29 May 2025
By Kathryn Smith OBE, SCIE Chief Executive Officer
The launch of the independent commission to transform social care marks a rare and urgent opportunity to shape the future of a system that is too often synonymous with fragility, fragmentation and failure to meet needs.
The Health and Social Care Committee’s inquiry, ‘Adult social care reform: The cost of inaction’, made the stakes abundantly clear: delay has come at a cost, not only to public finances and the NHS, but to millions of lives constrained by services that fail to enable them to live the lives they want – in homes they love, connected to their communities, with control and dignity.
The Casey Commission must be different. It must be bold where others have been cautious, inclusive where others have excluded, and rooted in evidence and experience from the outset.
The framework
The Commission’s terms of reference, published with little fanfare, offer a mixed bag. There are encouraging signs – a commitment to phased, implementable recommendations and to giving people who draw on care, and their families and carers, more power in the system. Yet the omissions are as significant as the inclusions.
There is no clarity on how the social care sector will be engaged, nor any tangible mechanism for ensuring the voices of people who draw on care and support, and unpaid carers, will shape the process. This is not a minor technical oversight. It risks repeating the core failing of past reform efforts: designing solutions without those most affected by the problem.
Neither do we have clarity about how the public’s views will be considered, nor how public consensus for a National Care Service will be built. Failure to galvanise public support has meant the many previous efforts to reform social care never took hold.
The Commission’s ambition to improve funding flows and accountability mechanisms is welcomed. These are difficult problems to address. However, a narrow focus on funding would overlook the opportunities for reforming how we organise care to deliver the greatest benefits. As part of its work, the Commission should take a more expansive view of what social care is for, who it is for, and its value to society at large, such as essential infrastructure of an inclusive society.
A vision for change
SCIE supports the Social Care Future vision. To achieve this, the Commission must embed five priorities as it undertakes its important work:
1. Co-production must underpin the Commission
Co-production must be baked into the Commission’s way of working. Co-production – where people who draw on care and support, including unpaid carers, work in genuine partnership with decision-makers to design and deliver services that are informed by and recognise the power of lived experience – must not be a retrospective and not a ‘light touch’ engagement exercise.
SCIE’s report, ‘Experiences and understandings of co-production in adult social care’, highlights the gap: only 59% of people with lived experience say they have had any opportunity to co-produce their own care.
The Commission must set a new standard: co-production not as consultation, but as governance. Dedicated resourcing, regional co-production panels, and a public commitment to acting on insights must follow.
2. Widening the lens: housing, mental health and community
The current terms of reference risk a blinkered view that treats social care as a standalone service. This would be a mistake. We recommend that the Commission take a holistic view of the care system because the social care sector interfaces with other public services and the voluntary sector.
- Housing: Housing is directly tied to health and wellbeing, especially for older adults and those with disabilities. Better housing options prevent care needs from escalating and reduce the demand for social care and NHS services by preventing falls, reducing loneliness and improving wellbeing. SCIE’s ‘Commission on the Future of Housing with Care and Support’ and the Government’s ‘The Older People Housing Taskforce Report’ both show how integrated housing and care planning improves wellbeing and reduces demand on crisis services.
- Mental health: Without accessible, community-based mental health services, people are more likely to experience crisis, hospitalisation, and long-term dependency on care. Investment in early intervention, supported housing and integrated mental health support is essential for enabling recovery and participation.
- Healthcare: The forthcoming 10-Year Health Plan lays out three key shifts for the health service, all of which require attention to the points of intersection and dependence on the social care system. Integration remains a key feature of the emerging proposals, especially in community services and primary care. As Lord Darzi recognised in his report last Autumn, we cannot reform the health service without also tackling the poorly resourced social care system.
- Community support: Expanding community-based models of care are vital to improving outcomes for people who need care and support, as well as the NHS’s financial and operational sustainability. SCIE’s ‘Supporting engagement with reablement: a practice guidance resource for reablement services’ shows the effectiveness of reablement services in promoting recovery, independence, and continuity of care post-hospitalisation. Whilst SCIE’s ‘Intermediate care guide’ indicates that 70% of people who received intermediate care after a hospital stay returned to their own home, and 72% did not move to a more dependent care setting. Maximising the potential for the community voluntary sector is just as crucial as ensuring alignment with other local public services.
3. A clear roadmap for prevention and early support
The first phase of the Commission, due to report in 2026, should make a compelling strategic and fiscal case for prevention and early support. Too often, prevention is promised but underfunded; that may partly be because it is poorly understood. The Time to Act Reform Board’s 2024 publication ‘Earlier action and support: The case for prevention in adult social care and beyond’, lays out a sound business case for rebalancing resources.
Without a prevention-first funding model, we will remain locked in reactive cycles that cost more and deliver less. The economic case is persuasive: every £1 spent on early intervention generates an average ROI of £3.17. Investing in recovery-focused and preventative services reduces demand on acute care, promotes independence, and improves quality of life.
With the forthcoming 10-Year Health Plan, the Commission has a timely policy window to position early intervention and the interdependency between health and care systems as a national imperative. The health system cannot meet its ambitions for prevention, digital transformation or integrated community services without equivalent shifts in social care.
4. Support for paid and unpaid carers
The social care workforce crisis is unsustainable; characterised by a significant vacancy rate, high turnover and poor retention, there is a knock-on effect on people’s care experiences and care outcomes, from poor care coordination to safety risks. Fair pay, career development, and parity of esteem are not optional extras, they are preconditions for a sustainable system.
The current state of the system is placing huge pressures on unpaid carers. The Accelerating Reform Fund showcases how innovation can flourish when local areas are supported to pilot new models of support for unpaid carers. The Commission should expand and embed such initiatives.
5. Clarity, accountability and long-term planning
The Commission must ensure its recommendations are not lost to the political tides. This means proposing mechanisms for long-term accountability – including an independent implementation body, cross-party oversight, and transparent progress tracking against outcomes for people, not just budgets.
Design principles for change
The Commission should embrace design thinking as its guiding approach to reform, one grounded in co-production, system integration, and radical collaboration. Design thinking enables bold, visionary aims to be translated into practical, iterative change. It is a fitting model for the kind of ‘moonshot’ ambition needed to avoid repeating the incrementalism and fragmentation of past reform efforts.
Moonshot thinking involves setting an ambitious North Star, a shared vision for a care system that supports people to live “gloriously ordinary lives”, while paving the way for clear, staged pathways to navigate the political and operational realities of delivery.
This approach should not shy away from the hard questions. Instead, the moonshot should explicitly address the historical sticking points where previous efforts have faltered, including:
- How do we fund the social care system?
- What are fair and reasonable eligibility criteria for publicly funded care?
- How do we end the postcode lottery in access and quality?
Unresolved, these challenges have consistently impeded previous attempts at reform, leading to party-political divergence and reflecting a lack of public consensus. By using design thinking, the Commission can frame these not just as policy questions, but as system co-design challenges – ones that require testing solutions at local level, with those who draw on and deliver care, before scaling them nationally.
Building from consensus
There is already a broad consensus across the care sector about what needs to change. The Commission should not waste time re-inventing what is already well supported as a North Star. Instead, it must focus on the interventions that will lead to effective change, including proposals that are feasible and affordable to implement in the near term. This would include identifying the policy levers for change, funding mechanisms, partnerships with communities and a wide range of providers, and the appropriate sequencing of changes that will lead to the shared vision over time.
This is a once-in-a-generation moment. The Commission must engage widely, act boldly, and think about the short-term pressures which need to be addressed, balanced against the long-term transformation goals.
SCIE stands ready to support its work, ensuring it is grounded in evidence, centred on people, and delivered in partnership with those who know social care best.
