Official portrait of Nigel Farage MP

Numbers

Their tails are up…

… that’s for sure…

… and I suspect Nigel is the sort of man who knows how to celebrate.

Reform have had a stonkingly good set of results in the local elections and will be well pleased with their national results. 

To say Labour are shell-shocked is probably an understatement. The Tories look like they’re a party of ghosts. Like it or not, the political landscape has been ploughed up.

Now, the NHS has to deal with the actuality of local authorities, run by a Reform party promising change and common sense and all the usual blah.

What will they actually do? 

A more useful question is, what can they do?

Not a lot.

Councils are legally required to provide certain services, including… adult social care and children’s services.

This is a statutory service… end of.

A situation that will get more pressured as demand rises. More-so in Reform areas where levels of social deprivation are high.

Reform’s problem is; since 2010 local authorities have seen cuts of around 25-40% in real terms to central government funding. They rely heavily on council tax, business rates, and grants, most of which are tightly controlled by central government.

Many councils, like Birmingham, are on the verge of, or have declared effective bankruptcy. The upshot, councils have no wriggle room.

The relationship with local government and Whitehall is pivotal. Labour as HMG, will have no inclination to make Reform councils any easier to run or successful.

Reform may be able to make minor changes to planning policy, maybe influence procurement policy to try and favour local providers… but even that’s tricky.

They can fiddle with branding, heritage funding, or local campaigns. Influence local partnerships but council tax rates are capped. 

Winning local control gives Reform a platform and visibility, but not much else.

Reform and radical policy change requires either national power or a reformed local government finance system. 

At best, they can prove competent or stir debate but not transform local government overnight… and they are very inexperienced. Council officers are likely to dominate.

In social care provision Reform councils will find very little room for major policy innovation, because of strict legal duties, financial constraints, and centralised regulation. 

They ‘must-do’, by Law:

  • Provide adult social care, for older people, people with disabilities, mental health conditions.
  • Children’s social services, child protection, fostering, safeguarding.
  • Assessments and care plans under the Care Act 2014.

None of this is an option. 

Failing to meet these standards opens councils to legal action, regulatory intervention and serious reputational damage.

In many Councils social care accounts for, over 60% of local authority spending. 

Costs that are increasing faster than inflation, driven by staffing shortages, rising demand and private care provider fees.

Reform could get busy with a Musk-like audit and challenge contracts for better value. Streamline assessments or admin to reduce bureaucracy but gains would be marginal and IT investments to do it, don’t come cheap.

They might try and recruit volunteers and cut non-statutory services like arts, diversity programmes but to be honest, most Councils have already done it. It’s obvious.

Councils are legally required (2010/2011 Acts) to eliminate unlawful discrimination, harassment and victimisation… and show how they are complying with the law… not just passively avoiding discrimination. 

Reform’s promise to ‘end woke’ policies will be difficult to deliver.

They can’t slash social care services, it’s illegal. Privatise or withdraw services? No, that’s blocked by national law… and they can’t raise substantial new revenue independently… it’s heavily capped.

They can make some managerial tweaks or value-based choices in social care, but they cannot fundamentally reshape the system without central government backing.

Social care is the big ticket item. 

They might attempt to prioritise ‘Locals First’ in eligibility or access. That would fit their national migration agenda.

They can’t legally deny care based on nationality, but they could politically highlight who is receiving services and campaign for changes to the national rules.

Social care is already mostly privatised, delivering the majority of home and residential care. Reform can’t do much more of that. They might in-source and try to run it cheaper. Perhaps pay relatives to provide care?

More likely; they’ll highlight ‘how broken the system is’… as ammunition for national policies come the election. Around 2m people no longer get the care they once did as eligibility criteria have been hiked to contain costs.

The recent report from the health select committee makes the point;

‘The Government does not have a robust understanding of the extent of the current system’s failings to provide people with the care they need.

Nor does it have robust data on the outcomes of delivering high quality care. Without this, it will be unable to make a clear case for reform.

You can bet the farm it won’t be long until Reform has the numbers…

Detailed breakdown of Local Authority Revenue Expenditure 2024-2025
Numbers 2

Discover more from The Training Network

Subscribe to get the latest posts sent to your email.

Previous Posts

Four classical musicians performing a string quartet in a nineteenth-century rehearsal room, illustrating Baumol’s cost disease and the limits of NHS productivity. NHS productivity and patient pathways

Anita

NHS productivity isn’t simply about working harder or treating more patients. Roy Lilley explores how shorter patient journeys, fewer interfaces and smarter pathways could transform healthcare efficiency without compromising care.

Read More »
Unfinished concrete bridge ending abruptly above a valley while a high-speed train races along a separate track towards the distant horizon. AI transformation in the NHS

Horizon

AI has arrived before the NHS is ready. Regulation, infrastructure, accountability and digital foundations remain unfinished, leaving healthcare racing to complete yesterday’s modernisation while tomorrow’s transformation accelerates beyond it.

Read More »
Overhead view of a senior management meeting room after a meeting, with a long table covered in briefing papers, notebooks, laptops, water glasses and coffee cups. Empty chairs surround the table while two officials leave the room in the background. NHS England abolition feasibility

Responsibilities

Abolishing NHS England was supposed to simplify management and save billions. Instead, workforce, legal and financial complications raise an awkward question: who decided this enormous reorganisation was actually feasible?

Read More »
NHS finance staff working on spreadsheets in a hospital office beside a busy clinical ward. NHS pension contribution £5.4bn saving

Spreadsheet

Britain may be run less by ministers than Treasury spreadsheets. NHS pension assumptions could release £5.4bn, raising a bigger question: will the NHS benefit, or will Treasury take it back?

Read More »
Staff outside Quarry House in Leeds, the NHS’s northern headquarters. NHS devolution and regional power

Power

Moving NHS managers and ministers from London to Leeds is not devolution. Real reform means transferring power, budgets and authority to regions, not simply relocating command-and-control bureaucracy further north again.

Read More »
Busy NHS community health centre waiting area with patients seated while nurses and clinical staff move between reception and consulting rooms. NHS Neighbourhood Health

Plug

Neighbourhood Health is the NHS’s eighth attempt to shift care from hospitals into communities. Without proven targets, extra capacity, workforce and double-running money, history looks likely to repeat itself again.

Read More »
Female GP prepares for the working day in a GP consultation room, with a computer, examination couch and blood sample tubes visible. NHS prostate cancer PSA testing policy

Newspaper

A quiet change to NHS prostate cancer testing shifts power from informed patients towards GP judgement, raising serious questions about transparency, inequality, evidence, cost and the future of PSA testing.

Read More »
A working mother sits in her parked car outside a UK care home, overcome with emotion after visiting her mother with dementia while balancing work and family responsibilities. Andy Burnham social care reform

Answers

Andy Burnham’s social care reforms promise fairness for families, but funding alone cannot solve workforce shortages, capacity constraints or NHS integration. After seventeen years, voters deserve detailed answers, not aspirations.

Read More »