Local ambition should fill the gap left by national adult social care policy

Earlier this month I was invited to join a panel at the Association of Directors of Adult Social Services (ADASS) Spring Seminar to share insights on ‘How to influence central government’. Almost exactly one year after leaving HM Treasury to join IMPOWER, this was a good opportunity to reflect on the things that I had found most useful during my time as head of adult social care spending and why the reforms I worked on have stalled.

There are a few staples that are needed for effective influencing of government, not least high-quality data. In my experience, ministers (and the media) respond well when there are metrics to paint a clear picture of both what is happening to public experience of services but also when it is possible to take action to improve those metrics. The focus on NHS waiting lists is a good example of this.

But getting this information in adult social care is hard. For some of the biggest problems there is simply no formal data collection – for example unmet need or 15-minute visits. And even when datasets exist, it quickly becomes apparent that different collection methodologies mean that the data can’t really be compared across areas – just look at the constantly changing requirements for data on discharge delays, a national priority across health and social care for the last 10 years. It is very difficult to make a case for more funding within HM Treasury if it’s possible to pick holes in the data that is being presented.

The other staple is public sentiment. Others are much better placed to discuss effective comms than me, but my experience suggests that ministers focus on polling and traditional media when making politically difficult decisions. This means continuing to make the case for change in adult social care, but also building support for how it is funded.

The costs of comprehensive reform are high, require an extension of the state offer (in the case of means test reform) and will only increase as the population ages. Taken together, and in a low-growth environment, this means that for significant reform to be credible, it needs an accompanying revenue raiser (a tax). Health and Social Care Secretaries can’t do this, and Chancellors don’t want to the push needs to come from the Prime Minister.

This is a high bar and following the rolling back of recent reforms, the political equation of the benefits of reform against the costs of a tax increase simply doesn’t add up in public sentiment. As a result, it feels as though comprehensive adult social care reform at the national level is off the agenda for the foreseeable future under both the Conservatives and Labour.

But that doesn’t mean that change isn’t possible.

Nationally, grants for social care are increasing from £5bn in 22-23 to £8bn in 24-25 as funding earmarked for reform is now being disbursed to local authorities, while the Department for Health and Social Care (in theory) still has c.£1bn to allocate to reform.

This needs to be set against the pressures councils are already facing from inflation, demand for services across the board, and NHS priorities such as discharge.

But in aggregate, the existing funding settlement should provide some breathing room for councils to focus on improvement. The agenda for adult social care from the centre is unclear and in its absence it is down to local leaders to fill the vacuum in driving change, using the building blocks of hope, innovation and ambition. And that’s exactly what Becky Wilson, Director of Adult Services at City of Wolverhampton, spoke about in our workshop at the event.

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