There’s no such thing as a new public policy idea, just a new name

Those of us who have been at the policy and implementation game for a while can be forgiven for thinking that there are few genuinely new ideas in public policy. Instead, the policy pendulum swings between solutions that are implemented, discarded for something better (or more accurately, something that is just different), and then reintroduced with a different name sometime later.

No part of the public sector is immune to this phenomenon. Our latest report on sector-led improvement in adult social care got me wondering if the sector was about to experience its own version of repeating past solutions when it comes to the approach to improvement.

In the 2000s, improvement approaches in adult social care had a strong national drive, including the inspection of local authority social care functions via the Commission for Social Care Inspection, an overall assessment of local authorities (the Comprehensive Area Assessment from the Audit Commission), and some big nationally-hosted teams of improvement support and advisers in the form of the Care and Support Improvement Programme and Care and Support Efficiency Delivery programmes, hosted in the (then) Department of Health.

'Reintroducing some of the aspects of the national approach is the right move in my opinion and will need to be done in way that is mindful of what we can learn from the strengths and weaknesses of these approaches in the past.'

Come the coalition government of the 2010s, and out went major planks of these national drives. A combination of a coalition government embarking on funding cuts, a broader push for decentralisation and a local government sector keen to remove external assessments combined to shift the landscape on improvement much more fully towards a local model. The Audit Commission was abolished, the new health and care regulator (the Care Quality Commission) inspected social care providers but not commissioners, and the Care and Support Improvement Programme and Care and Support Efficiency Delivery programme were closed down. In their place came a strong focus on sector-led improvement – reflecting local government accountability to its local population – with the Local Government Association and the Association of Directors of Adult Social Services co-leading the approach.

Now a decade later, a typical public policy pendulum would be almost overdue a swing back. Are we about to see a national approach dominate again?

There are certainly some clear signs that a shift back towards the national is happening. The Health and Care Act 2022 grants the Care Quality Commission the power to inspect the adult social care functions of local authorities – a move widely welcomed across the sector, even if there are debates now about the best time to introduce the new regime. The Levelling Up White Paper reintroduces a new independent body to oversee local government, providing ‘data, transparency and robust evidence’ to help hold local areas to account. Hello again, Audit Commission, how we’ve missed you!

Alongside these pulls to national, there remains clear roots in a local approach, with the social care White Paper committing to increased funding for sector-led improvement.

So what has caused these latest changes? The national approach of the 2000s can be seen as top–down and having risked improvement being done to the sector through one-off interventions and initiatives, rather than being owned by and embedded within the sector. The national approach brought advantages too – a mandatory system where all local authorities had to engage with improvement meaningfully, with external benchmarks and transparency that helped shape and drive where the improvement effort needed to be focused – but many local leaders felt that undermined their local accountability.

'Whatever the structure for improvement may be, its success will always be limited by the resource available to the sector to meet the needs of people who draw on care and support.'

In moving fully to a locally-owned approach, the regime of 2010s bought benefits in letting local leaders determine their priorities for – and approaches to – improvement. Some important aspects of national frameworks were also lost though, notably a national understanding of relative performance. Arguably this contributed to the severity of the austerity years for local government as central government could choose to be blind to the consequences of its cuts. There are also genuine questions about whether local accountability and a voluntary, sector-based approach was strong enough to respond to poor performance – especially for a service like adult social care, which, while a large budget, is relatively invisible to most local residents so doesn’t cut through at the local ballot box.

Reintroducing some of the aspects of the national approach is the right move in my opinion and will need to be done in way that is mindful of what we can learn from the strengths and weaknesses of these approaches in the past. Our new report aims to support just that, by exploring the experience of sector-led improvement over the past decade and considering its potential to continue to add value in a new landscape.

A word of warning to end, however. Whatever the structure for improvement may be, its success will always be limited by the resource available to the sector to meet the needs of people who draw on care and support. And regardless of the government’s claims to have fixed social care, there just isn’t enough money to have realistic ambitions for continuous quality improvement that really meets the expectations of people who rely on care and support to live their lives.