For those leading, commissioning and delivering adult social care services, the reality of variation is not abstract. It is visible every day; social care in England remains marked by stark geographic variation. People with similar needs can face very different experiences depending on where they live – from timely, personalised support that enables independence and dignity, to long waiting lists, high eligibility thresholds and unmet basic needs.
This is the social care postcode lottery – a system where access to support, quality of care and outcomes are shaped less by need and more by local circumstance. The consequences are serious – people’s safety, independence and wellbeing are put at risk, while unpaid carers absorb growing financial, emotional and physical pressures. For leaders across the sector, this variation also creates operational strain, reputational risk and avoidable cost.
The Government has launched the Casey Commission as a first step towards creating a National Care Service, underpinned by national standards of care. While this signals clear ambition, there remains limited clarity about what national standards should cover, how they should operate in practice and how they would genuinely reduce today’s postcode lottery.
SCIE’s new report, Towards a National Care Service: Raising national standards of care, supported by The Access Group, draws on a roundtable series of extensive engagement with commissioners, providers, regulators, people who draw on care and support and unpaid carers. Its starting point is clear – a critical challenge facing social care is not a lack of vision or values, but the absence of shared, operational expectations – expectations that consistently translate principles into people’s day-to-day experiences of care and support.
A baseline people can rely on
Despite legislation such as the Care Act 2014, people’s access to care, the quality of support they receive and the outcomes they experience continue to vary widely depending on where they live, how their care is funded and how local systems interpret statutory duties.
National standards could help address this by defining a consistent baseline of what people should be able to expect in their access to, and experience of, care and support. For local authorities and providers, this would offer greater clarity about what must be delivered everywhere, reducing ambiguity and making expectations more transparent across the system.
National standards are therefore best understood as a mechanism for clarifying expectations, anchored in lived experience outcomes, rather than as a prescriptive blueprint for service delivery. Done well, they offer a practical way to close the gap between statutory intent and lived reality, not by imposing a one-size-fits-all model, but by making clear what people should be able to expect wherever they live.
Not a blueprint and not ‘one-size-fits-all’
For leaders across the sector, the tensions will feel familiar – between national consistency and local discretion; between standardisation and personalisation; and between assurance and learning. These tensions cannot be designed away. They must be managed explicitly through standards.
As part of our roundtable series, people consistently highlighted concern that national standards could become overly prescriptive, undermining local innovation or shifting focus towards process compliance rather than outcomes. There is a legitimate fear that in a resource-constrained environment, standards could translate into additional reporting requirements without strengthening delivery conditions.
The emphasis must therefore be on standards that specify outcomes and experiences, rather than prescribing services, tasks or organisational models. National consistency should not become standardisation at the expense of personalisation and innovation. For system leaders, this means designing standards that are clear enough to reduce unjustified variation, but flexible enough to allow local strengths, partnerships and community assets to flourish.
From postcode lottery to shared expectations
National standards can reduce the postcode lottery by acting as a shared reference point for what people should expect, making variation easier to identify, explain and where necessary, challenge. Crucially, this is about eliminating unjustified variation in how statutory duties are applied, not removing legitimate local discretion. Standards can clarify minimum guarantees that sit alongside existing legal duties, making them more consistently visible and enforceable rather than aspirational.
For commissioners and providers, this clarity can strengthen market shaping, contract management and partnership working. For regulators and assurance bodies, it can support more coherent assessment of outcomes. For people drawing on care, it can make rights and expectations clearer and more understandable.
A floor of rights
A key debate is whether national standards should establish a minimum ‘floor’ of rights or act as a broader improvement ambition. A baseline creates clarity and enforceability that people, and systems, can rely on, regardless of postcode or funding route. Yet in a financially constrained system, minimum standards risk becoming interpreted as ‘good enough’, turning the floor into a ceiling and legitimising low ambition.
National standards must therefore include a non-negotiable, rights-based baseline while being explicitly designed to enable continuous improvement above that baseline. In practice, this means pairing minimum expectations with an improvement model – supporting shared learning, transparency and feedback loops – so that standards drive progressive reduction in inequity rather than static compliance.
A ‘common currency’ rooted in lived experience
There is strong agreement that standards should be framed around lived-experience outcomes – a ‘common currency’ that aligns personalised care, commissioning, regulation and improvement. At present, there is a disconnect between what people say defines a good life – safety, continuity, control, relationships, belonging – and the indicators often used to track performance, which tend to focus on episodes of care or activity counts.
For leaders, this presents a strategic opportunity. National standards, underpinned by outcome-focused metrics, can align commissioning, quality assurance and improvement activity around what matters most to people who draw on care and support. This shift would support more coherent decision-making, more meaningful performance conversations and a stronger link between resource allocation and lived outcomes.
Key touchpoints
The report proposes starting with a small number of high-impact touchpoints where variation in access, experience and outcomes is most acute, and where responsibilities are shared. Hospital discharge, mental health crises and transitions to adulthood are frequently cited examples. Accountability failures at these points are often the predictable outcome of separate budgets, competing priorities and unclear expectations about who must act, when and with what information.
Standards must therefore define clear expectations – including roles, timelines and minimum information-sharing requirements – and be supported by practical system levers such as joint commissioning capacity and interoperable digital infrastructure. For those leading integrated care partnerships and place-based systems, this provides a framework for strengthening reliability across organisational boundaries, reducing friction and improving outcomes at moments of highest risk.
Shared ownership, real accountability
National standards cannot succeed unless they are developed and delivered collaboratively. Social care reform cannot be designed by one part of the system alone. Good care depends on the combined actions of Government, local authorities, providers, regulators, the NHS, community organisations and critically, people who draw on care and unpaid carers.
Shared accountability must be visible and explicit, particularly where responsibility for outcomes is shared across organisational boundaries. For leaders, this requires clarity about who is responsible for what and how improvement will be supported – not simply how compliance will be monitored.
The enabling conditions
National standards alone cannot resolve workforce shortages, financial pressures or fragile markets. Their impact depends on how they are designed and implemented, and whether they are supported by the right system conditions. That includes workforce skills, capability and leadership; commissioning capability aligned to outcomes; robust co-production infrastructure; and stronger data and digital foundations. Without strengthening these enabling conditions, standards risk remaining aspirational or defaulting to narrow compliance exercises.
Compared to the intelligence available in other parts of the public sector, data in social care remains incomplete. A pragmatic indicator set should build on existing data but address what is missing – timely experience measures, touchpoint reliability indicators, and measures of prevention and co-ordination that capture avoided harm and sustained wellbeing. National standards can provide the organising framework for developing and aligning these measures over time.
Getting the foundations right
National standards are not a silver bullet. They cannot, on their own, resolve the structural constraints facing adult social care. The risk is that they become aspirational statements that raise expectations without strengthening delivery conditions, or additional compliance artefacts that increase burden without improving lives.
But done well – rooted in lived experience, focused on outcomes and supported by the right system conditions – they offer a credible mechanism for reducing unjustified variation and strengthening accountability. For those leading and managing services, the question is not whether variation exists, but how we collectively reduce it without losing what makes care personal, local and responsive.
As the Casey Commission moves forward, this is the opportunity to get the foundations right – to define clearly what good care should deliver, to align expectations across the system and to ensure that where someone lives no longer determines the quality and reliability of the care and support they receive.
To read Towards a National Care Service: Raising national standards of care, visit the SCIE website. Comment on this feature below and join the conversation.
Gerard Crofton-Martin is Interim Chief Executive Officer at SCIE. Email: [email protected] LinkedIn: @Social-Care-Institute-for-Excellence-(SCIE)