Local government reorganisation and adult social care – where do we go from here?

In September, the Burnham government announced a review of the local government reorganisation programme (see box below) and a ‘pause’ on related activity in most local areas where reorganisations had been planned. This followed councils threatening legal action over reorganisation plans in their areas and media allegations of gerrymandering. 

Local government is responsible for funding and organising publicly funded social care. So, the Health Foundation and ADASS brought together leaders representing social care and NHS providers, local government and central government to explore what this means for adult social care. 

Reorganisation could bring benefits but structures alone do not improve outcomes

Government plans for local government reorganisation (LGR) aimed to reduce duplication, improve public services and deliver efficiencies. It was also looking to achieve closer alignment between local government boundaries and larger strategic authorities established as part of the devolution agenda.

At our roundtable, there was broad agreement the government’s ambitions for LGR have merit. This included opportunities for more coherent planning and commissioning at a local level between social care, health, housing and other local services. Some providers, for example, provide both social care and housing, so unitarisation could enable more effective working with a single council to meet the needs of local people. Participants also agreed that boundary alignment between councils, NHS organisations and strategic authorities could help support collaboration across local public services.

But leaders at the roundtable were clear that structural change is not a solution in itself. Available evidence that supports this view includes a review of academic research, which concluded there is ‘no consistent or conclusive’ evidence larger councils are inherently more efficient and effective than smaller ones. Lessons from previous reorganisations suggest benefits can take time to materialise and success depends less on the structures adopted than on factors such as effective implementation, leadership and change management. Participants felt LGR processes in some local areas had become overly focused on boundaries, mergers and institutional interests, rather than outcomes for local communities and people who draw on care and support. 

The impact of disruption and uncertainty should not be underestimated

The LGR programme under review is significant in scale and could affect nearly a third of the population in England, who still live in two-tier areas. Central government received 69 council proposals in 2025 for new unitary authorities – including multiple proposals from different councils in the same area. Before the programme pause, proposals were being implemented in many areas.

At the roundtable, we heard how affected councils had already committed significant time, leadership attention and resources to preparation, causing considerable disruption and risking distraction from other priorities, including care services. This chimes with evidence on the impact of previous restructures in local government and wider public services. For example, a 2011 academic study found councils experienced increased expenditure and declining performance while preparing to shift from two-tier to unitary status.

While welcomed by some areas, the pause and review have also caused disruption. Leaders at the roundtable raised questions about what it means for boundary alignment of councils with strategic authorities; whether anticipated efficiency savings from reorganisation will still be achievable; and the effect of continued uncertainty on workforce morale and stability. Alongside these more immediate concerns, they expressed fears about the long-term impact of both contested reorganisation processes and the current review. In some places, the process has strained relationships and created distrust, both between organisations locally and between local and central government. Some feared that this could not only affect the resilience of these local systems but also broader ambitions to reform social care. Rebuilding trust and repairing working relationships will be essential if future reforms are to succeed.

The broader policy agenda has shifted

The policy context has changed dramatically since the LGR programme began in 2024. The Burnham government has committed to fundamentally ‘rewiring the state’ by shifting power, funding and accountability from Whitehall to local leaders. It has signalled greater uncertainty about the future of NHS reform but greater ambition for social care reform, accelerating the work of the Casey Commission to deliver a National Care Service. And care providers and commissioners are preparing to implement significant workforce reforms.

This creates challenges. At the roundtable, leaders questioned the ability of local systems to absorb concurrent major reforms, particularly given existing pressures on care services. And the LGR saga has highlighted gaps in local government capacity and capability to deliver major structural change. While the immediate future of reorganisation remains uncertain for many parts of the country, building change management capabilities should be a priority given the wider programme of reform facing local government and social care under this government. 

There is also uncertainty about the implications of these various policy agendas for social care. For example, leaders were unsure whether strategic authorities will be taking on greater responsibility for social care in the future – and whether they have the capabilities to do this. And some raised potential tensions between the government's ambition for a National Care Service, with its emphasis on greater consistency, and a devolution agenda that promises greater local autonomy.

At the same time, people at the roundtable generally recognised the opportunities the Burnham government’s agenda could create. Better alignment between care, health, housing and other services could support a more joined-up approach to improving population health. Leaders also saw potential to place greater emphasis on prevention in social care as part of the devolution agenda, while giving local areas more flexibility to design services around the needs of their communities.

In this changing context, debate on the future of the LGR programme is not simply about where to draw boundaries. The more fundamental question is how responsibilities for social care should be distributed between Whitehall, strategic authorities, councils and neighbourhoods. And the challenge for policymakers is to ensure that changes support better outcomes for people and communities, rather than treating organisational reform as an end in itself.

This blog draws on a roundtable on 2 October, chaired by Richard Humphries. Thanks also to Eva Shah and Mike Chard for their contributions to background research and planning for the event.