Social care worker talking with a family

Government health and care reforms still have room to improve

The publication of the government’s Health and Care White Paper this month was both encouraging and disappointing for local authorities. 

It was encouraging because many of the elements outlined in the white paper – chiefly efforts to closer integrate health and care – will be supported by councils like our members at the County Councils Network (CCN).

However, it was disappointing as its release only served to highlight that the government has once again prioritised reforming the health system first, despite the urgency with which the social care system has been waiting for its own equivalent promised white paper for close to four years.

There is however a commitment for the government to set out its plans for social care before the end of the year.  In anticipation of this, CCN begun to think about the type of social care system that is fit for purpose for the 2020s – and councils’ role within this.

Instead of examining well-trodden arguments on the need for a sustainable funding model for social care – with everyone in unanimous acceptance this is needed – our councils were clear that in contrast to the usual calls for more money which a system can then be built around, they wanted us to develop a blueprint of delivering care locally that started with the premise of how excellent, people-focused services should look.

Crucially it also required local authorities themselves to reflect on what works well, but also where there was room for improvement in the present system.

The eventual report was the culmination of months of research, with engagements from over 150 people within the adult social care sector (including those in care) carried out by care specialists Newton.

The report lays down a clear marker for local government to continue the delivery of social care in a reformed local system and it concludes that it is only by putting councils in the driving seat of this local reshaping of services that we will get a social care system as close to as what we should be aspiring towards as a nation.

In order to develop these local reforms in what Newton terms an ‘optimised delivery model’, there needs to be several foundations in place, not least a resolution to the long-term funding of social care. What was striking in the engagement carried out was the hand-to-mouth fashion in which councils are currently having to operate, with a significant chunk of social care funding only renewed each year. Our member councils were clear: this leaves little scope for long-term planning or strategic management of social care.

Perhaps most crucially, the local delivery of care by councils is one of the most important themes. Local authorities are best placed to bring care closer to communities because they are the community: they know their people and they know their providers. Their role should be enhanced, not diminished.

Going back to the NHS white paper, CCN will be making the case for councils to be an equal partner in Integrated Care Systems and for them to be aligned with social care authority boundaries to maximise collaboration in the drive for more joined-up care. At the same time, parity of esteem between the health service and social care – and a more positive profile for care – are also key ingredients for reform.

With these foundations in place, Newton have set out an ambitious blueprint for delivering adult social care locally, centred around a crucial premise: the individual with care needs comes first: services and funding should follow them rather than the other way around.

This recognises the importance of personalisation and choice, resulting in a service where individuals are supported to set their own goals and build on their own strengths – ultimately living as independently as possible.

In layman’s terms this means giving more young people with severe learning disabilities greater options to live outside of residential care, such as with Shared Lives carers or in supported living arrangements; or providing more people with access to short-term and reablement services after they have had a fall or a stint in hospital, to prevent their situation from deteriorating and them needing long-term support.

An optimised delivery model could have significant benefits, not only in keeping tens of thousands of people out of long-term care each year, but it could mean that the 1.4m people who approach local authorities for council-arranged care each year have access to better and more effective services.

The report sets out an ambitious vision of how care can be lived with councils are the forefront of reform and sets out how to achieve it. It throws down a challenge not only to local authorities, but to care providers and the NHS.

Only if all three work more effectively together can the full benefits of this system be realised. So, with all the current talk of reform aimed at better integrating care and health, let’s hope this is really is the beginning of closer collaboration.

Download the full report by visiting

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