Social Care Analytical Unit: Areas of Research Interest. 2026-2029

Adult social care in Scotland

This short overview of adult social care in Scotland describes social care and sets out the context for this ARI and its research themes. It summarises evidence about social care and the strategic and cross-cutting challenges facing social care policy and delivery in Scotland (now and into the future), outlining the role and importance of research and evidence to inform policies and decision making.

Social care supports people with daily living so they can be as independent as possible. It can also help people who look after a family member or loved one, as an unpaid carer. Social care is provided in the community, in people’s homes and in residential settings. Social care support is delivered in a diverse range of settings by a wide range of providers, supporting people with a variety of different needs and it interacts with healthcare and with other community services.

The need for care

Research plays a vital role in evidencing adult social care policy now but also how policy may need to evolve into the future. The demographics of Scotland, the population’s health, opportunities to access support, how we live in our communities, ability to care for others, and expectations are also evolving, and this all impacts on the need for adult social care and how it is designed and delivered. There are also a range of challenges facing adult social care, some of these are summarised below for context.

Current situation

While many services are delivering high quality care^[1], there are a range of existing pressures[2] relating to, demand^[3],[4],[5], workforce availability^[6], culture^[7], economic and financial constraints^[8] which are impacting on meeting the care needs of Scotland’s population. Some of the challenges particularly impact on the shorter term demand and availability of care, for example increasing demand around winter and other year-round surges.

Scotland has the widest socio-economic inequalities in health^[9] of any country in Western Europe. While life expectancy varies between geographical areas, like local authorities and health boards, the difference in life expectancy is far greater when levels of deprivation are taken into account. These differences have an impact on the need for care. Furthermore, the proportion of individuals who have two or more medical conditions simultaneously (referred to as ‘multimorbidity’) has risen across high income countries, including the UK^[10], partly reflecting increases in life expectancy across recent decades. Projections suggest that this trend is set to continue^[11]. While these trends reflect the ageing profile of populations, it is important to note that multimorbidity is not restricted to older people^[12].

The financial challenge facing the social care sector is high with increased demand for services^[13], growing complexity of needs^[14],[15] , new technologies^[16], cost of living^[17], gaps in service provision, increasing spend and rising workforce costs across areas including pay and national insurance^[18]. The financial challenges will impact local areas differently reflecting how adult social care is delivered across Scotland.

Many services report challenges filling jobs^[19] due to various reasons including low pay, antisocial hours and difficult working conditions^[20].

Access to care services can also be a challenge for many people. Analysis of survey results^[21] over time shows that positive sentiment towards experiences of receiving help, care or support has generally decreased from 2015-16 to 2023-24.

For the first time in the Health and Care Experience Survey in 2023-24, people who reported needing help, care or support with everyday living were also asked directly about their experience of unmet need. This included both those who reported receiving some form of support but still felt that their needs were not fully met, and those who reported that they were unable to access any support. Those who did not feel that they were receiving all the help that they needed were asked which options best described their situation. Among those people who responded, 44% of people who felt that they needed more help and care weren’t sure if they were eligible for more, or any, support, 34% did not know how or where to ask for help, and 17% reported they did not qualify for services.

Not all adult social care is free in Scotland. Therefore, the ability to pay^[22] for adult social care may also be a challenge for some people in accessing services and support.

The future

The population of Scotland is ageing and changing^[23]. In 2022, adults aged 85 or older comprised only around 3% of the adult population. This is projected to double between 2025 and 2047^[24]. The proportion of Scotland’s population of working age is not expected to increase.

With an ageing population the disease burden is expected to increase. The burden of disease is a measure of how disease and injury prevent us living longer and healthier lives. The proportion of individuals who have two or more medical conditions at the same time has increased in recent years and the burden of disease is expected to increase by around one fifth (21%) by 2043, especially for those aged over 65^[25].

This support for increasingly complex needs is expected to potentially increase demand for services^[26],[27] and require more holistic, person-led, coordinated care.

Additionally, any increase in the population’s expectations for health and care provision or rising needs for diverse groups within the population could further increase the demand for support.

Older people are more likely to live alone. Women are particularly impacted by this because they tend to live longer^[28]. Single person households are projected to continue to increase. This is mainly due to the growth in the number of older people, as older people are more likely to live alone or in small households^[29].

The ageing population means more people are living longer with long-term limiting illness and need to be cared for. Census data shows that the number of unpaid carers in Scotland was 627,700 in 2022, having increased by 27.5% (135,500) since 2011^[30] . Older people are more likely to be carers themselves, often caring for partners, younger family members or, in some cases, their parents, which has an impact on their own health and wellbeing^[31].

Scotland’s budget, and within that the amount given to health and social care will likely remain very constrained into the future^[32].

Digital and technology enabled care can support services by changing the way things are done. Developing these approaches and other new efficient and effective models of care, along with the evidence base on how these can be applied, will impact how care is delivered in future. This includes the potential for more prevention and early intervention approaches, to provide care and support earlier to people where it is needed.