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The Care Act 2014: Ten years on from Royal Assent

The Care Act 2014: Ten years on from Royal Assent
A decade on since the Care Act received Royal Assent, our publication reflects on the extent to which the aims of the legislation have been achieved and, where they have not, what changes are needed to deliver fully on the Act’s ambitions.


In its 2010 submission to the Law Commission’s consultation on proposals for reforming adult social care law, the Local Government Association (LGA) set out the need for ‘a better alignment between modern adult social care policy direction, its resource base, and the legal framework that underpins it.’ The Commission’s valuable work went on to form the basis of the Care Act, landmark legislation which received Royal Assent in May 2014 and went live in April 2015.

Of course, no Parliament is ever able to truly future-proof legislation. And nobody could have predicted the particular political, economic and societal events of the last ten years, many of which have impacted significantly on adult social care either directly or indirectly. But the government at the time, and the many people involved in bringing the Act to fruition, hoped the legislation would offer a sense of perpetuity. Or, as the then government put it: ‘modern law for 21st century care and support’.

Ten years on from Royal Assent, nearly a quarter of a way through the century, and with a general election on the horizon, now is a good time to take stock. Alignment between the three pillars of policy, resource and law certainly feels as important as ever. But it also feels out of reach, at times even out of view. So, in that context, how do we judge the extent to which the intent and ambition of the legislation has been achieved over the last decade? And how do we address any shortcomings?

Those are the two central questions the LGA has posed to experts from right across the social care landscape. Colleagues from councils, providers, health, the voluntary and community sector, the workforce, academic institutions and think tanks, and senior politicians and officials of the time have all kindly shared their thoughts. Crucially, so too have people who draw on care and support and have lived experience of the last ten years. This voice in particular needs to be heard and the LGA is especially grateful to these colleagues for their time and insights.

The articles make for fascinating reading; a snapshot of opinion on what is going well, what is not, and what areas we need to address in order to truly deliver on the full aspiration of the legislation. Whilst each contributor comes at the questions from their or their organisation’s own unique perspective, there are some strong and common threads.

First, the positives. Colleagues across the board feel the legislation remains broadly in the right space, codifying a set of principles and aims that collectively form the right legislative vision for care and support. Contributors are also quick to acknowledge the progress that has been made on aspects of the legislation and the change in practice that has followed. Whether that is tangible, such as the governance structures that have developed to embed safeguarding processes, or more foundational theoretically, such as organisational commitment to guiding forces of choice and control, the Act has brought about helpful and meaningful change.

On the other hand, colleagues are equally clear that the full ambition of the legislation has not been achieved. They may differ in their assessment of the extent to which the promise of the Act is unfulfilled, but there is a very strong sense that we are not where we need to be. This strength of feeling extends to some of the reasons why we are collectively falling short. Funding, underinvestment, a lack of resources – however it is described, ‘money’ is front and centre in people’s minds and the root cause of much inadequate progress. This may seem an obvious barrier, and the need for adequate and sustainable funding has certainly been a repeated refrain from across the sector for the last ten years. It is therefore essential that we do not allow an obvious and repeated message to lose its credence, nor shy away from being honest about the levels of investment needed.

Contributors align on a number of other reasons why progress has been slow (or absent) on aspects of the legislation. They may again seem obvious, but that makes them no less of a significant blockage. The challenges facing the care workforce, the growing strain on unpaid carers, provider instability, inadequate investment in prevention and wellbeing, rising unmet, under-met and wrongly-met need, and the politicisation of adult social care by national parties; all of these issues – and more – are identified time and again as barriers to advancing the intent of the Care Act.

But there are reasons for optimism. Colleagues are helpfully quick with ideas on how to tackle these issues. Looking at them in their entirety, perhaps the biggest lesson to draw (and the way we might avoid falling into the trap of ‘more funding’ losing its currency as a message) is that we need to think and talk differently about adult social care. Because for all the understandable frustration and disappointment that comes out strongly in the articles, there is also a strong sense of hope for change and a commitment to bringing it about. Much of that stems from a growing recognition of the need to reframe adult social care and that doing so could be the key to unlocking greater public understanding of, and support for, the real value of care and support to people and communities.

For an incoming government, we suggest this publication should be required reading. It helps to identify good existing work and it highlights some of the biggest challenges facing the sector. With a General Election forthcoming, we look forward to continuing our work to influence, inform and better understand the priorities of all the political parties and the funding envelope they will set themselves if in government. We remain adamant that the future of adult social care and support must be at the top of a new government’s in-tray and therefore highlight the main areas where action is needed to help fulfil the full ambition of the Care Act. We are clear that nothing should be off the table in terms of that pursuit.

Local government has shown strong leadership on adult social care since the Care Act received Royal Assent, carefully managing a prolonged and precarious financial environment and steering the service through the immense challenge of the COVID-19 pandemic to name but two examples. The LGA remains committed to working with people who draw on social care, councils, current and future governments, and our many national and local partners to ensure that policy, resource and law find a more harmonious balance within adult social care, underpinned by a more positive framing and imagining of the service and its fundamental value to us all.

Cllr David Fothergill, Chair, LGA Community Wellbeing Board

Cllr David Fothergill picture


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Executive summary

It is a decade since the Care Act received Royal Assent. With a general election approaching, now is a good time to reflect on the extent to which the aims of the legislation have been achieved and, where they have not, what changes are needed to deliver fully on the Act’s ambitions. The LGA has approached a number of senior experts from across the broad care and support sector for their views. Crucially, this includes people who draw on social care. Drawing on their views, we are setting out recommendations for change.

Addressing immediate- and longer-term funding pressures remains essential. Alongside this we want to see bold and ambitious action on prevention across health and social care. If done effectively and jointly with councils and the NHS as equal partners, backed up by better use of shared data, this has the potential to improve people’s outcomes and reduce demand and costs. It is essential that the NHS also focuses more on prevention, and that other priorities are not allowed to crowd this out. Too often the focus is exclusively on immediate challenges for the NHS and how social care can support discharge. This can frame social care as an adjunct of the NHS when it has crucial value in its own right. The need for support for voluntary and community sector services to bolster local community capacity, is a consistent message from experts and one we endorse. We are also seeking early action on workforce planning, recognising that there is no such thing as a ‘standard care worker’, and to maintain momentum on gathering better data about outcomes and value for money through continued engagement on the Care Data Matters strategy.

Adult social care is fundamentally about people’s rights and relationships. At its best, it helps ensure that everyone is able to pursue the things that matter most to them, irrespective of their age or conditions. The core purpose of adult social care, and its intrinsic value to us all, is not well enough understood. Changing this could help unlock public support for care and support, in turn unlocking the investment needed to mainstream the very best practice that exists across the country. That is why we seek to put people front and centre. We must commit to sustained and authentic coproduction with people who draw on care and support. The redesign of services should be done with people who draw on them. 

The origins of the Care Act were in the Law Commission’s review of adult social care law and the Dilnot Commission’s inquiry into how care should be paid for and funded. The subsequent decade has seen the publication of a number of important inquiries and reports that have sought to positively move the debate about the future of care and support further forward.

Common to many of these publications is contextual framing; the key developments – planned or otherwise – that have shaped adult social care and continue to do so. To set the scene, this publication focuses on three: funding, integration and the COVID-19 pandemic. We suggest that periods of austerity, early recovery reliant on local taxation, and continued recovery driven by one-off injections of resources, have characterised the adult social care funding picture, hampering full delivery of the legislation. National policy direction on integration has also influenced adult social care, with the scale and speed of integration between care and health having ramped up considerably in recent years. And, of course, the pandemic threw adult social care into the spotlight, highlighting its value and its extraordinary workforce, but also exposing the consequences of the pressures it has faced over many years.

Funding is cited time and again by contributors as one of the central reasons why the Care Act’s aims have not been delivered in full. This is allied to a lack of public understanding about, or prioritisation of, care and support, a greater governmental focus on the NHS (and hospitals in particular) in the ‘health and social care’ equation, and a quick descent into trading blows when adult social care debates enter the national political realm. These factors have created conditions in which adult social care is at best kept afloat and at worst sometimes ignored. They are the exact opposite of the conditions needed to help nurture, inspire, innovate, connect and deliver. So how do we bring about those conditions and harness the passion and optimism of those working in adult social care to ensure that people who have cause to draw on care and support to live their best life are able to do so?

There is no need to dispense with the legislation. Build on, it certainly; but do not reinvent the wheel. To really deliver the full spirit of the Act, significant additional and sustainable funding is an inevitable requirement. The Health Foundation’s work on the costs involved in a set of increasingly generous scenarios provides a valuable starting point. Future work also needs to be coproduced with people who draw on care and support as they know best what works for them and what the barriers are to more person-centred care. Their knowledge and expertise should play a central role in a more concerted national effort to raise the profile and value of great social care to us all. This could help end the politicisation of adult social care and forge a degree of cross-party consensus on a long-term plan for the future of care and support.

An immediate injection of funding to tackle some or all of the above issues could be a downpayment on a future multi-year settlement for adult social care, and a real signal of intent by an incoming government that care and support is central to our national infrastructure. It would begin to tackle issues, including: waiting times for assessments, commencement of care packages, and care plan reviews; unmet and under-met need; provider instability; workforce recruitment and retention pressures; and growing and unsustainable strain on unpaid carers. Such funding would also be a much-needed boost to the voluntary and community sector from which councils commission vital pre-eligibility services and which plays a key role in prevention and easing pressures at both the front and back doors of hospitals. Stabilising the system in this way would provide a platform from which to properly tackle the issue of care worker pay, begin a meaningful shift towards a far more preventative model of social care, and build the wider network of support structures across the public, private and third sectors that can together help keep people independent in the homes and communities they know and love.

Many of these conclusions and recommendations echo what Lead Members have reported in a new survey to accompany this publication. They highlight the consequences of funding pressures – including on other council services – the need to take a more preventative approach, the importance of tackling workforce challenges and the need to change the way we talk about adult social care.

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The real value of this publication lies in the expertise of those colleagues who have kindly contributed an article setting out their reflections on the last decade and what those mean for the future. Before reaching that main body, we set out what we believe are important principles and context.

First, we start with a statement about the importance of ‘people’ in the debate about care and support from the LGA’s perspective, followed by a helpful longer exposition from Social Care Future on why a reimagining of social care based on people – all of us – is needed.

  • The LGA is committed to putting the voice of lived experience at the heart of its work on the future of care and support.
  • We believe this voice, allied with a far more positive narrative about the importance and value of adult social care to us all, is essential in building public support for investment and change.
  • Over the last four years, Social Care Future has done invaluable and comprehensive work to understand what language resonates most with different audiences (and does not) when we talk about adult social care.
  • Social Care Future challenge us all to ditch the ‘doom loop’ narrative, which self-evidently has not yielded the level of investment required. Their vision has been adopted locally and nationally by a range of organisations and inquiries. 

Second, we provide a timeline of key moments from 2014 to the present day.

  • This is not an exhaustive list of all relevant developments but captures some of the main moments that have impacted on adult social care funding, priorities and policy direction.

Third, we expand on the timeline by providing the background to the legislation for those less familiar with its origins. We set out some of the main features of the Act and then highlight important recent work that has sought to move the debate about the future of care and support further along.

  • The legislation has its origins in the Law Commission’s review of adult social care law and the Dilnot Commission’s inquiry on how funding care and support. Taking many of both commissions’ recommendations, a draft Bill was subject to pre-legislative scrutiny before formally entering the parliamentary legislative process.
  • The Act replaced a patchwork of previous legislation and placed at its heart a duty on councils to promote people’s wellbeing. The Act introduced a range of other duties on issues such as prevention, integration, market shaping, assessment, care planning and safeguarding. The Act also contained provisions for charging reform (a cap on care costs, an extension to the financial means test thresholds, and the option for self-funders to ask councils to arrange services on their behalf, accessing lower council fee rates in the process).
  • In recent years, a number of important inquiries and reports have been published which seek to advance the debate about the future of care and support.

Fourth, we offer our own reflections on three key backdrops to the last decade: funding, integration and COVID-19.

  • Local government funding has been under considerable pressure over the last decade and a half. Significant reductions in core spending power have happened at a time of greater demand for council services. The wider local government funding picture has inevitably impacted on adult social care and we identify three distinct phases to care and support funding.
    • Austerity: when the Care Act received Royal Assent, adult social care was already under major pressure. Budgeted spend had fallen by 12.3 per cent between 2010/11 and 2014/15. This constituted relative protection given spending reductions in other services.
    • Early recovery: budgeted spend on adult social care grew by 11.4 per cent in real terms between 2014/15 and 2018/19, but a crucial driver of this increase was the social care precept. With acute pressures right across England’s adult services councils, the government’s response was local taxation.
    • Continued recovery: budgeted spend increased by 11.5 per cent from 2018/19 to 2023/24. The service slowly begins to recover but the position remains precarious and reliant on an approach of short-term, one-off funding injections.
  • Under the Care Act, councils are required to promote integration, cooperation and partnership with the NHS and other key partners to enable a care and support system which is person-centred. Since then, it has been national and local policy to further escalate the scale and pace of integration with the formalisation of Integrated Care Systems through the Health and Care Act 2022.
  • The COVID-19 pandemic highlighted the many considerable challenges facing adult social care and the value of the service to people and local communities. Key lessons learned from the pandemic must continue to shape thinking about the future of adult social care. These include the importance of putting people first and linking care and support to the way in which we improve social justice, and better enabling freedom and flexibility for local areas to determine local priorities.
  • There are, of course, many other important contexts, drivers and developments that have shaped adult social care over the last decade. The helpful emphasis on person-centred planning and wellbeing – two hallmarks of the legislation – have guided policy and practice since the legislation went live in 2015, for instance. More recently, and as another lesson from the pandemic, the importance and best use of data has come to the fore as a means for advancing the integration agenda and more outcome-focussed care, the government’s Care Data Matters strategy being a helpful example of national and local government working together on shared interests. Data is also a key component of the new system of ‘local authority assessment’ of adult social care, overseen by the Care Quality Commission. With the right approach, drivers such as these could help play a part in making the case for additional and sustainable investment. 

Fifth, we share the results of a new LGA survey of adult social care Lead Members, capturing their views on the current position facing the sector and what needs to be prioritised for the future.

Key findings include:

  • Only 8 per cent of lead members are ‘very confident’ of meeting all their statutory duties under the Care Act next year (2025/26)
  • Aside from funding, lead members indicated that the top three issues facing the sector are: workforce recruitment and retention challenges; increased demand and complexity of demand; and an inability to invest in prevention because of budget pressures
  • 100 per cent of lead members agreed that our current system of health and social care places too much emphasis on treating sickness and not enough on preventing or reducing people’s needs.

Sixth, we set out our broad conclusions from the array of expert articles and offer some high-level recommendations for what needs to happen next to ensure people are best supported to live the life they want to lead.

  • We see no reason why the Care Act should be dispensed with – it remains the right legal framework for care and support. But significant and sustainable funding, allied to a much bolder commitment to prevention and innovation, and a far better offer to the care workforce are essential enablers of bringing the full spirit of the law to fruition.
  • These enablers are more likely to be effective if we can harness a degree of cross-party consensus on a way forward for care and support and talk in far more positive terms about the value of great social care for us all.

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A focus on people

In 2018, the LGA launched its own green paper for adult social care and wellbeing, ‘The lives we want to lead’. Building on the title, the work deliberately started from the experience of people who drew on care and support. Their stories formed the opening substantive chapter of the publication, with one person – Vicki – stating, ‘we are human beings, not just numbers and figures’. In the rush to relay important information on funding pressures, assessment waiting lists or workforce turnover rates, we may sometimes lose sight of Vicki’s key point. Every statistic or piece of data has, at its heart, people. Whether that is the young disabled adult using a direct payment to attend their favourite gig, or an older person accessing reablement support to regain their independence in their own home they know and love, or the care worker darting between appointments to connect with those they are supporting. These are our loved ones, our friends, the people whose lives we want to see lived equally and fairly. And it may well be us at some point in the future.

In its influencing and lobbying work, the LGA continues to emphasise the importance of person-centred support and the role councils can play in supporting and improving people’s wellbeing, two key features of the legislation. We do so by centring people and what good adult social care means for them and our local communities. We work with people with lived experience directly and we highly value our ongoing relationships with organisations such as Think Local Act Personal and Social Care Future. Through this approach and related activity, we are proud to be part of work that is seeking to change the way that adult social care is perceived and thought about by the public. 

We fully subscribe to the idea that public understanding of, and public support for, adult social care is a prerequisite for securing the long-term and sustainable investment needed so that everyone who has cause to draw on social care can live the life they want to lead. We are grateful to Social Care Future for the following content on the importance of shifting the narrative on care and support.

Shifting the narrative, by Neil Crowther, Co-convenor, Social Care Future

Another world is possible

The Care Act 2014 heralded a paradigm shift in how social care was to be imagined, oriented, organised and practiced. It repositioned care and support not as an end in itself but as a means to the end of promoting individual wellbeing. It shifted the focus from ‘providing services’ to ‘meeting needs’ and required councils to do so respecting each individual’s own identity, will and preferences. It also included duties to the community at large, to act to prevent the emergence of more significant needs for care or support.

This expansive and progressive reimagining of what social care should be and do was not however matched by requisite investment from central government and has been largely absent in the debate about funding social care, which has dominated public or political discourse for the past quarter century. In that imagining of social care, which predates the Care Act 2014, it is rarely more than ‘washing, dressing or feeding’ delivered either in congregate care settings or via homecare visits, and focused exclusively on older people. 

The debate has centred on ameliorating the ‘catastrophic costs’ faced by some in paying for long term care and support, not on what the money buys. Rarely if ever has the question ‘what resources do we require to meet the obligations in sections 1 and 2 of the Care Act 2014?’ been asked. As a result, local councils are tasked with delivering on statutory obligations that are not only woefully under-resourced, but equally under-imagined.

It's unsurprising then that the public’s imagination of adult social care is also misaligned with that embodied in the Care Act 2014. Since 2019, #SocialCareFuture has been leading work to change the public narrative about adult social care with a view to shifting mindsets and inspiring a different imagination of the future. We began with a deep dive into how social care was represented by campaigners, in the print media, on social media and by politicians, and into what was top of mind when the public were invited to think about social care. 

We found that social care was largely represented by campaigners, in the media and understood by the public as a broken system in crisis, that ‘looked after vulnerable people who can’t look after themselves’ offering help with ‘washing, dressing and feeding’. Older people were the overwhelming focus, painted both as victims and as the cause of the crisis in social care. Metaphors such as ‘demographic timebomb’ and ‘silver tsunami’ were common ways to attribute the challenges faced to rising demand, not failure to have invested in and transformed our social care system in line with predicted demographic change and trends in. People rarely saw social care as relevant to them, or as holding any wider social or economic value. It is seen ultimately as a question of money, but of money that isn’t available. The narrative possessed features that the Frameworks Institute have identified as barriers to change across a range of issue areas: othering, a failure to depict, see or understand system causes or solutions and most challenging of all, fatalism about the potential for change.

Can we change this? The answer from #SocialCareFuture’s follow up research is a resounding yes. Alongside this work, we co-produced with our movement the story we ideally want the public to hold in their heads and which we believe should guide what social care should do and how it should be organised. We then went back to the public, working with the strategic communications organisation Equally Ours and public opinion research company Survation to get further under the skin of public thinking, and to begin to test and refine our story and the messages it contained. What we found was that, when presented with a well-framed story, strongly aligned to the values and ideas embodied in the Care Act 2014, not only did we see positive shifts in people’s imagination about what social care can and should be, its relevance and value, we also saw consequent increases in support for investment and reform and in people’s optimism about the potential to build something better.

Social Care Future's story

We all want to live in a place we call home, with the people and things that we love, in communities where we look out for one another, doing the things that matter to us.

If we or someone we care about has a disability or health condition during our life, we might need some support to do these things. That’s the role of social care.

When organised well, social care helps to weave the web of relationships and support in our local communities that we can draw on to live our lives in the way that we want to, with meaning, purpose and connection, whatever our age or stage of life.

There are already places that are thinking about and organising social care differently to achieve this. For example, by supporting facilitators who bring family, friends and neighbours together to support someone to do what matters to them, strengthening the relationships of everyone involved. Personal assistants, employed by people to provide practical support so someone can lead their life their way. And organisations that connect people with opportunities to use their skills and talents, which improves their wellbeing and benefits the local community.

We believe that this can and should be happening everywhere and for everyone.

For that to happen, the government must make good social care a priority and begin investing more in it. And more local councils need urgently to start working alongside and supporting local people and organisations to bring these ideas to life by organising and funding social care differently.’

Given the precarious state of adult social care, some people may be nervous about the prospect of unleashing such imagination. Isn’t it better to just portray the harsh reality? The point is that a relentless storyline of a broken system in crisis, letting down ‘our most vulnerable citizens’ has singularly failed to marshal public or political support for change. Evidence from other countries like Germany and Japan who have arrived at a new funding settlement for adult social care is that being able to offer a compelling vision of what people’s money would buy was fundamental in getting reform over the line. This is what we saw in our research: when we offer people a vision that taps into universal shared values, speaks to a ‘larger us’, explains how it can be achieved and sets out who is responsible, people’s support for investment and reform, and their belief it’s possible to achieve, grows.

As the Frameworks Institute have warned ‘Crisis framing has, over time, caused a decline in public engagement and eroded people’s confidence in our civic and social institutions. As a result, the greatest communications task for most advocates these days is not to convince people that a problem exists; it’s to convince them that it can be solved.’

If we want to escape the doom loop adult social care finds itself in, we have to create what Geoff Mulgan has called ‘the possibility space’ in which people can imagine a different, better future. #SocialCareFuture is now working with the Local Government Association, Association of Directors of Adult Social Services and others to do so. Another world is possible for adult social care and all who will have cause to rely on it or who work in the field, but we have to offer that different imagination to the public at large if we want to see the promise of the Care Act 2014 become a lived reality.

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Timeline of key events

May 2014 Care Act receives Royal Assent

May 2015 General election: Conservatives win majority and take office

Conservative party wins a majority in the 2015 general election and forms a new government. Its manifesto confirms the party will cap charges for residential social care from 2016 and introduce a universal deferred payment scheme.

July 2015 Cap on care costs postponed until 2020

The government postpones the implementation of the Care Act funding reforms from April 2016 until April 2020. The delay is explained as being due to the cost of the policy, the concerns of local government over its affordability at a time of limited funding for the system itself, and lack of insurance products available in the private insurance market. The Minister commits to using the additional time to ensure that ‘everyone is ready to introduce the new system’.

March 2017 New green paper proposed

In the 2017 Spring Budget, the Chancellor Phillip Hammond formally announces plans for a green paper on the reform of social care funding. He promises £2 billion extra funding for adult social care over the next three years.

April 2017 Election period

During the 2017 Election campaign, the Conservative party announces plans for a green paper including a more generous means test and a cap on lifetime costs. The policy is quickly dubbed a ‘dementia tax’.

November 2017 Delay to social care green paper

The government puts back publication of the social care Green Paper to July 2018.

December 2017 Cap on care costs postponed indefinitely

The government formally drops April 2020 as the date for implementing the Care Act’s funding reforms. No new date is announced, but the government affirms its commitment to a green paper.

July 2018 LGA green paper, ‘The lives we want to lead’

In the continued absence of a government green paper, the LGA produces its own. The publication receives extensive national media coverage and high engagement levels. More than 560 responses to the publication’s questions are submitted by people and organisations.

October 2018 Autumn budget

At the autumn budget, chancellor Phillip Hammond provides additional short-term funding but fundamental reform through a green paper is still elusive.

Spetember 2019 Spending round

Additional funding is announced and councils are enabled to increase the social care precept.

2020-22 COVID-19 pandemic

Adult social care is at the very heart of the national and local response to the pandemic.

December 2020 Spending review

Chancellor opts to conduct a one-year review to set budgets for government departments for 2021/22 only, rather than the agreed multi-year Spending Review. He announces a funding package including additional money to maintain care services and recover from the impact of COVID-19.

September 2021 ‘Build Back Better: our plan for health and social care’

Alongside funding for the NHS, the government publishes proposals to make the social care means test more generous and set a cap on the amount an individual would pay for care in their lifetime, raising the prospect that the reforms proposed by the Dilnot Commission in 2011 will be implemented. The cap will be set at £86,000. To fund the investment in health and social care, the government announces a UK-wide 1.25 per cent Health and Social Care Levy based on National Insurance Contributions (NICs). The levy will be introduced from April 2022. The government also promises to develop and publish a white paper on social care reform later this year with input from the sector.

December 2021 ‘People at the heart of care’ white paper

The government publishes its ten-year vision for adult social care based around three objectives: people have choice, control and support to live independent lives; people can access outstanding quality and tailored care and support; people find adult social care fair and accessible. The white paper announces various pots of funding to take forward different white paper initiatives, including £500 million to support the care workforce.

March 2022 Amendments to the social care cap reform

The government proposes amendments to the core components of the Dilnot reforms, the care costs cap and extended means test. The government now plans to stop any care that has been funded through the means test counting towards the cap. The government estimates that from 2027/28, the saving for HM Treasury is around £900 million a year, reducing the cost of reform by around one-fifth.

September 2022 Health and Social Care Levy

The Chancellor of the Exchequer announces that HSC levy introduced in April 2022 will be abolished.

November 2022 Health and Care Act

The Health and Care Act 2022 introduces significant reforms to the organisation and delivery of health and care services in England. The Act places a duty on the Care Quality Commission (CQC) to assess council’s delivery of their adult social care functions under part 1 of the Care Act 2014. It also provides for the Secretary of State to intervene where a council is judged to be failing.

November 2022 Autumn Statement

The government announces £2.8 billion more funding in 2023/24 and £4.7 billion in 2024/25 in cash terms for adult social care. However, the promised reforms to the social care cap and means testing will now be postponed until October 2025.

April 2023 Next steps to put people at the heart of care

The government publishes an update on its 2021 white paper on adult social care. It confirms that several measures from the white paper have been reduced in scope or even abandoned. Most notably, a promise of at least £500 million to be spent on workforce training, qualifications and wellbeing is reduced to £250 million, and a promised £300 million to transform housing options has been replaced by £102 million for smaller in-home adaptations.

January 2024 Government announces new funding for councils

In response to growing and vocal concern from across the sector about the pressures facing adult social care, the Government announces a £600 million support package for councils, £500 million of which is allocated through the Social Care Grant (for adults and children’s services).


Background to the legislation

Origins and developments

In 2008, the Law Commission announced it would consult on proposals to review the legislation governing adult social care and to consolidate it into a single statute. The final report was published in May 2011 and concluded that the legal framework for social care was too difficult to interpret and understand. It proposed the creation of a unified statute to govern the system and included the following key recommendations:

  • The governing principle of the adult social care system should be to promote and support the wellbeing of individuals and to involve individuals in decision making.
  • The introduction of two levels of service; a universal offer with a wider preventative focus, and a targeted offer following a community-based assessment focused on an individual’s care and support needs, and a duty to assess carers.
  • A proposal to place a duty on councils to ensure production of a care and support plan for people with assessed needs. 
  • The creation of a legal framework for the rolling out of personal budgets.

In June 2011, the Independent Commission on Funding of Care and Support (often called the Dilnot Commission after its chair, Sir Andrew Dilnot), published its report, ‘Fairer care funding.’ The Commission concluded the adult social care system was not fit for purpose and required more funding from both individuals and from the state in order for it to be sustainable and fair. The report set out proposals for the reform of adult social care including on the support individuals should be given to help pay for care and what they should contribute themselves. Of particular importance, the Commission recommended a cap on care costs that people themselves would be required to pay and an extension to the financial means test thresholds to make them more generous.

Building on the recommendations from the Law Commission and Dilnot Commission, the Government set out its plan to reform care and support in its 2012 white paper, ‘Caring for our future: reforming care and support’. From November 2012 to March 2013, the joint committee on the Draft Care and Support Bill carried out pre-legislative scrutiny. 

Notably during the process, the Government announced that the recommendations of the Dilnot Commission would be implemented through amendments to the draft Bill, meaning the committee would be unable to consider the provisions. Although the joint committee welcomed the Bill, it did identify several risks, gaps and areas for improvement, including around public awareness of the scope and cost of social care provision and the financial impact of the Bill.

The Care Bill was published in the House of Lords on 9 May 2013 and received Royal Assent on 14 May 2014, becoming the Care Act. It was considered landmark legislation, bringing together a range of previous statutes into a single, comprehensive legal framework. It made provisions for the cap on care costs and, through means of regulations, changes to the financial means test thresholds. These reforms were due to commence in 2016 but have been delayed twice, with implementation now due in October 2025.

Main features of the legislation

The Act was notable in its development through extensive consultation and collaboration with individuals drawing on care and support, unpaid carers, providers, commissioners and the wider sector.

The Care Act pulled together a patchwork of legislation built up since the 1948 National Assistance Act and defined the primary responsibility of councils as the promotion of individual wellbeing. The Act embedded a focus on meeting people’s needs, rather than the straight provision of services, and made them central to key processes such as needs assessments and care planning. To promote wellbeing, the Care Act placed a duty on councils to establish and maintain an information and advice service which is accessible to everyone and tailored to the needs of local people. It also set out council duties on prevention and early intervention, requiring councils to ensure the provision of preventative services which help prevent, delay or reduce the development of care and support needs (including carers’ support needs).

Throughout the Act there is an emphasis on collaboration and cooperation. The legislation requires councils to promote integration with the NHS and other key partners, including working through local Health and Wellbeing Boards. This is reflected in a general duty for councils to ensure cooperation with other organisations, and between their own services of adult care and support, housing, public health and children’s services. For the first time, adult safeguarding is codified in law with councils being required to make enquiries, or ensure that others do, if an adult who has needs for care or support is believed to be subject to, or at risk of, abuse or neglect.

Moving the legislation forward

In the years following the Care Act receiving Royal Assent, there have been a number of high profile and important inquiries and reports on adult social care funding and reform. These have examined the value of adult social care to people and communities, its importance as a local service, the challenges facing the sector, and what needs to change to ensure that people who draw on care and support, or those who make up its workforce, have what they need to thrive. Of particular note over the last 18 months:

House of Lords Adult Social Care Committee, ‘A ‘gloriously ordinary life’: spotlight on adult social care’ (December 2022)

This report argues that social care has largely been invisible and seen as synonymous with decline and crisis. Further, the report suggests these assumptions and associations have unhelpfully framed past and present policy. It sets out recommendations to make the adult social care system more progressive, visible, fairer, and kinder. The report makes recommendations on the collection of data, increasing the financial settlement for the system, remedying low pay in the sector, creating a national long-term plan for adult social care and establishing a commissioner for care and support.

Archbishops’ Commission on Reimaging Care (January 2023)

This commission called for a national care covenant to be developed through national dialogue which would set out the roles and responsibilities of government, communities, families and individuals. Key proposals include investment in communities, a stronger role for the state, a new deal for unpaid carers and a commitment to responsibilities as actively engaged citizens. It sets out a long-term aspiration of making care and support a universal entitlement. This would include a simplified assessment that leads to a guaranteed budget, people being trusted to manage their own care and decide what help they need, and independent advocacy to help people access their rights and entitlements.

Association of Directors of Adult Social Services, ‘Time to act: a roadmap for reforming care and support in England’ (April 2023)

This report argues that the status quo is no longer acceptable and that a new path to the future (building on other work already done, such as described here) needs to be forged. It identifies tangible actions for the short-, medium- and long-term, underpinned by public- and cross-sector dialogue and a new social contract between individuals, families, communities and the state.

Fabian Society, ‘Support guaranteed: the roadmap to a national care service’ (June 2023)

This report sets out ten building blocks for wholesale reform centred around a National Care Service ‘constitution’. Overall, the report makes 48 recommendations including launching a national brand, a fair workforce settlement and embedding coproduction with people who draw on social care. The report notes that many of its changes would require legislation and therefore proposes a National Care Service Act which would revise and expand on the Care Act. The report is clear that a national service would continue to be delivered locally, recognising the value and importance of local government’s role in overseeing care and support.

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Key context: funding, integration and COVID-19

There are many developments over the last ten years that have impacted on the fortunes of adult social care and support. Some have had an impact directly, others indirectly. Addressing them all in detail would require an entirely separate publication, but three are worth including here: funding, integration and the COVID-19 pandemic. These developments in particular have shaped care and support dramatically over the last decade and will likely continue to exert an influence on its future.


Adult social care finance since 2010/11

The last decade and a half has been especially challenging for local government finance. On one hand funding has fallen, with core spending power reducing by 23.3 per cent in real terms from 2010/11 to 2024/25 (see Figure 1). On the other, service demand has continued to rise and increase in complexity. This combination of dwindling resources and growing demand has meant that councils have been under pressure to do a lot more with a lot less.

Figure 1: Change in councils’ Core Spending Power 2010/11 to 2024/25

'Core spending power' is a measure produced by the Department for Levelling Up, Housing and Communities that captures the main streams of government grant funding to councils, including locally retained business rates and council tax. This chart shows that there has been an overall 23.3 per cent real terms reduction in core spending power between 2010/11 and 2024/25.

Many councils have struggled to retain their financial sustainability in this challenging context. In February 2024, the Department for Levelling Up, Housing and Communities (DLUHC) took the unprecedented step of announcing that 19 councils, all but one of whom had adult social care responsibilities, would receive Exceptional Financial Support in 2024/25 to manage financial pressures that the councils considered unmanageable . While the underlying reasons for this support vary across these councils, the scale of this intervention clearly indicates the depth and breadth of pressures faced by councils.

But as Figure 1 shows, the story of how we got here is more complex and nuanced than simply one of continuous austerity and spending cuts. Furthermore, the impact of these pressures has played out differently for different service areas. The imperative on councils to protect services with clearly defined statutory responsibilities, alongside decisions made by the Government in recent years to provide additional service-specific funding, mean that the finances of different services have fared very differently over this period.

While it may not feel like it to policymakers, practitioners, and people who draw on care and support, adult social care spending has in fact been relatively privileged and protected compared to other service areas. Figure 2 shows that adult social care experienced real terms funding reductions only for the first half of the decade. This is similar to children’s social care, but clearly different to non-social care services where budgeted spend fell in real terms throughout the 2010s. The spending cuts faced by adult social care in the first half of the decade were significant, however, and they were not reversed in real terms until 2019/20. At the same time there was constant and consistent growth in modelled demand for councils’ adult social care services.

Figure 2: Change in modelled demand for adult social care and real terms budgeted service spending across different service areas in England, 2010/11 to 2023/24

This chart shows how adult social care spending reduced over the first half of the 2010s (at a time of steadily increasing demand for services) and did not recover in real terms until 2019/20. This path of spending is compared to spending on non-social care services, showing that budgeted real terms spend for such services fell throughout the 2010s.

Looking more deeply at the data we think there are a number of distinct phases in terms of adult social care spending over this period. This analysis is based on budget data as this allows us to extend the time series to 2023/24. However, trends in budget data are slightly different to those in the outturn data. This means that the dates of these phases are slightly different in the outturn data. But these differences are not material and the overall narrative holds.

Phase 1 – Austerity

When the Care Act received Royal Assent in 2014, adult social care was already facing significant pressures. The full vision and ambition of the legislation was therefore overlaid onto a system struggling to meet demand.

Budgeted spend on adult social care fell by 12.3 per cent from 2010/11 to 2014/15 in real terms. This compares to falls of 16.6 per cent in children’s social care and 22.9 per cent for non-social care services. The National Audit Office (NAO) has demonstrated that adult social care savings were made by a combination of efficiencies and service reductions in this period (The impact of funding reductions on local authorities, NAO). Arguably, reductions in service levels pre-dated austerity and had begun in 2008/09 (Adult social care in England overview, NAO). Throughout this period demand for adult social care continued to grow, widening the gap between actual spend and modelled demand.

Phase 2 – Early recovery

When the Care Act went live in 2015, pressures remained acute. The challenge was across the board and national, yet the Government’s solution was local revenue raising through the social care precept. Other valuable council services – including those that contribute to people’s wellbeing in the widest sense – were cut disproportionately to help steady the gap between adult social care spend and demand.

Budgeted spend on adult social care grew by 11.4 per cent in real terms from 2014/15 to 2018/19, partly through an increase in NHS transfers following the creation of the Better Care Fund, and the beginnings of a new regime of specific grants through the Improved Better Care Fund towards the end of this phase. But a crucial driver of the increase in spend was the increased use of locally-raised resources following the introduction of the adult social care precept in 2016/17. 

Furthermore, there is evidence that councils chose to prioritise spending on adult social care over that on other service areas, with further cuts in non-social care services being used to subsidise spending growth in adult social care (Spending Review 2021 Submission). This upturn in spend stopped further growth in the gap between spend and modelled demand but did little to address the historic gap that had opened in the first half of the decade.

Phase 3 – Continued recovery

Adult social care funding pressures tentatively begin to stabilise, but the position remains precarious and reliant on an approach of short-term, one-off funding injections, which hampers councils’ ability to plan for the medium- to long-term.

Budgeted spend on adult social care has increased by 11.5 per cent from 2018/19 to 2023/24. This may look like a continuation of Phase 2, albeit at a slightly lower annual average growth rate, but the drivers of spending growth are different. One of the defining features of this period has been substantial growth in adult social care specific grants delivered through an ever-growing list of centrally-designed and controlled schemes. 

The second key feature of this period is the apparent ending of the cross-subsidisation of adult social care by other services. Spending cuts for non-social care services have stopped, and children’s social care has emerged as a significant pressure, requiring more resources from within council budgets. Arguably these two processes are connected, with the arrival of the new adult social care grant regime allowing councils to reduce the pressure previously exerted by adult social care on other budget areas. Consequently, this recent injection of resources is likely to have not only supported adult social care services, but also helped maintain the overall financial sustainability of a number of councils. However, while these are positive outcomes from a purely financial perspective, they have simply kept pace with modelled demand rather than leading to a widening of provision. 

Phase 4 – Where next?

The next phase for adult social care finances is unclear. But this analysis has demonstrated that while there may be a greater degree of stability in the system, adult social care finances are far from fixed. In fact, quite the opposite is true. In the face of continued increases in demand, councils have exhausted their own resources. Councils’ ability to keep up with year-on-year increases in costs and demand is dependent on annual growth in government grants. A hand-to-mouth financial system based on short-term funding injections is not a sustainable or efficient model for the future of adult social care. 

As a bare minimum, the series of government grants must continue in base budgets; turning the taps off now would be disastrous and return the system to the more challenging earlier phases outlined above. But such an approach would not constitute ambition and it would certainly not enable the full intent of the Care Act to be achieved. With the advent of adult social care assurance being overseen by CQC, we will watch with interest how the regulator assesses councils’ performance against the Care Act duties and – reading between the lines – the extent to which inadequate investment is impacting on performance.



Integrating health and social care to provide joined-up support that delivers better health and wellbeing outcomes to individuals is a long-standing national and local policy objective. Councils and NHS partners have been delivering integrated services, undertaking joint commissioning, and pooling funding for many years.

Integrating health and social care is one element of a wider integration agenda which includes integration across the NHS – the ‘triple integration’: between hospitals and primary care; the NHS and social care; and physical and mental health. NHS reforms have developed a new landscape for health planning and delivery framed around large geographical footprints; first, sustainability and transformation partnerships, then integrated care systems, which developed into the levels familiar today:

  • integrated care systems
  • places – often equivalent to a shared clinical commissioning group (CCG) and council area, or part of the footprint for a large council
  • primary care networks – partnerships between GP practices which aim to involve community health and care services – generally around 30,000 to 50,000 people
  • neighbourhoods and communities – smaller areas where people may have specific health and care needs.

Integration since 2014

Under the Care Act 2014, councils are required to promote integration, cooperation and partnership with the NHS and other key partners to enable a care and support system which is person-centred. In 2014, the Five Year Forward View set out a vision for transforming the NHS and social care in England to become more integrated. This was followed in 2019 by the NHS Long Term Plan that set out further steps towards in integration, and in 2021 by the health and care white paper Integration and Innovation, setting out legislative change to enable better integration in England.

Pooled budgets and the Better Care Fund

The Better Care Fund (BCF) required the NHS and councils to create a pooled budget to support joined up care and support across the NHS and social care. Health and Wellbeing Boards are required to develop and oversee BCF plans, which set out how health and care partners will use their BCF allocation locally. BCF supports local systems to successfully deliver the integration of health and social care in a way that supports person-centred care, sustainability and better outcomes for people and carers. Section 75 of the NHS Act 2006 allows partners (NHS bodies and councils) to contribute to a common fund which can be used to commission health or social care related services. Section 75 pooled budgets are currently used extensively, and creatively in many areas, for a range of care and support services. Every area has a section 75 agreement to support their BCF arrangements, but many council and NHS partners use section 75 pooled budges for public health services, children and young people’s services, care and support for people with learning disabilities and autism, prevention and reablement.

Health and Care Act

In recent years, it has been national and local policy to further escalate the scale and pace of integration, guided by the provisions set out in the Health and Care Act 2022. The Act was introduced to drive a joined-up approach to health and care services and health outcomes between different NHS organisations and between the NHS and its partners in the wider health and care system. Integrated care systems (ICSs) became formal partnerships, defined by two central governance structures: the Integrated Care Partnership (ICP); and the Integrated Care Board (ICB).

Integration is a key agenda for local government and the LGA has therefore developed and set out a number of key messages and positions on how to extract the maximum potential value of closer working between health and care. These positions interact closely with the adult social care and support agenda. For example, Make It Local: Improving our health and care services and LGA response to the Hewitt Review of ICS accountability and autonomy.


Coronavirus brought into sharp relief the challenges facing adult social care, many of which existed long before the pandemic. However, it also powerfully underlined the essential value of social care in helping people to live the lives they want to lead. During this period, temporary changes were made to the Care Act to ease pressures on councils and ensure that those requiring the most support were cared for, which allowed councils to temporarily delay non-urgent care needs that they were unable to meet. Although councils were still expected to provide as much support as possible, individuals’ entitlement for the duration of the emergency period was limited to services necessary to avoid breaches of their human rights.

Impact of Coronavirus on adult social care

The pandemic took a significant toll on the provision of care and support, impacting those who draw on care and support, their loved ones and the adult social care workforce.

It also impacted the pattern of social care demand, commissioning, and delivery, with initially fewer people asking for services but then a sharp increase in requests for support as the pandemic eased. However, there was also less council capacity to carry out assessments and less service availability (partly driven by increasing staff vacancies), leading to increasing waiting lists. A report from the Kings Fund found that while receipt of care fell sharply in 2020/21, there was an upturn this year, which they suggest was largely a correction after the pandemic.

Short-term grants made to councils in response to the onset of COVID-19 have influenced the overall position of councils’ budgets and reserves. Inflation and the upward pressure that this has put on the cost of living have led to an increase in costs for councils, including adult social care, more recently. It is likely that these will have a significant impact for some time, making savings to budgets for the current financial year more challenging to achieve.

Every pandemic-related death of someone accessing care and support, or in the adult social care workforce, is a unique tragedy. The LGA is working closely with the national COVID-19 Inquiry to ensure all the right lessons from the pandemic are learned for a future similar emergency. Learning also applies for thinking about how to better deliver the aspirations of the Care Act.

The LGA has done a lot of thinking in this space having held a series of roundtables on ‘learning from the pandemic’ in 2021 with colleagues and partners from across the care and support sector, including people who draw on care and support (The lives we want to lead: where next for the debate about care and support reform?) . This work helped define a set of principles which the LGA believes should guide ongoing efforts to deliver the very best care and support system for people who have cause to draw on it. In summary:

  • People first and the value of social care: adult social care and support must be considered as an important way in which we improve social justice and inclusion and support people’s freedoms and human rights. COVID-19 helped raise awareness of this and that must be built on for the future.
  • Subsidiarity and the importance of ‘local’: councils’ democratic accountability and leadership supports effective partnership working at the local level and the Government should follow this lead by working with local government and its many partners as equals in helping to build resilient communities that are geared towards prevention, wellbeing and public health
  • The power of communities and relationships: the pandemic highlighted the impact local communities had when they mobilised, for instance through the large-scale mobilisation of volunteers and through mutual aid. People and communities have assets which determine their health and wellbeing and these can be built on and strengthened. The starting point for adult social care reform must be recognition of what we all have in common: a desire for relationships and connections to friends, family and the communities in which we live.
  • A flexible approach: the pandemic demonstrated the speed at which systems were able to change and challenged the validity of historic ‘we’ve always done it this way’ explanations for why change is neither possible nor desirable. People emerged from organisational or functional silos and asked what they could do to help, both in personal contributions and through the resources at their disposal. There was a strong feeling of camaraderie, which should be harnessed for the future.
  • The importance of trust: while accountability for public funding is clearly important, such a system can breed an onus on compliance, which in turn can result in mistrust. A genuine focus on people, seeing the whole person and embedding control, choice and coproduction, could go a long way to fostering and sustaining greater trust within the relationships inherent in social care.
  • Workforce: the future requirements of and for the social care workforce should be a far more prominent consideration for Government, both as a standalone priority and in respect of its links with NHS workforce planning. We need a new deal for the care workforce and Skills for Care’s development of a workforce strategy will be key to this.

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Summary of lead members survey

As part of this project to reflect on the decade since the Care Act received Royal Assent, the LGA distributed an online survey of all Lead/Cabinet Members of adult social services on the legislation, the current state of adult care and support, and what the sector’s future priorities should be.

The survey was shared in March and April 2024, and of the 153 English councils with social care responsibilities, 49 responded – a response rate of 32 per cent. This means that the results should not be assumed to be representative of all Lead Members for adult social services. The results were weighted by type of authority to improve their representativeness.

The following are some of the key findings from the survey, the full results of which will be made available in a separate publication.

  • Whilst 27 per cent of respondents were “very confident” of meeting all their statutory duties under the Care Act this year (2024/25), this figure dropped to just 8 per cent for next year (2025/26). Relatedly, whilst only 7 per cent of respondents were “not very confident” of meeting all statutory duties this year, this figure rose quite dramatically to 22 per cent for next year. A further 8 per cent were ‘not at all confident’ of meeting all duties next year, meaning that nearly a third of councils had low levels of confidence in meeting statutory duties next year.
  • Respondents painted a stark picture about the impact on other council services of protecting adult social care spending. Over the last ten years, 28 per cent believed their council had to spend less on other services in order to protect adult social care spending “very often”. Looking ahead to the same issue over the next five years, this figure rose to 44 per cent. This clearly underlines the point that securing the financial position of adult social care is central to securing the financial position of council services more broadly, many of which contribute to people’s wellbeing in the widest sense, such as parks, leisure, and libraries.
  • When asked what they thought the biggest issues facing the sector were, excluding funding, respondents cited workforce recruitment and retention (including personal assistants), increased demand and complexity of demand, and an inability to invest in prevention because of budget pressures and immediate needs, as the top three issues.
  • On the legislation itself, 80 per cent of respondents believed the Care Act remains fit for purpose (29 per cent “to a great extent” and 51 per cent “to a moderate extent”). This reinforces the argument against dispensing with the Act and starting again, and suggests that success hinges instead upon creating the right conditions in which the legislation’s full intent can be achieved.
  • Respondents were asked how important they thought adult social care is to the public, including both those locally in their council area and the England population overall. The largest group of respondents said that adult social care was “not very important” either to their local population (39 per cent) or to the population of England (51 per cent). This finding echoes other polling work which shows that adult social care is not a prominent priority for the public at large.
  • When asked the extent to which they agreed that the current system of health and social care places too much emphasis on treating sickness and not enough on preventing or reducing people’s needs, 100 per cent of respondents agreed, including 87 per cent who agreed “to a great extent” and 13 per cent who agreed “to a moderate extent”.
  • Respondents provided an equally clear view on the benefits of adult social care being a local service overseen by councils. 70 per cent “strongly agreed” that the service benefits from being a local service, with a further 20 per cent “tending to agree”.
  • Respondents expressed mixed views on integrated care systems (ICSs). Thirty eight per cent said that collaborative working with ICSs supported delivery of better outcomes for people “to a great extent”, whilst another 38 per cent said this was true “to a moderate extent”, and 20 per cent said this was only true “to a small extent”.
  • Respondents were also asked what balance they thought the narrative around adult social care should strike between positive content, emphasising the value of the sector, and negative content, emphasising the challenges it faces. The majority view (56 per cent) was that the narrative should focus largely on positive messages, with some negative messages. No respondents advocated focusing almost entirely on negative messages, and only 5 per cent said that the narrative should focus largely on negative messages with some positive messages. This suggests a clear appetite for changing the way we collectively talk about adult social care and support.

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Conclusions and recommendations


Throughout all of the articles that follow, the inherent value of adult social care and support in its own right comes strongly to the fore. At its best it contributes to people living their best life and remaining in the communities they know and love. It helps maintain the many friendships, relationships, interests and passions that are the cornerstone of people’s lives, their identity and purpose. This alone makes care and support an absolutely crucial public service.

Yet its value has an even greater reach. With a workforce of 1.52 million people, it is a bigger employer than the NHS (1.43 million people). It contributes an estimated £55.7 billion gross value added to the economy each year – including supporting local economies – more than accommodation and food service activities (£41.8 billion). With an estimated 440,000 extra new adult social care posts needed by 2035 – the majority of which will likely be local jobs requiring smaller than average commutes – the workforce can also contribute to the green agenda (The state of the adult social care sector and workforce in England, Skills for Care). At its best it also helps mitigate some of the most acute pressures facing our health service, freeing up hospital capacity and playing a key role in bringing down hospital waiting times. As the majority of the paid workforce and unpaid carers are women, adult social care can potentially contribute significantly to gender equality. The same is true for the equalities agenda given that the workforce is more diverse than the England population as a whole. Services for unpaid carers also help this group of 5 million people continue their invaluable support to loved ones, contributing a staggering £162 billion to the economy every year, broadly equivalent to a second NHS in England and Wales (Key facts and figures about Caring, Carers UK).

There are multiple compelling reasons why investment in adult social care for people drawing on care and support and their carers should therefore be seen as an investment in the very fabric of our society and a key enabler of our future national prosperity. In many ways, the value of care and support has its roots in the Care Act, whether that be in the form of, for instance, a diverse and quality market of providers, integration with health, support for unpaid carers, or principles of wellbeing and choice and control.

Yet the full value of care and support remains untapped, and the full achievement of the Care Act’s intent remains unrealised. From the above articles, the reasons for this are set out clearly, starkly and persuasively. They include, but are not limited to, the following:

  • Significant historic underfunding latterly partially remedied only by incremental, short-term grant funding and the use of local taxation for a national-level problem. This has caused serious damage across the full architecture of social care and the Care Act. The consequences of this include:

    - A serious underinvestment in prevention and early intervention services, including those provided by the local voluntary and community sector, which relies in part on grants from local government.

    - Severe recruitment and retention challenges in the care workforce, which is essential to delivering the aims of the legislation, particularly its emphasis on person-centred care and choice and control.

    - Unsustainable pressure on providers, impacting on the Care Act’s aim to create a diverse and varied market delivering high quality services.

    - An inevitable degree of rationing in order to meet legal requirements to return a balanced budget each year, thus ratcheting up unmet and under-met need.

    - An equally inevitable over-emphasis on cost, complete with the bureaucratisation and national oversight of spending through inflexible grant conditions, onerous reporting requirements and threats of funding being withheld or withdrawn if conditions are not met. This erodes trust at every level.

  • Limited understanding amongst the public of what adult social care is and why it matters. This reduces the possibility of the public conceiving of the service as a priority, making it easier for governments to avoid the difficult decisions needed to ensure social care can thrive.
  • A far greater government focus on the fortunes of the NHS and, within that, the performance and capacity of hospitals in particular. This has led to a major emphasis on hospital discharge, so much so that some streams of funding for adult social care are linked explicitly to improving discharge rates.
  • The politicisation of adult social care, rendering prospects for cross-party consensus on a way forward for the future virtually non-existent.

Addressing these challenges, and the many others identified in this publication, will take political bravery, a willingness to work across party lines, and an acceptance that the level of change needed will not fit neatly with national electoral cycles. But the potential rewards are great. Not only would the full ambition of the Care Act be achieved, and the full value of adult social care be realised, it would also play a major role in helping to stabilise and harness the full potential of local government overall. If adult social care had the money it needed to deliver on the legislation over the long-term, other valuable council services would not need to be cut back to help steady the service. These other services, such as libraries, parks and green spaces, and leisure facilities, all play a vital role in supporting people’s wellbeing in the widest sense. In this way, successive governments have played council services off against each other, despite all such services being critical to creating local communities in which people can live, work and play safely, healthily and independently.


With a general election on the horizon, we look forward to continuing our work to influence, inform and better understand the priorities of all the political parties and the funding envelope they will set themselves. We are clear that the future of adult social care must be at or near the top of a new government’s in-tray. Our recommendations are therefore about encouraging a new government to tackle particular key issues and doing so with particular principles in mind.

  • Do not dispense with the Care Act – it remains a well-supported and valuable legal framework for modern care and support. Any changes to it must replicate the process involved in its creation: collaboration, coproduction and proper and ongoing engagement with people who draw on care and support.
  • Fund adult social care adequately, sustainably and with trust in councils as democratically accountable bodies. The exact funding requirement should be identified through a collaborative process, but we broadly support the Health Foundation’s analysis of the uplifts that would be required under the following different scenarios:

    - Meet future demand: £0.6 billion by 2024/25 and £8.3 billion by 2032/33 (a 3.4 per cent a year real-terms increase) (Adult social funding pressures, Health Foundation)

    - Meet future demand and make some improvements to access to care: £3.1 billion by 2024/25 and £11.6 billion by 2032/33 (a 4.3 per cent a year real-terms increase)

    - Meet future demand and cover the full cost of care: £5.4 billion by 2024/25 and £14.6 billion by 2032/33 (a 5.1 per cent a year real-terms increase)

    - Meet future demand and improve access to care and cover the full cost of care: £8.4 billion by 2024/25 and £18.4 billion by 2032/33 (a 6 per cent a year real-terms increase).

  • All options for raising revenue and the approach to allocations should be on the table, including for instance:

    - All disparate funding streams for adult social care to be brought together into a single pot, allocated directly to councils and with no (or only limited) conditions, and put into the funding base to provide certainty and the ability to plan for the long-term.

    - Funding to be more much more outcomes-focussed, linking back to the duties, intent and ambition of the Care Act.

    - End the reliance on council tax and the social care precept as key means for funding adult social care and instead look to national taxation. Formalise national funding for adult social care but with delivery remaining local and frame this positively (for instance fulfilling the ambitions of the legislation) rather than negatively (for instance ‘bailing out councils’).

    - Explore the potential for better alignment between adult social care and the benefits system, including for instance Attendance Allowance.

    - Commit to a review of NHS Continuing Healthcare.-Consider a different funding model for younger adults and older people to reflect the different life situations faced by people aged 18-64 and those aged 65 and over.

  • Provide an immediate injection of funding to continue tackling the issues set out in the Health Foundation’s work. This would be a down payment on a future multi-year settlement for adult social care and would help improve current challenges, including: waiting times for assessments, commencement of care packages, and care plan reviews; unmet and under-met need; provider instability; workforce recruitment and retention pressures; and growing and unsustainable strain on unpaid carers. Such funding would also be a much-needed boost to the voluntary and community sector, bolstering local community capacity.
  • Recognise there is no such thing as a ‘standard care worker’ and develop a comprehensive long-term plan for the care workforce, building on the important work that Skills for Care are leading on and which we know will be an invaluable contribution to the debate. A long-term plan must include a thorough review of care worker pay and conditions, with corresponding increases and improvements respectively. In the short-term, explore the case for one-off increases in pay, and/or retention bonuses, particularly as we head into winter.
  • Be bold and ambitious with prevention. Pump prime preventative activity with significant new investment but give local government and its partners the freedom to determine how investment will be used. Such activity would cross health and social care and, if done effectively and jointly (backed up by better use of shared data), would potentially reduce demand and costs for the NHS as well as social care.
  • Make an early decision on Part 2 of the Care Act with a realistic assessment of its costs set against the need to invest heavily in the system itself. Financial means test thresholds have not been changed for a number of years, making the means test even meaner. These thresholds should be increased by inflation as a minimum, irrespective of what happens to the entirety of Part 2 of the legislation. If Part 2 is to proceed in full, changes to the financial means test thresholds should be done before the cap on care costs as this will benefit more people. Ensuring fair fee structures for providers should also be resolved before implementing the cap.
  • To ensure progress and improvement across the system, maintain the momentum on gathering better data about outcomes and value for money by continuing to engage all parts of the sector – including people with lived experience – on the government’s Care Data Matters strategy.
  • Commit to sustained and authentic coproduction with people who draw on care and support, including on issues such as: the use of direct payments and how they could be enhanced, and their processes simplified, to help further the choice and control agenda; and the links between adult social care and SEND to help transitions and better planning for adulthood. The redesign of services should be done with people who draw on them.
  • End the politicisation of adult social care, put the national interest first, and work on a cross-party basis at relevant points to secure the future of care and support. Work with and across the care and support sector to help raise the public’s understanding of adult social care, its value and how it operates.

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The LGA is immensely grateful to the following colleagues who have contributed articles for this publication:

Caroline Abrahams CBE, Helen Allen, Lucinda Allen, Dr Ruth Allen, Elaine Argyle, Sir David Behan CBE, Dr Margaret Blake, Cllr Alison Born, Simon Bottery, James Bullion CBE, Rt Hon Paul Burstow, Rt Hon Alistair Burt, Gavin Butler, Pip Cannons, Rachel Kelso, Carmen Colomina, Natasha Curry, Cllr Tudor Evans OBE, Dr Clenton Farquharson CBE, Karolina Gerlich, Prof Jon Glasby, Penelope Green, Dr Laura Griffith, Trevor Holden, Rt Hon Phil Hope, Emily Holzhausen OBE, Rt Hon Sir Norman Lamb, Jacob Lant, Tricia Nicoll, Sarah Norman, Prof Vic Rayner OBE, Deborah Rozansky, Dame Philippa Russell DBE, Hiba Sameen, Anna Severwright, Oonagh Smyth, Matthew Taylor CBE, Cllr Martin Tett, Dr Jane Townson OBE, Caroline Waugh, Melanie Williams, Suzannah Young.

Other than minor stylistic edits for consistent presentation in accordance with LGA house-style, the articles are unchanged from their original submission. Some of the articles are deliberately and helpfully challenging and provocative. The views, thoughts and opinions expressed by the authors of the articles are theirs alone and do not necessarily reflect the views of the LGA.