Adult social care – a national or a local service?

This is the second think piece in the LGA's series 'Towards a sustainable adult social care and support system'.

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Foreword by Cllr Izzi Seccombe OBE

 

Cllr Izzi Seccombe

Open any newspaper or tune in to any broadcast media and chances are, if the focus is on public services, you will come across reference to ‘postcode lottery’. It is an emotive term and one that tends to be used negatively to underline a perceived sense of unacceptable variation. 

But is variation in and of itself necessarily a bad thing? Clearly radically different experiences of, or access to, services based solely on where you live rather than on what you need and want is something we should root out. But as someone who has been in local government since 2001 I would argue that the ease with which we can sometimes bemoan a sense of postcode lottery prevents a full appreciation of the real virtues of postcode choice. Viewed this way, variation is a positive, reflecting the vast differences between different places, and each council’s interpretation of their ‘place shaping’ role and the way in which they use more than 800 local services to build communities that are inclusive, cohesive and promote the life chances of everyone within them. Councils’ bespoke solutions to local challenges also allow greater space for innovation and improvement to flourish, which is harder to achieve with national-level services. Local investment decisions help change the way things are done on the ground, creating services and partnerships – particularly with the voluntary sector – that benefit our communities. It is no coincidence that many national programmes start from best practice from within local government.

The different between postcode lottery and postcode choice is not always an easy distinction to sell. For instance, Sir Michael Lyons’ seminal 2007 inquiry into local government found that “57 per cent of people objected to the idea of local levels of service not being the same in different areas of the country.” Those of us in local government know from experience that such objections can quickly fuel concerns about ‘unfairness’ which, particularly when amplified by the media, set national government cogs in motion towards national or minimum standards. One needs only to look at what has happened on delayed transfers of care over the last year as evidence of that. But at the other end of the machine are the cogs that turn towards local choice. For instance, research for the Lyons’ inquiry also showed that people “want the ability to influence the shape and delivery of services and take decisions locally”. And we know that people trust local government and local politicians to help make those decisions.

In short, there is – as there has always been and no doubt always will be – a balance to be struck between national and local. For adult social care, this balance is felt particularly keenly for a number of reasons. First, and as our previous think piece showed, adult social care matters. It is not a ‘nice to have’ but a vital service that supports people to live the life they want. Second, its fortunes and those of the NHS are inextricably linked and brought into sharper relief through the debate about the future of integration between care and health. And third, thanks to the combined efforts of the care and support sector, those using services and the national media, adult social care is growing in profile.

The stakes could therefore not be higher. But with that being the case, might the Government be more inclined, or at least tempted, to use its forthcoming care and support green paper to reframe social care as more of a national service like the NHS? Only time will tell. In this period ahead of the green paper it is essential that the sector tells its story about the importance of ‘local’ – both in terms of where we are now, and where we need to be in the future.

This second publication in our ‘think piece’ series ahead of the green paper is part of that story and I am very grateful to the high profile colleagues who have given their time to provide their expert views. They each have a distinct and different vantage point from which to observe adult social care but they are united around the core idea that responding to the needs of local people requires a response that is local, too.

Local government’s adult social care sector is a pragmatic one which has a long history of working effectively with national government and other national partners to improve services for the people we all serve. In this way, councils carry out their functions within numerous national parameters. The best of these – the Care Act being a fine example – are genuinely coproduced with councils as an equal partner, not an afterthought in an engagement process. It is essential that Government approaches its forthcoming green paper in line with this tradition, acknowledging – and making ample space for – the unique contribution that only local councils can make.

Cllr Izzi Seccombe OBE
Chair, LGA Community Wellbeing Board