Still ‘limited clarity’ on National Care Service, charity warns

Wide variation in access to adult social care across England is undermining people’s dignity, independence and safety, according to a new report from the Social Care Institute for Excellence (SCIE).

The report, Towards a National Care Service: raising national standards of care, argues that people with similar needs can face very different experiences of care depending on where they live – a situation commonly described as the “social care postcode lottery”. While some receive timely, personalised support, others encounter long waiting lists, high eligibility thresholds and unmet basic needs.

SCIE warns that this uneven application of social care duties places significant pressure on individuals, families and unpaid carers, with the greatest impact felt by marginalised communities, further deepening inequalities.

The publication comes as the government launches the Casey Commission, intended to lay the groundwork for a future National Care Service underpinned by national standards of care. While welcoming this ambition, SCIE says there is currently little clarity on what those standards should include or how they would work in practice to reduce variation.

Based on extensive engagement with the sector, the report argues that England does not lack a shared vision for social care. Instead, the challenge lies in translating widely held values – such as dignity, independence and choice – into consistent day-to-day experiences for people drawing on care and support.

Rather than proposing a uniform model of service delivery, SCIE sets out a framework for national standards that would define what is essential and non-negotiable, while preserving flexibility in how outcomes are achieved locally. The focus is on what good care should deliver for people, not on prescribing processes or structures.

According to the report, well-designed national standards could help expose unjustified variation, strengthen accountability and support learning across the system, without stifling personalisation or local innovation.

However, SCIE is clear that standards alone will not resolve the deep-rooted challenges facing social care, including workforce shortages and financial pressures. Their effectiveness, the report argues, will depend on careful design, phased implementation and the wider system conditions that support delivery, such as data, commissioning capability and co-production with people who use services.

Kathryn Marsden OBE, chief executive of SCIE, said it was “indefensible” that people with the same needs could experience radically different levels of support based solely on where they live.

“National standards of care offer a practical way to close that gap – not by imposing a one-size-fits-all model, but by making clear what people should be able to expect from the system wherever they live,” she said. “Done well, they can translate long-standing values in social care into clearer, outcomes-focused expectations rooted in lived experience and backed by accountability.”

Marsden cautioned against quick fixes, warning that poorly designed standards risk becoming symbolic or disconnected from reality. “Ending the postcode lottery will require sustained commitment, careful implementation and a focus on learning and improvement – not just ambition on paper,” she added.

The report also received political backing from Sojan Joseph, MP for Ashford, who said inequalities in adult social care had persisted for too long and must be addressed alongside NHS reform. He highlighted recent government measures including funding for home adaptations, greater use of technology and efforts to improve pay and status within the care workforce.

SCIE is calling for national standards to be developed collaboratively and tested in practice, with early piloting focused on areas where variation is most acute, particularly at the interface between health and social care. It proposes starting with a small number of high-impact “touchpoints” and refining standards over time in line with learning from the sector.

The organisation said it will continue working with government, The Access Group and the Casey Commission to support the development of credible, outcomes-focused standards ahead of the Commission’s final report, expected in 2028.