Adult social care · England · older people at home 2024 · council care 2014–15 to 2024–25

One in four older people at home reports not getting the help they need.

In England in 2024, 24% of people aged 65 and over in private households needed help with an everyday personal task but received none in the past month. Council services and unpaid carers meet different parts of that need.

Priority: Increase reliable, appropriate care and independence without transferring unmet need to families. What would change it →

Evidence last reviewed 3 October 2026

Overview

The short version

Three key measures

Who feels this most?

On Census Day 2021, 4.7 million people in England looked after someone because of illness, disability or old age, 1.4 million of them for 50 hours a week or more, and about 120,000 were aged 5 to 17. Women (10.3%) were more likely to care than men (7.6%), and people in the most deprived areas (10.1%) more than those in the least deprived (8.1%).

Help arranged by councils

Is council-arranged long-term care reaching more people?

Long-term care for over-65s fell for years and is now rising again; care for working-age adults has grown

People receiving long-term support provided or arranged by councils on 31 March, by age, England, 2014–15 to 2024–25, thousands. All care settings except prison.

England · 2014–15 to 2024–25

1996–2026 displayed window · observations only. Shading marks years outside the displayed record.

Thousands of peopleNo observations shown0k200k400k200020102020396k276k
396,000 people aged 65 and over were receiving council-arranged long-term care in March 2025, against 409,000 in 2014–15; the number fell to 360,000 in 2021–22 and has risen since. Working-age adults rose from 247,000 to 276,000. These counts show who councils support, not how many need care: they do not count self-funders or people who were turned away.

England · 2014–15 to 2024–25 · Official statistics in development

Sources, definitions and data — Long-term care for over-65s fell for years and is now rising again; care for working-age adults has grown
Geography:
England — Adults receiving council-arranged long-term care (community, residential and nursing)
Measure:
Thousands of people
Period:
2014–15 to 2024–25
Status:
Official statistics in development
Calculation:
As published, divided by 1,000. Plotted at the year-end date.
Compare with:
2014–15, the first year of the SALT return
Not included / breaks:
Excludes people who arrange and pay for their own care without council involvement, and all unpaid care. 2024–25 comes from client-level data rather than SALT; DHSC says long-term support remains directly comparable. Earlier years are excluded because community care was counted differently before 2014–15.

Source: DHSC, Adult social care activity report, England: 2024 to 2025, Table 60 (released 23 October 2025, updated 16 June 2026). Chart CARE-01.

View the data as a table
YearAged 18–64Aged 65+Total
2014–15247,445409,055656,500
2015–16247,070405,225652,295
2016–17254,500400,265654,765
2017–18253,810387,900641,710
2018–19255,115381,380636,495
2019–20254,375375,690630,065
2020–21256,110359,870615,980
2021–22253,625359,735613,360
2022–23258,850370,050628,900
2023–24264,465385,450649,915
2024–25275,825396,200672,025

Scroll the table sideways to see every column.

Separate measures, separate sources

These count different things over different periods. They are not steps in one funnel and should not be divided into each other.

  • 2.02m

    Requests for support from people new to social care

    2024–25; 1.39m people (some ask more than once) · DHSC activity report

  • 6%

    Requests leading to long-term support

    130,000 requests; 19% led to short-term support · DHSC activity report

  • 24%

    Over-65s at home reporting unmet need for personal care

    2024; help from anyone, paid or unpaid · Health Survey for England

  • 4.7m

    Unpaid carers

    Census day 2021; 1.4m care 50+ hours a week · ONS Census 2021

The number of needs assessments is not shown: DHSC’s 2024–25 report, now built from client-level records, does not publish it, and earlier figures are not comparable.

Adult social care is help with washing, dressing, eating, getting around and living safely — at home, in day services or in a care home — for older people and for working-age adults with disabilities or mental illness. It is not part of the NHS. Councils assess needs and finances, arrange care for people who qualify, and buy most of it from private and voluntary providers. People with savings above the means-test limit usually arrange and pay for care themselves and do not appear in council figures.

Councils supported 672,000 people in long-term care in March 2025, against 657,000 in March 2015, after a dip to 613,000 in 2021–22. Of 2.02 million requests from people new to care in 2024–25, 17% came at the point of hospital discharge. 24% of over-65s living at home report some unmet need for personal care — help from anyone, paid or unpaid.

Who funds and arranges what

Responsibilities and sequence, not measured effects

  1. 1

    Hospital (NHS trust)

    Treats the patient and decides when they no longer need a hospital bed. Funded by the NHS through integrated care boards.

    More on this step
  2. 2

    Discharge planning (NHS and council)

    Hospital and council staff agree what support is needed. Short-term reablement after discharge is free for up to six weeks under the Care Act.

    More on this step
  3. 3

    Council assessment and means test

    Councils with adult social services responsibilities assess eligibility against national criteria and assess finances. People above the means-test limit usually pay for their own care.

    More on this step
  4. 4

    Care providers

    Mostly private and voluntary home-care agencies and care homes, registered with the Care Quality Commission. Paid by councils, by people themselves, or both.

    More on this step
  5. 5

    Home, housing and family

    Adaptations come from housing authorities (Disabled Facilities Grant); day-to-day care also comes from unpaid family and friends (4.7 million carers in England at the 2021 Census).

    More on this step

On an average day in Sep 2026 about 13,647 patients in England’s hospitals no longer met the criteria to stay. Some were waiting for social care; others for NHS community services, assessments or transport. Published figures do not allow a reliable split by cause, so this page does not estimate how many beds more care would free. Details: why hospitals cannot move patients through.

Who feels this most?

Women and people in deprived areas are more likely to be unpaid carers

Usual residents aged 5 and over providing unpaid care, age-standardised per cent, England, Census 2021.

Per cent providing unpaid care
  • Women10.3%
  • Men7.6%
  • Most deprived areas10.1%
  • Least deprived areas8.1%
  • All, England8.9%

Source: ONS, Unpaid care by age, sex and deprivation, England and Wales: Census 2021 (13 February 2023). Self-reported; taken during the pandemic.

Unmet need is also higher for women (27% against 21% of men aged 65+) and, according to the Health Survey for England, more common in more deprived areas. More in who cares unpaid.

Go deeper

  • Who asks for care, and who gets it?
    +2.4%2014-15–2024-25England · people
    No observationsshown0400K800K19962026
    656,500 → 672,0252014-15–2024-25
    People receiving council-arranged long-term support at year end. This does not count everyone needing care or privately purchased care.
    Sources and data

    Counts rounded to the nearest 5; totals are sums of care settings and exclude prison support. Excludes people who arrange and pay for care entirely themselves, and unpaid care. 2024-25 comes from Client Level Data rather than the SALT return; DHSC says long-term support is directly comparable with earlier years. Earlier years (RAP, to 2013-14) are excluded because community care was counted differently before SALT.

    Source dataset →
    PeriodpeopleStatus
    2014-15656,500Outturn
    2015-16652,295Outturn
    2016-17654,765Outturn
    2017-18641,710Outturn
    2018-19636,495Outturn
    2019-20630,065Outturn
    2020-21615,980Outturn
    2021-22613,360Outturn
    2022-23628,900Outturn
    2023-24649,915Outturn
    2024-25672,025Outturn
    Requests, outcomes, eligibility and unmet need, measured separately.Read the chapter → Who asks for care, and who gets it?
  • What does care cost, and who pays?
    +67.8%2018-19–2025-26England (social-care-delivering authorities only — excludes shire districts) · £000s
    No observationsshown015M30M19962026
    16,065,093 → 26,952,5072018-19–2025-26
    Council net spending, £000s in cash prices. Inflation and changes in wages affect the trend; growth is not extra care delivered.
    Sources and data

    Summed from MHCLG's per-authority Revenue Outturn CSV, restricted to authorities that structurally deliver social care (Unitary Authority, UA, Shire County, London borough, Met District — shire districts excluded, since England's two-tier system gives them no social care or education function). This series answers 'what share of TOTAL net current service expenditure (including grant-funded education) goes to social care, among authorities that deliver it' — NOT the commonly-cited 60-70% figure, which almost certainly uses a narrower 'core spending power' denominator (excluding the Dedicated Schools Grant). See data/evidence-gaps.json's public-finances-social-care-share-denominator entry for the open question this raises. Local government reorganisation created new unitary authorities across several years in this window (e.g. Cumbria, North Yorkshire, Somerset in 2023) — the set of authorities summed changes composition year to year as former two-tier areas move from (excluded) district + (included) county to a single (included) unitary; this does not change the overall population covered, since the county-level social care spend was already included, but affects authority counts.

    Source dataset →
    Period£000sStatus
    2018-1916,065,093Outturn
    2019-2016,893,476Outturn
    2020-2118,699,484Outturn
    2021-2218,956,021Outturn
    2022-2320,503,773Outturn
    2023-2423,483,240Outturn
    2024-2525,149,845Outturn
    2025-2626,952,507Outturn
    Council spending, NHS contributions, charges and unit costs.Read the chapter → What does care cost, and who pays?

Evidence → choices → outcomes

What could improve it?

Older and disabled adults in England get help to stay safely at home after illness or a fall, and fewer report needs that nobody meets.

These options link to their national assessment, including funding, delivery constraints and remaining uncertainties.

  • Assessed option · provisional

    Help older people stay safe at home

    Target home adaptations and evaluate independence and care needs.

    8/10 criteria scored

    Coverage of the appraisal, not an impact score.

    Delivery: Amber

    Whole-life costs incomplete

    Evidence and delivery constraints

    Strong evidence supports targeted home-hazard reduction. Reablement does not inherit that evidence; the combined score is deliberately limited.

    Separate budgets and cohorts; arrange risk assessment, therapists, installers and care staff; compare reablement outcomes.

    Wellbeing listEvidence and assessment

  • Assessed option · provisional

    A costed social-care capacity plan

    7/10 criteria scored

    Coverage of the appraisal, not an impact score.

    Delivery: Red

    Whole-life costs incomplete

    Evidence and delivery constraints

    Need is established; no specified, evaluated expansion package. A funding-protection reform is not a capacity intervention.

    Model unmet need; specify pay, recruitment, training and commissioning; support unpaid carers; agree recurring funding.

    Wellbeing listEvidence and assessment

  • Assessed option · provisional

    Make heat protection operational in vulnerable settings

    Assess overheating in selected care settings and homes, then commission proportionate cooling, shading and response plans.

    8/10 criteria scored

    Coverage of the appraisal, not an impact score.

    Delivery: Amber

    Whole-life costs incomplete

    Evidence and delivery constraints

    The site records heat risk and options; it does not evaluate this exact package.

    Cost a local risk-led plan before the next warm season, prioritising people unable to protect themselves. Use risk-based standards; a mild summer is not proof the intervention worked.

    Resilience and sustainability appraisal queueEvidence and assessment

This domain in the UK SWOT →UK National Action Plan →

How we assessed these options

What would it take to improve this?

What would move the needle?

The outcome we want: Older and disabled adults in England get help to stay safely at home after illness or a fall, and fewer report needs that nobody meets.

The main constraint: Councils hold the duty but buy most care from private providers whose staff are shared between short-term reablement and long-term home care, so extra capacity needs named money in local Better Care Fund plans and staff who are already scarce; how much the state pays towards care (a cap or the means test) is a separate national decision for DHSC and HM Treasury.

Constraint type: workforce, money, coordination.

The options on the table

What is funded now, and the changes assessed against it — the current baseline and the alternatives, before the position today and the actions.

Provisional single-reviewer assessments from the 6 October 2026 review; not approved business cases, and not government policy.

  • Older people safe at homeDelivery RAG: Amber

    Funded now
    Not yet stated in the record.
    The change assessed
    Not yet defined.

    Range if completed: 17.0–23.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))

  • A costed social-care capacity planDelivery RAG: Red

    Funded now
    Baseline: a £500m first-year envelope agreed for the Fair Pay Agreement, with negotiations from about April 2027 and the first agreement in April 2028; an adult social care workforce plan promised by the end of 2026 (30 September 2026); the Casey Commission reports by summer 2027; the Prime Minister has proposed a National Care Service for the next Parliament. Making the workforce plan a costed capacity plan tied to the pay agreed is a UK Facts proposal, not government policy.
    The change assessed
    Not yet defined.

    Range if completed: 10.0–19.0 out of 30 (equal weights; not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co))

  • Targeted loneliness supportDelivery RAG: Amber

    Funded now
    Not yet stated in the record.
    The change assessed
    Test a specified facilitated social-connection intervention for an identified group, using validated loneliness measures and a comparison group.

    Range if completed: 15.0–21.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))

  • Make heat protection operational in vulnerable settingsDelivery RAG: Amber

    Funded now
    Baseline: the Adverse Weather and Health Plan (guidance; no statutory duty or indoor-temperature standard for care homes); building regulations on overheating (Approved Document O) for new buildings only; more than £32m for NHS cooling projects (September 2026), nothing yet for social care. Risk assessment and building-specific measures in existing care homes is a UK Facts proposal, not government policy.
    The change assessed
    Assess overheating in selected care settings and homes, then commission proportionate cooling, shading and response plans.

    Range if completed: 17.0–23.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))

Alternatives already on record: 25 options listed under the points in the position today (15 without an action record), and 3 earlier options under other options compared. They have not been scored in the review.

The position today

  • What we can build on (2)
  • What is holding us back (5)24% of people aged 65 and over living at home reported some unmet need for help with personal tasks such as washing or dressing (27% of women, 21% of men). (2024 · England (private households))
  • What could improve things (2)Targeted social and psychological support can alleviate loneliness. The DCMS review finds promising approaches, but variable designs, populations and follow-up limit transfer to a new service. Local delivery should remove barriers to participation and test sustained outcomes. (OECD intervention studies; application to local UK services requires testing)
  • What could make it worse (2)

Which quadrant a point sits in is our analytical judgement, not a statistical category. Each point says whether it is a measured fact, our synthesis or a risk.

What we can build on Strengths

What is holding us back Weaknesses

What could improve things Opportunities

What could make it worse Threats

The actions worth examining

Our shortlist for this page. Research quality, policy status, cost and funding are judged separately; none of these is government policy unless its status says so.Our shortlist. None is government policy unless its status says so.

  1. Fit home adaptations faster for older people at high risk of falling, after an occupational-therapist hazard check — programme funding exists; project allocation unconfirmed
  2. Offer reablement to more older people leaving hospital, and judge it by whether they are still at home three months later — programme funding exists; project allocation unconfirmed
  3. Publish a costed care workforce and capacity plan alongside the Fair Pay Agreement — not yet costed / funding not identified

And 1 more in the full list.

  • Action 1A52Policy status: established

    Fit home adaptations faster for older people at high risk of falling, after an occupational-therapist hazard check

    An occupational therapist assesses hazards at home for people at higher risk of falling, and the rails, lighting and level access they recommend are fitted quickly.

    The thread: issue, evidence, action

    1. Issue Weakness: Falls led to 221,600 emergency hospital admissions of people aged 65 and over in 2024/25 — 1,958 per 100,000, below the 2,256 of 2019/20 but about 600 admissions a day. Also: opportunity, strength
    2. Evidence Emergency hospital admissions due to falls, people aged 65+
    3. Action A52, this action

    Assessment (draft, 6 October review)

    • A broad priority including this action (GRP-03): Older people safe at home

      Delivery RAG: AmberGate: pending

      Range if completed: 17.0–23.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))

      National plan: Wellbeing list

    Who decides:
    Housing authorities (Disabled Facilities Grant) with social care occupational therapists and NHS falls services, through Better Care Fund plans (England)
    Evidence:
    Synthesis of robust evaluations. A 2023 Cochrane review of randomised trials found high-certainty evidence of fewer falls for people selected for higher risk, and no effect for people not selected.
    Expected effect:
    −38% rate of falls (rate ratio 0.62): rate of falls among older people at higher risk of falling (International trials, including the UK). No effect for people not selected for risk (rate ratio 1.05, 95% CI 0.96 to 1.16), so the targeting is the intervention. Trials measured falls, not admissions or care-home moves.
    Cost and funding

    £723m in total, 2026–27, price basis not stated by the source; 1 further cost line, some not yet costed

    Funding: Programme funding exists; project allocation unconfirmed

    Why it is shortlisted here: The best-evidenced option on this page: in randomised trials, home-hazard work cut falls by 38% for people at higher risk. A grant already exists; the change is to target it, add an occupational-therapist check and publish waiting times.

    What it takes
    The problem

    Falls are a common route into hospital and long-term care, and adaptations funded by the Disabled Facilities Grant took more than six months from application to completion in the last national review (nearly 10 weeks to approval and over 17 weeks to completion) — before the wait for an assessment.

    Who is affected, and where

    Older people in England living at home who are at higher risk of falling (for example after a fall), including those eligible for the Disabled Facilities Grant. Territory: England. The Disabled Facilities Grant covers England (Wales and Northern Ireland have their own grants; Scotland funds adaptations differently); not assessed here.

    Policy status

    Already in place. The Disabled Facilities Grant (£723m in 2026–27) and free minor adaptations up to £1,000 already exist. The proposal is to target them at people at higher risk of falling, with OT assessment and a speed standard.

    The evidence
    What the research found:
    Home fall-hazard reduction cut the rate of falls by 38% for people at higher risk (rate ratio 0.62, 95% CI 0.56 to 0.70; high certainty) and by 26% overall (0.74, 0.61 to 0.91; moderate certainty), with no effect for people not selected for risk (1.05). Occupational-therapist delivery: 0.68 (0.51 to 0.91), not significantly different from other staff.
    Evaluated on:
    Older people living in the community, in trials in several countries including the UK; Randomised trials included in the 2023 review
    Transfer to this case:
    Trials measured falls, not hospital admissions or care-home moves; English waiting times and grant rules will shape what is achieved.
    Our recommendation (separate from the research):
    Prioritise adaptations for people at higher risk of falling, with an OT hazard assessment and a published waiting-time standard, and measure falls admissions.
    Strongest counter-evidence:
    Untargeted home-hazard programmes did not reduce falls, so spending spread across everyone eligible would be wasted; the latest national waiting-time data are from 2018.
    Effects on record
    • Rate of falls among older people at higher risk of falling: −38% rate of falls (rate ratio 0.62) (usual care or no intervention in randomised trials; Trials included in the 2023 review; 95% CI 0.56 to 0.70 (falls −44% to −30%); 9 studies, 1,513 participants; high certainty). evaluated, high confidence; International trials, including the UK. No effect for people not selected for risk (rate ratio 1.05, 95% CI 0.96 to 1.16), so the targeting is the intervention. Trials measured falls, not admissions or care-home moves.
    Cost and funding

    Cost completeness: Not yet costed. Funding: Programme funding exists; project allocation unconfirmed.

    • Disabled Facilities Grant 2026–27 (programme envelope) (capital; paid by central government): £723m in total, 2026–27, price basis not stated by the source. Paid within the Better Care Fund; means-tested for adults, with a maximum mandatory grant of £30,000. Not ring-fenced to falls prevention or to people at high risk. No price basis stated.
    • Occupational-therapist home-hazard assessments and faster processing for people at higher risk of falls (recurring spending; paid by councils, NHS): Not yet costed. Not costed. Needs current local quotes for OT time per assessment and the minor works; minor adaptations up to £1,000 are already free under the 2014 regulations.
    • Disabled Facilities Grant allocations 2026–27: £723m, 2026–27 to 2026–27 — not committed (programme envelope, not a project award). Allocated to housing authorities by formula; not earmarked for falls prevention.
    Who pays:
    Central government through the Disabled Facilities Grant (paid to housing authorities); councils and the NHS for occupational-therapist time; some applicants contribute after the means test.
    Financing proposed:
    Prioritise high-risk applicants within existing DFG allocations (£723m in 2026–27) and fund OT assessments from local Better Care Fund plans.
    Gap remaining:
    Unknown: OT capacity and faster processing have not been costed; prioritising high-risk applicants within a fixed grant means others wait longer.
    What delivery needs
    Skills:
    Occupational therapists and trusted assessors; builders for adaptations.
    Operational capacity:
    Assessment slots and contractor capacity.
    Infrastructure:
    Referral routes from falls services and hospitals.
    Permissions:
    Landlord consent for adaptations in rented homes.
    Law:
    No new law; the upper limit of the grant is under review.
    Public consent:
    People choose whether to have adaptations.
    First step and stages

    First step: Publish current waiting times from referral to completed adaptation, and set a fast route for people referred by falls services. (owner: Housing authorities with social care and NHS falls services)

    1. Measure current waits and identify high-risk referrals — Housing authorities (proposed stage, not an official timetable)
    2. Run OT assessment and a fast adaptation route — Councils with NHS falls services (proposed stage, not an official timetable)
    3. Track falls and admissions among people adapted — Councils with the integrated care board (proposed stage, not an official timetable)

    Depends on: Occupational-therapist supply; Building contractors

    Trade-offs
    Who gains and who loses:
    Gains for older people at higher risk of falling; people with lower-priority adaptations may wait longer within a fixed grant.
    What else the money or effort could do:
    Grant and OT time spent on falls-risk adaptations is not available for other disabled applicants, including children.
    Strongest counterargument:
    Trial results come from structured research programmes; routine delivery with long waits may not reproduce them, and the grant is a housing budget meant for all disabled people.
    Risks:
    Waiting lists moving rather than shrinking; targeting that misses people at risk; quality of works.
    How we would judge it
    Baseline:
    Nearly 10 weeks from application to approval and over 17 weeks from approval to completion in the 2018 national review (excluding OT waits); no current national figure.
    Leading indicator:
    Days from referral to completed adaptation for high-risk referrals.
    Outcome:
    Falls and emergency admissions for falls among people adapted, against a comparison of people waiting.
    Continue, adapt or stop:
    Publish waiting times first; continue if waits fall without lengthening other applicants’ waits beyond a level set in the local plan.
    Earlier option on this page

    This card replaces the option “Home adaptations and falls prevention” (operating). Its evidence: A Cochrane review found home safety assessment and modification reduced the rate of falls, especially among people at higher risk and when delivered by occupational therapists. Gillespie LD et al., Interventions for preventing falls in older people living in the community, Cochrane Database of Systematic Reviews (2012), CD007146

    Sources

    Source published March 2023 (Cochrane); December 2018 (DFG review); February 2026 (DFG allocations); evidence reviewed 2026-10-04. Reconsider if: A decision on the DFG upper limit; New national data on adaptation waiting times; The Casey Commission’s recommendations.

  • Action 2A51Policy status: established

    Offer reablement to more older people leaving hospital, and judge it by whether they are still at home three months later

    Up to six weeks of free, goal-focused support at home after discharge helps people relearn daily tasks, so fewer need long-term care or return to hospital.

    The thread: issue, evidence, action

    1. Issue Weakness: Only 5.7% of people aged 65 and over discharged from hospital were provided reablement. Also: threat, opportunity, strength
    2. Evidence People aged 65+ discharged from hospital who were provided reablement; People aged 65+ still living in the community 12 weeks after discharge into reablement
    3. Action A51, this action

    Assessment (draft, 6 October review)

    • A broad priority including this action (GRP-03): Older people safe at home

      Delivery RAG: AmberGate: pending

      Range if completed: 17.0–23.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))

      National plan: Wellbeing list

    Who decides:
    Councils with adult social services duties, with NHS community services and integrated care boards, through local Better Care Fund plans (England)
    Evidence:
    Expert or audit recommendation. NICE recommends reablement as the first option before home care, but the Cochrane review found evidence too weak to support or refute its effect, and the main English evaluation was preliminary.
    Expected effect:
    Direction plausible; size not established.
    Cost and funding

    £8.43bn in total, 2026–27, price basis not stated by the source; 1 further cost line, some not yet costed

    Funding: Programme funding exists; project allocation unconfirmed

    Why it is shortlisted here: Few older people leaving hospital get reablement (5.7%), and it is free by law for six weeks. Its effect is not established by trials, so the action extends it to a defined cohort with funded staff and a 91-day comparison, rather than expanding on faith.

    What it takes
    The problem

    Only 5.7% of people aged 65 and over discharged from hospital in England were provided reablement in 2024–25, and its effect has not been established by trials.

    Who is affected, and where

    People aged 65 and over in England discharged from hospital who could regain independence; working-age adults where councils choose. Territory: England. Social care is devolved; Scotland, Wales and Northern Ireland run separate reablement services, not assessed here.

    Policy status

    Already in place. Reablement is a statutory, free service for up to six weeks in every council. The proposal is to extend it to a defined cohort with staffing and a 91-day follow-up, not to create a new service.

    The evidence
    What the research found:
    Cochrane (2016): “very low quality” evidence; effectiveness “cannot be supported or refuted”. MoRe (2019): outcomes improved between referral and discharge from reablement, but without a comparison group or a sample large enough to compare service models. In 2024–25, 60.7% of over-65s discharged into reablement remained in the community for 12 weeks — a description, not an effect.
    Evaluated on:
    Older adults receiving time-limited home-care reablement (Cochrane); English reablement services (MoRe); International trials to 2016; English services in the 2010s
    Transfer to this case:
    Who is offered reablement differs widely between councils, so local outcome rates partly reflect eligibility, not service quality.
    Our recommendation (separate from the research):
    Extend reablement to a defined discharge cohort in one area, with therapists and care workers funded, and evaluate it against a comparison at 91 days and later.
    Strongest counter-evidence:
    Systematic-review evidence cannot show that reablement improves independence, and short-term services use the same scarce staff as long-term home care.
    Effects on record
    • Older people still living at home after a hospital stay, without readmission or long-term care: Direction plausible; size not established. plausible spillover, limited confidence; England. 60.7% of over-65s discharged into reablement remained in the community for 12 weeks (2024–25), but that is a description of outcomes, not an effect: there is no comparison group, and the Cochrane review could neither support nor refute reablement’s effect.
    • Care hours available for people already needing long-term home care: A mixed effect; size not established. plausible spillover, limited confidence; England. A trade-off to plan for with 7.0% of care posts vacant (Skills for Care, 2024/25), not a measured effect.
    Cost and funding

    Cost completeness: Not yet costed. Funding: Programme funding exists; project allocation unconfirmed.

    • Additional reablement capacity — therapists, care workers and discharge coordination — for a defined cohort, with a 12-week follow-up (recurring spending; paid by councils, NHS): Not yet costed. Not costed. Councils already spend on short-term care (about £1.1bn gross in 2024–25, DHSC finance report); that is current spending, not the cost of expansion. MoRe’s £1,728 average cost per case has no stated price year and is not used as a unit cost.
    • Better Care Fund 2026–27, excluding the Disabled Facilities Grant (programme envelope) (recurring spending; paid by NHS, central government): £8.43bn in total, 2026–27, price basis not stated by the source. Minimum NHS contribution £5,791m plus the Local Authority Better Care Grant £2,640m (UK Facts sum of two Table 1 rows; the £9,154m total includes the £723m DFG, recorded separately as C-DFG-2627). A pooled envelope for many services, not an allocation to reablement; the framework states no price basis.
    • Better Care Fund 2026–27 pooled budget (NHS minimum contribution and Local Authority Better Care Grant): £8.43bn, 2026–27 to 2026–27 — not committed (programme envelope, not a project award). A programme envelope, not an award to a reablement scheme.
    Who pays:
    Councils and the NHS, through the Better Care Fund pooled budget; reablement is free to the person for six weeks.
    Financing proposed:
    A named allocation within a local Better Care Fund plan (the 2026–27 pool is £8,431m excluding the DFG), which displaces other services in that plan unless new money is added.
    Gap remaining:
    Unknown: the extra capacity for a defined cohort has not been costed; the BCF is an envelope for many services, not an allocation to reablement.
    What delivery needs
    Skills:
    Occupational therapists, physiotherapists and reablement care workers.
    Operational capacity:
    Starting support on the day of discharge; follow-up at 91 days.
    Infrastructure:
    Linked health and social care records.
    Permissions:
    Local agreement in the Better Care Fund plan.
    Law:
    No new law (free for six weeks under existing regulations).
    Public consent:
    People choose whether to accept reablement.
    First step and stages

    First step: Name the cohort, staffing and Better Care Fund allocation in one area, and set up a matched comparison with 91-day follow-up before expanding. (owner: A council and its integrated care board)

    1. Define the cohort, staffing and comparison — Council and integrated care board (proposed stage, not an official timetable)
    2. Run the extended service — Council reablement team with NHS community services (proposed stage, not an official timetable)
    3. Report at 91 days and 12 months — Council with an independent evaluator (proposed stage, not an official timetable)

    Depends on: Care workforce supply; Hospital discharge planning

    Trade-offs
    Who gains and who loses:
    Gains for older people who regain independence after a hospital stay; risk to people waiting for long-term home care if staff are moved from it.
    What else the money or effort could do:
    The same staff and BCF money could provide long-term home-care hours or community health services.
    Strongest counterargument:
    Without trial evidence, expansion may mostly reach people who would have recovered anyway, and outcome rates depend on who is selected.
    Risks:
    Cherry-picking people likely to recover; counting episodes rather than outcomes; draining long-term home care.
    How we would judge it
    Baseline:
    60.7% of over-65s discharged into reablement remained in the community for 12 weeks; 5.7% of over-65 discharges were provided reablement (2024–25, new measures, not comparable with earlier years).
    Leading indicator:
    Share of eligible discharges offered reablement, and days from discharge to start.
    Outcome:
    At home 91 days after discharge without readmission or long-term care, personal goals met, and long-term care hours at 12 months — each against the comparison group.
    Continue, adapt or stop:
    Set continue and stop thresholds in the local business case before launch, from the baseline and the size of the cohort; never from episode counts.
    Earlier option on this page

    This card replaces the option “More short-term reablement after illness or hospital” (operating). Its evidence: NICE recommends reablement as part of intermediate care, but evaluations are mixed and of limited quality. DHSC says 2024–25 reablement data are incomplete in some councils. NICE guideline NG74, Intermediate care including reablement · DHSC, Adult social care activity report, England: 2024 to 2025

    Sources

    Source published September 2017 (NICE); October 2016 (Cochrane); April 2019 (MoRe); December 2025 (ASCOF); evidence reviewed 2026-10-04. Reconsider if: The 2025–26 ASCOF release (due December 2026); A trial-grade UK evaluation of reablement; The Casey Commission’s recommendations (expected summer 2027).

  • Action 3A60Policy status: external proposal

    Publish a costed care workforce and capacity plan alongside the Fair Pay Agreement

    A published plan that models pay (from the Fair Pay Agreement) against vacancies, turnover and the posts needed, and sets the funding for each step, lets councils and providers commission capacity they can staff.

    The thread: issue, evidence, action

    1. Issue Weakness: About 111,000 care posts were vacant (7.0%) and 23.1% of staff left their job in a year. Also: threat
    2. Evidence Vacancy rate in adult social care
    3. Action A60, this action

    Assessment (draft, 6 October review)

    • This action: A costed social-care capacity plan

      Delivery RAG: RedGate: pending

      Range if completed: 10.0–19.0 out of 30 (equal weights; not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co))

      National plan: Wellbeing list

    Who decides:
    Department of Health and Social Care with HM Treasury, councils and the Fair Pay Agreement negotiating body (England)
    Evidence:
    Observational analysis. Econometric analysis of English care workforce data estimates that higher pay raises employment, but the authors say the estimate is an overstatement; no costed capacity plan or evaluated expansion exists.
    Expected effect:
    Direction plausible; size not established.
    Cost and funding

    Not yet costed

    Funding: Not yet costed / funding not identified

    Why it is shortlisted here: The national care-capacity option (Wellbeing list): about 111,000 posts are vacant and a quarter of staff leave each year, and no costed plan links the coming Fair Pay Agreement to the capacity councils must buy. Reablement and adaptations stay as the evidenced service changes.

    What it takes
    The problem

    About 111,000 care posts are vacant and almost a quarter of staff leave their job each year, demand alone needs 470,000 more posts by 2040, and no costed plan links the coming Fair Pay Agreement to the capacity councils must buy.

    Who is affected, and where

    Adult social care in England: about 1.6 million filled posts, the people who draw on care, and councils that commission it. Territory: England. Social care is devolved; Scotland and Wales have their own negotiating-body powers under the Employment Rights Act 2025. Not assessed.

    Policy status

    Proposed by researchers or others, not government policy. Baseline: a £500m first-year envelope agreed for the Fair Pay Agreement, with negotiations from about April 2027 and the first agreement in April 2028; an adult social care workforce plan promised by the end of 2026 (30 September 2026); the Casey Commission reports by summer 2027; the Prime Minister has proposed a National Care Service for the next Parliament. Making the workforce plan a costed capacity plan tied to the pay agreed is a UK Facts proposal, not government policy.

    The evidence
    What the research found:
    A 5% real pay rise is projected to add 9–11% employment (elasticity 3.85; 1.80 in residential care), ignoring wage responses in other sectors.
    Evaluated on:
    Care workers in the Adult Social Care Workforce Data Set, 2016–2022; England
    Transfer to this case:
    Projections from past data; overseas recruitment and wage rises elsewhere are not captured.
    Our recommendation (separate from the research):
    Publish the pay, vacancy and capacity modelling behind the Fair Pay Agreement and the National Care Service, with the cost of each step and who pays, before the first agreement.
    Strongest counter-evidence:
    Pay rises in care may be matched elsewhere, so recruitment gains could be smaller than projected; a plan does not itself add capacity.
    Cost and funding

    Cost completeness: Not yet costed. Funding: Not yet costed / funding not identified.

      Who pays:
      Central government through council funding; councils; people who pay for their own care.
      Financing proposed:
      Not identified beyond the £500m envelope.
      Gap remaining:
      Unknown: the recurring cost of the pay agreed, provider viability and the cost of extra capacity.
      What delivery needs
      Skills:
      Workforce modelling.
      Operational capacity:
      Recruitment and retention.
      Infrastructure:
      None for the plan.
      Permissions:
      None.
      Law:
      Fair Pay Agreement regulations (2026).
      Public consent:
      Employer and union agreement in the negotiating body.
      First step and stages

      First step: DHSC publishes the workforce and capacity modelling behind the Fair Pay Agreement remit, with vacancy and turnover scenarios and costs, before negotiations begin. (owner: DHSC with HM Treasury)

      1. Publish modelling and costs — DHSC (proposed stage, not an official timetable)
      2. Set funding for each step — HM Treasury and DHSC (proposed stage, not an official timetable)
      3. Track vacancies and turnover against the plan — Skills for Care; DHSC (proposed stage, not an official timetable)

      Depends on: Fair Pay Agreement regulations and negotiating body; The Casey Commission report (summer 2027)

      Trade-offs
      Who gains and who loses:
      Care workers on low pay and people waiting for care.
      What else the money or effort could do:
      Money for care pay and capacity competes with NHS and other spending.
      Strongest counterargument:
      Pay settlements, not plans, change capacity; a plan can be a substitute for funding.
      Risks:
      A plan published without funding; vacancies shifting to other low-paid sectors.
      How we would judge it
      Baseline:
      2024/25: vacancy rate 7.0% (111,000 posts); turnover 23.1% (Skills for Care).
      Leading indicator:
      Plan published with costs; Fair Pay Agreement negotiated.
      Outcome:
      Vacancy and turnover rates; unmet need for care.
      Continue, adapt or stop:
      Revise the plan where vacancies do not fall as pay rises.
      Sources

      Source published 15 October 2025 (Skills for Care); 16 July 2026 (Fair Pay Agreement response); April 2024 (Vadean et al.); evidence reviewed 2026-10-07. Reconsider if: Skills for Care State of the sector 2026 (14 October 2026); The Casey Commission report; The Budget on 28 October 2026.

    • Action 4A77Policy status: external proposal

      Assess overheating in care homes and fund building-specific cooling where risk is highest

      An overheating risk assessment of existing care homes followed by the measures that suit each building — shading with window rules, thermal mass or portable cooling in lounges — keeps residents cooler in heatwaves.

      The thread: issue, evidence, action

      1. Issue Weakness: Care homes had more heat-associated deaths than any other setting in summer 2025 — an estimated 677 (95% CI 406–949), 9% above the expected level — and there is no routinely collected data on overheating or adaptation in care homes. Also: threat (Health)
      2. Evidence Heat-associated deaths in care homes
      3. Action A77, this action

      Assessment (draft, 6 October review)

      Who decides:
      Department of Health and Social Care with UKHSA, the care regulator, councils and care providers (England)
      Evidence:
      Modelled scenario. Building-physics and health modelling of three care homes finds cost-effective options; no trial or evaluated programme exists, and the national heatwave plan has not been shown to change heat mortality.
      Expected effect:
      Direction plausible; size not established.
      Cost and funding

      Not yet costed

      Funding: Not yet costed / funding not identified

      Why it is shortlisted here: The resilience option for heat (appraisal queue): care homes had the most heat-associated deaths of any setting in 2025, and overheating rules do not cover existing homes; the action assesses risk and funds building-specific measures, measured by heat deaths in care homes.

      What it takes
      The problem

      Care homes had more heat-associated deaths than any other setting in summer 2025, there is no routine data on overheating or adaptation in care homes, and building rules on overheating cover only new buildings.

      Who is affected, and where

      Residents of existing care homes in England, starting with homes assessed at highest overheating risk. Territory: England. Health, care and building rules are devolved; not assessed outside England.

      Policy status

      Proposed by researchers or others, not government policy. Baseline: the Adverse Weather and Health Plan (guidance; no statutory duty or indoor-temperature standard for care homes); building regulations on overheating (Approved Document O) for new buildings only; more than £32m for NHS cooling projects (September 2026), nothing yet for social care. Risk assessment and building-specific measures in existing care homes is a UK Facts proposal, not government policy.

      The evidence
      What the research found:
      Cost-effective measures exist and depend on the building (shading with window-opening rules, thermal mass, portable air-conditioning in lounges); the Heatwave Plan evaluation found no evidence the temperature–mortality relationship changed after the plan began.
      Evaluated on:
      Three English care homes (modelling); England (heatwave plan evaluation); England
      Transfer to this case:
      Modelled, not trialled; results are sensitive to the temperature–mortality assumptions.
      Our recommendation (separate from the research):
      Assess overheating in existing care homes, fund the building-specific measures modelling supports, and measure indoor temperatures and heat deaths in care homes against comparison homes.
      Strongest counter-evidence:
      Most heat deaths occur outside alert periods and the heatwave plan has not been shown to reduce them; the benefit of building measures is modelled, not observed.
      Cost and funding

      Cost completeness: Not yet costed. Funding: Not yet costed / funding not identified.

        Who pays:
        Care providers and councils; central government if a grant is made.
        Financing proposed:
        Not identified.
        Gap remaining:
        Unknown: there is no costing of assessments or measures for care homes.
        What delivery needs
        Skills:
        Building surveyors and overheating assessors.
        Operational capacity:
        Provider estates teams.
        Infrastructure:
        Shading, ventilation and cooling.
        Permissions:
        Planning or listed-building consent in some cases.
        Law:
        None for voluntary measures.
        Public consent:
        Provider participation.
        First step and stages

        First step: DHSC and UKHSA fund overheating assessments in a sample of care homes, publish the share at high risk, and pilot building-specific measures with comparison homes before summer 2027. (owner: DHSC with UKHSA)

        1. Assess overheating in a sample of care homes — DHSC and UKHSA (proposed stage, not an official timetable)
        2. Fund building-specific measures — DHSC and providers (proposed stage, not an official timetable)
        3. Compare indoor temperatures and heat deaths — UKHSA (proposed stage, not an official timetable)

        Depends on: Indoor temperature monitoring; Provider capital

        Trade-offs
        Who gains and who loses:
        Older, frail care-home residents, who are most exposed to heat.
        What else the money or effort could do:
        Capital for cooling competes with other care-home investment.
        Strongest counterargument:
        Staff action on hot days (fluids, monitoring) may prevent more deaths than building work.
        Risks:
        Air-conditioning raising energy costs and emissions; measures that do not suit the building.
        How we would judge it
        Baseline:
        Summer 2025: 677 heat-associated deaths in care homes (95% CI 406–949), 9% above baseline.
        Leading indicator:
        Care homes assessed; measures installed.
        Outcome:
        Indoor temperatures and heat-associated deaths in care homes against comparison homes, read against how hot the summer was.
        Continue, adapt or stop:
        Scale where indoor temperatures fall and deaths are lower than expected for the heat.
        Sources

        Source published 2 April 2026 (UKHSA); 11 December 2025 (Ibbetson et al.); evidence reviewed 2026-10-07. Reconsider if: The UKHSA final heat mortality report for 2026 (early 2027); The next National Adaptation Programme.

      How the options are assessed

      One shared record per option — the same one the national plan reads. Delivery RAG, gate and list membership are separate judgements.

      • Older people safe at home — Amber delivery RAG; gate pending
      • A costed social-care capacity plan — Red delivery RAG; gate pending
      • Targeted loneliness support — Amber delivery RAG; gate pending
      • Make heat protection operational in vulnerable settings — Amber delivery RAG; gate pending

      Provisional single-reviewer assessments from the 6 October 2026 review; not approved business cases, and not government policy.

      • GRP-03Delivery RAG: AmberGate: pending

        Older people safe at home

        A broad priority grouping A52, A51; its scores are its own, never an average of its members.

        Provisional single-reviewer assessment; not an approved business case.

        Who and where
        Population not yet defined. Jurisdiction: not defined.
        Result so far
        Range if completed: 17.0–23.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))
        Funded now (baseline)
        Funded baseline not yet stated
        The change assessed (marginal)
        Marginal change not yet defined
        What the evidence supports—and the next decision

        Evidence for removing home fall hazards concerns a defined intervention; it does not price a general promise to keep older people at home.

        Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

        Define the change
        Separate targeted home assessment and adaptations from recurring care and discharge support. Identify eligible high-risk residents and existing provision.
        Test whether it works
        Falls, injuries, independence, quality of life and carer burden; compare like-risk residents and account for follow-up time.
        Establish the cost
        Assessments, adaptations, occupational therapy, maintenance and recurring support. Fewer admissions release cash only if a budget can actually be reduced safely.
        Protect against harm
        Respect choice and consent; home care must not transfer unsupported care responsibilities to families.

        Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

        Full assessment of Older people safe at home: ten criteria, scenarios, delivery, costs and monitoring
        The ten criteria (0–3)

        Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

        1. Scale and severity (Sc)2 of 3 — Serious harm to a defined group or widespread moderate harm

          Reviewer’s reason: Provisional problem-importance judgement from linked site pages; not the scale of achievable benefit.

        2. Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery

          Reviewer’s reason: Separate budgets and cohorts; arrange risk assessment, therapists, installers and care staff; compare reablement outcomes. A missing rating requires a defined marginal change.

        3. Confidence in the proposed action (Ev)2 of 3 — Relevant evaluated evidence with limitations

          Reviewer’s reason: Strong evidence supports targeted home-hazard reduction. Reablement does not inherit that evidence; the combined score is deliberately limited.

        4. Expected incremental benefit (Bn)Not yet assessed

          Reviewer’s reason: Unknown unless a reasonably defined target-population benefit can be judged; no bonus merely for spanning domains.

        5. Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards

          Reviewer’s reason: Scarce therapists; displacement of ongoing care; incorrect targeting.

        6. Incremental affordability (Co)Not yet assessed

          Reviewer’s reason: Assessment, adaptations, recurring care, follow-up and displaced workforce; do not assume fewer falls equal cash savings.

        7. Delivery capacity (Ca)1 of 3 — Binding scarce resource

          Reviewer’s reason: Separate budgets and cohorts; arrange risk assessment, therapists, installers and care staff; compare reablement outcomes.

        8. Distribution (Fa)3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens

          Reviewer’s reason: Provisional distribution judgement for the stated target; verify who pays, who gains and excluded groups.

        9. Meaningful first outcome (Ti)3 of 3 — Within one year

          Reviewer’s reason: First meaningful outcome, not announcement: Falls and independence separately; injuries, unmet care and 91-day outcomes.

        10. Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step

          Reviewer’s reason: Councils, housing providers and health/care commissioners; Split falls implementation from reablement test

        Four weightings

        Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

        • Equal weights: Range if completed: 17.0–23.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Evidence doubled: Range if completed: 17.3–22.7 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Scale doubled: Range if completed: 17.3–22.7 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Cost ignored (the funding gate still applies): Range if completed: 18.9–22.2 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.

        Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

        Delivery RAG and gate

        Delivery RAG shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.

        Review’s reason: Assessment, adaptations, recurring care, follow-up and displaced workforce; do not assume fewer falls equal cash savings.

        Why it is not Green yet

        • Scope (population, place and increment) not verified against the delivery baseline.
        • No verified owner with the powers in place.
        • Delivery capacity not verified.
        • Lifetime incremental costs not complete.
        • No credible funding (a committed allocation for the scope).
        • Safeguards not specified.
        • Monitoring lacks a metric, a data source or a baseline.

        Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

        Gate: Pending — appraisal incomplete (review label: “Pending: incomplete appraisal”).

        Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

        The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

        Cost and funding

        Lifetime costing: Not established. Review: “Full incremental costing not established in reviewed material”.

        Still to cost: Assessment, adaptations, recurring care, follow-up and displaced workforce; do not assume fewer falls equal cash savings.

        Funding status: not established in review.

        Owner, powers and capacity

        Proposed owner: Councils, housing providers and health/care commissioners (proposed, unverified).

        Powers: needs a decision or allocation. Capacity: binding constraint.

        Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

        England:
        not assessed
        Scotland:
        not assessed
        Wales:
        not assessed
        Northern Ireland:
        not assessed

        Not defined in the review.

        Dependencies, safeguards and risks

        Depends on: None recorded.

        Safeguards

        None specified yet.

        Risks and residual harms: Scarce therapists; displacement of ongoing care; incorrect targeting.

        Monitoring and measured results

        Metric: Falls and independence separately; injuries, unmet care and 91-day outcomes.

        Data source: Not yet named. Baseline: Not yet established.

        Measures already on the domain page

        A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.

        Evidence for the outcome

        Outcome: Falls and independence separately; injuries, unmet care and 91-day outcomes.

        Strong evidence supports targeted home-hazard reduction. Reablement does not inherit that evidence; the combined score is deliberately limited.

        Sources: cochrane.org (not yet in the source register)

        SWOT points it addresses

        Review record

        Assessment version: working-review-2026-10-06 (GRP-03@working-review-2026-10-06).

        Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

        Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.

        First 90 days (review): Produce a signed scope and current-delivery baseline; Separate budgets and cohorts; arrange risk assessment, therapists, installers and care staff; compare reablement outcomes. Obtain incremental costs and an accountable decision before expansion.

        Decision route: Split falls implementation from reablement test

        An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

      • A60Delivery RAG: RedGate: pending

        A costed social-care capacity plan

        Existing action A60, assessed at the same scope.

        Provisional single-reviewer assessment; not an approved business case.

        Who and where
        Adult social care in England: about 1.6 million filled posts, the people who draw on care, and councils that commission it. (from the action record) Jurisdiction: England.
        Result so far
        Range if completed: 10.0–19.0 out of 30 (equal weights; not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co))
        Funded now (baseline)
        Baseline: a £500m first-year envelope agreed for the Fair Pay Agreement, with negotiations from about April 2027 and the first agreement in April 2028; an adult social care workforce plan promised by the end of 2026 (30 September 2026); the Casey Commission reports by summer 2027; the Prime Minister has proposed a National Care Service for the next Parliament. Making the workforce plan a costed capacity plan tied to the pay agreed is a UK Facts proposal, not government policy. (from the action record)
        The change assessed (marginal)
        Marginal change not yet defined
        What the evidence supports—and the next decision

        A capacity plan becomes an intervention only when it specifies extra care hours, workforce and the services they replace or complement.

        Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

        Define the change
        Define a local care cohort, unmet need and provider capacity; compare pay, retention, commissioning and service-model options against funded provision.
        Test whether it works
        Needs met, continuity, quality of life and carer burden alongside safe discharge. A discharge count alone misses community need.
        Establish the cost
        Recurring wages, training, travel, provider viability, capital and commissioning; test demand growth and realistic workforce supply.
        Protect against harm
        Separate care and NHS budgets, avoid unsafe discharge and measure impacts on unpaid carers.

        Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

        Full assessment of A costed social-care capacity plan: ten criteria, scenarios, delivery, costs and monitoring
        The ten criteria (0–3)

        Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

        1. Scale and severity (Sc)3 of 3 — Severe harm across a broad population

          Reviewer’s reason: Provisional problem-importance judgement from linked site pages; not the scale of achievable benefit.

        2. Increment beyond baseline (Ad)Not yet assessed

          Reviewer’s reason: Model unmet need; specify pay, recruitment, training and commissioning; support unpaid carers; agree recurring funding. A missing rating requires a defined marginal change.

        3. Confidence in the proposed action (Ev)0 of 3 — No effect evaluation

          Reviewer’s reason: Need is established; no specified, evaluated expansion package. A funding-protection reform is not a capacity intervention.

        4. Expected incremental benefit (Bn)Not yet assessed

          Reviewer’s reason: Unknown unless a reasonably defined target-population benefit can be judged; no bonus merely for spanning domains.

        5. Residual harms (Hm)1 of 3 — Material harm/unresolved mitigation

          Reviewer’s reason: Major workforce constraint; service displacement; eligibility and quality trade-offs.

        6. Incremental affordability (Co)Not yet assessed

          Reviewer’s reason: Full workforce/pay bill, provider viability, capital, commissioning, transition and long-term liabilities.

        7. Delivery capacity (Ca)0 of 3 — Unavailable within scope

          Reviewer’s reason: Model unmet need; specify pay, recruitment, training and commissioning; support unpaid carers; agree recurring funding.

        8. Distribution (Fa)3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens

          Reviewer’s reason: Provisional distribution judgement for the stated target; verify who pays, who gains and excluded groups.

        9. Meaningful first outcome (Ti)1 of 3 — More than three but less than ten years

          Reviewer’s reason: First meaningful outcome, not announcement: Care actually delivered, unmet need, continuity and carer outcomes.

        10. Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step

          Reviewer’s reason: DHSC, Treasury, councils and care providers; devolved systems separately; Define and commission capacity plan

        Four weightings

        Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

        • Equal weights: Range if completed: 10.0–19.0 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Evidence doubled: Range if completed: 9.1–17.3 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Scale doubled: Range if completed: 11.8–20.0 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Cost ignored (the funding gate still applies): Range if completed: 11.1–17.8 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.

        Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

        Delivery RAG and gate

        Delivery RAG shown: RedReview’s claim: Red. Best the recorded evidence allows: Red.

        Review’s reason: Major workforce constraint; service displacement; eligibility and quality trade-offs.

        Why it is not Green yet

        • Delivery obstacle: Major workforce constraint; service displacement; eligibility and quality trade-offs..
        • Scope (population, place and increment) not verified against the delivery baseline.
        • No verified owner with the powers in place.
        • Delivery capacity not verified.
        • Lifetime incremental costs not complete.
        • No credible funding (a committed allocation for the scope).
        • Safeguards not specified.
        • Monitoring lacks a metric, a data source or a baseline.

        Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

        Gate: Pending — appraisal incomplete (review label: “Pending: incomplete appraisal”).

        Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

        The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

        Cost and funding

        Lifetime costing: Not established. Review: “Full incremental costing not established in reviewed material”.

        Still to cost: Full workforce/pay bill, provider viability, capital, commissioning, transition and long-term liabilities.

        Funding status: not identified.

        Owner, powers and capacity

        Proposed owner: DHSC, Treasury, councils and care providers; devolved systems separately (proposed, unverified).

        Powers: needs a decision or allocation. Capacity: binding constraint.

        Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

        England:
        Department of Health and Social Care with HM Treasury, councils and the Fair Pay Agreement negotiating body (action record)
        Scotland:
        not assessed
        Wales:
        not assessed
        Northern Ireland:
        not assessed

        Social care is devolved; Scotland and Wales have their own negotiating-body powers under the Employment Rights Act 2025. Not assessed.

        Dependencies, safeguards and risks

        Depends on: None recorded.

        Safeguards

        None specified yet.

        Risks and residual harms: Major workforce constraint; service displacement; eligibility and quality trade-offs.

        Monitoring and measured results

        Metric: Care actually delivered, unmet need, continuity and carer outcomes.

        Data source: Not yet named. Baseline: Not yet established.

        Measures already on the domain page

        A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.

        Evidence for the outcome

        Outcome: Care actually delivered, unmet need, continuity and carer outcomes.

        Need is established; no specified, evaluated expansion package. A funding-protection reform is not a capacity intervention.

        Review record

        Assessment version: working-review-2026-10-06 (A60@working-review-2026-10-06).

        Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

        Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.

        First 90 days (review): Produce a signed scope and current-delivery baseline; Model unmet need; specify pay, recruitment, training and commissioning; support unpaid carers; agree recurring funding. Obtain incremental costs and an accountable decision before expansion.

        Decision route: Define and commission capacity plan

        An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

      • A71Delivery RAG: AmberGate: pending

        Targeted loneliness support

        Proposed new action A71; sourced research home and appraisal design; scope and funding remain provisional.

        Not stated in the review record; treated as a provisional single-reviewer assessment, not an approved business case.

        Who and where
        Test a specified facilitated social-connection intervention for an identified group, using validated loneliness measures and a comparison group. (from the 6 October review) Jurisdiction: not defined.
        Result so far
        Range if completed: 15.0–21.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))
        Funded now (baseline)
        Funded baseline not yet stated
        The change assessed (marginal)
        Test a specified facilitated social-connection intervention for an identified group, using validated loneliness measures and a comparison group. (from the 6 October review)
        What the evidence supports—and the next decision

        Loneliness reviews cover varied interventions and populations; an average effect cannot specify a successful local service.

        Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

        Define the change
        Test a facilitated social-connection offer for a defined group, with accessible transport and sustained participation support.
        Test whether it works
        Validated loneliness and wellbeing measures against a comparison group; record isolation, dropout and exclusion as well as attendance.
        Establish the cost
        Facilitators, venues, transport, outreach and follow-up over the intended duration.
        Protect against harm
        Respect choice and privacy; avoid labelling non-participation as failure or diverting people from needed clinical care.

        Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

        Full assessment of Targeted loneliness support: ten criteria, scenarios, delivery, costs and monitoring
        The ten criteria (0–3)

        Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

        1. Scale and severity (Sc)2 of 3 — Serious harm to a defined group or widespread moderate harm

        2. Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery

        3. Confidence in the proposed action (Ev)1 of 3 — Indirect, mixed, modelled or weak causal support

        4. Expected incremental benefit (Bn)Not yet assessed

        5. Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards

        6. Incremental affordability (Co)Not yet assessed

        7. Delivery capacity (Ca)2 of 3 — Stretched but plausibly obtainable

        8. Distribution (Fa)2 of 3 — Mixed or broadly neutral with safeguards

        9. Meaningful first outcome (Ti)2 of 3 — More than one and up to three years

        10. Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step

        Four weightings

        Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

        • Equal weights: Range if completed: 15.0–21.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Evidence doubled: Range if completed: 14.5–20.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Scale doubled: Range if completed: 15.5–20.9 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Cost ignored (the funding gate still applies): Range if completed: 16.7–20.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.

        Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

        Delivery RAG and gate

        Delivery RAG shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.

        Review’s reason: Specify cohort and intervention; cost facilitators, venues, accessible transport and sustained participation. Measure loneliness, exclusion and wellbeing. Proposed owners: councils, public health and voluntary-sector partners.

        Why it is not Green yet

        • Scope (population, place and increment) not verified against the delivery baseline.
        • No verified owner with the powers in place.
        • Delivery capacity not verified.
        • Lifetime incremental costs not complete.
        • No credible funding (a committed allocation for the scope).
        • Safeguards not specified.
        • Monitoring lacks a metric, a data source or a baseline.

        Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

        Gate: Pending — appraisal incomplete (review label: “Pending baseline verification, incremental costing and funding; not a rollout approval”).

        Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

        The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

        Cost and funding

        Lifetime costing: Not established. Review: “Not fully costed in this review”.

        Still to cost: Specify cohort and intervention; cost facilitators, venues, accessible transport and sustained participation. Measure loneliness, exclusion and wellbeing. Proposed owners: councils, public health and voluntary-sector partners.

        Funding status: not established in review.

        Owner, powers and capacity

        Proposed owner: councils, public health and voluntary-sector partners (proposed, unverified).

        Powers: needs a decision or allocation. Capacity: unverified.

        Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

        England:
        not assessed
        Scotland:
        not assessed
        Wales:
        not assessed
        Northern Ireland:
        not assessed

        Not defined in the review.

        Dependencies, safeguards and risks

        Depends on: None recorded.

        Safeguards

        None specified yet.

        Monitoring and measured results

        Metric: Define and baseline the outcome described in delivery requirements before approval.

        Data source: Not yet named. Baseline: Not yet established.

        Evidence for the outcome

        Outcome: Define and baseline the outcome described in delivery requirements before approval.

        DCMS review identifies potentially helpful approaches but heterogeneous and sometimes weak evidence. This does not yet identify a national best-buy programme.

        Sources: gov.uk (not yet in the source register)

        Review record

        Assessment version: working-review-2026-10-06 (A71@working-review-2026-10-06).

        Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

        Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.

        An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

      • A77Delivery RAG: AmberGate: pending

        Make heat protection operational in vulnerable settings

        Existing action A77, assessed at the same scope.

        Provisional single-reviewer desk assessment, 6 October 2026.

        Who and where
        Residents of existing care homes in England, starting with homes assessed at highest overheating risk. (from the action record) Jurisdiction: England.
        Result so far
        Range if completed: 17.0–23.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))
        Funded now (baseline)
        Baseline: the Adverse Weather and Health Plan (guidance; no statutory duty or indoor-temperature standard for care homes); building regulations on overheating (Approved Document O) for new buildings only; more than £32m for NHS cooling projects (September 2026), nothing yet for social care. Risk assessment and building-specific measures in existing care homes is a UK Facts proposal, not government policy. (from the action record)
        The change assessed (marginal)
        Assess overheating in selected care settings and homes, then commission proportionate cooling, shading and response plans. (from the 6 October review)
        What the evidence supports—and the next decision

        Heat-associated mortality establishes a risk, not the causal effect of a local adaptation package.

        Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

        Define the change
        Assess overheating in specified care settings or homes; compare shading, ventilation, cooling and operational response options.
        Test whether it works
        Indoor exposure, implementation of response plans and health outcomes adjusted for weather, resident vulnerability and occupancy.
        Establish the cost
        Assessment, capital works, energy, maintenance, staffing and replacement; test hotter summers and power interruption.
        Protect against harm
        Protect frail residents, air quality and clinical safety; avoid interpreting a mild summer as success.

        Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

        Full assessment of Make heat protection operational in vulnerable settings: ten criteria, scenarios, delivery, costs and monitoring
        The ten criteria (0–3)

        Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

        1. Scale and severity (Sc)3 of 3 — Severe harm across a broad population

          Reviewer’s reason: Problem scale judged from the linked domain evidence; not a population estimate of those helped.

        2. Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery

          Reviewer’s reason: Assess overheating in selected care settings and homes, then commission proportionate cooling, shading and response plans. This is a provisional marginal-change judgement, to confirm against commissioned delivery.

        3. Confidence in the proposed action (Ev)0 of 3 — No effect evaluation

          Reviewer’s reason: The site records heat risk and options; it does not evaluate this exact package.

        4. Expected incremental benefit (Bn)Not yet assessed

          Reviewer’s reason: Unknown: no sufficiently supported magnitude for this exact change.

        5. Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards

          Reviewer’s reason: Energy costs, unsuitable retrofits and staff workload.

        6. Incremental affordability (Co)Not yet assessed

          Reviewer’s reason: Unknown: the proposed increment has not been costed and matched to an approved affordable allocation in this review. Existing programme envelopes are not that allocation.

        7. Delivery capacity (Ca)2 of 3 — Stretched but plausibly obtainable

          Reviewer’s reason: Use risk-based standards; a mild summer is not proof the intervention worked.

        8. Distribution (Fa)3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens

          Reviewer’s reason: Distribution assessed against the target group and the burdens described here: Energy costs, unsuitable retrofits and staff workload.

        9. Meaningful first outcome (Ti)3 of 3 — Within one year

          Reviewer’s reason: Timing judgement concerns the first meaningful outcome in: Indoor exposure, response readiness and heat-related harm with weather-adjusted interpretation. It does not imply all long-term benefits arrive then.

        10. Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step

          Reviewer’s reason: Cost a local risk-led plan before the next warm season, prioritising people unable to protect themselves. Owner: Health/care providers, councils and landlords with public-health advice.

        Four weightings

        Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

        • Equal weights: Range if completed: 17.0–23.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Evidence doubled: Range if completed: 15.5–20.9 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Scale doubled: Range if completed: 18.2–23.6 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Cost ignored (the funding gate still applies): Range if completed: 18.9–22.2 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.

        Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

        Delivery RAG and gate

        Delivery RAG shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.

        Review’s reason: Incremental lifetime costs and funding not established. Use risk-based standards; a mild summer is not proof the intervention worked.

        Why it is not Green yet

        • Scope (population, place and increment) not verified against the delivery baseline.
        • No verified owner with the powers in place.
        • Delivery capacity not verified.
        • Lifetime incremental costs not complete.
        • No credible funding (a committed allocation for the scope).
        • Safeguards not specified.
        • Monitoring lacks a metric, a data source or a baseline.

        Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

        Gate: Pending — appraisal incomplete (review label: “Pending cost, funding, scope and capacity appraisal”).

        Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

        The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

        Cost and funding

        Lifetime costing: Not established.

        Still to cost: Incremental lifetime costs and funding not established. Use risk-based standards; a mild summer is not proof the intervention worked.

        Funding status: not identified.

        Owner, powers and capacity

        Proposed owner: Health/care providers, councils and landlords with public-health advice. (proposed, unverified).

        Powers: needs a decision or allocation. Capacity: unverified.

        Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

        England:
        Department of Health and Social Care with UKHSA, the care regulator, councils and care providers (action record)
        Scotland:
        not assessed
        Wales:
        not assessed
        Northern Ireland:
        not assessed

        Health, care and building rules are devolved; not assessed outside England.

        Dependencies, safeguards and risks

        Depends on: Use risk-based standards; a mild summer is not proof the intervention worked.

        Safeguards

        • Cost a local risk-led plan before the next warm season, prioritising people unable to protect themselves (proposed, not yet specified)

        Risks and residual harms: Energy costs, unsuitable retrofits and staff workload.

        Monitoring and measured results

        Metric: Indoor exposure, response readiness and heat-related harm with weather-adjusted interpretation.

        Data source: Not yet named. Baseline: Not yet established.

        Measures already on the domain page

        A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.

        Evidence for the outcome

        Outcome: Indoor exposure, response readiness and heat-related harm with weather-adjusted interpretation.

        The site records heat risk and options; it does not evaluate this exact package.

        Review record

        Assessment version: working-review-2026-10-06 (A77@working-review-2026-10-06).

        Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

        Carried from the earlier domain review (C record): must be calibrated jointly with the G/W/E/NG/NW/NE records before any combined comparison.

        Decision route: Cost a local risk-led plan before the next warm season, prioritising people unable to protect themselves.

        An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

      Decision briefs

      • Fit home adaptations quickly for older people most at risk of falling
      • Offer reablement to more older people leaving hospital, and judge it by whether they are still at home three months later

      The leading option set out as a decision someone could take: who decides, who benefits, the best evidence, cost and funding, and the main trade-off. The full research record is one click away.

      Decision briefExisting programmeReviewed 2026-10-04

      Fit home adaptations quickly for older people most at risk of falling

      The thread: issue, evidence, action

      1. Issue Weakness: Falls led to 221,600 emergency hospital admissions of people aged 65 and over in 2024/25 — 1,958 per 100,000, below the 2,256 of 2019/20 but about 600 admissions a day. Also: opportunity, strength
      2. Evidence Emergency hospital admissions due to falls, people aged 65+
      3. Action Fit home adaptations faster for older people at high risk of falling, after an occupational-therapist hazard check
      Decision required
      Whether housing authorities, with falls services, set a falls-risk referral route, an OT hazard check and a time-to-installation standard for a defined share of Disabled Facilities Grant work.
      Who and where
      Older people living at home who are at higher risk of falling (for example after a fall or with falls-service involvement). Applies in: England.
      Accountable body
      Housing authorities (grant decisions); MHCLG with DHSC (grant guidance)
      Intervention
      Refer people at higher risk to an OT or trusted-assessor hazard check and fit the recommended adaptations quickly.
      Best evidence, and where it applies
      A 2023 Cochrane review: home hazard reduction cut falls by 38% for people selected for higher risk (high certainty) and had no effect for people not selected.Studied in: Community-dwelling older people; 9 studies (1,513 participants) selected for higher risk (Trials included in the 2023 review).
      Extra cost of this change
      Capital: Disabled Facilities Grant 2026–27 — £723m in total, 2026–27, price basis not stated by the source.Recurring: OT hazard assessments and faster processing — Not yet costed.One-off or mixed: Evaluation of falls and waits — not yet established.
      Funding
      Not funded yet: a possible funding route exists, but nothing is allocated to this change.Committed to this change: none.Possible source, not an award: Disabled Facilities Grant allocations 2026–27 (£723m).Unfunded: Assessment and evaluation costs are not established; the grant itself is an envelope, not an award to this change.
      Savings and wider benefits
      Not yet specified: no cashable saving or avoided cost has been costed for this change. Expected outcomes are listed one by one in the research appendix and are never added together or counted as money available.
      First 90-day step
      Current waiting times published and a falls-risk fast route running in a first set of authorities.The proposed first milestone; a 90-day date is not yet specified. Owner: Housing authorities with NHS falls services. Proposed by UK Facts, not an official deadline.
      Twelve-month milestone
      Not yet specified.Time to a first useful result: Waiting-time change within months; falls outcomes after about 12 months.
      Outcome, and when to scale or stop
      Measure: Days from falls-service referral to completed adaptation.Scale if: Falls among people adapted fall against the comparison without other applicants’ waits lengthening materially.Stop if: No difference in falls once targeting and speed are confirmed.
      Main trade-off
      Within a fixed grant, other applicants — including disabled children — may wait longer.
      Source and review date
      Environmental interventions for preventing falls in older people living in the community (CD013258) (March 2023). Reviewed 2026-10-04.

      An editorial proposal by UK Facts for discussion, not government policy. Records: A52 · effects E-A52-FALLS · costs C-DFG-2627, C-A52-OT

      Research appendix: study design, effect sizes and limits, alternatives, full costing, international comparisons and how we would know

      1.The change, in plain words

      Fit home adaptations quickly for older people most at risk of falling

      2.The decision requested

      Decision
      Agree, in a first set of housing authorities, a referral route from falls services and GPs, an OT or trusted-assessor hazard check, priority for a defined share of grant work and a published time-to-installation standard; MHCLG and DHSC reflect it in grant guidance if it works.
      Accountable institution
      Housing authorities (grant decisions); MHCLG with DHSC (grant guidance)
      Geography
      England
      Powers
      Existing powers under the Disabled Facilities Grant and Better Care Fund plans; no new law.
      Delivery partners
      Social care occupational therapists and trusted assessors; NHS falls services and GPs; Home improvement agencies and adaptation contractors

      3.Who it is for, and what changes beyond today

      Target population
      Older people living at home who are at higher risk of falling (for example after a fall or with falls-service involvement).
      Eligibility
      Disabled Facilities Grant eligibility and means test, prioritised by falls risk; minor adaptations up to £1,000 without a means test.
      Scale
      Set locally from falls-service referrals and OT capacity; the share of grant work prioritised is a local decision.
      Baseline
      Emergency admissions due to falls among people 65+ in England: 221,600 in 2024/25 (1,958 per 100,000). The last national review found nearly 10 weeks from application to approval and over 17 weeks to completion, before the OT wait.

      Source: Office for Health Improvement and Disparities (Fingertips), Emergency hospital admissions due to falls in people aged 65 and over (indicator 22401) (Indicator 22401, England); University of the West of England for MHCLG and DHSC, Disabled Facilities Grant (DFG) and other adaptations: external review (Chapter 7, Table 7.1)

      Change beyond existing law or funding
      The grant exists (£723m in 2026–27) but is not targeted by falls risk and has no speed standard; the change adds both.

      4.How it would work

      Do: Refer people at higher risk to an OT or trusted-assessor hazard check and fit the recommended adaptations quickly. Changing: Hazards removed (rails, lighting, level access) and safer routines.

      • Rate of falls among people at higher risk

        Measured for this interventionEffect record E-A52-FALLS

        Measured in international randomised trials (including the UK); the effect in routine English grant delivery is untested.

      • Emergency admissions for falls

        Hypothesis to test

        Trials measured falls, not admissions; admissions are a lagging measure moved by many other forces.

      Outcomes are kept separate and never added into one impact figure.

      5.Best evidence

      • Environmental interventions for preventing falls in older people living in the community (CD013258)

        Author or institution:
        Clemson L et al. (Cochrane)
        Published:
        March 2023
        Evaluation period:
        Trials included in the 2023 review
        Design:
        Systematic review and meta-analysis of randomised trials
        Sample or population:
        Community-dwelling older people; 9 studies (1,513 participants) selected for higher risk
        Effect and uncertainty:
        Rate ratio 0.62 (95% CI 0.56 to 0.70) for people at higher risk, high certainty; 1.05 (0.96 to 1.16) for people not selected
        Limits:
        Outcome is falls, not admissions or care-home moves; structured research delivery

        Where: Abstract; Analyses 1.1–1.4. Affiliation is provenance, not proof of quality.

      6.Alternatives, counter-evidence and who loses

      Closest feasible alternative
      Reablement after hospital discharge (A51), which reaches a similar group but has no established effect.
      Strongest counter-evidence
      Untargeted home-hazard programmes did not reduce falls, so loose targeting would waste the money.

      Source: Cochrane Database of Systematic Reviews, Environmental interventions for preventing falls in older people living in the community (CD013258) (Abstract (people not selected for risk))

      Distributional effects
      Gains for older people at higher risk, many on low incomes; other disabled applicants may wait longer.
      Main downside
      Waiting lists may move rather than shrink within a fixed grant.

      The options compared, including current policy

      • The proposal

        Falls-risk referral, OT check and speed standard

        Who is reached
        Older people at higher risk of falling
        Evidence
        High-certainty Cochrane evidence
        Likely outcome and timing
        Fewer falls within a year
        Cost and funding
        Within the existing grant; OT cost not established
        Main trade-off
        Others may wait longer

      • Current policy

        Current policy: grants by eligibility and means test

        Who is reached
        Disabled people of any age who apply
        Evidence
        Untargeted programmes showed no falls effect
        Likely outcome and timing
        Waits of months (2018 data)
        Cost and funding
        £723m in 2026–27
        Main trade-off
        No priority for falls risk

      • Alternative

        Reablement after discharge

        Who is reached
        Over-65s leaving hospital
        Evidence
        Effect not established
        Likely outcome and timing
        Unknown
        Cost and funding
        Better Care Fund
        Main trade-off
        Draws on the same staff

      7.What other countries or the devolved nations show

      No comparable evaluation found.

      Searched: Evaluations of a national or regional programme that targets adaptation grants by falls risk with a speed standard (as opposed to individual trials, which the Cochrane review pools). None found in this review.

      Next step: Run the first authorities as a phased comparison and publish falls and waiting-time results.

      8.What delivery needs first

      • staff — Occupational therapists or trained trusted assessors. (Scarce resource shared with other priorities; owner: Councils and DHSC)
      • procurement — Adaptation contractors able to work to a speed standard. (Scarce resource shared with other priorities; owner: Housing authorities and home improvement agencies)
      • data — Referral data from NHS falls services and GPs. (Requirement; owner: Integrated care boards)

      9.What it would cost

      How the cost is built up: Existing grant (prioritised, not new) + OT or trusted-assessor assessments + faster processing + evaluation.

      • Disabled Facilities Grant 2026–27

        England

        £723m in total, 2026–27, price basis not stated by the source (ledger C-DFG-2627)

        capital; price year not stated; 2026–27; Current quoted cost

        The existing grant, prioritised; not new money.

      • OT hazard assessments and faster processing

        Per participating authority

        Not yet costed (ledger C-A52-OT)

        recurring; price year not stated; From the first authorities; Not yet established

      • Evaluation of falls and waits

        First set of authorities

        Not yet established per evaluation

        one-off revenue; price year not stated; One to two years; Not yet established

      10.Who pays, and what is missing

      Programme envelope (a possible route, not an award)
      Disabled Facilities Grant allocations 2026–27: £723m, 2026–27
      Allocation committed to this change
      None
      Remaining gap
      Assessment and evaluation costs are not established; the grant itself is an envelope, not an award to this change.
      Proposed financing
      Prioritise within each authority’s grant allocation; fund assessments through Better Care Fund plans.
      Responsible payer
      central government, councils, NHS
      Budget displaced
      Other grant applicants’ place in the queue; OT time for reablement and discharge.

      11.First milestone and time to a useful result

      Current waiting times published and a falls-risk fast route running in a first set of authorities. (Owner: Housing authorities with NHS falls services. Proposed by UK Facts, not an official deadline.)

      Time to first useful result: Waiting-time change within months; falls outcomes after about 12 months.

      What could delay it: OT or trusted-assessor capacity can be found. Contractors can meet the speed standard.

      12.How we would know

      Baseline
      Current days from referral to installation, and falls and fall injuries among referred people.
      Comparison
      People referred before the fast route, or authorities that start later.
      Leading indicator
      Days from falls-service referral to completed adaptation.
      Follow-up
      Falls and fall injuries at 12 months; admissions as a lagging measure.
      Continue if
      Falls among people adapted fall against the comparison without other applicants’ waits lengthening materially.
      Adapt if
      Targeting reaches few people at higher risk, or waits for others grow.
      Stop if
      No difference in falls once targeting and speed are confirmed.
      Thresholds
      Not yet set: From local baselines and a power calculation once referral volumes are known.

      What is not yet known, and how to find out

      • What would OT assessments and faster processing cost? (cost)Next step: Cost from the first authorities’ activity.Scope: Assessments and processing per referred person · Data or quotes needed: OT and trusted-assessor time per assessment; processing staff costs · Who can estimate it: Participating councils with the Local Government Association
      • Does the trial effect hold in routine grant delivery? (effect)Next step: A phased comparison across the first authorities.Defensible route: bounded pilot
      • How long do adaptations take now? (data)Next step: Housing authorities publish current referral-to-installation times.

      Sources last checked 4 October 2026 · Owner: Evidence editor (James Harris) · Next check: Public Health Outcomes Framework: November 2026 data update (emergency admissions for falls) (3 November 2026) or the first trigger: Announcement of the 2027–28 Disabled Facilities Grant allocation.

      Decision briefPublic-policy proposalReviewed 2026-10-04

      Offer reablement to more older people leaving hospital, and judge it by whether they are still at home three months later

      The thread: issue, evidence, action

      1. Issue Weakness: Only 5.7% of people aged 65 and over discharged from hospital were provided reablement. Also: threat, opportunity, strength
      2. Evidence People aged 65+ discharged from hospital who were provided reablement; People aged 65+ still living in the community 12 weeks after discharge into reablement
      3. Action Offer reablement to more older people leaving hospital, and judge it by whether they are still at home three months later
      Decision required
      A council and its integrated care board extend free reablement to a defined group of older people leaving hospital, name the therapists and care workers and the Better Care Fund money that will pay for them, and compare outcomes at 12 weeks and 12 months with a matched group before expanding.
      Who and where
      People aged 65 and over in one council area discharged from hospital who could regain independence in daily tasks; working-age adults only if the council chooses. Applies in: Local.
      Accountable body
      The council (adult social services) jointly with its integrated care board, through the Health and Wellbeing Board’s Better Care Fund plan
      Intervention
      Start up to six weeks of free, goal-focused support at home on the day of discharge, led by therapists who set goals with the person and supervise care workers.
      Best evidence, and where it applies
      NICE recommends offering reablement first to people being considered for home care where it could improve their independence, but the Cochrane review found the evidence too weak to support or refute its effect; small Norwegian trials found better self-rated daily activity, with the gap narrowing by 12 months in the larger one.Studied in: Two trials, 811 participants: Western Australia (750) and Norway (61) (Searches April to June 2015).How closely the comparison transfers to this decision: Norway (one rural municipality; then 47 municipalities) and Denmark (all municipalities) — partial.
      Extra cost of this change
      Capital: none identified in the brief.Recurring: Extra reablement capacity for the cohort (therapists, care workers, discharge coordination) — Not yet costed; Record linkage and outcome reporting — not yet established.One-off or mixed: Independent evaluation with 12-week and 12-month follow-up and a matched comparison — not yet established.
      Funding
      Not funded yet: a possible funding route exists, but nothing is allocated to this change.Committed to this change: none.Possible source, not an award: Better Care Fund 2026–27 pooled budget (NHS minimum contribution and Local Authority Better Care Grant) (£8.43bn).Unfunded: Unknown: the extra capacity has not been costed and no Better Care Fund plan has allocated money to it.
      Savings and wider benefits
      Not yet specified: no cashable saving or avoided cost has been costed for this change. Expected outcomes are listed one by one in the research appendix and are never added together or counted as money available.
      First 90-day step
      The council and integrated care board publish the cohort rule, the named extra staff, the Better Care Fund line and the comparison design before the first person is enrolled.The proposed first milestone; a 90-day date is not yet specified. Owner: A council with its integrated care board. Proposed by UK Facts, not an official deadline.
      Twelve-month milestone
      Not yet specified.Time to a first useful result: About a year: enrolment for several months, then 12 weeks of follow-up for each person; the 12-month care-hours result comes a year after enrolment closes.
      Outcome, and when to scale or stop
      Measure: Share of eligible discharges offered reablement, and days from discharge to the first visit.Scale if: More people in the cohort remain at home at 12 weeks than in the comparison group, personal goals are met, and long-term home-care waits do not lengthen.Stop if: The cohort does no better than the comparison at 12 weeks and 12 months, or the pilot can only be staffed by withdrawing long-term care.
      Main trade-off
      The same therapists and care workers provide long-term home care, so extra reablement can lengthen waits for people who already need ongoing help unless new staff are found.
      Source and review date
      Time-limited home-care reablement services for maintaining and improving the functional independence of older adults (CD010825) (October 2016); Reablement services for people at risk of needing social care: the MoRe mixed-methods evaluation (April 2019). Reviewed 2026-10-04.

      An editorial proposal by UK Facts for discussion, not government policy. Records: A51 · effects E-A51-INDEP, E-A51-STAFF · costs C-A51-CAPACITY

      Research appendix: study design, effect sizes and limits, alternatives, full costing, international comparisons and how we would know

      1.The change, in plain words

      Offer reablement to more older people leaving hospital, and judge it by whether they are still at home three months later

      2.The decision requested

      Decision
      In one council area, offer reablement at discharge to a named cohort of people aged 65+ judged able to regain independence, with the extra occupational therapists, physiotherapists and reablement care workers named, a ring-fenced line in the local Better Care Fund plan, and a matched comparison reported at 12 weeks (the national definition) and 12 months.
      Accountable institution
      The council (adult social services) jointly with its integrated care board, through the Health and Wellbeing Board’s Better Care Fund plan
      Geography
      Local
      Powers
      Care Act 2014 prevention duties; reablement free for up to six weeks under the Care and Support (Preventing Needs for Care and Support) Regulations 2014; Better Care Fund pooled-budget arrangements. No new law.
      Delivery partners
      NHS community health services (therapists); Hospital discharge teams; Home-care and reablement providers; An independent evaluator; Health and Wellbeing Board

      3.Who it is for, and what changes beyond today

      Target population
      People aged 65 and over in one council area discharged from hospital who could regain independence in daily tasks; working-age adults only if the council chooses.
      Eligibility
      Judged at discharge as likely to benefit from short, goal-focused support at home; the eligibility rule is written down before launch so the comparison group can be drawn on the same rule. People already in long-term care are outside the cohort.
      Scale
      Set from the council’s own discharge numbers and the extra staff it can recruit, and stated in the business case. Councils’ provision varies widely (up to 20.9% of older discharges provided reablement in one council, against 5.7% across England), so the target share is a local choice, not a national number.
      Baseline
      In 2024–25, 120,005 of 2,092,425 people aged 65+ discharged from hospital in England (5.7%) were provided council reablement, and 60.7% of them remained in the community for the 12 weeks after discharge. These are the first year of new linked-data measures and cannot be compared with the old 91-day measure (83.8% at home in 2023–24); 13 councils have no reablement data for the measure, and NHS-funded intermediate care is excluded.

      Source: Department of Health and Social Care, Measures from the adult social care outcomes framework, England: 2024 to 2025 (Statistical commentary, metric 2D; Table_2d(1), Table_2d(2); council-level data for 2D(2)); NHS England Digital, Measures from the Adult Social Care Outcomes Framework, England, 2023–24 (Measure 2D(1), England total (CSV))

      Change beyond existing law or funding
      Reablement already exists in every council and is free for six weeks. The change is a defined cohort at discharge with named extra staff, a ring-fenced allocation inside the Better Care Fund plan, follow-up of every person at 12 weeks and 12 months, and a matched comparison — instead of counting episodes.

      4.How it would work

      Do: Start up to six weeks of free, goal-focused support at home on the day of discharge, led by therapists who set goals with the person and supervise care workers Changing: so that people relearn washing, dressing, cooking and moving safely, and need less long-term home care and fewer returns to hospital

      • Older people still living in the community 12 weeks after discharge, without emergency readmission or long-term residential care

        Hypothesis to testEffect record E-A51-INDEP

        The national 60.7% is a description of outcomes with no comparison group; the Cochrane review could neither support nor refute an effect. This is the primary outcome the comparison will measure.

      • Long-term home-care hours needed 12 months after discharge

        Hypothesis to test

        The cost-protection question, measured separately from capacity: does reablement reduce later care hours? No English trial has measured it.

      • Personal goals met, in the person’s own words

        Hypothesis to test

        Measured with a goal-attainment tool at the end of reablement; Norwegian trials found self-rated activity gains of about 1.5 points on a 10-point scale, which are not a forecast for England.

      • Care hours available for people already waiting for long-term home care

        Hypothesis to testEffect record E-A51-STAFF

        A possible harm: reablement draws on the same staff. Tracked through home-care waiting lists and unmet hours in the same area during the pilot.

      Outcomes are kept separate and never added into one impact figure.

      5.Best evidence

      • Time-limited home-care reablement services for maintaining and improving the functional independence of older adults (CD010825)

        Author or institution:
        Cochrane A et al., Cochrane Database of Systematic Reviews
        Published:
        October 2016
        Evaluation period:
        Searches April to June 2015
        Design:
        Systematic review of randomised, cluster-randomised and quasi-randomised trials of time-limited (up to 12 weeks) home-care reablement for people aged 65+, against usual home care or a waiting list
        Sample or population:
        Two trials, 811 participants: Western Australia (750) and Norway (61)
        Effect and uncertainty:
        Evidence of “very low quality”; the effectiveness of reablement “cannot be supported or refuted”.
        Limits:
        Very low-quality evidence from only two trials; read from the abstract only (the publisher blocked scripted access).

        Where: Abstract. Affiliation is provenance, not proof of quality.

      • Reablement services for people at risk of needing social care: the MoRe mixed-methods evaluation

        Author or institution:
        Beresford B et al., NIHR Health Services and Delivery Research
        Published:
        April 2019
        Evaluation period:
        Service survey in 2015, then follow-up from entry to six months after discharge
        Design:
        Mixed-methods evaluation of English services; no comparison group
        Sample or population:
        Survey of 201 services in 139 councils; outcome data for 186 people entering three services (128 at discharge)
        Effect and uncertainty:
        Outcomes improved between entry to and discharge from reablement, but the sample was too small to compare service models and the authors call the findings preliminary.
        Limits:
        Before-and-after change cannot separate reablement from natural recovery after illness; read from the abstract only.

        Where: Abstract. Affiliation is provenance, not proof of quality.

      • A multicenter investigation of reablement in Norway: a clinical controlled trial

        Author or institution:
        Langeland E et al., BMC Geriatrics
        Published:
        January 2019
        Evaluation period:
        Baseline to 12 months after a 4–10 week programme
        Design:
        Multicentre controlled trial, allocation not randomised (47 Norwegian municipalities)
        Sample or population:
        707 people receiving reablement and 121 receiving usual care; mean age 78
        Effect and uncertainty:
        Self-rated activity performance +1.61 points on a 1–10 scale at 10 weeks (95% CI 1.13 to 2.10) and +1.42 at 6 months (0.82 to 2.02); differences narrowed by 12 months.
        Limits:
        Not randomised, and the reablement group was more motivated at the start; outcomes self-rated; not limited to hospital discharges; Norwegian municipal services differ from English commissioning.

        Where: Abstract; Discussion. Affiliation is provenance, not proof of quality.

      • Intermediate care including reablement (NG74)

        Author or institution:
        National Institute for Health and Care Excellence
        Published:
        September 2017
        Evaluation period:
        Guideline evidence review to 2017
        Design:
        Practice guideline
        Sample or population:
        Adults in England considered for intermediate care or home care
        Effect and uncertainty:
        Recommends offering reablement as a first option to people being considered for home care, if it has been assessed that it could improve their independence; intermediate care is free for the period of delivery, which for most people is up to six weeks.
        Limits:
        A recommendation, not an effect estimate.

        Where: Recommendations 1.2.4 and 1.4.2; Terms used in this guideline. Affiliation is provenance, not proof of quality.

      6.Alternatives, counter-evidence and who loses

      Closest feasible alternative
      Put the same Better Care Fund money and staff into long-term home-care hours for people already assessed as needing them.
      Strongest counter-evidence
      The Cochrane review could neither support nor refute reablement’s effect, and the main English evaluation had no comparison group, so expansion may mostly reach people who would have recovered anyway; outcome rates depend heavily on who is selected.

      Source: Cochrane Database of Systematic Reviews, Time-limited home-care reablement services for maintaining and improving the functional independence of older adults (CD010825) (Abstract); NIHR Health Services and Delivery Research 7(16), Reablement services for people at risk of needing social care: the MoRe mixed-methods evaluation (Abstract)

      Distributional effects
      Gains go to older people judged able to recover after a hospital stay; people judged unsuitable gain nothing from it (the Norwegian trials excluded people with cognitive impairment); people waiting for long-term home care may lose hours if staff are moved. In 2024–25, 70,825 of the 120,005 older people discharged into reablement in England were women; the cohort’s mix by age, sex and deprivation should be published.
      Main downside
      Reablement uses scarce staff — about 111,000 care posts were vacant (7.0%) in 2024/25 — and without new recruits the extra capacity comes from long-term care.

      The options compared, including current policy

      • The proposal

        Extend reablement to a defined discharge cohort with a matched comparison (this brief)

        Who is reached
        Older people leaving hospital in one council area who could regain independence.
        Evidence
        NICE recommends it; the Cochrane review found the evidence too weak to support or refute an effect.
        Likely outcome and timing
        A measured 12-week result in about a year; 12-month care-hours result a year later.
        Cost and funding
        Not costed; possible route a ring-fenced Better Care Fund line, nothing allocated.
        Main trade-off
        Uses scarce staff shared with long-term home care.

      • Current policy

        Reablement as now

        Who is reached
        5.7% of people aged 65+ discharged from hospital in England (2024–25), with wide variation between councils.
        Evidence
        Outcome rates are published (60.7% in the community at 12 weeks) but without a comparison group.
        Likely outcome and timing
        No change; the next national figures due December 2026 (provisional).
        Cost and funding
        Existing council short-term care budgets and local Better Care Fund plans.
        Main trade-off
        No extra staff needed, but whether reablement works locally stays unknown.

      • Alternative

        Spend the same money and staff on long-term home-care hours

        Who is reached
        People already assessed as needing ongoing care, including those waiting for a package.
        Evidence
        No trial found that compares this with reablement.
        Likely outcome and timing
        Immediate extra hours for people waiting; no expected effect on later independence.
        Cost and funding
        The same Better Care Fund and council budgets.
        Main trade-off
        Meets today’s need for ongoing care, but gives up any chance of reducing future care needs.

      • Alternative

        Home adaptations after an occupational-therapist hazard check for people at high risk of falls (see the national decision brief)

        Who is reached
        Older people at higher risk of falling.
        Evidence
        Randomised trials show fewer falls for people selected for higher risk.
        Likely outcome and timing
        Fewer falls in trials for people at higher risk; timing for England not established. Decided in the national brief.
        Cost and funding
        Disabled Facilities Grant (programme envelope) plus occupational-therapist time, not costed.
        Main trade-off
        Competes for the same occupational therapists as reablement.

      • Alternative

        Change how much people pay towards care (a cap or a more generous means test)

        Who is reached
        People who pay for their own care, and their families.
        Evidence
        A separate decision for DHSC and HM Treasury; the Casey Commission is due to recommend by summer 2027.
        Likely outcome and timing
        Protects people from high care costs; does not by itself add care capacity.
        Cost and funding
        A national spending decision; judged on who pays, not on capacity outcomes.
        Main trade-off
        Moves cost from individuals to the state without adding staff or services.

      7.What other countries or the devolved nations show

      Country lesson · Norway (one rural municipality; then 47 municipalities) and Denmark (all municipalities), Norwegian trials published 2015 and 2019; Danish legal duty from 1 January 2015

      Reablement before home care in Norway and Denmark

      Evidence: Experimental or quasi-experimental evaluationPartial match: some conditions differ

      What was changed
      Norway: a time-limited (about 4–10 weeks), goal-led programme at home in which occupational therapists and physiotherapists set goals with the person and supervise home-care staff in daily training. Denmark: municipalities must offer a short, time-limited, goal-led rehabilitation course (typically 8–12 weeks) before assessing anyone for home help, if it is judged able to improve their function — for new applicants and existing recipients at reassessment.
      Study design and population
      Norway: a parallel-group randomised controlled trial (61 people) and a multicentre controlled trial without randomisation (707 reablement against 121 usual care). Denmark: a government-commissioned practice study of how municipalities apply the duty (survey of 65 municipalities, eight case studies, 108 citizens surveyed) — an implementation review, not an outcome evaluation. Home-dwelling adults with functional decline applying for or referred to home-based services (mean age 78 in the multicentre trial); not only people leaving hospital.
      Measured outcome there
      Randomised trial: self-rated activity performance improved by 1.5 points on a 1–10 scale at 3 months (p = 0.02) and 1.4 at 9 months (p = 0.03); no significant difference in physical capacity or health-related quality of life. Multicentre trial: performance +1.61 points at 10 weeks (95% CI 1.13 to 2.10) and +1.42 at 6 months (0.82 to 2.02), with some physical and quality-of-life gains at 6 months; differences narrowed by 12 months.
      Cost status
      No cost per person was read. In the Norwegian randomised trial, home-service work hours in the first three months did not differ significantly between groups, but the reablement group had far more therapist visits. Denmark: no cost estimate read; half of municipalities used private providers for some or all of the course.
      What failed or remains uncertain
      The randomised trial was small and single-site; the larger trial was not randomised and its reablement group was more motivated at the start; outcomes were mostly self-rated; in the larger trial the differences narrowed by 12 months. No Danish outcome evaluation was read. Neither source compares eligibility, reliance on unpaid carers or care-worker costs with England, so those conditions remain untested.
      Why the UK differs
      In both countries municipalities run home care and rehabilitation together and apply reablement before any home-care assessment; in England councils commission most home care from private providers, reablement is free for six weeks, and the national measure covers people aged 65+ discharged from hospital. The Nordic outcomes are self-rated function, not still living at home, so they are not a forecast of the English 12-week measure.
      First change required here
      A council and its integrated care board name the discharge cohort and the therapists who will set goals and supervise care workers, then compare people offered reablement with a matched group on the national 12-week definition and at 12 months.

      Not a UK forecast: the effect above was measured in that place and population. Source: BMC Geriatrics 15:145, Reablement in community-dwelling older adults: a randomised controlled trial (Abstract; Methods; Results (Table 2, work hours)); BMC Geriatrics 19:29, A multicenter investigation of reablement in Norway: a clinical controlled trial (Abstract; Discussion (allocation not randomised; mean age 78)); Rambøll Management Consulting for the Danish Ministry of Health and the Elderly (Sundheds- og Ældreministeriet), Praksisundersøgelse af servicelovens § 83 a (practice study of section 83 a of the Social Services Act) (Sections 1.1–1.2, 1.4 and 1.6 (printed pp.1–6)). Reviewed 2026-10-04.

      8.What delivery needs first

      • staff — Occupational therapists, physiotherapists and reablement care workers recruited or released for the cohort, when about 111,000 care posts were vacant (7.0%) in 2024/25. (Scarce resource shared with other priorities; owner: Council and NHS community services)
      • dependency — A ring-fenced line agreed in the local Better Care Fund plan; without it the pilot displaces other services in the plan or does not start. (Genuine veto: nothing proceeds without it; owner: Health and Wellbeing Board (council and integrated care board))
      • data — Linked hospital and social care records by NHS number, so every person can be followed at 12 weeks and 12 months on the national definition, and a comparison group drawn. (Requirement; owner: Council with the integrated care board)
      • infrastructure — Discharge planning that refers people on the day of discharge, with equipment and minor adaptations (free up to £1,000) ready. (Requirement; owner: Hospital discharge teams and council)
      • public consent — People choose whether to accept reablement and agree to follow-up. (Requirement; owner: Council reablement team)

      9.What it would cost

      How the cost is built up: Cohort size × (therapist and care-worker hours per person × hourly cost) + discharge coordination + equipment + independent evaluation + record linkage + contingency. Any later saving in long-term care hours is reported separately and never netted against the budget as cash.

      • Extra reablement capacity for the cohort (therapists, care workers, discharge coordination)

        One council area: people aged 65+ discharged from hospital who could regain independence

        Not yet costed (ledger C-A51-CAPACITY)

        recurring; price year not stated; Pilot period (to be set in the business case); Not yet established

        Not costed. Councils’ existing short-term care spending is current spending, not the cost of expansion; MoRe’s average cost per case has no stated price year and is not used.

      • Independent evaluation with 12-week and 12-month follow-up and a matched comparison

        One council area: cohort and comparison group

        Not yet established per evaluation

        one-off revenue; price year not stated; Pilot period plus 12 months; Not yet established

      • Record linkage and outcome reporting

        Council and integrated care board analysts

        Not yet established per year

        recurring; price year not stated; Pilot period plus 12 months; Not yet established

      10.Who pays, and what is missing

      Programme envelope (a possible route, not an award)
      Better Care Fund 2026–27 pooled budget (NHS minimum contribution and Local Authority Better Care Grant): £8.43bn, 2026–27
      Allocation committed to this change
      None
      Remaining gap
      Unknown: the extra capacity has not been costed and no Better Care Fund plan has allocated money to it.
      Proposed financing
      A named, ring-fenced line in the local Better Care Fund plan for 2026–27 or later; the national pool is an envelope for many services, not an award to reablement.
      Responsible payer
      councils, NHS
      Budget displaced
      Other services in the same Better Care Fund plan — long-term home care, community health services or discharge support — unless new money is added.

      11.First milestone and time to a useful result

      The council and integrated care board publish the cohort rule, the named extra staff, the Better Care Fund line and the comparison design before the first person is enrolled. (Owner: A council with its integrated care board. Proposed by UK Facts, not an official deadline.)

      Time to first useful result: About a year: enrolment for several months, then 12 weeks of follow-up for each person; the 12-month care-hours result comes a year after enrolment closes.

      What could delay it: Therapists and care workers cannot be recruited without drawing staff from long-term home care. Record linkage between hospital and social care data takes longer than planned. The Fair Pay Agreement (first agreement due to come into force in 2028) or the Casey Commission’s recommendations (expected summer 2027) change council budgets mid-pilot.

      12.How we would know

      Baseline
      The council’s own share of older discharges provided reablement and the share remaining in the community at 12 weeks, on the national ASCOF 2D definitions, for the year before launch.
      Comparison
      A matched group of people meeting the same eligibility rule who were not offered the extended service (for example, from neighbouring wards or the period before launch), followed on the same linked records.
      Leading indicator
      Share of eligible discharges offered reablement, and days from discharge to the first visit.
      Follow-up
      12 weeks after discharge (national definition) and 12 months (long-term care hours, care-home admission, readmissions).
      Continue if
      More people in the cohort remain at home at 12 weeks than in the comparison group, personal goals are met, and long-term home-care waits do not lengthen.
      Adapt if
      Outcomes match the comparison group, or long-term home-care waits lengthen: change the eligibility rule or the staffing mix before expanding.
      Stop if
      The cohort does no better than the comparison at 12 weeks and 12 months, or the pilot can only be staffed by withdrawing long-term care.
      Thresholds
      Not yet set: Set in the local business case before launch, from the baseline, the size of the cohort and the comparison design; never from episode counts.

      What is not yet known, and how to find out

      • Does extended reablement keep more older people at home than a matched group at 12 weeks and 12 months? (effect)Next step: Run the one-area pilot with the matched comparison and publish both results; reconsider when a trial-grade UK evaluation reports.Defensible route: bounded pilot
      • Does reablement reduce long-term home-care hours (cost protection), separately from adding capacity? (effect)Next step: Measure care hours at 12 months in the pilot and report them separately from the 12-week outcome; never net them against the budget as cash.Defensible route: bounded pilot
      • What would the extra capacity, evaluation and record linkage cost for the cohort? (cost)Next step: Cost the cohort in the business case before the Better Care Fund plan is agreed.Scope: One council area: therapists, care workers and discharge coordination for the cohort, plus evaluation and linkage · Data or quotes needed: Local discharge numbers, staff hours per person from current reablement activity, current pay rates and provider quotes, and evaluation tender quotes · Who can estimate it: The council’s adult social care finance team with the integrated care board
      • Can staff be recruited without drawing from long-term home care? (delivery)Next step: The council tests recruitment for the named posts before launch and tracks long-term home-care waits during the pilot.
      • How do eligibility, reliance on unpaid carers and care-worker costs compare with Norway and Denmark? (data)Next step: Commission a structured comparison (for example from OECD long-term care data) before using Nordic results to set the English cohort.

      Sources last checked 4 October 2026 · Owner: Evidence editor (James Harris) · Next check: DHSC measures from the Adult Social Care Outcomes Framework, England: 2025 to 2026 (reablement measure 2D) (17 December 2026, provisional) or the first trigger: Better Care Fund policy framework for 2027–28.

      What it would take

      The order things have to happen in, who pays, and the effects and appraisals on record.

      The order things have to happen in

      1. First, the prerequisite

        Publish adaptation waiting times and name the reablement cohort and comparison

        Owner: Housing authorities and councils with integrated care boards

        No date: the timing depends on the steps before it.

      2. Then, the decision

        Allocate staff and money in the local Better Care Fund plan

        Owner: Health and Wellbeing Boards

        No date: the timing depends on the steps before it.

      3. Then, delivery

        Run OT hazard checks with a fast adaptation route; extend reablement at discharge

        Owner: Councils with NHS falls and community services

        No date: the timing depends on the steps before it.

      4. Finally, the measured outcome

        Falls admissions among people adapted, and people at home 91 days after discharge, each against a comparison

        Owner: Councils with an independent evaluator

        No date: the timing depends on the steps before it.

      5. Then, the decision

        Publish the workforce plan with pay, vacancy and capacity costs before Fair Pay Agreement negotiations

        Owner: DHSC with HM Treasury

        No date: the timing depends on the steps before it.

      6. Then, delivery

        Assess overheating in a sample of care homes and pilot building-specific measures

        Owner: DHSC with UKHSA and providers

        No date: the timing depends on the steps before it.

      Who pays, and what is still missing

      Cost, committed funding and the remaining gap for the same scope and years. A programme envelope is not an award to a project; a proposal is not committed money. No total is shown because these costs are on different bases or periods and cannot be added.

      Cost and funding ledger

      • Disabled Facilities Grant 2026–27 (programme envelope)

        A52 · capital · published programme envelope

        Amount
        £723m in total, 2026–27, price basis not stated by the source
        Who pays
        central government
        Committed
        None identified
        Proposed, not committed
        £723m (Disabled Facilities Grant allocations 2026–27)
        Gap
        Not established

      • Occupational-therapist home-hazard assessments and faster processing for people at higher risk of falls

        A52 · recurring spending · not costed

        Amount
        Not yet costed
        Who pays
        councils, NHS
        Committed
        None identified
        Proposed, not committed
        —
        Gap
        Not established

      • Additional reablement capacity — therapists, care workers and discharge coordination — for a defined cohort, with a 12-week follow-up

        A51 · recurring spending · not costed

        Amount
        Not yet costed
        Who pays
        councils, NHS
        Committed
        None identified
        Proposed, not committed
        —
        Gap
        Not established

      • Better Care Fund 2026–27, excluding the Disabled Facilities Grant (programme envelope)

        A51 · recurring spending · published programme envelope

        Amount
        £8.43bn in total, 2026–27, price basis not stated by the source
        Who pays
        NHS, central government
        Committed
        None identified
        Proposed, not committed
        £8.43bn (Better Care Fund 2026–27 pooled budget (NHS minimum contribution and Local Authority Better Care Grant))
        Gap
        Not established

      “Not yet costed” means no defensible cost has been found — not that the action is free. Lifetime benefits, benefit-cost ratios and forecast savings are never shown here as money available to spend.

      Effects on record, with evidence ratings (3 records)

      What the evidence says each action changes

      Effects on record — these measure different outcomes, so they are not drawn on one scale
      ActionOutcome and areaEffectCompared withEvidence
      Offer reablement to more older people leaving hospital, and judge it by whether they are still at home three months laterOlder people still living at home after a hospital stay, without readmission or long-term care Health and careDirection plausible; size not established—plausible spillover; limited confidence; England60.7% of over-65s discharged into reablement remained in the community for 12 weeks (2024–25), but that is a description of outcomes, not an effect: there is no comparison group, and the Cochrane review could neither support nor refute reablement’s effect.
      Offer reablement to more older people leaving hospital, and judge it by whether they are still at home three months laterCare hours available for people already needing long-term home care Health and care · mixedSize not established—plausible spillover; limited confidence; EnglandA trade-off to plan for with 7.0% of care posts vacant (Skills for Care, 2024/25), not a measured effect.
      Fit home adaptations faster for older people at high risk of falling, after an occupational-therapist hazard checkRate of falls among older people at higher risk of falling Health and care−38% rate of falls (rate ratio 0.62)95% CI 0.56 to 0.70 (falls −44% to −30%); 9 studies, 1,513 participants; high certaintyusual care or no intervention in randomised trials; Trials included in the 2023 reviewevaluated; high confidence; International trials, including the UKNo effect for people not selected for risk (rate ratio 1.05, 95% CI 0.96 to 1.16), so the targeting is the intervention. Trials measured falls, not admissions or care-home moves.

      How we would know

      People aged 65+ still living in the community 12 weeks after discharge into reablement; People aged 65+ discharged from hospital who were provided reablement; Adults 65+ at home with some unmet need for personal care; and 4 more.

      The outcome measures to watch. A baseline is where we start, not a target; where there is no official target we say so.

      Measured results

      What each option would be judged on, and the latest value of the measures already on this page. A measure moving is not proof that an option caused it.

      Where the ideas come from

      Research, counter-evidence and methods (20 sources; 3 claims held back)

      Counter-evidence and criticism

      • Fit home adaptations faster for older people at high risk of falling, after an occupational-therapist hazard check: Untargeted home-hazard programmes did not reduce falls, so spending spread across everyone eligible would be wasted; the latest national waiting-time data are from 2018. (Cochrane Database of Systematic Reviews)
      • Offer reablement to more older people leaving hospital, and judge it by whether they are still at home three months later: Systematic-review evidence cannot show that reablement improves independence, and short-term services use the same scarce staff as long-term home care. (Cochrane Database of Systematic Reviews)
      • Publish a costed care workforce and capacity plan alongside the Fair Pay Agreement: Pay rises in care may be matched elsewhere, so recruitment gains could be smaller than projected; a plan does not itself add capacity. (NIHR Policy Research Unit in Adult Social Care)
      • Assess overheating in care homes and fund building-specific cooling where risk is highest: Most heat deaths occur outside alert periods and the heatwave plan has not been shown to reduce them; the benefit of building measures is modelled, not observed. (London School of Hygiene & Tropical Medicine (for PHE))

      Claims held back

      • The share of older people at home 91 days after reablement has risen or fallen — The 91-day measure (83.8% in 2023–24) was discontinued; its 2024–25 replacement uses a 12-week window and different data, and DHSC says it cannot be compared with earlier years. Needed: Two or more years of the new measure, or a local 91-day follow-up on the old definition.
      • Current waiting times for Disabled Facilities Grant adaptations — The latest national figures found are from the 2018 review. Needed: A national collection of referral-to-completion times.
      • What the Casey Commission will recommend on funding and cost protection — Phase 1 had not reported by 4 October 2026; recommendations are expected by summer 2027. Needed: The Commission’s published recommendations.

      “Full text checked” means we read the report itself; “relevant passages” means the sections behind each figure; “summary or abstract only” means we could not read the full study, so no number from it is published here without another source.

      Other options compared — not on the shortlist (3)

      Other options compared

      Options from earlier work on this page that are not on the shortlist. They remain valid choices; their evidence is shown as before.

      • capacityStatus: legislated

        Raise and standardise care workers’ pay

        Aims to:
        Fewer vacancies and lower turnover, so more care hours can be delivered.
        How:
        A sector-wide Fair Pay Agreement sets minimum pay and terms; councils fund higher fees so providers can pay them.
        Who decides:
        DHSC; the Adult Social Care Negotiating Body (employers and unions); councils as commissioners.
        Main constraint:
        Council budgets and fee rates; self-funders’ fees; providers’ margins.
        Evidence:
        Limited evidence — plausible mechanism, little direct evaluation
        See the trade-offs and evidence
        What the evidence shows
        Skills for Care reports high turnover in a low-paid workforce, but there is no evaluation of sectoral bargaining in English social care; effects on recruitment depend on pay relative to other jobs.
        Policy status
        Employment Rights Act 2025 provides for the agreement; negotiations planned for 2027 and the first agreement in 2028.
        Resources
        £500m announced for the first agreement; recurring council fee uplifts.
        Consent and decisions needed
        Requires agreement between employer and worker representatives and government approval.
        Time
        First agreement expected in 2028; effect on vacancies over following years.
        Cost and yield
        £500m announced (cash); full recurring cost depends on the pay level agreed. No official estimate of the total.
        Trade-offs and who pays
        Higher fees for councils and self-funders; may draw staff from the NHS and retail.
        How we would know it worked
        Leading indicator: Care worker pay relative to the National Living Wage and to entry-level NHS roles. Outcome: Vacancy and turnover rates (Skills for Care). It would not be working if: Pay rises but vacancies and turnover do not fall.
      • capacityStatus: operating

        Pooled NHS and council budgets for discharge and community care

        Aims to:
        Patients ready to leave hospital get the care they need sooner.
        How:
        The Better Care Fund pools NHS and council money for community services, reablement and discharge.
        Who decides:
        NHS England, integrated care boards and councils (Health and Wellbeing Boards).
        Main constraint:
        Workforce on both sides; different funding rules; data sharing.
        Evidence:
        Limited evidence — plausible mechanism, little direct evaluation
        See the trade-offs and evidence
        What the evidence shows
        The National Audit Office found earlier integration programmes, including the Better Care Fund, had not delivered the expected reductions in hospital activity. Joint working is necessary but has not, by itself, shown measurable savings.
        Policy status
        NHS planned contribution £3.06bn in 2024–25.
        Resources
        Pooled budgets; shared data; discharge teams.
        Consent and decisions needed
        Requires local agreement between NHS bodies and councils.
        Time
        Annual plans; effects on delays within a year if capacity exists.
        Cost and yield
        £3.06bn planned NHS contribution (2024–25, cash), largely existing money.
        Trade-offs and who pays
        Ring-fencing for discharge can draw resources from people already living in the community.
        How we would know it worked
        Leading indicator: Patients a day no longer meeting the criteria to reside. Outcome: People at home 91 days after discharge. It would not be working if: Funding rises but delays stay flat.
      • structuralStatus: proposed

        Change who pays: a cap or a more generous means test

        Aims to:
        Protection from very high care costs and fairer access for people with modest savings.
        How:
        A lifetime cap on personal care costs and a higher means-test threshold shift more cost to the state.
        Who decides:
        DHSC and HM Treasury; Parliament.
        Main constraint:
        Fiscal cost; council assessment capacity; interaction with care fees paid by self-funders.
        Evidence:
        Not evaluated — a mechanism to test, not an evidenced fix
        See the trade-offs and evidence
        What the evidence shows
        A cap on care costs was legislated in the Care Act 2014 but never brought into force; the most recent plan was cancelled in July 2024, so there is no English evaluation. The independent Casey Commission was set up in 2025 to recommend long-term reform.
        Policy status
        The 2026–27 means-test capital limits stay at £14,250 and £23,250 (DHSC charging circular, 17 February 2026). Judged on who pays and on protection from catastrophic costs — not on extra care capacity, which is what the reablement and adaptations actions are judged on.
        Resources
        Recurring public spending; councils’ capacity to assess many more self-funders.
        Consent and decisions needed
        Needs legislation and spending decisions; no current proposal to test support against.
        Time
        Several years from decision to implementation.
        Cost and yield
        No current official costing.
        Trade-offs and who pays
        Spending goes mainly to people with assets to protect rather than to unmet need among those on low incomes.
        How we would know it worked
        Leading indicator: Number of self-funders assessed by councils. Outcome: People spending down savings on care; unmet need. It would not be working if: Costs to the state rise but unmet need does not fall.
      The options side by side
      OptionResourcesTimeEvidenceOutcome to watch
      Raise and standardise care workers’ pay£500m announced for the first agreement; recurring council fee uplifts.First agreement expected in 2028; effect on vacancies over following years.limitedVacancy and turnover rates (Skills for Care).
      Pooled NHS and council budgets for discharge and community carePooled budgets; shared data; discharge teams.Annual plans; effects on delays within a year if capacity exists.limitedPeople at home 91 days after discharge.
      Change who pays: a cap or a more generous means testRecurring public spending; councils’ capacity to assess many more self-funders.Several years from decision to implementation.not evaluatedPeople spending down savings on care; unmet need.

      Plan reviewed 2026-10-07. How we judge evidence.

      How this connects

      Sources and methods (7)

      Method notes

      • England only: social care is devolved, and Scotland, Wales and Northern Ireland run separate systems with their own statistics.
      • Adult social care only. Children’s social care and childcare are separate services and are not included.
      • Council activity data cover care councils provide or arrange. People who arrange and pay for care entirely themselves, and unpaid care by family and friends, are not counted.
      • Request and reablement statistics for 2024–25 come from new client-level data and cannot be compared with earlier years; long-term support can.