four - ‘The end of local government as we know it’ – what next for adult social care?

Summary

Under the coalition government (2010–15), local authorities have suffered such massive funding cuts that one council leader has described the situation as “the end of local government as we know it”. While councils have tried hard to protect their social care spending as best they can, this has inevitably led to significant financial challenges, and to social care leaders struggling to make ends meet. All this comes on the back of new responsibilities under the Care Act 2014, changing demographics and policy pressures to develop more personalised services and to integrate care more fully with the NHS. While both personalisation and joint working with partners might be part of a longer-term solution, pursuing both goals at a time of austerity is incredibly difficult – and both agendas are arguably being implemented in less than optimal ways. Taking stock of these developments, this chapter looks at recent changes in adult social care, and argues that even more fundamental reform will be necessary in future.

In 2014, the House of Commons Committee of Public Accounts published its review of adult social care in England. In a boxed summary at the start of the report, the Committee concluded that (p 3):

The challenge posed to society by the changing and growing need for adult social care is considerable. The need for such care is increasing while public funding is falling. The Government's agenda to change and improve adult social care is rightly ambitious but achieving these ambitions will require unprecedented levels of coordinated working between government departments, between central and local government and across local authorities and health bodies. The Departments recognise the complexities and risks but we are not convinced that the responsible bodies will deliver on these ambitions and are concerned that they are raising expectations too high.

The summary goes on to make recommendations around three main areas: ‘collaboration across bodies involved in the care system’; ‘better understanding of the capacity of the system to cope and for whether money really reaches the frontline services on which people depend’; and ‘the Government's oversight arrangements to reflect the overriding importance of quality of care in a sector where up to 220,000 workers earn less than the minimum wage and around one third of the workforce are on zero-hour contracts’ (p 3).