What Could a National Care Service Mean for Adult Social Care Providers, Governance and Commissioning in England?

For an adult social care provider, the significance of a National Care Service would not be measured simply by whether a new national organisation appeared on an organisational chart. It would be measured by what changed when a person needed support, a care worker required specialist training, a local authority reviewed a contract, or a Registered Manager escalated concerns about service sustainability. Those operational decisions determine whether structural reform improves people's lives.

In England, discussion of a National Care Service raises fundamental questions about the relationship between national expectations and local decision-making. These questions sit at the centre of governance, leadership and regulatory oversight in adult social care. Providers need to understand not only the political ambition behind reform but also how responsibilities, assurance and accountability might operate under different models.

The implications extend into organisational governance and leadership, particularly where new national standards intersect with existing provider responsibilities. They also raise questions about workforce planning, because a more consistent national framework would achieve little without sufficient skilled people to deliver care.

This article examines what a National Care Service could mean in practice, distinguishing current legal duties from policy proposals and plausible future arrangements. Its focus is England, with proportionate consideration of the different approaches already operating or being developed elsewhere in the UK.

What Would a National Care Service Actually Be?

The expression National Care Service can describe several substantially different policy models. One possibility is a nationally coordinated framework that establishes stronger standards for quality, workforce development, access and information while retaining local authority commissioning. Another is a more centralised model in which national or regional bodies assume greater responsibility for funding, purchasing or planning services. A third involves closer integration with the NHS without transferring all adult social care functions into a single institution.

These distinctions matter because national consistency does not necessarily require national ownership or delivery. Independent businesses, charities, social enterprises, local authorities and individuals employing personal assistants could continue to play significant roles under a national framework. Equally, changing the commissioning structure would not automatically resolve shortages of care workers, insufficient fee rates or gaps in suitable housing.

England's reform debate has included proposals for a National Care Service and the establishment of an independent commission examining adult social care reform. Such developments should be understood as policy direction and reform activity, not evidence that a fully operational National Care Service has already replaced existing arrangements.

A meaningful assessment therefore begins with the functions a future service might perform: setting standards, determining eligibility or entitlements, allocating funding, supporting the workforce, planning capacity, coordinating health and care, and monitoring outcomes. Each function could be organised differently, and each would have distinct consequences for providers.

England's Existing System: What Would Reform Need to Change?

Under the current English framework, local authorities retain substantial responsibilities under the Care Act 2014, including assessment, eligibility decisions, care and support planning, safeguarding and market-shaping duties. Their commissioning approaches vary according to local demographics, funding, geography, provider markets and strategic priorities. The NHS has separate responsibilities, including NHS Continuing Healthcare and other relevant health services, while integrated care boards participate in planning and commissioning across their statutory functions.

Providers operate within this mixed economy through local authority contracts, NHS arrangements, self-funded care, direct payments and other purchasing routes. A homecare organisation may deliver services for several councils with different fee schedules and reporting requirements. A supported living provider may coordinate with commissioners, housing organisations, community health teams and families while supporting individuals whose needs change considerably over time.

This variation can encourage local responsiveness, but it also creates fragmentation. Providers may encounter different expectations for contract reporting, mobilisation, quality schedules, travel-time funding and outcome measurement even when the underlying care activities are similar. The consequences become especially visible in homecare commissioning and contract management, where funding assumptions directly affect staffing capacity and continuity.

A National Care Service might seek to reduce avoidable variation while preserving legitimate local flexibility. The difficulty is determining which differences are unjustified and which reflect genuine local needs. Rural travel arrangements, specialist autism services, culturally appropriate support and accessible housing cannot always be designed effectively through a uniform national specification.

Reform would also need to clarify whether national standards are backed by sufficient funding and operational capability. A national expectation for timely assessment, continuity of support or workforce development has limited practical effect if the organisations responsible lack the resources to implement it.

Four Possible Reform Models and Their Provider Implications

Rather than assuming a single inevitable structure, provider boards can assess four broad possibilities. These are analytical models, not confirmed descriptions of a future English National Care Service.

• National standards with local commissioning: stronger common expectations for quality, workforce and outcomes, while councils retain substantial purchasing responsibilities.
• National funding and entitlement reform: changes to how care is financed or accessed, potentially altering demand, charging arrangements and the balance between public and private purchasing.
• Regional or integrated commissioning: greater coordination between councils, NHS organisations and other partners, potentially reducing fragmented pathways while creating new contractual interfaces.
• More centralised commissioning or delivery: national or regional bodies taking greater control of planning, purchasing or provision, requiring significant legislative, financial and operational transition.

Under the first model, providers might retain most current contractual relationships but face more consistent quality reporting and workforce expectations. Under funding reform, demand patterns and purchasing behaviour could change materially. Integrated commissioning might encourage multidisciplinary pathways, while centralisation could change contract ownership, procurement arrangements and escalation routes.

The Digital Twin Scenario Modeller offers a practical way for providers to test assumptions about workforce capacity, demand and service stability. Such modelling cannot predict government decisions, but it can reveal which operational dependencies would become vulnerable under different reform scenarios.

Funding, Fair Cost of Care and Market Sustainability

For many providers, the decisive issue is not whether commissioning becomes more nationally coordinated but whether funding arrangements better reflect the cost of safe, sustainable care. Fee rates must support the actual workforce, travel, supervision, management, training, equipment, property and quality-assurance requirements of a service. Specialist provision may also require clinical input, multidisciplinary coordination or higher staffing ratios that cannot be captured through generic hourly prices.

A National Care Service could potentially establish more consistent approaches to cost assessment, funding transparency or provider sustainability. However, national fee methodologies would need to accommodate regional labour markets, rural delivery costs, different service models and individual complexity. Uniform prices without credible cost adjustment could transfer financial pressure rather than resolve it.

Providers should also distinguish between the funding of care and the funding of accommodation. In supported living and extra care housing, housing arrangements, care contracts and individual rights may involve different legal relationships. Reform that overlooks these distinctions could disrupt otherwise effective models of independent living.

Market sustainability is therefore a matter of public responsibility and provider governance. Directors should understand contract profitability at service level, exposure to unfunded costs, reliance on individual commissioners and the risks created by short-term purchasing. A provider unable to sustain safe staffing has a quality and continuity problem, not merely a commercial problem.

The strongest reform would connect fair funding, service quality and accountability. It would enable commissioners to examine whether expenditure achieves meaningful outcomes while recognising that prevention, stable relationships and specialist expertise can create value beyond the number of commissioned care hours.

What Would Change for Commissioners and Contract Management?

A more nationally coordinated care system could alter the division of responsibilities between national government, local authorities, integrated care boards and providers. Yet even where national expectations become stronger, someone must still assess local demand, develop specifications, arrange services, monitor contracts and respond when delivery deteriorates.

The operational opportunity lies in reducing duplication without removing meaningful scrutiny. Common definitions for workforce continuity, missed visits, safeguarding themes and individual outcomes could make provider performance easier to interpret across different areas. However, a national reporting framework should not obscure the distinctive circumstances of a small specialist service or a geographically dispersed homecare contract.

Providers may increasingly need to demonstrate the connection between commissioned activity, actual delivery and the outcomes experienced by people receiving support. The Commissioner Evidence Builder can help structure that relationship through clearer contract-monitoring evidence, performance explanations and improvement reporting.

Changes to commissioning could also affect procurement and mobilisation. Existing contracts would not automatically disappear because a national framework was announced. Any transfer, replacement or variation would depend on the legal design of reform, relevant procurement and contractual provisions, and the decisions of the responsible authorities. Providers should avoid assuming that future national coordination guarantees contract extensions or eliminates competition.

Operational Scenario: A Homecare Provider Working Across Three Councils

Consider a medium-sized homecare provider supporting older people and adults with physical disabilities across three neighbouring local authority areas. Its care workers follow the same organisational policies, but each council operates different visit-verification requirements, contract reporting cycles and fee assumptions. Managers spend considerable time reconciling reporting formats rather than analysing patterns of late calls or continuity.

Under a hypothetical national standards model, common definitions for visit punctuality, continuity and unmet demand could reduce administrative duplication. The provider might produce one consistent operational dataset, with local commissioners retaining the ability to examine individual contracts and local access issues. This would create opportunities for more reliable comparison and earlier identification of service pressures.

However, the provider's rural contract includes substantial travel between isolated communities. If national benchmarks compared productivity without recognising travel conditions, managers could face pressure to compress rotas in ways that undermine safe delivery. The Registered Manager would need to explain the relationship between travel time, staffing deployment, missed visits and people's experiences.

For a person receiving support with morning personal care, the meaningful test is whether familiar workers arrive at an agreed time and support the person's preferred routine. National consistency has value only if it protects that outcome rather than merely standardising the reporting system.

The provider's board could use evidence of call reliability, staff travel, complaints and individual feedback to distinguish administrative efficiency from actual service improvement. Where the new model created unexpected pressure, commissioners and provider leaders would need a route for reviewing the specification rather than treating every exception as poor performance.

Workforce Reform: National Ambition and Local Employment Reality

A National Care Service could provide a platform for more coherent workforce planning, professional development and recognition across adult social care. Possible reforms might involve stronger national competency expectations, clearer career pathways, improved workforce intelligence or more consistent approaches to pay and employment conditions. The precise design and funding of any such measures would determine their practical effect.

National workforce standards could improve portability of learning and make it easier for workers to develop careers across services. Nevertheless, a certificate does not establish competence in supporting a particular individual with complex communication, distressed behaviour, delegated healthcare tasks or changing mental capacity. Organisations would still need observed practice, supervision, reflective discussion and role-specific assessment.

Registered Managers would continue to carry significant operational responsibility for safe deployment, while workforce leads and directors would need to address recruitment pipelines, turnover, sickness, retention and management capacity. Mature workforce assurance connects these factors with service quality rather than treating vacancies as an isolated human-resources measure.

The risk is that national reform introduces additional expectations without sufficient time, funding or training infrastructure. Providers could face new competency requirements while struggling to release staff for learning or recruit qualified supervisors. Workforce transition plans would therefore need realistic implementation periods, funded backfill where appropriate and clear recognition of existing skills.

There is also an important distinction between national workforce policy and the responsibilities of individual employers. Unless legislation or contractual arrangements change those responsibilities, providers remain accountable for employment compliance, safe recruitment, supervision and the competence of the people they deploy.

Operational Scenario: A Supported Living Service and a National Competency Framework

A supported living provider supports six adults with learning disabilities and autism across separate tenancies. The service has a stable team with strong knowledge of individual communication preferences, sensory needs and community routines. A proposed national competency framework offers the possibility of more consistent recognition for staff skills, particularly when workers move between employers.

The operational director welcomes the principle but recognises that generic training cannot replace individualised practice. One person communicates distress through changes in movement and routine rather than spoken language. Another has specific preferences about who enters their home and how support is provided during periods of anxiety.

The provider maps the hypothetical national requirements against existing competency assessments, Positive Behaviour Support arrangements and supervision records. Staff are involved in identifying gaps, while people receiving support and their advocates contribute to decisions about what competent, respectful support looks like in daily life.

Where staff require additional development, the Registered Manager arranges coaching and observed practice rather than relying solely on course completion. The quality lead examines whether changes improve community participation, reduce avoidable distress and maintain personal choice. Relevant supported living governance and assurance arrangements help connect individual outcomes with management oversight.

The case illustrates a central reform principle: national competence expectations may establish a common foundation, but person-centred capability is demonstrated in relationships and practice. A successful transition would preserve the knowledge held by experienced staff while strengthening development opportunities for the wider workforce.

Would a National Care Service Change CQC Regulation?

In England, the Care Quality Commission regulates registered health and adult social care providers within its statutory remit. A proposed National Care Service would not, by itself, remove existing registration duties or replace the Health and Social Care Act 2008 regulatory framework. Any material change to CQC's powers, responsibilities or relationship with providers would require the appropriate legal and policy arrangements.

Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relevant provider duties include person-centred care, safe care and treatment, safeguarding, good governance and staffing. Regulation 17, for example, concerns systems for assessing, monitoring and improving quality and safety and managing risks. These duties remain significant regardless of whether services are commissioned locally or through a more nationally coordinated structure.

CQC assessment and commissioner contract monitoring serve different purposes. A provider might satisfy a particular contractual reporting requirement while still having weaknesses in care delivery or governance. Conversely, a positive regulatory assessment does not remove contractual obligations or the need to respond to local commissioning concerns.

Any future national standards would need to align with existing CQC evidence and provider assurance arrangements rather than create unnecessary parallel systems. The CQC Evidence Gap Analyzer can help providers review the evidence available for current regulatory expectations while keeping proposed reforms separate from obligations already in force.

The strongest evidence would continue to combine care records, direct observation, staff accounts, incidents, feedback and outcomes. A national framework might make certain measures more consistent, but it should not encourage organisations to mistake uniform documentation for uniform quality.

Governance and Accountability Under a Reformed System

A national care structure could change who sets policy, allocates resources or commissions services. It would not eliminate the need for clear provider-level accountability. Registered Managers would still need to oversee operational quality within their responsibilities, while Nominated Individuals, senior leaders and boards would need to understand organisational risk, delegated authority and the adequacy of assurance.

For boards, reform readiness is less about predicting a final organisational model than understanding where the business depends on existing arrangements. Relevant exposures include concentration of commissioning income, specialist workforce availability, digital reporting capability, contract terms, property commitments and the ability to respond to changing quality requirements.

The Governance Maturity Assessment provides a structured way to examine whether leadership roles, escalation routes, assurance mechanisms and organisational decision-making are sufficiently developed to manage complex change.

Boards should receive more than policy briefings. Effective board assurance would identify which reform assumptions matter, the evidence supporting them, the decisions that may be required and the consequences for people receiving services. A significant change in commissioning responsibility, for example, might warrant an assessment of contract risk, workforce transfer implications and continuity arrangements.

Responsibility should also be distinguishable across organisational boundaries. Commissioners may determine purchasing priorities and contract terms, but providers retain their own regulatory and employment duties. Safeguarding concerns still require appropriate protective action and escalation through established local authority and multi-agency processes. A national reform programme should strengthen these interfaces, not make them ambiguous.

The Latest Policy Direction: Free Personal Care and the Casey Commission

The reform debate has become more concrete following the Prime Minister's announcement on 29 September 2026 that a National Care Service would be established in the next Parliament, with free personal care for older people based on need rather than ability to pay. The announcement represents an important policy commitment, but it does not mean that free personal care has already been introduced in England or that the future service's operating arrangements have been settled.

The distinction between free personal care and free residential accommodation is particularly important. Personal care, accommodation, domestic assistance, community support and specialist interventions may be funded or charged for differently under any eventual model. Providers should not assume that the removal of personal care charges would automatically make every element of adult social care free at the point of use.

The timetable for Baroness Louise Casey's Independent Commission on Adult Social Care has also changed. The government confirmed in September 2026 that the earlier two-phase approach had been replaced by a single accelerated process, with final recommendations expected by summer 2027. The Commission's work will therefore be particularly significant in shaping the practical choices around funding, access, accountability and implementation.

One unresolved question concerns working-age disabled adults. Their support requirements often involve lifelong independence, employment, housing, communication, community participation and specialist provision rather than primarily personal care associated with older age. A credible National Care Service would need to address these different objectives rather than assume that one reform model serves every population equally well.

For providers, the immediate governance response should be proportionate. The September announcement creates a clearer strategic direction, but not a complete operational specification. Financial forecasts, contract decisions and service redesign should distinguish confirmed changes from political commitments and recommendations still under development.

Operational Scenario: A Residential Care Provider Considering Free Personal Care

A residential care provider operates two homes supporting older people, including individuals living with dementia and significant physical frailty. Residents include people whose care is funded by local authorities and others who pay privately. Families have heard the government's announcement about free personal care and begin asking whether their relatives' fees will be reduced.

The provider's management team recognises the importance of responding accurately without speculating about future entitlements. The Registered Managers explain that existing contractual and charging arrangements continue to apply until the relevant reforms are introduced. They distinguish personal care from accommodation and other services, while directing individual funding questions to the appropriate local authority or financial adviser where necessary.

At organisational level, the finance director examines several hypothetical funding scenarios. One assumes that public funding replaces some private expenditure on personal care. Another considers a phased implementation with eligibility rules and transitional arrangements. A third explores the possibility that changes in demand increase pressure on staffing and available placements.

These exercises do not produce a reliable forecast of future government policy. They identify which financial assumptions the provider needs to monitor, including fee composition, occupancy, staffing costs and the relationship between local authority rates and actual delivery costs.

The board also considers the experience of residents and families. Clear communication matters because an ambitious national announcement can create immediate expectations even when implementation remains several years away. The provider records questions and concerns, reviews the clarity of its fee information and ensures that nobody is given an unsupported promise about future charges.

This is an example of responsible reform readiness: maintaining current legal and contractual compliance while preparing for a potentially significant change in the funding environment.

Personalisation, Choice and the Risk of Excessive Standardisation

A National Care Service should be judged partly by whether it strengthens people's control over their lives. National standards could make rights and entitlements easier to understand, reduce unjustified variation and improve access to information. Yet greater consistency can become counterproductive if it encourages inflexible service packages that prioritise administrative uniformity over individual circumstances.

England's existing framework includes duties concerning wellbeing, involvement and care planning under the Care Act 2014. The Mental Capacity Act 2005 provides the legal framework for decision-making where capacity is in question, including the presumption of capacity and requirements to support people to make their own decisions. Future structural reform would need to work alongside these established protections unless Parliament expressly changed the relevant law.

Personalisation is particularly significant for direct payment recipients and people who employ personal assistants. Their arrangements may offer flexibility over who provides support, when assistance is delivered and how individuals organise daily life. A national model that improves consistency while retaining co-production, choice and control could strengthen independence. A model that inadvertently restricts those options could undermine it.

There is also a safeguarding dimension. National arrangements should make it easier for people to raise concerns, obtain advocacy and understand accountability, especially where services involve several organisations. The relevant test is not simply whether a complaint reaches the correct national body but whether someone responds promptly, protects the person where necessary and secures a meaningful resolution.

Providers can use the Positive Risk-Taking Planner to structure consideration of autonomy, proportionate safeguards and individual decision-making. Such approaches remain important regardless of how funding and commissioning responsibilities are organised.

Operational Scenario: A Working-Age Adult Navigating Integrated Support

An adult with an acquired brain injury lives in their own flat and receives support with daily routines, community access and managing fatigue. They also receive input from a community rehabilitation team. Their central objective is to return to part-time employment while retaining control over how support is organised.

Under current arrangements, the individual may need to navigate separate conversations with social care, health professionals, employment services and their housing provider. Reviews do not always take place together, and the person may repeatedly explain the same goals to different teams.

A future nationally coordinated model could encourage clearer shared pathways and more consistent information exchange. The local provider might participate in a joint review with the individual, an advocate where appropriate, an occupational therapist and the relevant commissioner. Support hours could then be considered alongside rehabilitation goals, travel arrangements and workplace adjustments.

However, the person does not want every organisation to have unrestricted access to their information. The provider and partners therefore need appropriate lawful bases, transparent information-sharing arrangements and clarity about which records are necessary for each professional's responsibilities. Integration should not become a justification for excessive data collection.

The provider measures success through outcomes that matter to the individual: confidence travelling independently, progress towards employment, manageable fatigue and control over support arrangements. Those measures are more informative than simply recording that a multidisciplinary meeting occurred.

The scenario demonstrates why multidisciplinary working and integrated pathways need to be designed around the person's goals. National coordination may remove organisational barriers, but it is the quality of local relationships and decisions that determines whether independence improves.

Digital Infrastructure, National Data and Information Governance

A National Care Service could create opportunities for more consistent information standards and improved visibility of demand, workforce capacity, quality and outcomes. National datasets might support better planning of specialist services, earlier identification of unmet need and more reliable comparisons between local areas. Shared definitions could also reduce the administrative burden created when providers report similar information in different formats.

These benefits depend on data quality, interoperability and proportionate information governance. Providers already use different digital care records, scheduling systems, medicines platforms and quality-management tools. Requiring new national reporting without considering these systems could increase duplicate entry, implementation costs and cybersecurity exposure.

Under UK GDPR and the Data Protection Act 2018, organisations need appropriate lawful grounds for processing personal information, with additional conditions where special category data is involved. Clear controller and processor responsibilities, data minimisation, security and transparency would remain essential. National reform would not make unrestricted sharing of sensitive care information acceptable.

The governance opportunity is to establish information that can support both operational decisions and system planning. A consistent measure of missed homecare visits, for example, becomes more valuable when it can be interpreted alongside staffing availability, travel conditions, individual risk and the person's experience. Without that context, apparently comparable performance figures may be misleading.

The Quality Dashboard Builder can support providers in organising indicators and exception reporting while preserving the distinction between numerical performance and demonstrated care quality. Strong data quality and performance measurement will become increasingly valuable if future commissioning arrangements rely on more consistent national information.

Preparing for Reform Without Premature Organisational Change

Providers face a difficult strategic balance. Ignoring reform until legislation is enacted could leave insufficient time to respond to new funding, workforce or reporting requirements. Restructuring prematurely around an unconfirmed national model could waste resources, unsettle employees and distract management from current service quality.

The more credible approach is to strengthen capabilities that remain useful across different reform outcomes. These include transparent service-level finances, effective workforce planning, reliable quality information, clear governance, person-centred outcome measurement and constructive relationships with commissioners and system partners.

Leadership teams may find it useful to organise their preparation around four distinct areas:

• Confirmed obligations: maintain current regulatory, employment, safeguarding and contractual compliance.
• Announced policy commitments: assess the potential implications of a future National Care Service and free personal care without assuming implementation details.
• Emerging recommendations: monitor the Casey Commission's findings and subsequent government decisions, identifying which proposals would materially affect services.
• Organisational resilience: strengthen financial, workforce, digital and governance capabilities that support continuity under multiple plausible scenarios.

For larger organisations, this may involve formal scenario reviews at board level. Smaller providers may achieve the same discipline through a concise strategic risk register, periodic management discussions and documented decisions. The scale of the process should reflect organisational complexity, not an assumption that reform requires an elaborate new committee structure.

Providers should also retain meaningful engagement with people drawing on care and support. Their experience can reveal whether proposed changes would improve accessibility, continuity, choice and independence or simply rearrange administrative responsibilities. This is particularly important for groups whose needs may receive less attention in public debate, including working-age disabled adults, people with complex communication needs and individuals relying on specialist community support.

What Should Providers Expect Over the Next Several Years?

The government's September 2026 commitment gives the National Care Service a clearer political destination, but its detailed architecture remains subject to further recommendations, decisions and implementation planning. The Casey Commission's expected final report in summer 2027 is an important forthcoming milestone. Subsequent developments could involve legislative proposals, funding decisions, national standards, implementation programmes and changes to commissioning arrangements.

Some changes may be introduced through existing policy or administrative mechanisms, while others would require legislation and substantial transition planning. Providers should distinguish between these routes because they carry different timescales and levels of certainty. The announcement that a National Care Service is intended for the next Parliament should not be interpreted as a guarantee that every proposed entitlement, workforce measure or commissioning reform will commence simultaneously.

Experience elsewhere in the UK offers useful comparisons without providing a direct blueprint. Scotland has pursued its own National Care Service reform debate within a different statutory and commissioning environment. Wales operates under distinct social services legislation and regulatory arrangements, while Northern Ireland has an integrated health and social care structure. None of these arrangements can simply be transferred into England without considering its legal framework, provider market and local authority responsibilities.

The strongest long-term opportunity is a system in which national expectations are clearer, funding is more sustainable, workforce development is better coordinated and people experience fewer barriers between services. Achieving that outcome will depend on detailed implementation, local relationships and the ability to identify unintended consequences early.

Conclusion

A National Care Service could represent a substantial change in the organisation and funding of adult social care in England. The government's commitment to establishing such a service, alongside its ambition for free personal care for older people, has made reform more tangible. Nevertheless, the practical model remains to be determined, and the distinction between announced policy and implemented entitlement is fundamental.

For providers, the most important questions concern what happens to commissioning responsibilities, sustainable fee arrangements, workforce expectations, regulatory accountability and people's control over their support. National consistency could reduce fragmentation and strengthen fairness, but poorly designed standardisation could also create new administrative pressures or weaken responsiveness to individual circumstances.

The case for reform is strongest when national ambition is connected to operational reality. A more coherent funding system needs sufficient skilled workers. Clearer standards need proportionate assurance. Integrated pathways need effective information sharing and local professional relationships. Above all, improvements should be visible in the independence, dignity, safety and quality of life experienced by people receiving support.

Provider leaders do not need to predict the final structure of a National Care Service to prepare responsibly. They can strengthen governance, understand their financial and workforce dependencies, improve evidence of outcomes and maintain constructive engagement with commissioners and people using services. Those capabilities will remain valuable whatever model eventually emerges.

The ultimate measure of a National Care Service will not be the scale of its organisational reform, but whether it makes high-quality, personalised and sustainable care more accessible in everyday life.