Why the future of social care depends on relationships and community strength

Stuart Cowley, Director of Adult Social Care and Health at Wigan Council, explores why the future of adult social care reform depends on empowering communities, neighbourhoods and local systems to shape solutions that reflect local needs, rather than pursuing a single national model. He shares Wigan Council’s relational approach to reform, showing how collaboration and strong relationships can create lasting change and improve outcomes for people and communities.

A lot of people are talking about what an Andy Burnham Government might do about adult social care. 

They’re talking about the Casey Commission, what it might recommend and whether those recommendations will be accelerated. They’re talking about a National Care Service and what that could mean for people who draw on care and support, their families and the wider health and care system. 

All of that is important. But I sometimes wonder whether we’re focusing on the wrong question. 

The question isn’t simply what a future Prime Minister might do to adult social care. 

The bigger question is what a future Prime Minister might do to change how Government itself works. 

Because if we’re serious about improving people’s experiences of care, strengthening communities and helping more people live well, then the answer may lie as much in reforming the relationship between government, places and citizens as it does in reforming social care itself.

High national ambition, local freedom 

I strongly support the idea that Government should hold a high national ambition for adult social care. 

People should be able to expect dignity, quality, safety and support regardless of where they live. Rights should be clear. Entitlements should be easier to understand. Navigating health and care services should not feel complicated or overwhelming. 

The Care Act remains an important foundation for much of that ambition. Fifteen years on, it still contains a strong articulation of people’s rights, wellbeing, prevention and strengths-based support. Rather than starting again, there may be real value in building on those foundations and making them clearer and easier for the public to navigate. 

But having a national ambition does not require a nationally uniform solution. 

One of this country’s greatest strengths is the diversity of its places. Communities have different histories, different assets, different challenges and different strengths. What works in one place may not look exactly the same somewhere else and that’s not a weakness. It’s often a source of resilience. 

The role of Government should therefore be to set the ambition, establish the conditions for success and ensure that nobody is left behind. The role of places should be to bring that ambition to life in ways that make sense locally. 

In many ways, this feels consistent with the direction of travel outlined by the Prime Minister and with the broader thinking that has emerged through the Greater Manchester Live Well agenda. The emphasis is not on more central prescription. It is on empowering communities, neighbourhoods and local systems to take greater ownership of their future. 

From my perspective, that is exactly the right direction. 

Learning from the last fifteen years 

One reason I have confidence in this approach is that we have already seen evidence of it. 

Over much of the period since 2010 and now, local government faced some of the most challenging financial conditions in its history. Spending power reduced significantly. Councils were required to make difficult decisions year after year. Adult social care experienced growing demand at the same time as resources became increasingly constrained. 

And yet the overall picture is not one of collapse. 

Of course, there have been challenges and variations in performance. There always will be. But the reality is that local Government continued to deliver for its communities through an extraordinarily difficult period. That achievement matters. 

It suggests that when local leaders, practitioners, communities and partners are trusted to work through difficult issues together, they often find innovative and effective solutions. 

As the CQC’s new assessment framework develops, we should hold onto that lesson. 

Regulation is important. People deserve assurance that services are safe and effective. Where leadership, culture or performance are not delivering for citizens, intervention and support must be available. 

But regulation should not become solely an exercise in identifying weakness. 

Its equally important purpose should be to accelerate the spread of excellence. 

The greatest opportunity from the current CQC baselining work is the chance to understand what is working well and share it more effectively. There is great practice happening in almost every part of the country. We should celebrate it, learn from it and create systems that allow it to travel. 

Improvement works best when it is built on openness rather than defensiveness.

The importance of trust and psychological safety 

That brings us to culture. 

Anyone who has worked in public services understands that regulation and inspection can create anxiety. That’s simply a human response to being assessed. 

The challenge is ensuring that accountability does not inadvertently create fear. 

The most successful organisations and systems are often those where people feel able to speak openly about problems, learn from mistakes and collaborate honestly with others. In other words, they have psychological safety. 

The same principle applies nationally. 

If we want improvement, we need cultures that encourage honesty, curiosity and learning. Regulators, Government departments and sector partners all have a role in creating those conditions. 

The future should be about combining accountability with support, challenge with encouragement, and assessment with practical help. 

The knowledge that sits within organisations such as CQC, DHSC and across the wider sector is a national asset. Using that knowledge to connect places, share learning and support improvement may ultimately prove just as valuable as the assessment process itself. 

Prevention requires a different relationship with Government 

There is another lesson we should draw from the last decade. 

Many of the most significant opportunities for improving lives sit in prevention, yet prevention often struggles within traditional funding models. 

Treasury departments are rightly expected to protect public money. Evidence matters. Evaluation matters. Accountability matters. 

But the reality is that prevention rarely comes wrapped in perfect certainty. 

The benefits frequently emerge over many years. Outcomes often span multiple organisations. Some of the most valuable impacts are social rather than purely financial. 

If every preventative investment requires complete certainty before action is taken, innovation inevitably becomes harder. 

That’s why I believe Government should consider a different approach: longer-term prevention funding, greater local flexibility and a willingness to accept a degree of managed risk. 

Not because places always get things right. They don’t. 

But because local systems are often closer to the issues, closer to communities and better placed to understand where opportunity lies. 

The evidence suggests that when places are trusted, supported and given sufficient time, they frequently develop solutions that central Government could never design from a distance. 

Why social care matters to the future of neighbourhood health 

This is where social care occupies a uniquely important position. 

Over recent decades, much of our national conversation about public services has focused on institutions. Hospitals. Services. Organisations. Processes. 

Important though all of those things are, people’s lives do not happen inside organisational charts. 

Lives are lived in streets, neighbourhoods, families, friendship groups and communities. 

Social care understands that better than most public services. 

At its best, social care helps people draw upon their strengths, maintain their independence and stay connected to the people and places that matter to them. It recognises that wellbeing comes not only from professional support but from relationships, purpose, belonging and community. 

That places social care in a unique position between formal services and informal support. 

It can connect people to community resources. It can help families build resilience. It can work alongside voluntary organisations and neighbourhood groups. And when people need direct care and support, it can provide that too. 

If the future of neighbourhood health is about helping people stay healthier, more independent and connected for longer, then social care has to sit at the heart of that vision. Not as an adjunct to healthcare, but as an equal partner. 

Because the ultimate goal is straightforward: wherever possible, people should be supported to live well at home, connected to their communities and able to maintain control over their own lives. 

What gives me confidence and hope 

I say all of this not as a theoretical proposition but as somebody who has seen aspects play out over many years. 

In Wigan, we have pursued a relational approach to reform for more than a decade. We are by no means unique. Many places across the country have travelled similar journeys. 

But our experience has reinforced some important lessons. 

When trust and respect become organising principles, outcomes improve. 

When staff are empowered, morale improves. 

When communities are seen as assets rather than problems to solve, social capital grows. 

When organisations collaborate around people rather than protecting institutional boundaries, services become more effective. 

And when citizens are supported to build on their strengths rather than simply being defined by their needs, lives improve. 

None of this represents a blueprint for everybody else to copy. 

But it does provide confidence that a different way of working is possible. 

A National Care Service built on trust 

The debate about a National Care Service should ultimately be about more than structures. 

It should be about creating a country in which people can live good lives, remain connected to their communities and receive support that respects their dignity, aspirations and strengths. 

Government has an essential role in setting that ambition and ensuring that quality exists everywhere. 

But the quickest route to achieving it is unlikely to come from greater central control. 

Because if there is one lesson I would offer from the last decade, it is this: 

The future of adult social care may depend less on finding a perfect national model and more on creating the conditions in which every place can develop its own version of success. 

If that is the direction the country chooses, then social care will have an enormous role to play. 

Not simply as a service, but as part of a broader renewal of trust, hope, community and local agency. 

And that feels like a future worth building.