A vision for reform is only the beginning. Gerard Crofton-Martin, Interim Chief Executive at SCIE, explores what it will take to turn ambition into better lives—from sharing power with people who draw on care to joining up services and tackling inequities now.
The Prime Minister’s commitment to a National Care Service, outlined at the Labour Party Conference, marks a significant turning point for the social care sector. The challenge now is turning this commitment into meaningful reform.
Previous attempts to reform the adult social care system have hit political and public gridlocks. The result was short-term, incremental progress rather than the transformational change the system desperately needs.
Building the foundations for reform
Breaking that cycle requires clear understanding of both why we deliver care and how to incentivise improvements in the quality and experience of it. This in turn requires a focus on the foundations that make improvement possible. This means investing in workforce capability and leadership, strengthening commissioning practice, improving data and digital infrastructure, and ensuring sustainable funding. It also means building stronger connections across health, social care, housing and community services, so that support is better coordinated around people’s lives.
Just as important is ensuring that reform is understood and supported beyond the sector itself. Lasting change will require public – and political — understanding and support. Without a strong and sustained case for change that resonates beyond the sector, previous reform proposals have failed to endure. To achieve this, there must be a clearer understanding of what social care is, who relies on it, and the difference reform could make to people’s lives.
If a future National Care Service is to deliver the lasting change that previous efforts have not, it must also be shaped by the people who experience social care every day: the people who draw on care and support, unpaid carers and frontline staff. Together, they bring invaluable perspectives and expertise that must be recognised and respected. Their insights will be essential to understanding how proposed system reforms will work in practice and where unintended consequences may arise.
There are established approaches for involving people with proven benefits. One option is Making it Real, which translates people’s experiences and priorities into a shared understanding of what good, personalised care and support look like. At the heart of engagement is co-production: working in partnership by sharing power between people who draw on care and support, carers, families and citizens. Co-production must be embedded throughout reform, from setting priorities and designing solutions to testing ideas and evaluating progress.
The Casey Commission’s Big Conversation on Care provides an important opportunity to do this. Its first phase attracted 7,776 proposals and more than 709,000 votes, demonstrating the appetite for change. With the platform due to reopen later this winter, people who draw on care and support, unpaid carers, professionals and the wider public should be encouraged to engage. Their contributions will be vital in shaping a National Care Service that addresses the underlying causes of inequity, rather than simply its symptoms.
The same principle should shape how we define improvement in a new care system. Success is typically centred on the things systems find easiest to count, rather than the outcomes people themselves value. This includes things like having genuine choice and control over their lives, experiencing continuity in support, maintaining relationships and community connections, feeling safe, independence, and being able to navigate services with ease and confidence.
Making change happen now
While the long-term shape of a National Care Service is still emerging, there is much that can be done now to rewire the social care system and improve access, quality, and outcomes for people who draw on care and support. SCIE’s ‘How care inequities shape social care experiences’ report highlights how inequities are systemic, deep-rooted and compounded by factors such as geography, financial circumstances, disability and ethnicity. Addressing these challenges will require sustained investment and structural change, but that should not prevent us from making meaningful improvements now.
One immediate priority is reducing the burden placed on people who draw on care and support, and unpaid carers, to navigate an often complex and fragmented system. SCIE’s research shows how people are too often left to navigate between organisations, repeat their story to multiple professionals and take responsibility for coordinating their own care. Practical improvements such as clearer and more proactive information and advice, named points of contact, better continuity of support, accessible non-digital routes and culturally appropriate services can help address some of these challenges.
Funding and commissioning arrangements also have a role to play. Emerging approaches, such as the work underway in Greater Manchester to embed prevention across local services, demonstrate how partners can begin working differently within existing structures. Mechanisms such as pooled budgets and gain-share arrangements could help further align incentives and encourage more collaborative, preventative approaches.
Ultimately, the success of a National Care Service will be decided by how we collectively translate ambition into practice and change. This is a once-in-a-generation moment to create a system that helps people live the lives they want to lead, in homes they love, connected to their communities, with autonomy, dignity and control over the support they receive. We must use it to ensure we grasp the opportunity to deliver the lasting change that has, for so long, remained out of reach.
