If there is a bulge now into children’s mental health services, we can reliably predict that there will be a rolling bulge into adults’ mental health services over the next few years. We need to consider this swell as we resource and plan our adult mental health services.  

When SCIE has supported Local Authorities and mental health trusts with reviewing their mental health pathways, knowing your data, understanding your populations and being able to predict with accuracy are critical for enabling service flow. And fluent services are central to the smooth experience of people through a system.  

If our services are going to be effective, then the experience of engaging, accessing, and exiting services needs to be smooth. A challenging service experience is additional stress, burden, and pressure on the person accessing support.  

In addition, we are all seeking to move towards an early help and preventative model across health and social care. So, we need to be thinking about this high rate of young people accessing mental health and consider how we can achieve support for them through a “reduce, prevent, delay” lens.  

Again, when SCIE works with systems, ensuring that there are well-commissioned services to enable earlier help, peer support, and community assets is essential to meeting need. None of us wants the system to get better at saying no to people who have genuine needs. We want to get better at finding help that is easy, swift, and palatable. We want to meet needs and outcomes by having straightforward options that do contribute to mental health recovery and prevention.  

Married to this need for good commissioning is the need for strong practice. This means adopting a personalised and strengths-based approach to mental health support. And central to these approaches is a confident management of risk. When SCIE supports practice in the sector, we always focus on building a shared and confident management of risk. Where practice is strengths-based and risk confident, we are empowering the individual to develop and enhance their own resources. The link to a recovery approach is evident. In our experience, the young people who are accessing mental health services don’t want to be trapped in services indefinitely, they want flexibility and independence. This means services that can be there when crisis situations emerge, but also that encourage choice and control for the individual.  

SCIE is in the midst of working with partners from across children’s and adults’ social care, young people, families, carers, and other stakeholders to think about a national set of practice principles and guidance for the transition from children’s to adults’ services. Mental health needs to be central to this conversation.  

So, if you would like to join SCIE in this important, national conversation then please sign up to our workshops, complete and share our survey and get in touch by emailing transitions@scie.org.uk. We want to hear as much as we can from all of you.  

As a not-for-profit charity, SCIE supports the development of innovative solutions to address challenges faced by children and families, helping ensure high quality, co-produced, ethical and evidence-based practice.

What is guaranteed?

What does the system promise people — and on what basis?

The Care Act provides a framework for answering this question. It describes a system centred on wellbeing, independence and participation. In that sense, it can be read as an articulation of what people should reasonably expect.

But those expectations are not always clear in practice.  Access to support depends on eligibility thresholds, local interpretation and available resources. For many people, the point at which support becomes available remains uncertain. This uncertainty shapes how people experience the system, often requiring them to navigate complex processes at moments of stress or crisis.

Reform requires greater clarity about what is guaranteed, and for whom.  That, in turn, brings into focus the boundary between the responsibilities of:

• the state
• the individual
• the family

These questions can be approached in different ways. At one end of the spectrum are more collective models of provision, in which risk is pooled across society and entitlements are more clearly defined. At the other are arrangements that place greater emphasis on individual responsibility, with the state providing a more limited safety net.

There is no settled consensus between these positions. But reform cannot avoid the need to work through their implications, including how they shape expectations, incentives and the distribution of risk.

How is it funded and sustained?

How are costs and risks shared over time?

Adult social care already operates as a mixed economy. A significant proportion of care is funded privately, with individuals and families bearing a substantial share of financial risk. This reflects a system in which public funding, private contributions and unpaid care all play a role in meeting need.

Reform cannot assume a blank starting point. It must work with — and, where necessary, rebalance — these existing arrangements.  That raises practical questions:

• how public funding interacts with private contributions
• how self-funders are treated within the system
• how funding arrangements support, or undermine, long-term sustainability

The mixed economy also provides flexibility, responsiveness and capacity that would be difficult to replicate through wholly public provision. At the same time, it can create variation in access, experience and outcomes, and can expose individuals and families to significant financial risk.

These are not simply questions of affordability. They shape incentives, access and public expectations, and influence how the system is experienced in practice.

Who is responsible for what?

How responsibilities are defined and exercised is a central design question.  In practice, responsibility is shared:

• between national and local government
• between health and care systems
• and between the state and the individual and their family

As longevity has increased, and eligibility for publicly funded care has tightened, the line between what is provided through the NHS and what is subject to means-testing has shifted. These changes have taken place gradually and are not always visible to those who rely on services.

These shifts have not always been explicit, nor widely understood.

Attempts to bring health and social care into closer alignment have often highlighted these underlying questions of structure and accountability — rather than resolving them. Efforts to integrate services have exposed differences in funding models, entitlement and governance that reflect deeper design choices within the system.

Reform therefore requires clarity not only about formal responsibilities, but about how those responsibilities are made real in practice — through commissioning, funding flows, data and accountability.

These questions also extend beyond social care alone, touching on housing, public health and income support. The boundaries between them are often experienced as blurred, even where responsibilities are formally distinct.

How is consistency achieved?

How does the system ensure that people experience reliable, high-quality care wherever they live?

This brings together several elements:

• workforce stability and capability
• standards that clarify expectations
• the sustainability of providers
• the capacity to innovate and develop new models of care

There is a persistent gap between agreement on what good looks like and the consistency with which it is delivered. This is reflected in variation in access, quality and outcomes across different parts of the country, and for different groups of people.

Standards can help to address that gap, but only if they support improvement rather than constrain it. Consistency does not require uniformity. It requires clarity about outcomes, alongside space for local leadership and provider innovation.

At the same time, reform is delivered through a diverse provider landscape. Provider viability, and the ability to invest and innovate, are part of how the system functions in practice. The resilience of this landscape is shaped by workforce conditions, funding flows and the wider economic environment.

These questions are not abstract.  They reflect an existing distribution of responsibility in which individuals, families and independent providers already carry a significant share of cost and risk. Evidence consistently shows that unpaid carers and providers absorb pressures where the system is under strain.

Reform must therefore do more than restate ambition. It must work through how these arrangements are aligned, and where they may need to be rebalanced.

That, in turn, requires making trade-offs explicit.  The question is not what the system stands for. It is how its different elements are brought together in a way that can be delivered consistently, understood by the public, and sustained over time.

For many years, the need for reform has been widely recognised. There is broad agreement about purpose: supporting people to live well, with dignity, independence, choice and control. That ambition is reflected in the Care Act’s focus on wellbeing, and in wider work that has sought to articulate, in more accessible terms, what people should be able to expect from care and support.

Yet reform has repeatedly stalled. The reason is not the absence of ideas, or even of shared intent. It lies in the gap between agreement and implementation.

The Care Act illustrates this tension.  It provides a framework that is more adaptable than is sometimes recognised. It sets out not only duties and responsibilities, but an underlying proposition about what good care should enable — a focus on wellbeing, participation and individual control. In that sense, it can be read as an articulation of expectations as much as a piece of legislation.

But those expectations are not experienced consistently in practice. Access varies. Outcomes vary. People often encounter care at the point of crisis rather than through a coherent offer understood in advance. For many, social care remains something encountered late and under pressure, with choices often constrained by what is available locally.

This reflects a more general problem. The key elements of the current arrangements are not aligned:

• funding and entitlement
• workforce and commissioning
• national ambition and local delivery
• public provision and a predominantly independent provider market

A significant share of care is already funded by individuals and delivered by independent providers. Responsibilities — financial and operational — are distributed across the state, families and the market, often implicitly rather than by design.

The result is not simply variation, but a lack of clarity about how the different parts fit together.

In this context, reform is not simply a matter of policy intent. It requires working through how these elements relate to one another in practice. Developing a shared understanding of people’s journeys through the care system highlights the gaps, but also what matters most to people themselves.

That, in turn, brings trade-offs into view.  Reform involves choices: between pace and affordability, national consistency and local flexibility, collective provision and individual responsibility. These are not constraints on ambition. They are how ambition becomes actionable.

They also surface a tension that has not always been addressed explicitly: between the aspiration for choice and control, and the constraints created by funding, workforce capacity and local variation.

Without clarity about those choices, government is presented with pressures rather than propositions. Different parts of the sector make legitimate claims, but without a shared account of how those claims can be reconciled.

The result is caution. Reform drifts. Incremental change becomes the default. The care sector, especially people who draw on care, are regularly dismayed and disappointed by the lack of progress.

There is also a more basic constraint.  Public understanding of social care remains limited. Many people encounter the system only when they or a family member need support. The boundaries between health care and social care are not well understood. The financial rules are opaque. There is no single, visible institutional identity.

In these conditions, reform struggles to build a public mandate.

This matters because the questions at the heart of reform — what people should expect, who should pay, and on what basis — are not only technical. They are questions about the relationship between the state and the individual.

The Casey Commission has been explicit that a national conversation is needed to address them.

The effect is familiar.  There is agreement about what social care should achieve. There is less clarity about how it is organised. And there is limited consensus about how costs and responsibilities should be shared.

Reform stalls not because the destination is unclear, but because the route has not been worked through.

The task now is not to restate the case for change, but to align the conditions under which change can be delivered.

• Why reform stalls – SCIE
• What would a working social care system require?- SCIE
• Who makes reform work? Delivering Adult Social Care change in practice- SCIE
• Making care work fairly: evidence, experience and equity – SCIE
• The work reform leaves behind – SCIE

Adult social care in England is often described as a system. In practice, it is better understood as a set of arrangements that have evolved over time, shaped by successive reforms but never fully brought together as a coherent whole.

There is no shortage of agreement about what good care and support should deliver for people who draw on care and support, and also for their carers. This has been articulated through Social Care Future’s ‘North Star’ vision: “We all want to live in the place we call home, with the people and things we love, in communities where we look out for each other, doing the things that matter to us”.

The Care Act sets out a clear ambition, grounded in wellbeing and individual rights. Think Local Act Personal’s Making It Real framework translates these statutory duties into outcomes expressed directly through lived experience. Its co-produced ‘I statements’ describe what good support should look and feel like for people drawing on care and support, and these are presently being used as part of the regulation of social care.

What is less clear is how these ambitions are translated into arrangements that can be delivered consistently, understood by the public, and recognised in people’s lived experience.

This matters because the wider context is shifting. The Casey Commission has been established to build a clearer public mandate for reform, including through deliberative engagement. At the same time, policy attention is focused on workforce, choice and control, and integration with the NHS.

Yet reform has historically stalled despite repeated attempts. The system remains fragmented, and progress has been incremental rather than structural.

The purpose of this series is to explore that gap between ambition and delivery.

It does so by focusing on four related questions:

Article 1: Why reform stalls

Agreement on purpose has not translated into a system that can be delivered in practice.

Reform has not failed for lack of ambition or consensus. The Care Act and wider sector thinking provide a clear account of what social care should achieve.

But the key elements of the current arrangements — funding, entitlement, workforce, commissioning and delivery — are not aligned.

Without clarity about how these elements fit together, reform remains partial and incremental. Public understanding is limited, trade-offs are avoided, and political risk outweighs momentum for change.

Article 2: What needs to be designed

Reform depends on working through the choices that shape how social care operates in practice.

Reform is not a statement of principle. It is a set of choices about how arrangements would work in practice.

Four sets of questions sit at the heart of this:

• what is guaranteed, and for whom
• how costs and risks are shared over time
• who is responsible for what, across national and local government, health and care, and individuals and families
• how consistency in outcomes is achieved within a diverse provider market, including the shift from crisis response to earlier intervention

These questions reflect an existing mixed economy, in which responsibility is already distributed across the state, individuals, families and providers.

Reform requires working through how these elements are aligned — and where they may need to be rebalanced.

Article 3: Who makes it work

Reform depends not only on policy, but on the capacity to deliver and sustain change.

Previous attempts at reform have focused on legislation or funding. Less attention has been given to how change is translated into practice.

A functioning approach depends on infrastructure and capability, including:

• workforce development and leadership
• standards and guidance
• commissioning and accountability
• data, evidence and learning
• a sustainable and innovative provider market

These functions exist but are not yet organised as a coherent whole. Reform also takes place within a mixed market, where providers, investors and self-funders play a central role in delivery.

The challenge is not to start from scratch, but to bring these elements into alignment in a way that can be enacted and sustained over time.

Article 4: What reform must achieve

Reform must be judged not only by coherence, but by whether it delivers fair and consistent outcomes.

Adult social care is experienced unevenly. Access varies, outcomes vary, and people’s experiences of care are not consistent.

These differences are not incidental. They reflect how the system is organised — including funding arrangements, workforce capacity, commissioning practices and the structure of the provider market.

Addressing this requires attention to three dimensions of equity:

• equity of access — who gets support, and when
• equity of experience — whether people feel informed, heard and in control
• equity of outcomes — whether care improves lives and reduces avoidable harm

Work by SCIE and others highlights a persistent gap between ambition and experience, and the importance of co-production in shaping solutions that work in practice.

Reform must therefore be judged not only by whether it is coherent, but by whether it produces outcomes that are fair, consistent and recognisable in people’s lives.

Overall framing

This series does not propose a single model for reform.

It argues that progress depends on something more fundamental:

• clarity about how the current arrangements fit together – and where they fall short
• a willingness to work through trade-offs with the public, people who draw on care and political leaders
• a shift from advocacy towards shared design
• and a focus on whether outcomes are fair and consistent in practice

In that sense, it is intended to contribute to the wider public and policy conversation now underway — including the work of the Casey Commission — by focusing not only on what should change, but on how change becomes possible.

Paul Burstow is Chair of the Social Care Institute for Excellence (SCIE). He served as Minister of State for Care Services from 2010 to 2012 overseeing the drafting of the Care Act and was a Liberal Democrat MP from 1997 to 2015.

SCIE has co-produced a working definition of equity in social care, inspired by the World Health Organisation’s definition of health equity, which reads: 

“Equity in social care means the absence of unfair, avoidable, or remediable differences in access to, experience of, or outcomes from care and support among groups of people – whether defined by social, economic, demographic, or geographic factors, or by characteristics such as sex, gender, ethnicity, disability, or sexual orientation.” 

In our online conference and other activities, we’ll be exploring a range of approaches that aim to further the cause of equity, and we’ll be highlighting projects that are challenging unfair, avoidable and remediable differences by the work they’re undertaking in the real world. We’ll be facilitating conversations and providing opportunities to learn from people with lived experience and practitioners in the field. We want to inspire people to make a difference in the communities they are part of. 

I’m pleased with what we came up with as a title in the end. ‘Who Gets Care?’ not only raises questions about accessibility, but it also has the meaning of who understands what we mean by care – what it means to the people who access care and support, to unpaid carers, service providers and policymakers. It’s likely that there will be different understandings, differences in emphasis, and differing priorities. But I’m sure there will also be key issues that impact on everyone, and something we’ll be able to do is identify the ways in which co-production is essential in addressing these issues. 

One of the titles we considered for the week was ‘Is Care Fair?’  We decided not to go for that, because it’s been established that the answer to the question is ‘no’. Apparently, we’re living in a world in which everyone knows that care isn’t fair, which raises the question of what we’re going to do about it. Co-production Week will play its part in helping us to rise to the challenge of that question, and show how SCIE can help support you in answering it. If you meanwhile want our support to help improve your co-production approach, or just a chat about it, do contact consultancy@scie.org.uk. 

 SCIE’s work: Get me to hospital 

The MCA can be used by health and social care practitioners to take a person unable to make decisions for themselves to hospital for urgent, potentially life-saving physical health treatment when they are refusing to go. However, evidence from the 2023/24 ‘LeDeR Annual Report: Learning from Lives and Deaths – People with a Learning Disability and Autistic People’, makes it clear that practitioners struggle to make these decisions and use the MCA correctly, with catastrophic consequences.  

The report, which investigates the death of every adult with a learning disability and autism in England to understand what happened, improve care, reduce inequalities and prevent future premature deaths, demonstrated that people with a learning disability are three times more likely to die from a condition which could have been treated.  

SCIE’s ‘Get me to hospital’ project looks to support both the individual who is at the centre of decisions relating to conveyance to hospital, and the practitioner responsible for arranging, or undertaking, conveyance of them, to address these inequalities.  

Our ‘Get me to hospital’ guide was co-produced with the Stop People Dying Too Young (the LeDeR programme) – Inclusion North group. It explains how to assess decision-making capacity, when the MCA can be used to support decisions about hospital admission, and how to determine best interests lawfully and compassionately. It encourages forward planning instead of crisis response; knowing the person well, understanding how they communicate distress, and having clear plans in place can make these situations safer and less distressing.  

SCIE has also published a ‘Get me to hospital’ e-learning course that is designed to deepen understanding. It takes learners through a potentially life-threatening situation involving care practitioners, healthcare workers and families, and asks how the MCA should be applied to make the best decisions for the person concerned.  

SCIE’s work: Introduction to the Mental Capacity Act and Deprivation of Liberty for professionals working with children and young people  

While the MCA applies from the age of 16, DoLS formally apply only to those aged 18 and over; however, recent years have seen a growing number of cases where courts authorise the deprivation of children’s liberty to keep them safe when no less restrictive options are available.  

This is not a niche concern reserved for specialist lawyers or senior clinicians. It is a reality that a residential support worker, a teacher, a community nurse or a social worker might face on any given day. Yet many practitioners feel underprepared to navigate these situations with confidence. 

That’s why, last year, SCIE developed a course titled, ‘Introduction to the Mental Capacity Act and Deprivation of Liberty for professionals working with children and young people’. The course, designed for practitioners from a wide range of organisations and in a wide range of roles, explores the core principles of the MCA and the legal framework around DoLS, and how they apply to children and young people. Participants are encouraged to hold the legal framework alongside a commitment to rights-based, child-centred practice—asking not just ‘Is this lawful?’ but ‘Is this right for this young person, at this point in their life?’ 

Impact  

SCIE’s work around MCA and DoLS is supporting people to live fulfilling lives and creating a fairer and more equal society, where care maximises people’s choices and removes social inequality. 

Our ‘Get me to hospital’ resource has had a measurable and demonstrable impact, with a frontline professional reporting that it is being actively used to secure hospital admission for people who are frightened or reluctant to go into hospital. This feedback has highlighted that it is influencing practice and improving outcomes for people.  

And participants on our ‘Introduction to the Mental Capacity Act and Deprivation of Liberty for professionals working with children and young people’ course fed back that they left with not just improved knowledge, but a clearer sense of how to apply it—and share it—in their day-to-day work. 

We continue to develop training and guidance in this space. Follow SCIE on social media and sign up to our newsletter to stay informed about new courses, publications, and practice resources.  

To find out more about this area of work and what SCIE does more broadly, read our Impact Report 2025/26, which spotlights key projects over the last year and their outcomes.  

Action for yourself 

I have experienced anxiety for as long as I can remember. It manifests in different ways depending on the situation I’m in—and it ranges in severity from relatively minor to completely debilitating—but it’s almost always there. Because of this, I didn’t realise there was anything ‘wrong’ with me until I suffered a significant mental health crisis in my early 20s; anxiety was, and is, my ‘normal’.  

My experience isn’t unique. Most of us aren’t mental health experts, and most of us don’t always understand what we’re feeling, why we’re feeling it, or how to cope with it. That’s why it’s important that when we’re talking about acting for our own mental health this Mental Health Awareness Week, we aren’t conflating that with facing mental health challenges alone.  

Taking action for our own mental health will, for most people, mean reaching out to professionals, friends, and family for support—at least initially. I know I wouldn’t have the tools and strategies that allow me to now manage my mental health (mostly) independently without having first had extensive treatment.  

Action for someone else 

Given this, one of the most effective actions we can take to support someone else with their mental health is to empower them to reach out for help.  

People often assume that this means being able to identify when someone is struggling. The reality, however, is that no two people experience mental health challenges in the same way. They won’t always display the behavioural changes you might expect, and some behaviours (reduced food intake, for example) can be very difficult to recognise unless you’re around someone all the time.  

We also can’t underestimate the significance of mental health stigma. I became an expert at hiding how I was feeling because of a deep, pervasive sense of shame—to the extent that I spent much of my early recovery repeatedly apologising to my family for ‘letting them down’. This is, again, certainly not a unique experience.  

We can’t rely only on ‘noticing the signs’, therefore. We also need to make sure people feel comfortable enough to come to us about their mental health. Being willing to talk about our own is essential to this; people find it much easier to be vulnerable and honest with someone who has previously been vulnerable and honest with them. This doesn’t need to be profound—simple actions like admitting to a colleague that you’re finding a project overwhelming can identify you as a safe person to talk to.  

We also need to be brave enough to ask the question when we’re not sure if someone needs support. It’s always better to approach someone (sensitively) and get it wrong than potentially leave them to suffer alone. You can find out more about how to approach conversations about mental health, and what to do if someone discloses a problem, here.  

Action for all of us 

Empowering people to reach out for support is crucial. So is ensuring that, as a society, we have the right systems in place to provide that support when they do.  

This means addressing the systemic barriers that make it harder for some people (often because of factors like age, gender, disability, ethnicity, location, and socioeconomic status) to access high-quality mental health treatment.  

It also means changing the way we collectively frame the mental health conversation, which is often inaccurate and stigmatising—focused on questioning the validity of people’s mental health problems instead of what factors are causing them.  

SCIE’s work 

There is reason to be optimistic. The Mental Health Act 2025—which marked a significant reform of the Mental Health Act 1983—was a welcome step towards a system that more effectively protects and supports people like me. 

SCIE hosted three advisory groups in January to understand how the sector is responding to the Mental Health Act 2025 and to ensure our work is credible, co-produced, and delivers practical, evidence-informed support. Our new report shares insights from these advisory groups, highlighting the immediate reactions, concerns, and support organisations will require to meaningfully implement the change.  

Ultimately, we’re working to promote approaches that are person-centred, led by people’s lived experience, and focused on their strengths. To find out more about our new offer in this area, sign up for our mailing list and tick mental health here. 

And to find out more about Mental Health Awareness Week, how you can get involved, and access free resources, visit the Mental Health Foundation’s website. 

A practical framework to support local areas 

The Housing Toolkit was designed to support local authorities to take a more structured, evidence-informed, and co-produced approach to housing strategy development. 

It brings together ten steps that guide local areas through key stages—from understanding demand and identifying what people want from their homes through to understanding cost and benefit and engaging with stakeholders. 

Although the toolkit focuses on both autistic adults and adults with a learning disability, it is important to recognise that these are distinct groups. People’s experiences, support needs and housing preferences vary, and the toolkit is designed to help local areas understand and respond to this diversity, rather than applying a one-size-fits-all approach. While developed with these groups in mind, the approach is intentionally adaptable. The principles of combining robust evidence with meaningful co-production are relevant across a wide range of housing and support contexts. 

At its core, the toolkit is about bridging a common gap: the disconnect between high-level strategy and the lived reality of people’s everyday experiences. 

Learning from the pilot 

To test how the toolkit works in practice, SCIE partnered with Norfolk County Council and Cumberland Council between October 2025 and March 2026. The pilot focused on the areas that local authorities identified as most critical to strengthening their strategies. Across both areas, a consistent message emerged: having a structured approach helped teams move forward with greater clarity and confidence. 

The toolkit provided a shared framework that brought together different partners—including housing, adult social care, data teams, and people with lived experience—helping to align perspectives and priorities. It also supported a more consistent way of working, particularly in how evidence is gathered, interpreted, and used. 

Importantly, the pilot reinforced that co-production needs to be embedded throughout the process. When people with lived experience are involved in shaping not only the outputs but also the approach itself, the resulting strategies are more grounded and meaningful. 

What difference did it make? 

While each local area applied the toolkit in a way that reflected its context, several common benefits were identified. 

Greater clarity in decision-making. Local teams reported that having a clear structure made it easier to move from broad ambition to more defined strategic thinking. 

Stronger connection between evidence and action. The approach supported a more systematic way of linking what is known about local need with what should happen next. 

More joined-up working across teams.  The process helped break down silos, creating space for collaboration across services that do not always work closely together. 

Building local capability. Rather than relying on external outputs alone, the pilot focused on developing tools, approaches, and shared understanding that local teams can continue to use. 

These changes may seem subtle, but they are critical. Developing a supported housing strategy is not just about producing a document, it is about strengthening how decisions are made. 
 

The updated toolkit  

The Housing Toolkit has now been updated to incorporate learning from the pilot and is available online for local authorities and partners to use. These updates strengthen clarity, usability, and the flow between steps, making it easier for local areas to apply the approach in practice. 

The Toolkit, as well as SCIE’s ‘Toolkit for place-based plans for housing for older adults’ and ‘Co-production: what it is and how to do it’ guide, were cited in the Government’s statutory guidance for councils in England on preparing and delivering supported housing strategies.  

As more local authorities begin or continue developing their supported housing strategies, there is an opportunity to use and adapt the toolkit to reflect local needs and priorities. SCIE can support this process, helping ensure the approach is applied in a way that works for each area. 

Moving beyond awareness 

Autism Acceptance Month is an important reminder of the barriers many people continue to face. But it is also a moment to focus on how systems can respond more effectively—not just by understanding these challenges, but by taking practical steps to address them. 

Housing is central to this. Having the right home can support independence, wellbeing, and a sense of belonging. When housing does not reflect people’s needs or preferences, it can limit choice, increase reliance on crisis responses, and reduce quality of life. 

The work through the Housing Toolkit—and the learning from the pilot—shows how local systems can move towards a more person-centred approach. By bringing together better evidence, meaningful co-production, and clearer planning, local areas are better equipped to develop housing options that reflect what people actually want and need. 

This is closely linked to the idea of autism acceptance. Acceptance means recognising autistic people as individuals with their own preferences, strengths, and ways of living—and ensuring that services and systems are designed with this in mind. In housing, this means creating options that are flexible, supportive, and shaped by people’s own experiences. 

While change takes time, this work demonstrates that there are practical ways to improve how decisions are made—and, ultimately, to improve outcomes for autistic people and people with a learning disability. 

If you would like advice, guidance or simply an exploratory chat on how we can support you, contact us here.  

And to find out more about Autism Acceptance Month, click here.   

The problem: evidence about care equity exists, but it is hard to find and use 

People working in policy, commissioning and practice are making decisions about care every day. In October 2024, SCIE convened three roundtables involving policymakers, commissioners, providers, researchers, voluntary and community sector organisations, people who draw on care and support, and unpaid carers. 

We heard through these roundtables that the evidence they need is often: 

• hard to find 

• hard to understand and spread across multiple sources 

• written in ways that are not easy to apply 

So decisions are often made without a clear, consistent view of what the evidence says. 

It is important to highlight the fact that this is a structural issue. There exists a considerable body of literature on social care and equity. But it is fragmented and difficult for decision makers to access and apply. And when evidence is fragmented, action is too. 

A different approach 

By bringing together evidence that is often scattered across reports, research papers and policy documents, the Care Equity Evidence Hub aims to make social care evidence easier to find and apply in real-world decision-making. This means no long lists of search results, no need to interpret complex academic papers, and no time lost trying to piece information together. 

Instead, the Care Equity Evidence Hub gives you: 

• clear summaries of key evidence 

• the main messages, up front 

• content organised around real-world priorities 

• examples of how evidence is used in practice 

The aim is straightforward. Better access to evidence means more informed decisions, which means action on inequities. 

Through this, we also have clearer visibility of gaps, and that helps target future evidence more effectively. Both access to information and understandings of gaps are needed to address inequities. 

Built with the sector, not for it 

SCIE’s new Care Equity Evidence Hub has not been developed in isolation. It has been co-produced with the sector from the start. 

That includes: 

• policymakers and commissioners 

• providers and practitioners 

• researchers and voluntary organisations 

• people who draw on care and support 

• unpaid carers 

They were clear about what was needed. Not necessarily more evidence in all areas, but better access, clearer summaries, and stronger links to practice. There was also a consistent message that gaps in the evidence are not always visible or well understood in decision-making. 

That input shaped the Evidence Hub’s structure, content and priorities. 

A project advisory group, including people with lived experience, continues to guide the work, as have several rounds of stakeholder engagement.  

At SCIE, we feel this is essential. Because if the Evidence Hub is going to support action on inequities, it has to reflect the reality of how decisions are made in practice, and the people they affect. 

Why this matters now 

Inequities in social care are not new. Differences in access, experience and outcomes are known to be shaped by geography, deprivation, ethnicity, disability, the availability of services, and much more. 

What is new is the opportunity to bring the evidence together in a way that supports action. 

With growing focus on social care reform, including work led by the Casey Commission, there is increased attention on how the system delivers for different groups and communities. 

The Care Equity Evidence Hub helps you: 

• see where inequities exist 

• understand how they affect different groups 

• identify what the evidence says might help address them 

This shifts the focus from recognising inequities exist to acting on them with evidence. 

Next steps 

The Care Equity Evidence Hub will continue to grow with more themes and additional content. This is not a ‘snapshot in time’ resource. It will evolve based on what people need, what evidence emerges, and where the gaps are. Organisations and individuals across the sector are part of that process. We will be seeking regular feedback from the hub’s users.  

This ongoing engagement will help ensure that the hub remains relevant to the needs of the social care sector. 

A clear goal 

The Evidence Hub is built on a simple idea. If people can access and use evidence more easily, they can make better decisions. And if gaps in the evidence are clearer, future work can be better targeted. 

Both matter. Because better decisions, supported by the right evidence, are how inequities in social care are addressed. 

Not in theory, but in practice. 

To explore the Evidence Hub, click here. And to find out more about the work SCIE does and how we can support you, read our Impact Report 2025/26, which spotlights the key projects we’ve worked on in the last year, including the Evidence Hub, and their outcomes, or contact us. 

Feedback from attendees was overwhelmingly positive. Participants highlighted how the webinar helped clarify common safeguarding myths and strengthened confidence in applying legal frameworks, particularly the Mental Capacity Act 2005 and Human Rights Act 1998, in everyday practice. Many valued the opportunity to hear clear legal perspectives and to reflect on situations where safeguarding responsibilities can feel blurred or contested.

Several strong themes have emerged from the feedback. Attendees highlighted the ongoing need for greater legal clarity and shared understanding across agencies, especially in cases where there is no apparent crime, capacity is fluctuating, or risk is escalating but thresholds feel unclear. Others reflected on the frustration practitioners experience when safeguarding concerns are passed between organisations without clear ownership or accountability.

These themes resonate strongly with the wider national conversation. In her recent recommendations to government, Baroness Casey highlighted adult safeguarding as a key area of concern, calling for stronger national oversight, clearer accountability and the establishment of a new National Safeguarding Board. The webinar discussion reinforced why these recommendations matter: many of the challenges practitioners face are systemic, not individual, and cannot be resolved through local practice alone.

Our work at SCIE is always evidence-based, using the latest and most rigorous insights about what constitutes best practice. We will continue to support this work in safeguarding by providing evidence‑informed resources and creating opportunities to challenge myths, build confidence and strengthen safeguarding practice as national reforms begin to take shape.

SCIE partners with organisations to anticipate and manage safeguarding risks, with expert-led insights, tailored training and co-produced solutions built around your people and pressures. Contact our team for more information or to find out how SCIE can support you: safeguarding@scie.org.uk

Case study

One of these projects is SCIE’s CQC improvement support to Redcar and Cleveland Borough Council. Redcar and Cleveland Borough Council faced a significant moment in its adult social care improvement journey when the Care Quality Commission (CQC) rated it as Requires Improvement in how well it is meeting its responsibilities to ensure people have access to adult social care and support under the Care Act (2014) in July 2025. A key finding was that the council ‘recognised they were not currently undertaking co-production and development in this area was in its early stages’. To support this, SCIE was commissioned to deliver a rapid-improvement project that addressed gaps while laying the foundation for sustainable, long-term change. 

Challenge

Although the council had a strong commitment to co-production, there was a lack of shared understanding of what good co-production looks like in practice.

Council leaders recognised the need for a shared understanding and a framework that could support consistent practice aligned with CQC expectations. This need formed the basis of SCIE’s partnership with the council.

SCIE’s approach

Understanding the local picture

The project began with SCIE conducting an evidence review of the council’s co-production strategies, plans, performance data, existing engagement activity, and stakeholder feedback. This confirmed a strong commitment to co-production, with carers and partners already influencing services through established forums, partnership boards and joint commissioning arrangements. However, the review also identified variation in practice across adult social care, with some teams working in partnership with people with lived experience while others relied on consultation or engagement activity.  Understandings of co-production was not consistent and some groups such as hidden carers, people in full-time work and residents with limited digital access, were less involved. These findings ensured all recommendations were rooted in the local context and targeted areas where consistency and inclusion could be strengthened.

Mapping stakeholders and strengthening collaboration

SCIE worked with council leads to identify relevant stakeholders essential to shaping and championing co‑production, including people with lived experience, unpaid carers, families, frontline teams, managers, commissioners, and partners across the sector. This highlighted key voices and where they were missing or underrepresented.

From this, we developed a communication and engagement plan to support ongoing collaboration with residents, partners, and adult social care colleagues.

Co-designing the vision and approach

We co-designed and delivered a series of workshops that brought stakeholders together to explore what co-production means locally. Activities included gathering lived experience insights, case studies, mind mapping, group discussion, and shared reflection. The sessions helped develop:

• a shared vision for co‑production
• lived experience-led principles
• clarity around roles and responsibilities
• collective agreement on what success should look like.

Participants highlighted the value of hearing from a diverse mix of professionals and people with lived experience. One participant shared:

“It’s been very informative hearing from a range of professionals and people with lived experience, sharing ideas of best practice to make co-production a core value and not an afterthought.”

This collaborative approach reflects wider evidence on the importance of early and meaningful involvement of people with lived experience in shaping services. SCIE’s ‘Shaping change together: co-producing innovation in social care’ report explores this in detail and highlights the importance of trust, shared ownership and acting on people’s contributions.

Creating a tailored co-production knowledge base

A major output was a tailored co-production knowledge base—an accessible resource hub with templates, tools, best practice examples and CQC-aligned guidance. This served as a single point of reference to support consistent co-production across adult social care, helping colleagues understand expectations and apply them in everyday practice.

Impact

The project helped establish the foundations for a more consistent, resident‑led approach to co‑production across adult social care and collaboratively we achieved:

• greater confidence and shared understanding of co-production
• clearer, more coordinated approach to engagement with residents, people with lived experience and carers
• improved relationships with residents, people with lived experience and carers
• identification of co-production champions
• establishment of a co-production group 
• a robust framework aligned with CQC expectations.

Residents expressed renewed confidence in their voices influencing future adult social care planning. In the final workshop, several people with lived experience committed to co‑facilitating upcoming workshops and contributing directly to the development of the Adult Social Care Strategy. The council also provided positive reflections on the project: 

“Working in partnership with SCIE has helped us strengthen co-production in Redcar and Cleveland. Together, we created strong foundations to fully embed our co-production culture.  SCIE’s expertise supported us to develop a co-created vision, guiding principles and formalise a co-production steering group. We are proud to work in equal partnership with people with lived experience to make decisions together and create services that work for everyone.” – Adult Social Care Inspection and Improvement Lead.

Next steps

With the project now concluded, the council will take forward and embed the work by:

• using the co-production knowledge base as a core resource for adult social care
• supporting the newly established co-production group to lead and shape activity
• co-designing and finalising the Adult Social Care Strategy with people with lived experience.

These steps will support the council to sustain co-production as a central part of their improvement journey, drawing on SCIE’s lived experience-led approach, practical resources and guidance to embed consistent, CQC-aligned practice.

To learn more about our Impact Report 2025/26 and stay up to date on announcements, make sure you’re following SCIE on our social media channels and regularly checking our website. And to find out more about how we can support you, contact us here.

Technology must start with people’s lives, not the tech itself

Across the roundtable, there was strong agreement that the value of technology lies in enabling independence, choice and positive risk-taking. As we discussed, there is huge potential for better use of data to help people engage with the risks they want to take, rather than feeling limited by the offers available to them.

This echoes one of the strongest messages from SCIE’s Digital Programme on behalf of the Department of Health and Social Care (DHSC) and Partners in Care and Health. The programme, delivered over the past 12 months, explores the practice, governance and ethical implications of AI use in adult social care.

Throughout the programme, participants repeatedly emphasised that AI must support, not replace, professional judgement — a theme captured clearly in SCIE’s upcoming Digital Programme report ‘AI Decision Making in Adult Social Care’, which will be published in April: “AI may alert us to patterns or risks, but it cannot determine what those signals mean without human oversight.”

The roundtable also highlighted how data is still too often siloed across agencies in ways that don’t reflect how people experience their own lives, as an indivisible whole. Bringing information together offers the possibility of understanding people as unique individuals and supporting more effective integration and partnership working. But doing so requires confronting some significant ethical and technical hurdles.

Co-production and fairness must be built in from the start

One of the most powerful themes from both the roundtable and our recent programme is the need for early, meaningful co-production. People with lived experience told us repeatedly that involvement often happens too late or becomes symbolic when they feel they need technical expertise to contribute – issues also highlighted in SCIE’s 2025 report ‘Embracing change: scaling innovation in social care in practice’, sharing invaluable learnings from our work supporting the DHSC’s Accelerating Reform Fund.

As one participant in SCIE’s AI Co-production working group put it: “Co-production should shape purpose, assumptions, and values… not just comment on finished products.” As part of SCIE’s Digital Programme, this group helped produce an AI Co-production Charter and Toolkit — a practical resource that local authorities can use to ensure that people’s voices shape AI design, deployment and monitoring from the outset. This emphasis on values-led design was also reflected in our recent work with Bromley Council, where SCIE provided an independent review of their AI transcription pilot before it was scaled up. Bromley recognised that successful digital transformation required more than technology alone; it needed a strong focus on culture change, and they delivered this alongside a linked project to develop their co-production strategy. This mirrors the wider lesson that ethical, inclusive innovation depends on organisational readiness as much as technical capability.

Equity and bias were also major concerns. SCIE’s ‘AI Decision Making in Adult Social Care’ report highlights that bias is embedded not just in algorithms, but in data, design choices and organisational systems. A participant of SCIE’s Digital Programme described examples of AI misinterpreting everyday actions — like “picking food from fridge” being recorded as “able to prepare meals”.  This graphically illustrates how context or cultural nuance can be lost. This was echoed in the clear view that emerged from the Care Talk roundtable: data is rarely neutral. It is influenced by the questions asked, the method of collection, recording, access and interpretation by the person using that data.

These risks underscore why inclusive design, diverse testing and culturally competent procurement are essential.

Data ethics, consent and trust are non-negotiable

At the roundtable, we spoke about the need to rebalance what we make visible. Care is full of moments that go right every day, yet many systems are designed to surface what went wrong. Technology should help us recognise and celebrate quality, not just evidence risk.

But trust is the foundation for all of this. SCIE’s Digital Programme revealed that meaningful consent is one of the most challenging areas. Consent is too often treated as a one-off administrative step, yet, as our report notes, “meaningful consent must be informed, ongoing, capacity sensitive, and free from coercion.”

Governance must be iterative, not a one-off assurance step

Another strong theme from the roundtable was the need for a more confident, mature relationship with innovation — one that embraces opportunity but is honest about risk. This aligns closely with the findings of SCIE’s Digital Programme. As one participant put it: “We need governance that learns and evolves… and fits within our broader systems of monitoring, reflection and improvement.”

As part of our forthcoming ‘AI Decision Making in Adult Social Care’ report, we set out practical tools local authorities can adopt, including:

• clear accountability and decision rights
• continuous monitoring for drift, bias and hallucinations, as reported experience shows that learning systems can have a tendency to learn bad habits if not carefully monitored
• safeguarding specific governance
• cultural and linguistic fairness checks
• controls to ensure informed procurement practice
• mechanisms to manage informal or ‘shadow’ AI use, as it would be wrong to assume that the lack of formal adoption of AI tools by organisations means that their staff are not using these when freely available on smartphones and browsers.

These insights also fed into our development of a six-domain evaluation framework (part of the AI Decision Making in Adult Social Care report) to help local authorities assess proposals, supplier pitches and internal ideas in a structured, values-led way.

Bringing it all together

What struck me at the roundtable was how aligned the sector is becoming. Whether discussing predictive analytics, Technology Enabled Care, workforce tools or data sharing, the same principles kept resurfacing:

• start with people’s lives, not the technology
• strengthen, don’t replace, human judgement
• build trust through transparency and honesty
• treat data as relational, not just technical
• co‑produce early, diversely and meaningfully
• design for inclusion, not just efficiency
• make governance a living system.

These themes are central to SCIE’s work this year and will underpin our new resources being published on the Knowledge Hub in April—the DHSC space for AI and digital guidance for local authorities. Together, they give local authorities a practical, values-driven foundation for exploring and adopting AI safely, ethically and with confidence.

The roundtable reminded me that while technology can help us move faster, what matters most is that we move in the right direction, one that strengthens autonomy, dignity, inclusion and the relationships at the heart of care.

To ensure you receive information about these resources as soon as they are available, please sign up to SCIELine, and if you would like an exploratory chat about how we can help support you with digital transformation to achieve better care while saving costs, contact us.