Recommendation 9

HM Government Acknowledged

We agree with the committee’s recommendation for market shaping to include a dedicated focus on outcomes-based commissioning. People at the Heart of Care set out a new ambition for market shaping, emphasising a partnership approach between commissioners of health and social care and people who draw on care and support, in order to deliver what best promotes wellbeing, personalisation, and independence. To deliver this ambition and ensure that excellent market shaping practice is universal, we are investing funding to strengthen local authority market-shaping, commissioning, and contract management capability. As set out in Next Steps to Put People at the Heart of Care, this programme will include: • the design and delivery of a new package of support to upskill commissioners with taking strategic, preventative and outcomes-based approaches and making the best use of data • the development of clear standards for commissioners • supporting local authorities to access data and market intelligence, as well as providing tools and guidance to improve data analysis • a central repository to ensure easy access and clearer signposting to guidance and best practice • establishing strategic oversight for driving improvements in commissioning activity as part of the innovation and improvement unit The Health and Care Act 2022 also created new duties to enable national government to better understand the issues facing adult social care and target support appropriately. This includes the introduction of a new duty for CQC to independently review and assess the performance of local authorities in delivering their adult social care duties under the Care Act 2014, of which there is a specific duty for local authorities to ensure the promotion of diversity and quality in provision of services. The Secretary of State has also set priorities for local authority assessments so national government can understand better how local authorities are commissioning to support good care outcomes, including for those with complex needs and to support preventative care, and how they are commissioning to support a sustainable local care system. 16 Government response Local government finance Conclusion 14 and 15 – sources of funding Conclusion 14 - As well as the desperate human impact on those needing, receiving, and providing care, the underfunding of adult social care has led to many councils having to cut other public services in order to do their best to meet their care duties. The Government should address three core issues to improve the sustainability of adult social care funding: the balance of funding sources, long-term planning and forecasting, and geographical distribution. Conclusion 15 - We recognise the benefits of raising a proportion of funding for adult social care locally. As we have argued in previous reports, we support greater fiscal devolution. In finding the right balance of funding sources for adult social care, however, we are concerned by the increasing reliance on locally raised tax revenue as currently constituted. In our previous report on local authority financial sustainability and the section 114 regime, we recommended a variety of ways in which the mix of funding to local authorities could be improved, including: resetting business rates, implementing the Fair Funding Review, 75% business rates retention with additional funding put towards an equalisation grant, and revaluing council tax. For this inquiry, we heard that the amount that areas can raise through council tax is not related to need: often the places with the lowest income from council tax have a higher proportion of adults who are eligible for state support for their care. We also recognise that the decision to raise social care precept will become a harder sell for councils when residents have already seen their National Insurance Contributions increase to pay for health and social care.