‘Devolution and social care are inextricably linked’

Andy Burnham has pulled no punches on big ideas and large-scale policy change since coming to office. On the one hand, devolution to drive good growth in every postcode. On the other, a National Care Service to deliver better care for older people. So far these have been treated as separate agendas with different audiences. Yet the two are intimately linked, without action the social care crisis will undermine good growth ambitions.

Far from a postcode lottery for care, ILC’s new research reveals a stark postcode penalty. Older people in the worst-off areas have a quarter fewer good-quality care options, relative to need, than those in the best-off. Unpaid carers fill the gap: nearly double the proportion of residents in the worst-off areas provide 20 or more hours of care a week compared with the best off. Where unpaid caring is greatest, economic inactivity among 50 to 64-year-olds is highest too.

READ MORE: ‘Social care – and how we pay for it – is everybody’s issue’

Those living in places at the sharp end, such as Tameside, Knowsley and Halton, also pay more for less care. The adult social care precept costs a Band D home 12% more in the worst-off areas, yet raises 40% less for every older person in poor health. That eats into local capacity and household budgets in exactly the places where economic growth is hardest. It is the antithesis of spreading prosperity across the country by design.

Compare Tameside, in the worst-off fifth of our index, with Wokingham in the best-off. Older people in Tameside are sicker for longer, yet have around a third of the good-quality care options relative to need.

Source: ILC, Inequality street (2026)

For hope to spread again, we need urgent action. We can’t wait for a National Care Service in the next Parliament. We suggest several stop-gap measures to ease the pressure on these areas and support local capacity where it’s needed most.

Firstly, central government should pick up a bigger share of care costs in the worst-off places, so councils with the most limited tax bases aren’t forced to lean harder on residents already paying more. Taxing local populations more isn’t working as a solution to fund care, so funding needs to come from the centre and must also follow need. Most of the postcode penalty is driven by poor health in an area rather than the overall numbers of older people and so health outcomes must drive how funding is allocated.

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We also need to see Mayors playing their part. Most do not have responsibility for social care but our analysis shows that the availability of care locations is also an economic issue. Strategic authorities are set to get more powers over employment support and targeting this at over-50s in areas with high numbers of family carers could support local economies.

Including social care within emerging neighbourhood health services and employment support is hard because it means getting NHS commissioners, councils and jobcentres, working much more closely. But devolved authorities are well placed to force that conversation. They already have a legal duty to improve population health, and good care is itself prevention. Freeing up unpaid carers over-50 would allow more of them to work as they would like.

The postcode penalty means worse care, more unpaid caring and more people out of work. It falls on the places good growth most needs to reach. The government has a rare chance to bring its devolution and care agendas together and act now, in a way that can support the rewiring the country so badly needs.

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