Care Sector Caught in Health and Social Care ‘No Man’s Land’, Warns The King’s Fund
A major new report from The King’s Fund has highlighted the ongoing challenges facing older people as they navigate the divide between the NHS and social care, warning that many residents and families are becoming trapped in a “no man’s land” between the two systems.
Published today, the report, ‘No man’s land’: the experience of patients at the interface between health and social care, argues that structural differences between health and social care continue to create delays, confusion and fragmented support for people with complex needs, particularly during key transitions such as hospital discharge and access to ongoing care.
The King’s Fund says the problems go far beyond operational issues or poor communication, instead stemming from fundamental differences in funding, eligibility criteria and accountability between the NHS and adult social care. While NHS services remain free at the point of use, social care is means-tested and commissioned through local authorities, creating friction at precisely the moments when individuals require seamless support.
Growing Pressures on an Ageing Population
The report focuses largely on the experiences of older people, who are the biggest users of both health and social care services. With increasing numbers of people living with frailty, dementia and multiple long-term conditions, demand on both sectors continues to rise. According to The King’s Fund, this growing pressure is contributing to avoidable hospital admissions, delayed discharges and a greater reliance on unpaid family carers.
For care home providers, many of the findings will feel familiar. The report identifies delayed hospital discharge as one of the clearest examples of a failing interface between health and social care. On average, around 10,000 hospital beds each day are occupied by patients who are medically fit to leave but remain in hospital because appropriate support arrangements have not been put in place.
While social care shortages are often blamed for delays, the report notes that many hold-ups also originate within the NHS, including waits for assessments, medicines, therapies and other internal processes. The result is a system where residents can experience prolonged hospital stays, loss of independence and increased health risks.
Continuing Healthcare Under Scrutiny
The King’s Fund also highlights ongoing concerns around NHS Continuing Healthcare (CHC), describing it as one of the most contentious areas where health and social care responsibilities overlap.
The report says families frequently find CHC assessments complex, inconsistent and difficult to navigate. Eligibility rates have fallen significantly over recent years, with the proportion of applicants approved for standard CHC funding dropping from around 31% in 2017 to approximately 17% today. Significant regional variation remains, leading to concerns about fairness and consistency.
The report notes that disputes over whether an individual’s needs are primarily health-related or social care-related can create uncertainty, financial anxiety and delays for families and providers alike. In some cases, individuals have died before assessment or appeals processes were completed.
Workforce and Funding Challenges
The King’s Fund identifies workforce shortages as a major contributor to problems across the care pathway. It estimates there were around 90,000 vacancies in adult social care in England during March 2025, with lower pay, weaker terms and conditions, and limited career progression continuing to affect recruitment and retention.
The report also warns that fragile provider markets and ongoing financial pressures on local authorities are restricting access to care and increasing unmet need. Older people and families are increasingly required to bridge gaps through privately funded care, top-up payments or unpaid caring responsibilities.
Call for Reform
While welcoming initiatives such as care transfer hubs, integrated neighbourhood teams and the Better Care Fund, The King’s Fund argues that these measures alone will not resolve the underlying issues.
Instead, the think tank is calling for stronger joint accountability between health and social care organisations, greater investment in social care, improvements to workforce conditions, better data sharing, and reforms to Continuing Healthcare. It also suggests that expanding access to publicly funded social care would help reduce pressure on hospitals while improving continuity of care for older people.
The report concludes that unless the longstanding divide between health and social care is addressed, people requiring support will continue to experience delays, uncertainty and fragmented care, with consequences felt not only by residents and families but across the wider health and care system.
Gerard Crofton-Martin, Interim Chief Executive at SCIE, said: “The ‘no man’s land’ that exists between health and social care because of support delays, confusion, and service fragmentation leaves too many people without the care and support they need to live well and independently.
“The Government has repeatedly sought to address this through legislation. As this report makes clear, however, success has been limited. We know that ambitions have been unevenly realised, with persistent differences in people’s access to services, their experiences of those services, and the outcomes they achieve.
“Improving how people navigate services must be a priority. This means ensuring information and advice are accessible and timely, and can support everyone to understand their rights and the options available to them. Adopting a holistic approach that considers someone’s journey across health and social care systems will also be essential—the Government’s own review of the NHS made clear that we need stronger community-based support to prevent needs escalating and to better sustain people’s health and wellbeing over time.
“With demand for care continuing to rise and more people forced to self-fund their care because they don’t qualify for local authority support, the need for a national conversation on the future of social care has never been greater. The Casey Commission offers an opportunity to build an evidence base for a system that is fairer, more sustainable, and better able to support everyone, regardless of who they are and where they live, to lead fulfilling lives.”
