A National Care Service must be built around people and places, not institutions

This contribution is written from the perspective of Wigan, a place whose adult social care services are widely recognised as among the strongest in England. That recognition does not imply perfection. Like every area, we continue to face significant challenges, increasing complexity of need and financial constraints. There remains much to improve and much to learn.

However, our experience has reinforced some important convictions.

First, that devolution and localism matter. The closer support is designed and delivered to the lives of people and communities, the more responsive, human and effective it becomes.

Second, that social care is fundamentally relational. Whilst systems, structures and processes are important, the outcomes that matter most are often created through trusted relationships between individuals, families, communities and practitioners.

Third, that people are not standardised and should not be treated as though they are. Adult social care works best when it understands not only a person’s needs, but also their strengths, passions, aspirations, culture, relationships and unique contribution to the world around them.

This is one of the limitations of highly centralised or overly standardised approaches. Consistency of rights and entitlements is essential. Consistency of outcomes matters. But consistency should not be confused with uniformity.

The most effective social care is rarely delivered through applying identical solutions to identical categories of people. It is delivered through understanding individuality, recognising strengths, building on what matters to people and creating support around lives rather than services.

From that perspective, the debate about a National Care Service presents a significant opportunity. But its success should not be judged simply by whether it creates a new national structure. It should be judged by whether it creates a clearer, fairer and more understandable system whilst retaining the flexibility, humanity and local leadership required to support people as individuals.

A National Care Service for Living Well

The Prime Minister’s ambition to create a National Care Service presents an opportunity that extends far beyond reforming adult social care.

For decades, governments have wrestled with the question of how social care should be funded and organised. Yet the deeper challenge has never been solely about care. It has been about how we help people live good lives; how we support independence, participation and contribution; and how we build communities where people can thrive at every stage of life.

As the Casey Commission has clearly described most citizens are not interested in the distinction between the NHS, adult social care, disability benefits, housing support, carers’ services or community provision. They simply want to know what help is available, how they access it, and whether it will enable them and those they care about to live well.

Too often, people encounter a system that is fragmented, difficult to navigate and organised around institutional boundaries rather than everyday life.

The opportunity presented by a National Care Service is therefore not simply to redesign services, but to establish a new social contract around independence, wellbeing and participation in community life.

Building on the Spirit of Live Well

This vision aligns closely with the principles emerging through Greater Manchester’s Live Well movement.

Live Well begins not with services, but with people’s lives. It recognises that most people want the same things: a safe and decent home, good health, meaningful relationships, opportunities to contribute, financial security, purpose and a sense of belonging within their communities.

The central insight is that these outcomes cannot be delivered by any single service acting alone.

Health is shaped as much by housing as by healthcare. Independence is shaped as much by community relationships as by formal services. Opportunity depends as much upon employment, inclusion and participation as it does on professional intervention.

This has led Greater Manchester towards a broader understanding of public service reform, one that seeks to strengthen the foundations of everyday life rather than simply improve individual services.

A decade of local reform rooted in this understanding provides insight into whats possible, with over 500 people living independently and away from more costly long-term adult social care than a place like Wigan might expect.

A future National Care Service should embrace this philosophy.

It should not be conceived simply as a service for caring for people when things go wrong. It should be understood as part of a wider commitment to helping people live well, remain connected, contribute to their communities and realise their potential.

In this sense, social care is not merely a response to need. It is one of the key building blocks of a thriving society.

Free at the Point of Need, But About More Than Care

If the nation chooses to make adult social care free at the point of need, that would represent an important extension of the principle that support should be available according to need rather than ability to pay.

However, the future model should not simply replicate the structures or culture of the NHS.

The NHS remains one of the nation’s greatest achievements, founded on universal access and equity. But social care emerged from a different tradition.

Its primary purpose is not the treatment of illness. It is enabling people to live independently, maintain relationships, exercise choice and control, remain connected to their communities and pursue the lives they value.

At its best, social care begins with the question: “What matters to you?” rather than “What is the matter with you?”

That distinction is important.

The future challenge is therefore not how social care becomes more like healthcare. It is how both traditions can be brought together in pursuit of a wider ambition: helping people live well.

A National Care Service should strengthen the partnership between community health and social care whilst preserving the distinctive values, strengths and contributions that each brings.

Towards a Single Community Health, Care and Independence Entitlement

Over time, England should move towards a simpler and more understandable system of support.

Not necessarily by creating a single organisation, but by creating a single public offer.

Citizens should experience one coherent conversation about their lives rather than multiple assessments, multiple funding systems and multiple organisational thresholds.

Community health support, social care, support for carers, disability-related benefits, employment support, housing assistance, adaptations, technology and community opportunities should increasingly feel like different aspects of the same commitment to independence and wellbeing.

The principle is simple.

People should not have to understand the architecture of the state in order to access support from it.

The responsibility for navigating complexity should rest with institutions rather than citizens.

Neighbourhoods as the Front Door to the State

The strongest resonance between a future National Care Service and the Live Well approach lies in the importance of neighbourhoods.

People’s lives are lived locally. Health is created locally.

Resilience is built locally. Relationships are formed locally.

Opportunity is experienced locally.

Neighbourhoods should therefore become the primary front door to support, bringing together community health, social care, welfare advice, employment support, housing assistance, carers’ services and community organisations around people’s everyday lives.

This is not merely about integrating services.

It is about creating a different relationship between citizens, communities and the state.

A relationship that sees communities as assets rather than deficits, recognises social capital alongside financial capital and understands that strong neighbourhoods are themselves an essential part of the public service infrastructure.

Social Care as a Foundation of Good Growth

The debate about social care is too often framed solely through demand, cost and pressure.

Yet social care also contributes to prosperity, inclusion and economic participation.

People who receive the right support are more able to remain in work, volunteer, learn, care for others and contribute to their communities. Carers who are supported are better able to sustain employment and family life. Inclusive communities enable more people to participate in civic, social and economic activity.

Social care provides nurturing employment opportunities and the chance to build long-term, fulfilling careers, creating social value, strengthening local economies and helping communities to thrive

This is why social care should be viewed as part of the broader mission of creating good growth in every postcode.   Social care in Wigan is recognised as a priority.  Not just because of the essential care it provides, but also because of its role in building community wealth with over 9,000 people working in the sector. 

Our local neighbourhood model of home care, designed with the community and delivered by like minded local partners who share our commitment to relational working and prioritising investment in the reward and recognition of our valued care workforce.  Boosting local employment opportunity and ensuring all carers receive a minimum of the real living wage, independent of age.

The measure of success should not simply be the volume of services delivered.

It should be whether more people are able to participate, contribute and flourish.

Whether communities become stronger.

Whether inequalities reduce.

Whether people experience greater wellbeing and opportunity throughout their lives.

In that sense, social care is not simply a public service. It is a form of social and economic infrastructure that supports inclusive growth and thriving communities.

National Rights, Local Stewardship

A stronger national entitlement does not require greater centralisation.

Indeed, one of the most important lessons of devolution is that strong national rights and strong local leadership can and should coexist.

National government should determine the rights, entitlements, funding principles and expectations of fairness that citizens can rely upon wherever they live.

But places should retain the freedom to organise around the assets, needs and opportunities of their communities. Equity is not achieved by treating everyone the same. People begin from different circumstances, face different barriers and draw strength from different communities, cultures and identities. A fair National Community Health, Care and Independence Service will combine a clear public offer with the flexibility to respond to difference.  Live well is showing us that a good life is built on health, independence and the human need to contribute, connect and belong This is why national rights are best achieved at a neighbourhood level through local stewardship

Local government remains indispensable because it is uniquely positioned to connect health, housing, transport, employment, community development, economic growth and social care around a shared vision of place.

A National Care Service should therefore be built upon local stewardship rather than replace it.

A Different Kind of National Care Service

The most compelling destination is not an NHS-style National Care Service.

It is a National Community Health, Care and Independence Service that combines the NHS principle of universal entitlement with the social care principles of independence, citizenship, personalisation, community connection and human relationships.

A service that makes support free at the point of need whilst recognising that the ultimate purpose of public services is not simply to manage illness or dependency.

It is to help people live well.

It is to strengthen communities.

It is to support good growth in every postcode.

It is to create the conditions in which every person can contribute, belong and flourish.

The ambition is ultimately simple: one clear set of rights and entitlements, delivered through strong neighbourhoods, strong communities and strong local leadership, organised around helping people live good lives rather than helping institutions manage organisational boundaries. The promise is national. The relationships remain local. And it is through those relationships that independence, wellbeing and opportunity are most often created.

Stuart Cowley, Director for Adult Social Care and Health, Wigan Council

Cllr Keith Cunliffe, Deputy Leader and Portfolio Holder for Adult Social Care and Health, Wigan Council