slope index of inequality, which differs.