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.

During these difficult times, my dad worked hard to keep the family moving forward, all while dealing with everything himself. He raised myself and my siblings largely by himself. Luckily, we had the support of other family members and our friends. Whether it was helping with childcare when things became too overwhelming, spending time with us, or simply being there to listen.  

Over time, I came to understand that this was our ‘community.’ Their support didn’t remove the hard times, but it made all the difference. That is why this year’s theme, ‘community’, means so much to me.  

Mental health doesn’t mean you need to exist in isolation; it is deeply important to connect to the people around you in your support networks. This could be family, friends, neighbours, work, schools or clubs; your community could have the power to help someone in a time of need.  

I do want to be clear; I don’t blame my mum for anything. Mental illnesses are not a choice, and she was doing the best she could in incredibly hard circumstances. I have very fond memories of my childhood, and we have a wonderful relationship to this day.  

Mental Health Awareness Week encourages everyone to talk more openly, challenge the stigma and discrimination, and promote mental well-being for individuals and communities. It is a very important reminder that mental health can affect anyone, in any part of your life, and it is ok to ask for help and support.   

How SCIE is supporting mental health  

The Social Care Institute for Excellence (SCIE) believes that strong communities are built through great care and support that respond to people’s real lives. Improving social care is essential to supporting mental health, by helping people stay connected to their communities, maintain relationships and access opportunities.  

During Mental Health Awareness Week, it is important to highlight how better social care improves outcomes for individuals and families living with mental health conditions.   

Here’s how we are contributing to better mental health outcomes:  

• Promoting strength-based approaches: SCIE champions strengths-based, person-centred models that focus on individuals’ strengths, including personal strengths and community networks, promoting their wellbeing.   
• Providing support to achieve integrated care: We are working with the Local Government Association to produce an accessible and practical resource that supports local systems in fulfilling their ambition of integration, encouraging services to work together.   
• Supporting co-production: Co-production with people with lived experience of social care underpins and informs what we do, and we actively involve people with lived experience in designing and improving services, because we know the best support is built with the people who use it.  

The Mental Health Foundation have selected a great topic this year, and has some very useful information on their website to explain more about Mental Health Awareness Week and the theme of community.  

Resources

What good looks like (local.gov.uk)

NHS England » Brick by brick

NHS England » Joint guiding principles for integrated care systems – learning disability and autism

National strategy for autistic children, young people and adults: 2021 to 2026 – GOV.UK (www.gov.uk)

Building the right support for people with a learning disability and autistic people – GOV.UK (www.gov.uk)

NHS England » Meeting the needs of autistic adults in mental health services

Learning from Lives and Deaths – people with a learning disability and autistic people (LeDeR) – King’s College London (kcl.ac.uk)

NHS England » Culture of care standards for mental health inpatient services

These kinds of communities exist in all shapes and sizes. Last year, I came across some great practice in Northern Ireland, where General Practice Multi-Disciplinary Teams are connecting people to both informal and formal communities. The positive impact on individuals was clear to see.  

As a professional, I’ve learnt over time that it is not so much my knowledge of a subject that matters—it is more the links I have with people and communities. The wider and deeper those links, the more creative and locally relevant the support becomes for each person.  

So, this Mental Health Awareness Week, take some time to find out what is happening around you. Like a squirrel gathering for winter, store that knowledge. You never know when a friend, colleague, or client might find it helpful.    

And finally, ask yourself: Who might you connect those Year 9 and 10 boys to?   

Resources

What good looks like (local.gov.uk)

NHS England » Brick by brick

NHS England » Joint guiding principles for integrated care systems – learning disability and autism

National strategy for autistic children, young people and adults: 2021 to 2026 – GOV.UK (www.gov.uk)

Building the right support for people with a learning disability and autistic people – GOV.UK (www.gov.uk)

NHS England » Meeting the needs of autistic adults in mental health services

Learning from Lives and Deaths – people with a learning disability and autistic people (LeDeR) – King’s College London (kcl.ac.uk)

NHS England » Culture of care standards for mental health inpatient services

For example, local groups. My colleagues and I are involved in  groups outside the workplace, many of them centred around sports and fitness. It’s a longstanding recommendation ‘to keep active’, but the groups are much more than that, they are connection and belonging, bringing people together for a common interest and often creating spaces for more meaningful conversations, support and friendships.

This, to me, is a key consideration in applying the Care Act’s wellbeing principles that relates to social and economic wellbeing and contribution to society and supporting people to connect with opportunities where they live.

Supporting early intervention and tackling inequality

People also often associate mental health support with psychiatrists, psychologists and hospitals. Some of the most impactful mental health support starts before this, in local, primary and community arrangements. I’ve seen incredible work from mental health nurses based at GP surgeries, talking therapies, mental health hubs, schools (to name a few).

It’s also important to recognise that local, small, community support is likely to have better knowledge and connection with groups who often face inequities in accessing mental health support, including black people, autistic people and people with learning disabilities.

Early mental health, help, is not just good to have, it’s vital, people don’t want to turn up at A&E to access mental health support, it is not a therapeutic or inclusive environment, it needs to be available where people live, in places they feel safe to walk into or pick up a phone to – in the small places close to home.

This is a thread that drives our work with integrated care systems in addressing inequalities in mental health support, and supporting them to identify and implement solutions that improve health and social care, for people drawing on (or trying to draw on) mental health support.

As we look to the future, SCIE remains dedicated to creating spaces where diverse voices are not only welcomed but drive change—ensuring our work continues to reflect the needs and strengths of the communities we serve.

To learn more about how you can get involved in this year’s Mental Health Awareness week, please see the Mental Health Foundation website.

Resources

What good looks like (local.gov.uk)

NHS England » Brick by brick

NHS England » Joint guiding principles for integrated care systems – learning disability and autism

National strategy for autistic children, young people and adults: 2021 to 2026 – GOV.UK (www.gov.uk)

Building the right support for people with a learning disability and autistic people – GOV.UK (www.gov.uk)

NHS England » Meeting the needs of autistic adults in mental health services

Learning from Lives and Deaths – people with a learning disability and autistic people (LeDeR) – King’s College London (kcl.ac.uk)

NHS England » Culture of care standards for mental health inpatient services

Investment in social care

The path forward is clear: Achieving the NHS reforms will depend on a parallel investment in social care services.  This is the case for all three policy shifts expected in the NHS 10-Year Plan.

Through local care services we can deliver personalised, high-quality, and financially sustainable services that meet the care needs of people in their communities and allow them to live independently for longer—thus improving NHS efficiency.

What’s needed is tangible investment and prioritisation of all community services to relieve the strain on local health and care systems.

However, in its current state, the social care sector faces significant and critical challenges: inflation, demographic and epidemiological changes, falling recruitment and retention, and rising demand are placing immense pressure on care and support services and impacting their quality and availability. As a result, the sector relies heavily on unpaid carers who, sadly, often do not get the recognition or support they deserve.

The Case for intermediate care and reablement

The human case for joint investment is critical. Take intermediate care, for example. Intermediate care services are provided to patients, usually older people, after leaving hospital or when they are at risk of being sent to hospital. Our research indicates that 70% of people who received intermediate care after a hospital stay returned to their own homes, while 72% did not move to a more dependent care setting—giving them the crucial opportunity to maintain their independence, dignity, and quality of life.

The economic case for investment is also compelling:  wider sector research demonstrates that every £1 invested in earlier action and support, including intermediate care, achieves an ROI of, on average, £3.17.  Acting on known interventions shouldn’t depend on where the benefits accrue. We should consider the effects on ‘whole systems’ instead.

Beyond funding, we also need to find new ways to deliver social care more efficiently and effectively. For example, there are substantial opportunities to enhance post-discharge assessments and care, particularly through reablement services. Reablement is a short-term, intensive intervention aimed at helping individuals regain or maintain their independence after events like hospital admissions.

SCIE published a series of evidence-based and practical recommendations in 2024 in our ‘Supporting client and family engagement with reablement’ resource to address the barriers that can prevent people from fully benefiting from reablement. Resources like this can help streamline care delivery, ensuring that support is targeted, timely, and productive.

A vision for the future of health and social care  

The Government’s vision is for an NHS that is both resilient and sustainable—but turning that vision into reality requires decisive action. The adult social care sector, employing approximately 1.59 million people and contributing approximately £68.1 billion to our economy annually, is a ‘sleeping giant’ of largely untapped potential.

If we get future reforms right, we can tackle the pressures facing both health and social care and create systems that are fit for the future.

He can tell the weather in a visitor’s home by observation alone. He can defeat the worst of criminals with his intellect and deductive reasoning. He can protect the weak with his mastery. However, he is rude, irascible and breaks the law at his own discretion. In addition, he misuses substances, can’t maintain healthy relationships and has an exploitative network of child workers in the Baker Street Boys. 

So, would we be glad if Sherlock Holmes was real or are we better off that he is constrained within the walls of fiction? Is he the perfect detective or a liability?

In addition to fictional doctors and detectives, I am sure that we can all think of many television and film lawyers, judges, nurses, spies and the like. And yet social care doesn’t show up on our screens with any frequency.

Do the general public even know what workers make up the social care workforce? Do they know about the family support workers, the youth workers, the care workers, the occupational therapists and the social workers? Do they know about all the other people who make up the rich tapestry of children and adults’ social care? Do they know what we all do? How we all fit together? How what we do makes a difference?

I think you’d be hard pressed to find fictional examples of the perfect social care worker. That’s a challenge, as a sector do we have an exemplar out there who really stands for our values, professional skills and priorities? Which caped crusader really speaks to social care?

I think we are probably lucky that we don’t have too many of the negative, counter examples either. We are not rich in the anti-social care worker types. As much as the general public might not be able to conjure up a famous, fictional “perfect” reablement coordinator. I think they also cannot cite the most awful, fictional placement broker. And there is a benefit to this, because we don’t have to counter unrealistic and unproductive examples. We will be judged by people directly on their experience of us, not against a fictional template – good, bad or indifferent.

So, we have an opportunity to write a fresh script when we are working with people who have not experienced social care previously. This is an enormously valuable opportunity and it is important to reflect on whether we fully capitalise on this opportunity in our work.

However, there are many people who we work with, where we are not encountering people fresh, they have already formed an expectation based upon their encounters with others within social care. It is not fair on us that they are pre-judging us based on the actions of others, but this is our reality.

This is our reality, but it is also an opportunity. We have an opportunity to reverse the impression. We have an opportunity to break the pattern. We have the opportunity to start anew.

We also have the opportunity to show how to build constructive, professional, caring relationships with people who are wary, cautious, and watchful. This is a powerful message that we can send. We are here to work with you, here to be in a caring relationship with you and here to help even if you feel suspicious about me and others like me. We can work with you regardless.

I think social care aspires to work with people in this embracing and resilient way. However, it is not always easy to be this inclusive and resilient as a worker when we are working within stressed systems.

I think there is an important diversity point that needs to be made here. One of the joys of social care is that so many different professional roles combine to make our social care systems work. We are inherently diverse in our constitution. But we also are enriched by the diversity of people who fulfil these roles. We have people with an academic background, a practice background and a lived experience background. Sometimes all 3. We have people from all ages and stages of life. We have people of all backgrounds, religions, races and beliefs. We have people on their first day in social care and people with decades of experience. This means, there is no one view of how to be the perfect social care worker, but we are all continuously creating multiple different ways to be a good social care worker for this individual, this carer, this young person, this family and this organisation. Personal excellence, relational excellence and excellence within frameworks.

So, how do we measure whether we are operating well as workers within this social care system? We have dashboards and datasets. We have reporting and scorecards. We have regulators, inspectors and standards. But we also have the experience of all of those who draw upon our services for care and support.  

SCIE is proud to host a co-production steering group, and within Think Local, Act Personal (TLAP) we also have the national co-production advisory group. These bodies help SCIE, TLAP and the rest of the sector in distilling excellence via the voice of lived experience. 

If you want to progress your practice and go further along your improvement journey with participation, engagement and co-production, then please get in touch. SCIE is happy to meet and discuss how we can be part of your co-production journey.  

Ensuring that your systems, practices and strategies are co-produced might not make them perfect, but it will go a long way to ensure that they are meeting the requirements of your people. And if any of you are worried, I think we can safely say that nobody would co-produce a detective like Sherlock Holmes, nobody would co-produce a doctor like House despite what the TV might have you believe.  

So, who is the perfect social care worker? Nobody knows. And that’s OK.  

More of the same is simply not a possibility and something needs to change. If we adopt a proactive model of care across statutory and voluntary community services, we can help transform the lives of those who need care and support.

Adopting a proactive model of care 

A sustainable social care sector is fundamental to the success of the NHS. Social care plays a crucial role in supporting people both to prevent the need for emergency care and to recover after a hospital stay. However, the sector remains overstretched, underfunded, and reactive. Adopting a proactive approach would enable community services to focus on early intervention and recovery, reducing the strain on hospitals and improving outcomes for individuals. 

For example, our ‘Intermediate care guide’ illustrates how effective community-based models can transform care pathways. Among people receiving intermediate care following a hospital stay: 

• 70% returned home safely. 
• 72% avoided transitioning to higher-dependency care. 
• 92% maintained or improved independence. 

Similarly, reablement services demonstrate the impact of supporting people to regain abilities after hospitalisation. SCIE’s ‘Supporting engagement with reablement: a practice guidance resource for reablement services’ highlights the positive outcomes for recovery and continuity of care. By prioritising these approaches, we can embed proactive, joined-up care at the heart of neighbourhood services. 

This isn’t just about better care; it’s about addressing systemic challenges. A proactive model of care will require statutory and voluntary services to collaborate more effectively, working together to identify risks earlier, intervene sooner, and integrate care seamlessly. 

Investment in community services

 Central to achieving this government’s ambitions for the NHS is a significant investment in community services. Years of underfunding have left the social care sector with workforce shortages, service gaps, and challenges in meeting growing demand. This has affected the entire system: hospital discharges are delayed, recovery is hindered, and preventable crises escalate. 

Investment in community services is essential. It is particularly urgent for services that support recovery after a hospital stay, where timely and effective care can prevent readmissions and improve long-term outcomes. Without proper resourcing, the aspirations of government will remain unfulfilled. 

The economic case is compelling. The social care sector’s work on early intervention through the Time to Act Reform Board ‘Earlier action and support: The case for prevention in adult social care and beyond’ demonstrates that 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.  

The human case is just as critical. People recovering from illness or injury should have access to care that helps them regain their strength, independence, and dignity. This is not a luxury, it is fundamental to building a sustainable and compassionate health and care system. 

Time for action  

The government’s vision for a sustainable NHS is ambitious, but it is achievable if we commit to action. This includes: 

• adopting a proactive care model across statutory and voluntary services, focused on prevention and recovery
• investing in community services to ensure timely hospital discharges and effective recovery pathways
• building partnerships to deliver joined-up, person-centred support. 

When we get this right, the impact is transformative, not just for the NHS but for individuals and communities.  

Reappraisal of geography  

Local government reform (LGR) brings the real opportunity to join up services around ‘places’ and across the local system that are difficult to achieve in some geographies. There is near unanimity on the power of delivering services through localities and the consequent clearer focus on the goal of keeping people independent, at home and closely aligned with their local communities and getting great support from local ‘community assets’. 

However, there remains a challenge in many two-tier areas that these localities often seem to reflect a professional and efficient division of geography rather than those geographies necessarily recognised by other services, partners and residents and communities themselves. 

SCIE believe there are often greater synergies that could be achieved through a more coterminous locality delivery model which maximises the ability to collocate and work together cross-service and cross-organisation more effectively. 

Needs analysis and risk stratification   

One of the biggest shifts we have seen across the sector is a shift in the way data is being analysed to improve intelligence about care needs, vulnerability and risk. 

This new wave of data analytics and risk stratification work, partly buoyed by the developments in population heath management techniques in local systems, provides greater opportunities to focus prevention efforts and manage key risks that bring people into the care system much earlier (such as falls, UTIs etc.). 

Sophisticated data and performance management approaches can also help to manage the escalation of care needs and are becoming an increasingly important way of maintaining independence for longer periods in their own homes. 

This opportunity should be placed ‘front and centre’ of new care and support strategies. In many ways, evidence-based care and support are fast becoming a real, deliverable organisational driver for decision-making and the design of care and support delivery.  

Transforming practice models 

Most local authorities, if not all, are pursuing strengths-based practice models as a key philosophical foundation in their approach to care and support. Most local authorities are in the midst of implementing and embedding this model and the benefits that this will bring. This good work should continue to be prioritised and supported and, SCIE believe, is one of the keys to the sustainability of the service in the future. 

Strengths-based thinking takes time to embed. We often find that while there are clear commitments to strengths-based working, key supporting processes and systems are often in conflict with these principles which can lead to the persistence of deficit-based thinking and working. 

There is a significant opportunity to properly incubate strengths-based working through more aligned processes and systems, workforce empowerment, valuing creativity and encouraging reflective practice and peer learning. 

We are also seeing the increasing use of technology at scale in the approach to practice. Digital tools, assistive technology and artificial intelligence (AI) are becoming increasingly used elements of triage, evidence-based decision-making, monitoring, engagement, knowledge management and risk identification. Technology, particularly AI, will continue to build on fundamentals, as in AI transcribing, with further opportunities to significantly enhance ways of working and productivity. 

In many ways, we are entering an era where the expectation is that care professionals will need to work hand-in-hand with technology to deliver their work effectively. We believe that transformation of practice should lie at the heart of all ASC structural thinking and new delivery models. This is another cultural change that ASC must embrace. 

  Rethinking commissioning strategy and market relationships  

The final critical success factor of our five success factors is the transformation of commissioning and the role that service providers and the local ‘market’ can play in the delivery of new ASC strategies. 

Too often we see commissioning models that aren’t aligned sufficiently with practice models and service strategic ambitions and create a critical ‘disconnect’ in the way care and support services are delivered. 

There are some great examples of co-produced, outcome-based services that are delivering quality results and joining up responsibilities for delivering new strengths-based care models. 

However, there is still a long journey to deliver commissioned services that provide continuity and deliver on key strategic intentions. There is often too big a gap between social care practitioners and commissioners and not the confidence, ethos and partnership arrangements in service providers to deliver effectively. 

Partnership working and building market capacity will be key to delivery in the future, particularly as care estate needs to evolve and place increasingly less emphasis on long-term residential care as a solution to meet individual care needs. How local authorities work closely and flexibly with the local care markets is likely to see increasing emphasis over the next few years. 

Close working with housing services and planners will be critical to setting out needs and building infrastructure to meet the needs of the next generation of individuals receiving care and support. It will be a key element in meeting the tsunami of need and demand that is coming. 

While we have identified just five critical success factors in the transformation of ASC (we could easily add to this list and I am sure readers could too!), if local authorities embrace these challenges and LGR delivers marked change in these areas it would be a process that has delivered real value. 

SCIE is working with councils across all tiers to support them in assessing and understanding preferred options around the future provision of ASC. We would love to talk to you to explore your thinking and your priorities in your areas. 

Our team have been actively involved in the development of LGR business cases (and subsequent change programmes) in the previous four rounds of LGR – so we have some insight – and understand the difficulties – from all of this learning and previous processes.  

Here at SCIE, we’re all about collaborating and innovating to improve lives, so we are keen to share and support you.

Despite this progress, the sector faces significant and critical challenges. Inflation, demographic and epidemiological changes, falling recruitment and retention, and tightening local authority budgets are placing immense pressure on care and support services and impacting their quality and availability.  

On 3 January 2025, the Government launched the Casey Commission to inform the creation of a National Care Service underpinned by national standards.  

There is understandable reason for apprehension. This is not the first Commission that has been launched and the first and second phases of the Commission won’t report until 2026 and 2028 respectively.  

However, there is real cause for optimism. The Commission has the potential to end decades of gridlock and create a clear roadmap for how care and support will be funded and delivered going forward. 

At my evidence session with the Health and Social Care Committee on 8 January 2025, I emphasised that social care is fundamentally about people – the millions of people who draw on care and support daily as well as those who provide care. The Commission needs to be guided by an inclusive approach to engaging with the sector, putting the people who use services at its centre. Such an approach will also create agreement about the key design principles needed to guide the planning of a social care system fit for the future, one which builds on the consensus and partnerships that already exist across the sector.  

It is now our responsibility to work with the Commission to create a more responsive, sustainable, and equitable system. This is a real moment to create a system that enables people who draw on care and support to live fulfilling lives. There are challenges ahead, but I have confidence that the resilience, dedication, and passion within the social care sector will see this vision realised. 

SCIE believe all of these structural decisions are rightly the result of debates and discussions with local communities, including people with lived experience of drawing on care and support, politicians (both local and national), local businesses, public sector partners, the voluntary sector and other key stakeholders on the right configuration of local government in different geographical areas. There is no ‘one size fits all’ model.

The position of ASC may be further complicated by the recent announcement of the independent  commission into adult social care to inform the work needed to deliver a National Care Service. The recommendations of the commission will no doubt bring further dimensions to this debate, with the reporting timetables for the commission likely to coincide with critical LGR discussions and considerations.

It is currently unclear how all of these different policy strands will work as an integrated and aligned process.

However, crucially LGR does bring a ‘once in a lifetime’ chance and the opportunity to fundamentally re-think ASC, to build new service delivery models with residents and potentially new local authorities. 

While it might feel like we are seeing ‘once in a lifetime’ opportunities with ever-increasing frequency, SCIE does believe this is a genuine opportunity that provides a great platform for service transformation.

The timing of LGR is particularly interesting given the real challenge that complex demographics will bring to most areas over the next decade. Based on the demographic changes, ASC will need to develop new ways of working that are capable of delivering with significantly greater demand for services and probably without much fiscal wriggle room.

SCIE is working with councils across all tiers to support them in assessing and understanding preferred options around the future provision of ASC. We would love to talk to you to explore your thinking and your priorities in your areas.

Our team has been actively involved in the development of LGR business cases (and subsequent change programmes) in the previous four rounds of LGR, so we have some insight (and bruises) from all of this learning and previous processes. 

As always at SCIE, we are keen to collaborate and share. 

Firstly, I was struck that this was an adult who was abused and yet, who on the face of it did not have any vulnerabilities that would have prompted involvement from formal services. A lack of vulnerability does not, in this instance, protect you from harm.  

This reflection is self-evident if you consider the assaults on Mme Pelicot through the lens of crime. In this country, we are able to use multiple lenses and consider these types of abuse as crimes but also as safeguarding difficulties.  

In adults’ safeguarding, I suspect that no authorities would have been aware of Mme Pelicot had this situation arisen in the UK. In children’s safeguarding, there is a greater sense that we should be aware of people at harm, but again, in a case like this, should this have been a child, with all the positives apparent and all the harm secret, would there have been any opportunity for services to be made aware? 

This raises the critical question, how do we safeguard those people we don’t know about?  

Many organisations feel overwhelmed by the responsibilities of safeguarding, feeling like it is an impossibly high bar for them to uphold and that the consequences of not living up to it are serious. 

I think this French trial speaks to these fears, the worst imaginable crimes have taken place and we were collectively powerless to prevent it.  

SCIE works with organisations to audit and review their safeguarding activities, policies and processes. We also support organisations by offering training. All of our safeguarding support is delivered by professionals with extensive experience of safeguarding in a multitude of settings, local authorities, charities, faith organisations, health locations and education settings. We bring this professional experience and learning from the national evidence to help organisations to find their own way to uphold the highest standards of safeguarding. 

To consider the counterfactual, if this had taken place in England it would require a multi-agency response and would meet the high risk threshold for MARAC (Multi-agency risk assessment conference). This emphasises the importance of a multi-agency response to serious incidents.   

No society is immune to evil acts, but we can strengthen as many systems as we can to make them unlikely. We can reduce the odds by ensuring that all of our services have the most robust safeguarding processes in place. We can audit and review regularly to ensure that our systems remain fit for purpose. And we can train all practitioners in safeguarding to maximise the number of eyes, minds and hearts who are skilful in spotting abuse. We can also make sure that we report all of our concerns and ensure that the responsible agencies act upon these concerns.  

Recognising coercive control

A second reflection on this case is that domestic abuse comes in many different guises. Domestic abuse is often a crime and also a safeguarding matter.  It is, as in this case, also something that happens in privacy, behind closed doors and within the home.  

The terminology coercive control is used to describe these types of situations, where a person has their rights, health and wellbeing undermined. This is a type of harm and abuse that remains difficult for professionals to recognise and in the UK has only been a criminal offence since 2015. Recognition of this type of harm is essential for us to respond to the safeguarding matter, to prosecute the crimes and to restore safety for the individuals. Recognition is at the heart of safeguarding activity. 

Domestic violence is incredibly risky for individuals because of this secret nature of the abuse. It relies on several features to become apparent. It relies on the courage of the person to report it and if this happens they need receptive services to offer support. It relies upon the observation skills of friends, families and other members of the community to raise the topic with the individual and to offer help. It also relies upon all those community services to put the information together and to realise the risks and harms.  

Again, this can seem like a responsibility and a burden for the organisations. However, in SCIE’s training, we offer advice around the tricky subject of domestic abuse, including how to be trauma-informed in response to it, who to talk to and how to report it, and most importantly how to recognise the signs. Our training aims to give all of us who work in related services the practical skills needed to intervene and reduce this harm. 

Addressing digital and cyber harms

As a final reflection, in this case there has been an online, cyber and digital element. The abuses of Mme Pelicot were, it is my understanding, made possible by the digital technology we now have available to us.  

I am not intending to get into the debate as to whether technology is a good or bad thing for society. However, it is important that we continue to evolve our safeguarding law, regulations, systems, processes and practice to reflect the changing demands and pressures that the evolving technological landscape presents. 

So, here at SCIE we propose three things: 

• Governments to continue to ensure that they are using their power to reduce the opportunities for abuse with legislation, regulation, practice guidance and high quality information 
• digital organisations to work with national and local governments to reduce the opportunities that the emerging technologies provide for abusive content 
• use of training to ensure that online, digital and cyber harms are understood and acted upon by all who use providing services. 

In conclusion, I hope you will join me in grieving this case in France, in sympathising for Mme Pelicot and her family and in continuing to find ways that we can constructively respond to these horrific circumstances and take all the steps necessary to ensure that they cannot be repeated.  

Given this embarrassment of riches, I was pleasantly surprised to talk to someone at NCASC who said to me “I have the best job in social care”. 

What a brag, what a boast, or indeed, as my children would say, what a flex. 

I am going to repeat it, she claimed that she has “the best job in social care”. 

Do you want to argue with her about that? Is your job the best job in social care? Do you know someone who has the best job in social care?  

Now, I am not going to name this person, I am not going to divulge their job title and I am not going to reveal which local authority they work for. It would not be discreet. I am also not going to incite a competition about who has the best job, I don’t think a league table would fit with our professional values. However, I am going to talk about what this person said made their job “the best job in social care”. I think there is something valuable to be learnt about what it is that gives us pride in our professions.  

So, she said “we know every child we look after”. In smaller authorities, or authorities with lower numbers of children looked after, it is easier to have a close view of children even when one has a strategic-level role. However, it seems to me that having this personal level of understanding of the children in our care is the ambition of every local authority.  

Here at SCIE we are fortunate to host the charity Think Local Act Personal (TLAP) and they have spent years developing the personalisation tool Making It Real. Making It Real is a wonderful, multipurpose tool which allows us to understand how our services, systems and performance are perceived by those people who are directly in receipt of services, and also serves as a method for self-assessment. This is achieved by the powerful simplicity of the co-produced set of ‘I/We statements’. I can easily see why the Care Quality Commission (CQC) have adopted these into the assessment framework for their assurance programme: A truly personalised method of not only understanding what a person’s experience of system is, but also one that moves us on from knowing the name, identifying number and legal status of a child. This framework moves us away from just understanding what we think needs to happen for a child, and moves us far more into that relational, outcomes-focused space that we have been aspiring to.  

So, maybe more of us can share this trait of the “best job in social work” and maybe we can all know the children in our care from a personal perspective. 

What else did this blessed social worker say? She told me that they have to be creative with every child in their system. Now, I imagine that this will be a statement that will divide opinions. There will be people reading a requirement for professional creativity and feeling an absolute sense of horror. This dread could be of two types: How can a person continuously perform creatively? and; How can we ensure that our services are consistent if we are creative? 

There will be, I presume, people reading this and rejoicing at the prospect of working in a creative environment. There are many people working in both children’s and adults’ social care in all roles who are determined to be creative in their practice. They bring their creative drive to their direct work with individuals, they make original plans, they devise new services and this benefits their own professional sense. This aids the people they work with and also the systems and services they operate within. 

Adopting digital innovation requires a creative approach and feeling able to take risks – safely, which is important as it offers such huge potential for social care reform. 

 At SCIE, within our consultancy and our safeguarding work, we have sought to bring responses to those two questions above together. We support organisations to achieve robust, consistent and reliable services, while also having a requirement for creativity and personalisation. One of the reliable pleasures of working to spread the benefits of a strengths-based approach is that creativity is the hallmark of this practice. This is also reflected in our approach to digital innovation, demonstrated by our work with councils such as Bromley, and our new partnership with Agilisys, leading sector provider of Generative Artificial Intelligence (GenAI), helping councils adopt the AI products safely and ethically. 

In a strengths-based practice framework, practitioners are empowered to be creative in their work with individuals. They are released from bureaucracy that continually reproduces the same limited palette of options, and they are encouraged to look to see whether there are personal, local, flexible solutions that are more authentic to the individual in question.  

And so often when I speak to people about the pleasures that they find in their social care work, it is this creativity and strengths-based approach they talk about. Occupational therapists will brag about how strengths-based their profession is, family support workers will show off about how much they work with the unique circumstances of their families, and social workers will flaunt how they secured sustainable outcomes by working creatively. 

Except no, they don’t. They don’t brag, or show off, or flaunt. Because we are a humble sector and we tend not to display our successes. We tend to feel pride for the individuals. However, I hope that there are many people reading this short blog who also feel that they have the best job in social care. Or maybe in your organisation there is someone or ‘several someone’s’ with the best job in social care. Indeed, having that ambition for our workforce seems like an interesting stance to assume when thinking about the cross-cutting workforce issues.  

Even if we aren’t aiming for this high peak of the best job in social care, I think we can take on board the learning that personalisation and creativity elevate our work. SCIE can evidence that these practices elevate social care. They can be achieved practically. They sound high-minded but like all things that are valuable, they rely on repeated high standards found consistently across systems. Whatever job you have in social care, SCIE has seen people working with creativity and applying the same care to all individuals. And where we see it in practice, it is coupled with a quiet job satisfaction from the privilege of doing a job well.