Transforming adult social care
Alongside our market-shaping programmes, Norfolk County Council is delivering a major transformation programme to reshape how adult social care operates across the county. This work is grounded in six strategic aims and delivered through integrated portfolios of change that bring together health, housing, providers and community partners.
Our approach is built on the principles of Human Learning Systems - a model that focuses on relationships, learning, and collaboration rather than process and performance alone. This means we are testing and learning as we go, co-producing solutions with providers and communities, and scaling what works. The aim is to deliver meaningful, sustainable change that improves quality, strengthens independence, and delivers better value for money.
Communities and neighbourhoods
This portfolio is about building a preventative, place-based offer in partnership with communities, local councils and the wider Integrated Care System (ICS). It includes initiatives such as local area coordinators, integrated neighbourhood teams, and asset-based community development pilots. The programme also explores the use of AI and digital tools to enhance community engagement and service delivery. The goal is to strengthen local networks, reduce demand on statutory services, and improve health and wellbeing outcomes through early intervention and community empowerment. For providers - this will mean we will be working increasingly on PCN footprints and testing integrated neighbourhood teams (INTs) which should include you as part of a multi-disciplinary team.
Population health management
This portfolio aims to shift the system from reactive to proactive care by identifying and supporting people at risk earlier. It includes the rollout of a proactive intervention operating model and the implementation of a cardiovascular disease (CVD) population health management programme across the ICS. The programme is already underway and will continue to evolve through 2025/26, with a goal of aligning NHS and social care strategies by 2026/27. It supports improved health outcomes and reduced demand by focusing on prevention and early intervention. For providers - this will mean increased opportunities for those delivering preventative interventions, such as reablement, information advice and guidance and targeted wellbeing interventions like physical activity.
Relational practice and community-led support
Focusing on embedding relational, strengths-based practice across adult social care, this portfolio supports workforce development, digital transformation, and quality assurance. It includes redesigning assessment tools, piloting new digital systems, and running organisational development workshops to define "what good looks like." The programme is being delivered in partnership with place boards and primary care networks, with learning experiments planned for 2025/26 and wider rollout from 2026/27. The aim is to improve the quality of social work practice and ensure that support is tailored to individual strengths and aspirations. For providers- this will mean interacting with redesign assessment and review processes (and associated tools) that are more focused on relational, strengths, and asset-based approaches.
Commissioning
The commissioning portfolio is focused on transforming adult social care commissioning through integrated, place-based approaches, with a strong emphasis on co-production and quality procurement. The programme is structured as a three-year transformation and aims to deliver improved wellbeing for residents, better care quality, and more efficient use of resources. For providers - this will mean the development of key partnerships to respond to key areas of sufficiency and market sustainability.
Intermediate care
The intermediate care portfolio focuses on transforming the bedded and home-based intermediate care offer for Norfolk residents. It aligns NCC and NCH&C priorities to deliver a more integrated, responsive system that supports people to regain independence and avoid unnecessary hospital admissions. Key areas include reablement, 24-hour unplanned care response, and digital integration such as shared records. Learning experiments will test new models in 2025/26, with a view to wider rollout from 2026/27. This work supports the broader ambition to integrate community care and reduce demand on acute services. For providers - this will mean growing reablement activity and reducing short term bed-based provision that does not offer recovery support.
Complex community support
Alongside community healthcare, we are focused on transforming the bedded nursing care market to ensure there are sufficient high-quality and affordable services, alongside expanding supporting residents through a new approach to delegated health interventions. For providers, this means we will work with you to improve pathways into nursing care including revising policies, processes, training etc; improve ways of working between health and social care staff, underpinned by a new contract; and develop integrated commissioning strategy, with a clear plan to develop the required nursing capacity through ways that offer greater market sustainability.
Going forward
In the coming months, there will be opportunities for providers to hear more about the transformation programme and to get involved in shaping its delivery. We will work with providers through forums, newsletters, and dedicated engagement sessions to co-design, test, and refine new approaches together. As we move forward together, that same principle of collaboration applies when we consider the financial and operational challenges ahead. We recognise the very real pressures that continue to affect providers, and the following sections set out the key risks, national policy context, and how we are working together to respond.
Understanding the risks and the current financial context
The adult social care market in Norfolk continues to face significant pressures. Future risks around provider failure and market stability include:
- Unfunded national policy changes: national policy changes - such as the increase in employers' national insurance contributions (NICs) - have introduced new cost pressures for providers and councils alike, without additional funding to offset the impact. This creates growing concern over the long-term financial sustainability of local care provision.
- Provider financial viability: many providers are operating in an increasingly difficult environment, with rising operational costs and limited scope to absorb further pressures. This can affect investment, innovation, and long-term stability.
- Workforce capacity and retention: the recruitment and retention of a skilled, workforce remains one of the most significant risks to market stability. Pressures around pay, conditions, and career pathways continue to challenge the sector.
- Uncertainty around social care reform: while reform is needed, the lack of clarity around implementation timelines, responsibilities, and funding levels creates significant uncertainty for the sector. This makes it harder to plan, invest, and adapt with confidence.
We remain committed to working transparently with the market to understand and manage these risks. Our approach to market shaping and commissioning is designed to support providers in navigating these challenges - focusing on stability, sustainability, and the quality of the care and support provided.
Social care reform and the case for sustainable funding
National social care reform remains uncertain. Key proposals announced by the previous government - such as the introduction of a lifetime cap on care costs and changes to how care is funded - will now not be taken forward. We recognise that this uncertainty continues to make forward planning and investment difficult for providers, particularly in the context of rising demand, workforce challenges, and inflationary pressures.
Although the national reforms have not progressed, the work we undertook with providers during 2022/23 remains valuable. It gave us a clearer understanding of the gap between the average fee rates paid by the Council and the median rates calculated through the national fair cost of care exercise. This insight has shaped our local approach to funding and market stability in the years since.
Looking ahead, the government launched the Casey Commission in 2025 to examine the current state of adult social care in England and make recommendations for future reform and funding. The review will be delivered in two phases:
- Phase 1 will report in 2026, setting out medium-term recommendations
- Phase 2 will follow in 2028, focusing on longer-term reform proposals, including the potential development of a National Care Service
In the meantime, Norfolk County Council remains committed to transparency and partnership with the sector. Through our annual fee review process and ongoing dialogue with providers, we continue to shape a funding approach that reflects real pressures, supports sustainability, and maintains a focus on delivering better outcomes for people.
We are also actively engaging with the Norfolk Care Association, regional peers, and national networks - including ADASS and the County Councils Network - to make the case for long-term reform and sustainable funding. We believe Norfolk's voice must help shape the future of adult social care policy, and we will continue to advocate strongly on your behalf.
We will keep providers informed as national decisions unfold and work with you to respond to the outcomes of the Casey Commission and any future reform proposals.
