Local government’s role in adult social care reform
For too many years, adult social care has been discussed primarily through the language of crisis, pressure and failure.
The pressures facing councils, providers, unpaid carers and the workforce are very real, and should not be understated, as are the consequences of those pressures on people drawing on care and support.
But framing the issues in only those terms is a disservice to the millions of people who draw on care and support, their unpaid carers and the dedicated workforce.
Countless commissions, reviews and inquiries into the future of adult social care in England have stalled, and their associated policy papers litter the long grass. For everyone connected to adult social care, the frustration is deep.
At its best, adult social care is one of the foundations of a good society. As our population changes and expectations evolve, its necessity for all of us will only continue to grow.
This time, though, it feels different. The work being led by Baroness Louise Casey, through the Independent Commission on Adult Social Care, has grasped a cross-party consensus that could just mean the conditions finally exist to build a broader and more lasting change.
The work of the commission carries weight and credibility across local and national government, and the adult social care sector. Baroness Casey’s reputation for confronting difficult issues honestly, building alliances across institutional boundaries and driving reform through complex environments matters enormously.
She has placed important emphasis on the first-hand expertise of people drawing on care and support, and is bringing in public thought through the launch of a national consultation – the ‘big conversation’.
This moment is bigger than any one review or commission on adult social care, however.
The shifts set out in the 10 Year Health Plan for England – from hospital to community, from sickness to prevention, from fragmentation to place-based partnership, and from dependency to independence and wellbeing – are now shaping a debate beyond adult social care.
It is a debate in which local government is well versed. Councils understand the interconnections across multiple other services and systems – about benefits, homes, the built environment, employment and skills – and local government’s convening powers are essential to making adult social care reform work and stick.
Through the LGA’s Care Where We Live engagement, we set out to explore a question that sits at the heart of the debate: what should the role of local government be in a future, reformed system of adult social care?
Bringing together professionals, people who draw on care, unpaid carers, partners and wider stakeholders, the programme was designed not simply to gather views, but to help inform and enrich the national picture.
“We call on the Government to lead a campaign to change how the public thinks about social care”
Our engagement process provided an opportunity to test ideas, surface difficult questions and ensure the perspectives of local government, communities and people with lived experience are reflected in the debate about what comes next.
Just as importantly, it helped identify strong cross-party and sector consensus for a future system of adult social care that is place-based, preventative, grounded in lived experience, and has a sustainable national funding settlement; one where national and local government work together but have clear and distinct responsibilities, helping to speed up the system and reduce inefficiency and inconsistency.
Our new report, ‘Care where we live: local government’s role in adult social care reform’, presents the key findings from our engagement process, and a series of recommendations for government and the Casey commission.
We call on the Government to make the case for a national funding solution for adult social care, and to lead a national public campaign to change how the public thinks about social care. Reform will fail unless the public narrative changes.
We recommend making prevention a core national infrastructure, funded like the NHS, with a dedicated national prevention and transformation fund focused on early intervention, housing, community support and independence.
Other recommendations include ensuring a National Care Service strengthens consistency and entitlement, exploring how greater consistency can be delivered within assessment processes and frameworks, returning oversight of integration and place-based delivery to local government, and establishing a national programme to improve transition from children’s to adult services.
We want to explore the role of council tax in funding adult social care, with all options on the table, including how reforms might lessen the reliance on it and whether it remains a suitable mechanism for funding adult social care in the future.
We need to: recognise housing as a core component of care, prevention and independence, and develop a National Care, Wellbeing and Housing Plan for England; develop a new national approach to recognise, identify and support unpaid carers, and develop a package of practical support measures; and review whether the Care Quality Commission’s market oversight powers should extend to a wider range of medium and large providers to improve transparency around provider ownership, financing and the role of private equity within adult social care.
This is a starting point for further exploration of the key issues by the LGA and we will be diving deeper into the key emerging themes in the coming months.
We are ready to work with government and the Casey commission to explore all options for reform and help co-design and lead this change for a system that is built around people, not services.
Successful reform will require a new partnership between national government, local government and citizens. It will be measured by whether people who draw on care and support can live the independent and dignified lives they want to lead, with the people and in the places they know.
- ‘Care where we live: local government’s role in adult social care reform’ can be read in full on the LGA website.