Adult social care services help people with care and support needs to live better lives. Local authorities receive more than 5,000 requests for care and support each day.

This report considers how NICE’s evidence-based guidance contributes to improvements in adult social care.

Published July 2019

Most people who have help from adult social care services are satisfied overall but surveys suggest that more could be done to help people feel in control of their lives.


Examples from our shared learning collection show how our guidance on managing medicines for adults receiving social care has been used to improve care.


Most people who use intermediate care services have a good outcome. Many more services are being commissioned in an integrated way as recommended by NICE, helping people to move between them depending on their needs.


Providers and commissioners have used our quality standards to assess performance and make improvements, as shown in these examples.


Andy Tilden, interim CEO of Skills for Care, considers how our guidance can be used by people working in adult social care services.

This report highlights progress made by the health and care system in implementing NICE guidance. We recognise that change can sometimes be challenging and may require service reconfiguration. It may also require additional resources such as training and new equipment.

We work with partners including Skills for Care, the Local Government Association, the Association of Directors of Adult Social Services, the Care Providers Alliance, the Think Local Act Personal partnership, the Social Care Institute for Excellence and NHS England to support changes. We also look for opportunities to make savings by reducing ineffective practice.

We'd like to thank Andy Tilden and Jim Thomas at Skills for Care for their input, and we're grateful to the CQC and NHS Benchmarking for their contributions to this report. We would also like to thank all the people who spoke to us about their experience of care and support, or about using NICE guidance in practice, and allowed us to quote them in this report.

Why focus on adult social care?

NICE impact reports review how our recommendations for evidence-based and cost-effective care are being used in priority areas of the health and care system, helping to improve outcomes where this is needed most.

Demand for adult social care is growing. People are living longer, and more people are living with complex care and support needs, including younger adults with a physical or learning disability. Local authorities in England spent nearly £18 billion on adult social care in 2017/18 and many people fund their own care and support, adding to the total spend. Nearly 1.5 million people are estimated to work in adult social care, across more than 21,000 organisations.

In 2013 we gained new responsibilities to develop guidance for people working in and using social care. Our social care guidelines make evidence-based recommendations on the effectiveness and cost-effectiveness of approaches and services. The social care guidelines included in this report were produced in collaboration with the Social Care Institute for Excellence (SCIE). All our social care guidance is co-produced with people who have lived experience of using social care.

In 2018 NICE published its first quick guide, providing key information for social care topics in a simple format. These are produced in collaboration with SCIE. We also develop health and public health advice and guidance, and many of these recommendations are also relevant to people who work in or use social care. All of our guidelines, quality standards and tools to help improve social care services are brought together on our social care community page.

We routinely collect data which give us information about the use of our guidance. This report uses these data alongside real-life examples to look at how our recommendations might be making a difference in priority areas of adult social care. We've also looked at areas where there's room for improvement.


Adults with social care needs are supported in 2 main ways: either formally through services they, their local authority or the NHS pay for, or informally by family, friends or neighbours. This report looks at the experience of people receiving formal care and support through adult social care services.