A Local Government Association report provides the answers to the question of what role its members should play in a reformed system of adult social care. Tony Rock reports

In the summer, the Local Government Association published a report called ‘Care Where We Live: Local government’s role in adult social care reform’.

It asks, simply, what should the role of local government be in a future, reformed system of adult social care?

More than 600 people contributed through an online platform, workshops, stakeholder discussions and committee sessions. Participants included people drawing on care and support, unpaid carers, councillors, social workers, providers, voluntary organisations, and academics.

The report states that while opinions differed on some issues, participants consistently described a future system that is more person-centred, preventative, relational and community-rooted. They want support organised around people’s lives rather than organisational boundaries, with a stronger emphasis on independence, wellbeing, housing, prevention, community connection and support for unpaid carers.

Participants also described adult social care as part of a wider ecosystem of housing, public health, communities, employment, voluntary action and neighbourhood support. “The future model people described was not simply a care model; it was a place-based model,” says the report.

Interestingly, the report insists another clear message was that local government should remain central to the future of adult social care. Participants were said to have identified councils’ democratic legitimacy, local place perspective, convening power and understanding of local communities as “essential strengths”. It goes on to say “there was little evidence of support for removing adult social care from local government’s responsibility”. Instead, respondents favoured a clearer settlement in which local government retains responsibility for local stewardship, safeguarding, commissioning and delivery, while national government, through the initial form of a National Care Service, takes greater responsibility for funding, workforce policy, standards, rights, accountability and infrastructure.

The report sets out 10 conclusions:

• Adult social care requires a far stronger public narrative that inspires hope and trust; far greater public understanding of the value of adult social care to us all; and national politicians willing to help achieve parity of esteem between health and social care.
• A prerequisite for successful reform must be a greater understanding among the public of the true value of adult social care to people, communities and the country. The public must then have the opportunity to share their thinking on the future of the service.
• Integration and delivery of care and support will only succeed if social care is treated as an equal partner to health, with clearer local leadership, stronger accountability and independent assurance of system performance.
• A future system of adult social care must strike the right balance between national government responsibility for appropriate system elements and retained local government responsibility for delivery, oversight and accountability. If/when established, a National Care Service should strengthen consistency and entitlement, not replace local democratic leadership.
• In addition to funding being inadequate… the model of funding for adult social care – particularly the continued reliance on council tax – needs considerable reform.
• A future adult social care system should be built far more around preventing, delaying and reducing the escalation of need. Achieving this will require prevention and housing to move from the periphery of reform discussions to the centre, supported by dedicated investment, stronger accountability and a much closer alignment between care, housing, communities, public health and wider public services.
• The workforce should be viewed as a key enabler of wider reform. Delivering a more preventative, person-centred and community-rooted model will require an approach to workforce strategy that supports continuity, relationships, professional development and long-term sustainability, alongside a Fair Pay Agreement (FPA) that is fully funded and deliverable. That approach must be grounded in operational reality and with local government embedded in the decision-making process surrounding the FPA.
• The transition from children’s to adult services remains a significant and persistent fault line within health and care. A future reform programme should place greater emphasis on planning, coordination and accountability across the transition period.
• A future adult social care system should better recognise unpaid carers as partners in care rather than an invisible resource. Reform will not succeed unless unpaid carers are systematically identified, supported and involved.
• A future adult social care market should be shaped around public value, sustainability and outcomes for people rather than short-term transactional purchasing. Reform should strengthen local government’s role as strategic market shaper, improve transparency and accountability across the market, and ensure regulatory oversight keeps pace with the increasing scale and complexity of provider organisations.

The LGA also made a whole series of recommendations for tackling the points listed above, including, but not limited to:

• The government urgently convening a national working group to deliver an awareness-raising campaign on both the role and value of adult social care to us all, and the way in which it functions.
• The government making the case to the public for a national funding solution for adult social care, especially if/when we move to a National Care Service.
• A fundamental review of council tax.
• The government establishing a longterm Prevention and Independence Transformation Fund to accelerate investment in early intervention, community support, housing and neighbourhood-based approaches.
• The government ensuring that local government is sufficiently resourced, involved and engaged in the Fair Pay Agreement process to ensure any ratified agreements are fully funded, deliverable and aligned with workforce reforms that are grounded in operational reality.
• The government reviewing whether existing market oversight arrangements remain sufficient, including 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.

CONCLUSION

The LGA states in the report that the participants of its survey don’t want a continuation of the status quo, and that “they recognise the need for significant reform, stronger national leadership, more sustainable funding, improved workforce arrangements, clearer rights and entitlements, and greater consistency of experience”.

“But neither do they see the future of adult social care as one in which local government’s role is diminished or replaced,” it adds.

The engagement, the report continues, points towards a rebalancing of the settlement between national government, local government and citizens. In this future model, national government would provide the funding, rights, standards, frameworks and – potentially, the report adds – some aspects of delivery that only it can provide. Local government would act as the place-based and accountable steward, bringing together services, communities and partners around the needs of local people. Citizens would not be seen as passive recipients of care, but as active participants whose strengths, relationships, experiences and aspirations would help shape both individual support and the wider system itself.

The report concludes: “Ultimately, if reform is to succeed, it cannot simply be something that is designed nationally and implemented locally. Reform must be shaped through partnership, rooted in place and built around people. That, more than anything else, is the message that emerges from Care Where We Live.”