Who owns standards of care—and how do we make them work?

Accountability can’t become blurred responsibility

Across the series, there has been broad agreement that accountability for national standards cannot sit with one organisation. People’s lives don’t fit neatly into organisational charts. Good care depends on the combined actions of government, local authorities, providers, regulators, the NHS, community organisations, and, of course, the people who draw on care themselves and unpaid carers.

Our final roundtable confronted us with an important truth: shared accountability only works if it is visible, explicit and real. Otherwise, it risks becoming what one participant memorably described as a “sticky concept”—a place where responsibility quietly drains away until no one quite owns the problem anymore. Yet this is complicated by the complexity of how care is commissioned, funded and delivered.

There were live debates about whether a single national body should hold the ring, setting expectations, tracking progress and ensuring learning is acted on. Others argued just as strongly for a more distributed model, with overlapping responsibilities across the system—a kind of accountability “Venn diagram”, where everyone can see who is responsible for what, and how those responsibilities connect.

What mattered most, though, was not the structure itself but the culture behind it. Again and again, people returned to the need for accountability that supports learning, not fear; curiosity, not defensiveness; improvement, not box-ticking. That requires a fundamental shift away from inspection as the dominant lever of raising care standards, towards helping people say, safely and honestly: “This isn’t working—and here’s what we’re learning.”

From compliance to curiosity

This shift from compliance to curiosity also reshaped how we talked about measurement. For too long, social care has been judged by what is easiest to count—visits or tasks, for example. Yet what people consistently told us matters most are things like independence, personal choice, belonging, dignity, safety, relationships, purpose and feeling at home.

Progress, as several participants said, is not always about improvement in a conventional sense. Sometimes it’s about stability. Sometimes it’s about choosing to live differently, even more quietly. National standards, if they are to mean anything, must be able to hold that complexity and allow for individual preferences and personalisation.

There was a strong consensus that stories and data both matter to the measurement of care standards. Stories give depth, truth and context. Data gives scale, leverage and credibility in systems that still run on spreadsheets and dashboards. The challenge is resisting the gravitational pull back to narrow compliance once numbers enter the room.

And underpinning all of this is trust—or more accurately, the lack of it. Many people fear that the care data and personal information they share will be used against them: to tighten eligibility, reduce support, or trigger scrutiny. If future standards are to be meaningful, they must be built on data ownership, transparency and consent, not extraction and surveillance.

Future-proofing in a short-term system

The final roundtable also highlighted the uncomfortable gap between the long arc of people’s lives and the short cycles of politics and policy. For many people, drawing on care and support is a lifelong experience, with their needs changing over time. Workforce investment takes decades. Community capacity grows slowly. Yet national priorities can change instantly.

Participants were clear that any attempt to future-proof national standards has to grapple with the realities of:

• rising care complexity and people’s longevity
• persistent workforce shortages
• fragile provider markets
• unsustainable funding models
• deeply fragmented digital infrastructure.

These directly challenge the impact and sustainability of standards.

If standards are reprioritised every electoral cycle, we will never achieve long-term improvements. If accountability sits only within current departmental structures, it will always bend towards short-term pressures or the will of the incumbent political party. Participants were clear about the need for cross-party, cross-sector consensus—whether that comes through parliamentary agreement, independent commissions, or new governance models that embed lived experience at their heart.

This matters because national standards do more than describe quality. They shape markets. They influence the kinds of services that survive or disappear. They signal what the system truly values. If we want innovation, neighbourhood-based care, personalised support and strong community capacity to thrive, then standards and accountability must actively enable them—not squeeze them out through risk aversion and rigid compliance.

Where do we go next?

If national standards are to deliver consistency, equity and quality across the country, then they must be grounded in what matters to people, responsive to changing needs, and supported by systems that encourage honesty, curiosity and shared responsibility. That is not the easiest path. But it is, I believe, the only one that will truly stand the test of time.

With the series now having concluded, SCIE and The Access Group are pulling together the insights from the roundtables and will be publishing a framework for national care standards early in 2026.