The Future of Adult Social Care

The COVID-19 pandemic has increased the visibility of adult social care, but there remains a general lack of understanding of what adult social care is and how it is delivered.

As a result, there can be a negative societal perception of social care, where individuals seek to avoid engaging with the sector. The profile of adult social care therefore needs to be raised so that people feel there is no stigma attached to approaching these services, and for the whole workforce to feel proud to work in the sector, and see a clear route to career development and progression.

This profile should be underpinned by a shared vision for adult social care, deeply understood both locally and nationally, that supports and enables individuals to live as independently as possible.

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So much of social care is about prevention and enhancing long-term wellbeing. The majority is provided informally through families, informal carers and voluntary and community groups and assets. Local government is uniquely placed to effectively coordinate and manage this overall ecosystem, with deep roots in informal care networks that exist in a community. To centralise this responsibility, as has previously been suggested, would risk disrupting these crucial local links, which are the foundation of an optimised model, and would lead to a much greater need for state-funded care.

Alongside this, a shared understanding of both local and national performance could begin to create the conditions for parity and help each party to understand how they best play their role in improvement and innovation. An outcomes-based performance framework would serve to highlight local areas of innovation or best practice that could be shared, tailored, or adopted as appropriate.

There is no doubt that any reformed system should be based on stable finances and a funding model that promotes the right behaviours by those who commission care services.

Adult social care is delivered locally, and while most of the funding for care services is raised through local taxation, central government funding is, and will remain, critical. Decisions made centrally have a significant impact on both the quantum of funding local authorities have access to, as well as, to a certain extent, what they need and are able to spend it on. This creates a tension that makes adult social care both a local responsibility and a national responsibility.

A funding model which gives longer-term certainty would promote local accountability and support local leaders to make decisions in the best interests of the local population. This will enable local authorities to tailor services to their unique demographic, delivering good outcomes at a sustainable cost through the optimised delivery model described in this report.

The NHS long-term plan sets out the vision for Integrated Care Systems (ICSs), built off the foundational building blocks of Primary Care Networks (PCNs). The plan to implement ICSs relies on governance changes and improved wider system relationships. It is not (currently) strengthened with strict legislation, policy or more profound changes to organisational form or function.

Social care leadership in PCNs and as an ICS requires building strong local relationships with health partners; investing the time and effort into ensuring there is a common purpose, mandate and accountability for joint teams; and building, coordinating and navigating community assets to fundamentally reduce the presenting need of the future population.

Alongside this, delivering adult social care is not only the responsibility of the adult social care directorate within a local authority. The far-reaching nature of the system and its intersection with other services makes partnership working across different agencies not just desirable, but completely essential.