Who pays? Understanding cost misalignment between the NHS and Local Government

The Local Government Association (LGA) is seeking a supplier to undertake a focused policy research project exploring the interaction between NHS Continuing Healthcare (CHC) and local authority adult social care. Recent evidence has highlighted growing concerns about the relationship between CHC decision-making, adult social care expenditure and the incentives created by current funding arrangements. ADASS's Spring Survey 2026 found that 75% of Directors of Adult Social Services reported an increase in the number of people presenting to adult social care who were, or previously would have been, eligible for CHC, while 84% reported that Integrated Care Board (ICB) disinvestment in CHC was contributing to adult social care overspending pressures. Research published by The King's Fund found that CHC eligibility rates have fallen significantly despite no change to the national eligibility framework, alongside substantial variation between different ICB areas. While CHC provides the primary lens for this project, the LGA is also interested in the wider question of whether current funding and accountability arrangements across health and social care create incentives that transfer costs and risks between organisations rather than supporting whole-system decision making.

The LGA wishes to better understand:

• How these issues are playing out locally
• Whether current arrangements create misaligned incentives between organisations
• The impact on local government, the NHS, people drawing on care and support, and unpaid carers
• What reforms could improve alignment between health and social care funding and accountability.

This work will inform future LGA policy development and engagement with government, national partners and stakeholders.