Local authority assessments 2023 to 2026: Emerging themes and findings

Unpaid carers play an essential role as partners across the whole system of care and health. Local authorities have a statutory duty to assess, support and promote the wellbeing of unpaid carers, ensuring their needs are met and their role is recognised. They must be proactive in identifying unpaid carers and undertaking a carer assessment with them.

As the population of England continues to age, and people live longer with multiple care and support needs, the number of unpaid carers will increase across the country. Ensuring growing numbers of unpaid carers have access to support at an early stage can allow early intervention, preventing escalation of needs and crisis situations by managing risk.

The Survey of Adult Carers in England, 2023-24 shows that unpaid carers are less satisfied with the services and support they receive than the wider cohort of people using services (65% of people using services reported that they were very or extremely satisfied with the care and support they received, compared with just 37% of carers). According to the survey, only 30% of unpaid carers reported that they had as much social contact as they wanted with people they liked, suggesting that local authorities in England have more to do to develop support that helps carers to reduce their isolation and loneliness.

While we found examples of good support to carers, it was not always sufficient, or easy to access, and there were areas of unmet need and significant gaps in proactive identification of carers. Inspectors consistently described unpaid carers as a group whose legal rights and needs are widely recognised in principle but inconsistently realised in practice. Inspectors consistently highlighted that the words and phrases used across policy, assessments and commissioning often act as barriers rather than enablers of support, for example describing unpaid carers as “hidden” or “unseen” by adult social care systems.

Identifying unpaid carers and recognising their needs

According to research by The King's Fund, the 7.9 billion hours of care provided annually by family members and friends (unpaid carers) in England is the equivalent of 4 million full-time paid care workers in the social care system, stating that “Without them, the system would collapse.”

Inspectors highlighted identification of unpaid carers as the most significant issue, with carers often only being seen in crisis. A large cohort of carers, particularly those supporting older people, self‑funders or relatives living at a distance, have no contact with local authorities until something goes wrong. Reliance on crisis, breakdown or statutory thresholds to trigger support undermines prevention and increases safeguarding risk.

Language was repeatedly highlighted as a significant barrier to identification, assessments and access to support for unpaid carers. Terms such as “hidden carer”, “respite”, and “eligible needs” were described as masking risk, normalising burnout and implicitly placing responsibility on individuals rather than on systems. Inspectors reflected that many unpaid carers never come into contact with services because they do not recognise themselves within the language used by the system. This was particularly evident for people caring for partners, parents or children, who often understand their role or ‘duty’ as part of a relationship rather than a defined caring identity.

Self-identification as an unpaid carer was also linked to equity, as unpaid carers within strongly family‑oriented communities, where caring is viewed as a moral or relational responsibility rather than a service‑linked identity, were particularly unlikely to come forward. Reliance on self‑identification and crisis thresholds therefore disproportionately delays support, and this reliance is reflected in decisions around how services are commissioned, designed and triggered without prioritising early identification and support of carers.

Addressing challenges in identifying carers was sometimes a focus of local authorities’ carer’s strategies or one of the local authority’s priorities. Some local authorities told us how the nature of this challenge was affected by changing population demographics in the local area. For example, we heard that the leaders in a local authority “recognised the expected population growth for carers in the county in line with the ageing population” and emphasised the importance of all unpaid carers having access to support in this context.

Identifying unpaid carers was often done at the same time as carrying out an assessment for a person with care needs. However, this should not be the only method, and we saw other measures in place to identify unpaid carers, such as during hospital stays or at the point of discharge. This sometimes involved having teams embedded in hospitals, whose role was to identify and provide support to unpaid carers. This included one local authority creating a “Carers Discharge Support officer” role to increase the numbers of carers identified and supported at the point of hospital discharge of the person they were caring for. In another authority, a commissioned partner ran a carers hospital liaison service, which oversaw a 400% increase in the number of carers identified at a local hospital.

Partnerships with the voluntary and community sector were also seen as a vital way of identifying carers. Inspectors described strong practice where carers were supported through well‑commissioned voluntary sector services. Effective approaches included separate carer assessments, culturally targeted support, and flexible or alternative short break options. Inspectors described seeing effective carers centres that tailored support to specific communities and geographies rather than offering a single generic model. For example, one local authority:

focused on building on relationships with voluntary and community organisations to enhance communication. For example, staff were able to provide unpaid carers who were previously unknown to adult social care services with information about the resources and assistance they could access.

Access to carer assessments

Inspectors found that access to carer assessments and the length of time carers had to wait for an assessment varied. Some reports described access positively – for example, in one local authority we heard that the carer assessments were routinely offered during social care assessments or when referred, and were carried out by practitioners across hospital, locality, learning disability, and mental health teams. This approach across different care settings increased the availability of timely assessments, therefore enabling carers to be supported more quickly. However, inspectors often reported feedback from carers that described how they felt frustrated due to long waits for assessment, and feeling unsupported in their caring role, or “forgotten about”. Inspectors reflected that in some local authorities, even obtaining a carer assessment remains difficult, with limited proactive engagement and poor visibility of carers’ rights.

As well as commenting on delays, some reports noted that unpaid carers had failed to be offered assessments at all. One, for example, noted that some unpaid carers who cared for their adult children with complex needs had not received carer assessments, which left them feeling “increasingly isolated and under pressure, particularly during unexpected events”. Without providing access to effective carer assessments for all those who need them, local authorities won’t be able to understand, monitor and cater for the full extent of carers’ needs in their area.

Several of our assessment reports showed how local authorities understood their responsibilities to treat unpaid carers’ needs as distinct from the needs of the people they supported. Feedback from some unpaid carers showed they valued when local authorities tailored their approach to support their needs, saying, for example, that “staff were accessible and demonstrated awareness of people’s individual circumstances and protected characteristics.”

However, we also saw examples of local authorities failing to assess and monitor distinct carers’ needs and, as stated in one assessment report, treated the needs of unpaid carers “as extensions of the person receiving care and support”. Inspectors noted that an enduring cultural tendency to frame carers as secondary to the person they support, rather than as individuals with needs in their own right, constrains strategic prioritisation and investment in carers’ support.

Failure to provide support that appropriately accommodates their individual circumstances, characteristics and preferences can also result in these carers disengaging from the local authority’s support altogether. For example, in one local authority some unpaid carers told us that, although they were aware of the services their local authority offered, “they did not have enough time to attend support groups or felt that the support available did not suit their needs”, highlighting current gaps in arrangement and provision of carers’ breaks, as explored further in ‘Support for Unpaid Carers’. Inspectors found that these negative factors around access to assessments were often compounded by a lack of clear and accessible information about the process from local authorities. For example, across several local authorities, carers were not aware of their right to request an assessment or reassessment, which showed that further improvements in communication and outreach were required.

Inspectors highlighted concerns about bureaucratic terminology in carer assessments and eligibility decisions. Phrases such as “eligible needs”, “self‑sufficiency” and “resilience” were described as masking sustained caring effort and transferring responsibility back onto families. Rather than recognising that risks to carers’ health and wellbeing can increase, this language often signals that carers are expected to continue coping unless they can evidence failure.  The use of terms such as “service user” or “client” was also discussed as contributing to emotional distance and dehumanisation. This can obscure the relational nature of caring, where support is given to someone a carer loves rather than a transactional recipient of services.

In one local authority, we saw the impact of delays and a lack of communication following carer assessments, was that they contributed to carers feeling “like they were carrying the burden of caring alone and did not always feel listened to.”

By contrast, in another authority, feedback from carers described their assessment as providing them with knowledge, guidance and support, with one person feeling “valued in the process”. Another report described carer assessments as being part of a “whole-family approach” to support. These examples indicate that these local authorities understood the importance of collecting information that enabled person-centred, effective and responsive support. This in turn enables carers to support the people they are caring for and maintain their own quality of life.

For assessments to be accessible it is important that a carer is offered flexibility and choice. This might include choice over who conducts the assessments, when or where they take place, what type of information is collected and how this information informs a choice of support. In some cases carers could choose to either have their assessments alongside the person being cared for, or to have them performed on a separate occasion. One report described how a local authority offered carers flexibility in when their assessment took place while maintaining the holistic understanding of how the carer’s and person’s needs intersect with one another:

The process for carer assessments was closely aligned with the cared for person’s needs assessment and were jointly recorded in the care and support plan. However, staff acknowledged that carers should always be offered the opportunity of an assessment of their own, either because they wanted to discuss things they may not have wanted to say in front of the cared for person, or because they wanted a more structured discussion.

By comparison, a carer at another local authority had not been given a choice about having a separate assessment, which meant they “did not always feel able to talk freely, and the carers’ unique needs may have been missed or not recognised."

Support for unpaid carers

Once a carer’s needs are assessed and recognised, local authorities are required to put appropriate support in place for them.

One of the most common forms of support noted across our assessments was support with carers’ breaks. This involves temporary care being provided for a person either in their own home or in a residential setting. The accessibility of breaks for unpaid carers varied between local authorities. We saw that it worked well when authorities were able to maintain a flexible approach to delivery – for example, flexibility around times, or adapting to a carer’s change of circumstances.

Some reports also described local authorities supporting people to employ personal assistants, sometimes funded through direct payments . We were told an example where a personal assistant was recruited, which could enable a person with dementia to attend a dementia choir, giving their unpaid carer a break. However, we also heard of issues with systems for accessing direct payments, which carers said were “slow and confusing” and others highlighting it being “time-consuming.

Some local authorities used technology and equipment to ease caring responsibilities. This included support to access technology that allowed carers to leave home for short periods by helping them to manage risks to the person being cared for. Also, we saw funding allocated to purchase household appliances to reduce physical strain, which “gave carers more choice and control while improving resilience and wellbeing”.

We saw evidence of limited access to carers’ breaks. For example, in one local authority some unpaid carers told us that they “did not feel they had time to engage in activities and interests that enriched their own lives”. In one authority a staff member said there were difficulties in sourcing breaks for carers, which was confirmed by a partner organisation who told us they were aware of carers waiting over 6 months to hear about support. We also saw insufficient allocation of time for carers’ breaks – for example, during one local authority assessment some unpaid carers told us they had as little as 3 hours of support per week through a direct payment which they described as “insufficient to support their role” as it did not enable time for themselves, with this time often used for domestic tasks.

Inspectors consistently described language linked to carers’ breaks and support as problematic. They felt that terms such as “respite” and “emergency respite” reinforce a reactive, crisis‑led model of support. Inspectors reflected that breaks are often only available once a carer reaches breaking point or becomes unwell, rather than being part of planned, preventative support. This framing risks normalising burnout as an expected step before help is offered. Several inspectors noted that many local authorities are actively moving away from the term “respite”, reflecting its dictionary definition as “a short period of rest or relief from something difficult or unpleasant”, and instead adopting the term “short breaks”. We observed that the language used by staff and in policy documents often revealed the underlying culture and maturity of an authority’s approach to carers.

Initiatives such as dementia cafés and support groups are often run by the voluntary sector, and in some cases local authorities provide funding for these initiatives. For instance, in one authority carers were said to have consistently praised the carers’ groups they attended, with one describing the group as having “saved them, describing the value of meeting others in similar situations, sharing laughter and tears, and even receiving a hug when needed”. At the same authority, days out organised for carers were described as a “godsend”, especially as the carer had not opened up to friends before attending. We also saw examples where unpaid carers were unable to use such groups and initiatives, despite being aware of them, because they didn’t have time away from their caring responsibilities.

An area of weakness identified in our assessments was how local authorities planned in either the short or long term with unpaid carers for any potential changes of circumstances that may affect their ability to provide effective care and support in the future. The ADASS Spring Survey July 2025 reported an increase in carer breakdown, with carer burnout cited by directors as the number one reason. Individual contingency support planning for unpaid carers was identified as a critical weakness in many systems. For example, unpaid carers in a local authority told us contingency planning was often “reactive, with a lack of responsiveness during moments of urgent need”, which meant they relied on support from family members. At another we heard from a carer who felt worried about how they will manage their caring role in the future and another having concerns about continuity of support and whether future arrangements would be sufficient to meet the needs of the person being cared for. Poor future planning with unpaid carers is an issue that has wider implications for the system as a whole, with unplanned hospital admissions placing high demand on stretched health services, as well as impacting wellbeing outcomes for the people admitted to hospital and unpaid carers.

Local authority staff described widespread reliance on unsafe or minimal guidance, such as advising unpaid carers to contact emergency duty teams in the absence of any commissioned emergency replacement care. Where caring arrangements broke down, risk was frequently placed onto families rather than managed through planned support. Although less common, some assessment reports contained positive examples of contingency planning and effective support in unplanned situations. For example, we heard from an unpaid carer who told us about the support they received from the local authority while they were managing their own health issues following time in hospital. In this case their social worker extended the stay in a residential care service for the person being cared for until a new day service opened.

We noted that unpaid carers’ positive accounts of contingency measures tended to be about the actual response of their local authority at a time of crisis, rather than positive accounts of proactive contingency planning prior to such occurrences. This may also speak to the low expectations of carers. We heard about commissioned emergency card schemes and automatic crisis response for carers admitted to hospital, which were cited as examples of how commissioning can actively mitigate risk and prevent sudden breakdown. This demonstrates the importance of having a person-centred approach to contingency planning where unpaid carers and the people they care for play an active and collaborative role in shaping those plans alongside the local authority.

Inspectors told us that where unpaid carers were supported through effectively commissioned voluntary and community services, outcomes were markedly stronger. Commissioned models in some local authorities were described as enabling more flexible, preventative and personalised support, including tailored direct payments and ongoing advice, rather than one‑off statutory intervention. Local authority staff noted that these arrangements reduced pressure on social work teams and enabled earlier engagement with carers, before crisis or breakdown. In one local authority, more flexible and personalised carers’ support moved beyond traditional short breaks to include peer support and tailored options. This contrasted with more rigid, process‑led models.