Learning from the pandemic: Building a stronger future for social care

18 August 2025

By Kathryn Marsden OBE (Formerly Kathryn Smith OBE), SCIE Chief Executive Officer

On 31 July 2025, the UK Covid-19 Public Inquiry’s Module 6 concluded five weeks of evidence on the pandemic’s impact on adult social care across England, Scotland, Wales, and Northern Ireland.

For those of us who work every day to strengthen social care, this Inquiry is more than a historical exercise. It is an opportunity to understand what went wrong, recognise what went right, and ensure those lessons shape the future. If the findings of Module 6 are left on the shelf, the chance for meaningful reform will be lost. This becomes all the more important as the sector approaches critical junctures, not least the delivery of the 10-Year Health Plan and the Casey Commission.

A sector under strain

When Covid-19 arrived, adult social care was already living with long-standing pressures. For decades, the sector has operated in the shadow of the NHS; vital to the nation’s wellbeing, but chronically underfunded and undervalued.

Funding for social care is a patchwork of public and private sources. Local authorities are legally responsible for meeting eligible needs, but their budgets have been squeezed for years. In many places, funding has been held at 2011–12 eligibility thresholds, meaning more people now fall outside the scope for publicly funded support. This has led to a growing reliance on unpaid family carers and on people’s own resources, further deepening inequalities.

The sector’s structure adds to the challenge. Unlike the NHS, which is a single, national entity, social care is delivered by more than 18,500 mostly private or voluntary providers in England alone, offering a wide mix of residential care, home care, supported living, and day services. This diversity is a strength when it allows for tailored local solutions, but it can become a weakness in a national emergency when decisions are taken without understanding how the system actually functions.

Successive governments have acknowledged problems such as the “postcode lottery” in access to care and the bottlenecks in hospital discharge caused by limited community care capacity. Numerous commissions, including the Dilnot Commission in 2011, have set out solutions, but political consensus on funding reform has never been reached. Instead, we have relied on short-term crisis funding, which cannot provide the stable foundation the sector needs.

The pandemic

As such, the pandemic struck a system already under strain. The specific challenges posed by Covid-19 – its speed of transmission, the need for infection control in people’s homes and communal settings, the risks to an already stretched workforce – were not fully anticipated by public health experts responsible for pandemic planning.

In the early months, decisions were made at pace, often with unintended consequences for those who draw on care and support. Rapid hospital discharges, in some cases without adequate testing or preparation, led to harm. Suspension of parts of the Care Act reduced statutory protections. Restrictions on visiting severed vital social connections. For some, this meant months of isolation, confusion, and fear.

Public understanding of social care often reduces it to care homes for older people. This narrow view risks leaving out the millions of people supported in their own homes or in supported living. It also underestimates the sector’s role in preventing hospital admissions, maintaining independence, and supporting people to live fulfilling lives. The Inquiry heard evidence that early decision-making did not adequately consider this broader scope.

Despite the challenges, the sector responded with ingenuity and determination. Local leaders cut through bureaucracy to make rapid changes. Social workers and care providers embraced technology for virtual assessments and contact with families. Community networks stepped in to provide companionship and practical support.

SCIE’s role

While SCIE was not responsible for setting government policy, we recognised that the sector needed accessible, trusted guidance and resources. In March 2020, we established a Covid-19 information hub to address the absence of a centralised source of social care-specific advice. Throughout the pandemic, we expanded the hub’s content, disseminated a variety of practical resources, and offered a popular series of learning webinars. These efforts helped the sector implement both government policies and best practices, many of which emerged from the sector itself.

We worked with sector partners to translate complex, rapidly changing government guidance into “Quick Guides” that could be used by care workers, managers, and commissioners. These were practical, concise, and grounded in evidence-based good practice. Many were developed directly in response to questions from the frontline.

Our SCIEline newsletter and online resources reached thousands of people across the UK, including local authority staff, private and voluntary sector providers, NHS colleagues, and social workers. We also contributed to the Government’s Social Care Sector Covid-19 Support Taskforce, ensuring that the sector’s needs and realities were represented at the national level.

By summer 2020, we launched Beyond COVID: New Thinking on the Future of Adult Social Care, a programme of research, sector engagement, and policy recommendations. Our key messages then remain relevant today:

Workforce reform: improve pay, conditions, and career progression to achieve parity of esteem with the NHS.
Sustainable funding: move from short-term crisis injections to long-term stability.
Prevention and early support: invest in housing, technology, and community-based care to reduce demand for crisis intervention.

Applying the lessons: the 10 Year Health Plan

The newly published 10 Year Health Plan offers a real chance to embed these lessons into future policy. SCIE’s experience during the pandemic reinforces several of its priorities:

Integration must be real, not rhetorical, when delivering the Neighbourhood Health Service. Health and social care are interdependent; lessons from the pandemic reflect that reality.
Social care is critical to the NHS’s prevention ambition. SCIE’s ‘Supporting engagement with reablement: a practice guidance resource for reablement services’ highlights how preventative approaches can reduce long-term dependency and improve outcomes for people post-discharge, while also relieving NHS pressures.
To truly move from hospital to community, a sustainable workforce is the bedrock of this ambition. For neighbourhood services to succeed, social care workers must have pay, conditions, and professional status that reflect their vital role.

Applying the lessons: the Casey Commission

Module 6 of the Public Inquiry has confirmed what the sector has been saying for years: the vulnerabilities that shaped the pandemic response were not created by Covid-19, they were the product of decades of underfunding and piecemeal reform. Many of the systemic weaknesses exposed during the crisis are the very issues identified as far back as the Dilnot Commission in 2011. They remain unresolved today.

The Casey Commission has the potential to break this cycle, but only if it avoids the incrementalism and fragmentation that have characterised past reform efforts. SCIE’s vision is for the Commission to adopt design thinking as its guiding method: an approach grounded in co-production, system integration, and radical collaboration. This is not just about producing another report; it is about setting a bold, shared North Star for a care system that enables people to live “gloriously ordinary lives,” and then charting a realistic, staged pathway to get there.

The Inquiry has shown how, in a crisis, the absence of consensus on these fundamental questions can cost lives and limit the effectiveness of the response. That is why the Commission’s “moonshot” must directly confront the historical sticking points:

How do we fund the social care system sustainably?
What are fair and reasonable eligibility criteria for publicly funded care?
How do we end the postcode lottery in access and quality?

By framing these as system co-design challenges, the Commission can test solutions locally, working with people who draw on care, their families, and those who provide it, before scaling what works nationally. This collaborative, iterative process offers the best chance of building the public and political consensus needed to implement lasting reform. In this way, the Casey Commission can not only respond to the lessons of the pandemic but also help ensure those lessons are never forgotten.

A call to action

The Public Inquiry has shone a light on what happens when social care is treated as an afterthought. Another pandemic, or any large-scale public health emergency, would expose the same weaknesses, unless we act now.

Whilst we await the final recommendations of the Inquiry, the 10 Year Health Plan and Casey Commission are rare opportunities to put social care on a sustainable footing. Social care is not simply a service; it is the infrastructure that enables millions to live the lives they choose. The pandemic showed us the cost of neglect; the challenge now is to show the value of investment.

Module 6 of the Inquiry may have concluded its hearings, but for all of us in the sector, the work of reform is just beginning.