Community-based health and social care demand associated with frailty in people aged 50 and over in England 2025-40: routine data analyses and simulation modelling.
Demand for community-based health and social care services will increase substantially as the population ages and becomes more frail, with mental health, community health and publicly funded social care use projected to increase by 16%, 30% and 30% respectively between 2025 and 2040.
Key Findings
Results
Mental health, community health, and publicly funded social care use in England are projected to increase by 16%, 30%, and 30% respectively over the 2025–2040 simulation period.
Projections were made using System Dynamics (SD) simulation modelling over a 16-year period (2025–2040).
Projections applied to the population aged 50 and over in England.
Service use rates were derived from cohort data from North-West London, stratified by age and electronic frailty index (eFI) categories.
Population estimates and mean service use data were combined to generate national demand projections.
Results
Lowering frailty incidence could reduce mental health, community health, and local authority social care contacts by 1.4 million, 10 million, and 400,000 million contacts respectively between 2025 and 2040, compared to baseline.
Reductions are expressed as cumulative contacts avoided over the full 2025–2040 period against a baseline scenario.
Mental health contact reduction: 1.4 million contacts.
Community health contact reduction: 10 million contacts.
Local authority social care contact reduction: 400,000 million contacts.
Results
Slowing frailty progression could reduce mental health, community health, and social care contacts compared with baseline by 2.8 million, 45.3 million, and 2 million respectively over 2025–2040.
Slowing progression produced larger reductions in community health contacts (45.3 million) compared to the frailty incidence reduction scenario (10 million).
Mental health contact reduction from slowing progression: 2.8 million contacts.
Social care contact reduction from slowing progression: 2 million contacts.
Both intervention scenarios were modelled against the same baseline projection using System Dynamics simulation.
Results
Demand will continue to grow even with interventions to reduce frailty incidence or slow progression, due to the large numbers already living with mild to moderate frailty.
The authors note that large numbers of people are already living with mild to moderate frailty at the start of the projection period.
Both intervention scenarios reduce but do not reverse projected demand growth.
This finding highlights the importance of early intervention alongside managing existing frailty in the population.
Methods
Rates of mental health, community health, and publicly funded social care contacts were estimated from cohort data in North-West London, stratified by age and electronic frailty index (eFI) categories for people aged 50 and over.
Data source was a cohort from North-West London.
Stratification was by both age and eFI category.
These local rates were used to inform national projections via System Dynamics modelling.
The study focused on community-based services, distinguishing these from primary and secondary care.
Background
There is currently no known estimate of demand for community-based health and social care associated with frailty, despite good evidence existing for primary and secondary care demand.
The authors identify this as a gap in the existing literature.
Prior evidence on frailty-related demand has focused on primary and secondary care settings.
This study is positioned as addressing the gap specifically for community health services and publicly funded social care.
The study covers mental health services, community health services, and local authority social care.
What This Means
This research used data from North-West London and computer simulation modelling to estimate how much demand for community health and social care services in England will grow between 2025 and 2040, driven by the ageing population and increasing frailty. Frailty refers to a state of reduced resilience in older people that makes them more vulnerable to illness and in need of more health and care support. The study found that demand for mental health services, community health services (such as district nursing and physiotherapy), and publicly funded social care is expected to rise substantially — by 16%, 30%, and 30% respectively — over the next 15 years if current trends continue.
The research also modelled what could happen if interventions were introduced to either prevent frailty from developing in the first place or slow its progression once it begins. Both approaches could meaningfully reduce the total number of service contacts over the period, with slowing progression appearing to have a particularly large effect on community health contacts (a reduction of 45.3 million contacts compared to 10 million from reducing incidence). However, even with these interventions, demand would still grow because large numbers of people are already living with mild to moderate frailty today.
This research suggests that community health and social care systems face a significant and growing pressure from population ageing and frailty that is not yet fully captured in planning estimates. Addressing frailty — both by preventing it and by slowing its worsening — could help manage this demand growth, but services will still need to expand capacity to meet rising need. The findings highlight the importance of investing in frailty prevention and early intervention strategies as part of long-term health and social care planning.
Walsh B, Fogg C, England T, Brailsford S, Vernon M, Griffiths P, et al.. (2026). Community-based health and social care demand associated with frailty in people aged 50 and over in England 2025-40: routine data analyses and simulation modelling.. Age and ageing. https://doi.org/10.1093/ageing/afag256