A few weeks ago, I sat with a group of social workers in a cramped council office. They spoke about the people they had supported that week: a man with dementia whose wife was exhausted beyond words: a young disabled woman whose independence depended on a single morning care visit that kept being cancelled and a family in crisis after months of trying to get help that never came.

For those working in local government, none of this is surprising. They live it every day.

Many times, I have seen first-hand the impact local government has, from working on the Troubled Families programme, in homelessness, on anti-social behaviour.

And yet, over the past year as we have been meeting councils from up and down the country, I have been struck by how alone and isolated people in local government can feel when it comes to social care.

Take the relationship with health services. Let's be honest, when we refer to health – the NHS, I think we are talking about a National Hospitals Service. People are treated and discharged in a system driven by moving patients in and out as quickly as possible. I hear countless examples, including from medical professionals, that the NHS can provide people with medical treatment costing many thousands of pounds a day, but often cannot provide basic care like walking someone to the toilet.

This is not just about money, as the arguments around reform are so often dominated by, but about infrastructure and integration. I have seen a system where responsibilities are shared but power is not. ICBs, in theory designed to knit systems together, in practice often focus on joining up parts of the health system, with social care treated as an adjacent cousin rather than integral.

Decision-making around Continuing Healthcare, for example, remains a source of deep frustration from many of the councils I have spoken to. Despite joint assessments, final decisions overwhelmingly sit with the NHS, often leaving councils to absorb both cost and consequence.

Or, let's look at a different area. Nowhere is the value of local government more visible or more irreplaceable than in safeguarding. Councils bring together democratic accountability, local proximity and statutory powers in a way no other public agencies can match. They see patterns of risk, exploitation, self neglect and provider failure as they emerge.

Yet, unlike children's safeguarding, adult safeguarding has no national mechanism for learning from serious incidents, identifying patterns or escalating risks. Councils carry the burden of safeguarding without the national architecture that other parts of the welfare state rely on.

I used my first speech on social care to call out this abdication of national responsibility and called for the delivery of a new, national safeguarding board led by the chief social worker.

Or, let's turn to the legislative framework. The Care Act, widely regarded as a landmark piece of legislation, set out a modern vision for a new type of person-centred care. Yet without the money or workforce to deliver it, councils have been put in the impossible position of being responsible for rights they cannot fully realise. If councils are to be truly able to deliver the care they are capable of, they need the conditions to be able to do so.

Or look at how social care is funded. The social care precept, introduced in 2016-17, looks neat on paper: localism, democratic choice. But in reality it is government delegating – saying this is too difficult, too politically risky, so we will let councils carry the can. We are left with a social care system entirely reliant on local authorities increasing council tax each year for a service which is poorly understood and hidden from most taxpayers' view. That is not a vote winner.

No one person or agency is to blame for the challenges we face. We are all operating in a structure that evolved by accident rather than intentional design. We owe it to the public, and to the many social workers and carers stretched to breaking point, to build something better

A national conversation will be our opportunity to do that. This cannot be a technocratic project. It is about what people believe is fair, what families can reasonably be expected to do, and what they want the state to provide.

If we are serious about building a National Care Service with the clarity and national legitimacy the NHS enjoys, then local government cannot remain an afterthought. It must be fully visible, an equal partner in designing a system to replace the one it shoulders every day. Without this, a National Care Service will be an illusion built on local strain.

Baroness Louise Casey is chair of the Independent Commission on Adult Social Care