Good governance is not always what is written in audits, policies or meeting minutes. A service can have completed audits, action plans and full files, yet still lack effective oversight, accountability and quality assurance in practice. True governance is about culture, leadership, visibility and outcomes. It is reflected in: how leaders respond to concerns whether actions are followed through how supported staff feel how incidents are learned from whether people receive consistently safe, effective care In many organisations, the challenge is not the absence of governance systems, it is whether those systems genuinely drive improvement. I often see: audits completed without measurable outcomes actions repeatedly identified but not embedded leaders working in isolation inconsistent standards between services poor communication and lack of shared accountability governance meetings focused on process rather than impact Strong governance should provide assurance, challenge and support across the organisation. It should help providers identify risks early, strengthen decision making and create a culture of continuous improvement. Governance is not simply about what sits in a folder ready for inspection. It is about what happens every day when nobody is watching.

I don't often talk about why I left one organisation. It wasn't one conversation or one decision. It happened gradually. The most honest conversations never happened in the room where the decisions were being made; they happened afterwards. I'd leave the meeting, gather my things and start walking back to the office when someone would quietly say, "Have you got a minute?" Sometimes my phone would ring later that evening. The conversations nearly always started in exactly the same way: "I didn't want to say this in the meeting." "Can I be honest?" People weren't telling me shocking secrets. They were talking about everyday things that were getting in the way of providing good care: a process that wasn't working, a decision that hadn't landed well, concerns that had already been raised more than once, or ideas that could have made life easier for residents, families or colleagues. Nothing that should have needed a private conversation. That's the part I found difficult. Not that people had concerns. I'd expect that. Health and social care is complicated, if everyone agreed all the time, I'd be more worried. It was that people no longer believed the meeting was the right place to have those conversations. What frustrated me was that none of these conversations came as a surprise. Most of the people in the room already knew there was an issue, they just weren't talking about it together. I've come to realise that culture isn't always obvious, sometimes you only notice it in the hesitation before someone answers a question, or in the person who waits until everyone else has left the room. When I carry out quality reviews now, I still pay attention to the audits and the evidence. But I also watch the people. Who speaks first? Who never speaks at all? Who changes what they were about to say when someone more senior walks into the room? Who waits until we're walking back down the corridor before saying, "What I really think is..."? Those moments tell me far more than most governance reports ever will. Creating a culture where people feel confident speaking up in health and social care isn't as simple as asking the question. Most people won't tell you they don't feel safe to speak. They'll show you. If the real conversation only starts once the meeting has ended, I'd want to understand why. I want to understand what has happened that made people decide silence was the safer option. Once people stop believing their voice matters, organisations lose something they can't replace: trust. Without trust, improvement becomes much harder than it needs to be.

The Journey of Leadership A few years ago, someone told me they didn't think they were management material. They had lost confidence, and others began to doubt whether leadership was the right path for them. When I got to know them, I saw something different. I saw someone who genuinely cared about people, wanted to do the right thing, listened carefully, and was willing to learn. More than anything, they simply needed someone to believe in them. Today, they're an excellent manager. I didn't make them a leader. I simply saw in them what they couldn't yet see in themselves. That conversation has stayed with me because it reminded me what leadership really is. It's about helping people discover what they're capable of. Learning from Experience Like most of us, I've completed leadership programmes, read the books, and learned from some exceptional people. Every experience has taught me something. However, the biggest lessons haven't come from a classroom. They have come from working alongside people, seeing how different leaders make others feel, and watching confidence grow when someone is trusted, supported, and given the opportunity to step forward. I've always been a hands-on leader. I don't believe you can truly support people if you've lost touch with what they're experiencing. Being visible isn't about checking up on people. It's about being available, knowing your team, understanding the pressures they're under, and taking the time to listen before jumping to conclusions. The Power of Conversations The conversations that have taught me the most have rarely been planned. They happen because someone feels comfortable enough to be honest. It might be a member of staff who's had a difficult day, a relative who's worried, or simply time spent with residents, listening and observing. Those moments tell you what's really happening in a way nothing else does. When the chips are down, I roll my sleeves up. Not because I have to, but because people need to know they're not facing things on their own. I've learned that people usually rise to the expectations we have of them. Give someone trust, support, and the space to grow, and they'll often surprise you. Encouraging Growth That's why I tend to ask more questions than I answer. I'd rather help people think something through than tell them what I'd do. Confidence grows when people discover they're capable of finding the answer themselves. Whether I'm supporting someone taking their first step into management or working alongside an experienced leadership team, my role isn't to become indispensable. It's to leave people more confident than they were before we met. Influences on My Leadership I often reflect on the people who've influenced my own leadership. Those I remember most weren't the loudest or the most authoritative. They were the people who made time for others, listened properly, and saw potential where others sometimes didn't. I've come to believe that one of the greatest privileges of leadership is seeing other people grow in confidence, step forward, and realise what they're capable of. If I've managed to do that, even a little, then I'd like to think I've made a difference. Conclusion In the world of nursing and residential care services, leadership is crucial. It shapes the environment where care is delivered. By fostering a culture of trust and support, we can empower individuals to thrive. As leaders, we must remember that our role is not just to lead but to uplift. When we see potential in others, we create a ripple effect that enhances the entire team. For more insights on leadership and care, visit Cheryl Baird Consultancy.

"We've always done it like that." I think most of us who have worked in care for any length of time have heard that phrase. I've probably said it myself at some point, although hopefully not too often! This phrase doesn't necessarily mean that what someone is doing is wrong. Sometimes, there is a perfectly good reason for doing something a particular way. However, when nobody can explain that reason, we need to take notice. Understanding Poor Practice in Care Services I've been reflecting on how poor practice develops in care services. We often discuss it after an adverse inspection outcome. But how did that practice become acceptable in the first place? How did it lead to a "requires improvement" or "inadequate" rating? A new employee can complete all the induction and training we ask of them. Yet, they will learn a great deal from their colleagues. That's certainly how I learned in my first care role. They observe experienced care workers who seem to know what they're doing. They see what happens when things get busy. They notice what tasks are prioritised and, more importantly, what tasks are overlooked. If everyone takes the same shortcut, why wouldn't they assume that's the right way to do it? If the manager knows it happens and doesn't challenge it, that reinforces the behaviour even more. We can have a beautifully written policy stating one thing while everyday practice teaches people something completely different. We probably don't need to think too hard about which one will have the biggest influence. The Reality of Shortcuts Most shortcuts don't start with someone deciding to provide poor care. Often, people are just trying to cope. You're short-staffed. Someone has phoned in sick. A resident isn't well, and another resident has fallen. The phone is ringing, and the manager is helping on the floor. The task you planned for two o'clock isn't going to happen. So, you move it to tomorrow. That's normal. Anyone who has managed a care service knows there are days like that. But what happens when tomorrow is just as busy? The supervision gets moved again. The competency assessment can wait until next week, and we'll catch up with the records later. Nothing disastrous happens. Everyone gets through the day, so it happens again. Over time, a temporary workaround can become the normal way of working without anyone deciding that it should. Then, a new staff member joins and learns that version of the job. Caring Staff and Poor Care I've been involved in investigations where people have said, "But they're really caring." Sometimes they absolutely are. This isn't just something we see internally when things go wrong. I reviewed some recent CQC findings while writing this. In one service rated "Inadequate" this year, CQC reported that people and relatives generally felt safe. Inspectors observed staff being kind and caring. Yet, they also found significant problems with training and management oversight. Only 12 of 47 staff had received falls prevention training, despite many residents being at high risk of falls. Patterns and trends in residents' risks weren't being identified or acted upon. Caring staff and poor care aren't necessarily opposites. People can genuinely care about the residents they support while working in a service where the systems, skills, oversight, or leadership around them aren't adequate. That doesn't mean we ignore individual accountability. If someone knew what they were supposed to do, had been trained, was competent, and simply chose not to do it, that needs addressing. However, if I discover that five people are doing exactly the same thing, I will ask more than who did it. At that point, I don't think I have just a problem with five individual staff members; I potentially have a problem with what the service has come to accept. What Are We Overlooking? Leaders set standards in various ways, not just through policies, meetings, and supervision. What we walk past really does matter. You don't have to formally tell someone that something is acceptable. Sometimes, seeing it repeatedly and saying nothing does the same job. This also applies when someone tells us they're struggling. If staff repeatedly receive the message that everyone is busy and they just need to get on with it, they may eventually stop communicating their struggles. I would much rather have someone say, "I don't know," or "I'm not confident doing this," than copy what everyone else seems to be doing. Connecting the Dots Another recent CQC report provides a sobering example. One resident experienced 30 falls in 12 months. The falls occurred, and information about them existed. However, CQC found that provider-level leaders and the registered manager failed to identify and effectively monitor the pattern to ensure improvements were made. Thirty falls. It would be easy to look at each fall individually. Was the person injured? Was the falls risk assessment reviewed? Was the family informed? Was the incident form completed? All perfectly reasonable questions. However, someone also needs to ask why this person has fallen 30 times and whether there is anything else we should be doing. The same principle applies more broadly. A manager covering a couple of shifts might not worry me. An increase in agency use might have a reasonable explanation. A few overdue competencies need addressing, but they don't necessarily mean a service is unsafe. Neither does an increase in incidents on its own. However, if the manager is regularly covering shifts, agency use is creeping up, staff are leaving, competencies are overdue, and incidents are increasing simultaneously, I want someone to connect those dots. That's what good governance should do. It should not provide us with six separate reports telling us six separate things are happening. Instead, it should help us understand whether those issues might be connected. By the time poor care is obvious, whatever contributed to it has likely been building for quite a while. The Bigger Picture When something goes wrong, we need to establish who was responsible. Individual accountability matters. However, we also need to ask what allowed it to happen and whether we could have seen it coming. If we only deal with the person at the end of the chain, we might solve the immediate problem while leaving everything around them unchanged. We shouldn't be surprised if we find ourselves dealing with a similar issue again. I'm discussing this in the next episode of Beyond the Audit, which I'm recording for September. The episode will explore how good people can sometimes end up delivering poor care. The answer isn't always as simple as finding the person who made a mistake. Sometimes, it is about the individual. Sometimes it's about competence, leadership, or pressure. Sometimes several fairly small issues have been allowed to become normal over time. So, rather than another checklist this week, I encourage you to observe what happens when things get busy. What are people doing because "that's how we do it here"? And would you be comfortable explaining why?

I once spent about six months in a home with my sister (we worked together!) trying to turn things around. It was one of the hardest periods I can remember. The situations were complex, the pressure was constant, and there were weeks where we were running on a few hours’ sleep because something always needed sorting, and none of it could wait. The Journey of Improvement We worked unbelievably hard. By the time we left, the home was in a much better place. There was more consistency, better oversight, clearer expectations, and far less of the constant firefighting we’d walked into. A few months later, we went back. A lot of what we’d put in place had slipped. I can still remember how that felt. After six months of pouring everything into that service, it was honestly soul-destroying to see things starting to unravel again. At the time, I thought it meant we’d failed. Looking back, I see it differently. We had improved the service, but we were also part of what was holding that improvement in place. This is something we don’t talk about much in turnaround work. When a service is under close scrutiny, everyone becomes laser-focused. Actions get chased. Expectations are clearer. Senior oversight increases, and there’s far less tolerance for drift. The Challenge of Sustaining Improvement That is exactly what’s needed in those situations, but the problem arises when those standards only hold because that level of attention is still there. I’m always wary of improvement plans that look impressive because everything is marked “completed.” Training delivered, competencies checked, care plans updated — all good things, but none of them tell me whether the original issue has actually gone away. I want to know whether practice changed afterward. Whether the same issue popped up somewhere else. Whether the improvement was still there months later. Otherwise, we end up being great at completing actions and not quite as good at checking whether they worked. I’ve seen this play out in many ways. A manager holds a service together because they’re constantly checking and chasing. Staff work to a higher standard because they know there’s extra scrutiny. Governance meetings become sharp and focused because everyone knows the service is under pressure. Then the attention reduces, normal life resumes, and you start to see which parts genuinely became part of the culture and which parts were being carried by the people around it. The Real Test of Improvement That, for me, is where the real test starts. Not when everything looks better, but when the extra support steps back. Can the manager still spot the issue without someone pointing it out? Are staff still working to the same standard when nobody is checking as often? Does the service notice something slipping before it becomes a bigger problem? That’s the hard bit. Sustainable improvement isn’t just about putting things right; it’s about making sure the service can keep them right once the pressure reduces. I think we sometimes pull support away too quickly because things look better and everyone is keen to move on. I’d rather step support down gradually and watch what happens. If something was reviewed weekly, move it to fortnightly. If senior leaders have been chairing every improvement meeting, hand it back to the manager. If every incident has had central scrutiny, reduce it and sample instead. You’re not trying to catch anyone out. You’re checking whether the improvement can stand on its own. If it can’t, that’s important to know. Maybe support came away too quickly. Maybe the original action didn’t address the real issue. Maybe the service still needs more leadership, more clinical oversight, or clearer accountability. The Importance of Continuous Monitoring None of that is helpful if you only discover it six months later when the same issue reappears. You fix wound care, then nutrition starts slipping. Medication improves, but escalation is still weak. Care planning gets better, but follow-up is patchy. That’s when I start wondering whether the original problem was ever really about wounds, medication, or care plans. Sometimes the real issue is much more basic: weak oversight, poor challenge, lack of confidence, unclear responsibility, or people not following things through. That’s why improvement work needs a proper look-back — thirty days, sixty days, ninety days, whatever makes sense. Not for the sake of another process, but because we need to know whether what we did actually lasted. Lessons Learned That home taught me that the hard way. We did make a difference while we were there. I don’t doubt that. But we hadn’t yet built enough around the service for that difference to survive without us. That’s the bit I pay far more attention to now. For me, sustainable improvement in social care is not about how good things look while everyone is focused on the service. It is about whether those standards still hold once the extra support steps back. Because that’s usually when you find out whether the improvement truly belongs to the service or whether it still belongs to the people who drove it. In conclusion, sustainable improvement is a continuous journey. It requires ongoing commitment and vigilance. By ensuring that the improvements made are embedded within the culture of the service, we can achieve lasting change. This is the essence of effective care management, and it is crucial for the success of care homes across the UK.

I'm writing this while on holiday in Greece, having already answered several work emails and taken a few calls this week. Which probably tells you everything you need to know about how successfully I've mastered the art of switching off. I know I shouldn't be doing it. I've given the same advice to managers over the years about taking proper breaks, delegating responsibility and not making themselves available around the clock. Sensible advice, so why can't I follow it! The thing is that nobody has actually told me I need to work while I'm away. In fact, I work for myself. I'm my own boss, so if anyone should be able to give me permission to switch off, surely it's me! And yet here I am, answering emails and taking calls when I should be deciding what to have for lunch. Apparently, I'm not very good at following my own instructions. And I know I'm not alone in this. Anyone who has managed a care service will recognise the Sunday afternoon phone call, the message that starts with "Sorry to bother you, I know you're off..." or the straightforward question that turns into half an hour of sorting something out. Sometimes it genuinely is urgent. In the care sector, there will always be situations that need an immediate response, but plenty of things don't. They've just become things that people are accustomed to asking the manager to deal with. Once you've shown that you'll answer, even when you're not supposed to be working, it becomes very difficult to stop. The unwritten expectation I've worked in organisations where leaders were actively encouraged to take their annual leave and reminded about the importance of work-life balance. I've also seen those same people contacted while they were away because somebody needed a decision, couldn't find something or wasn't sure how to address a situation. It wasn't through any deliberate disregard for their time off; they just knew they would get the answer. That right there is the problem! When you're known for being responsive, reliable and willing to sort things out, people naturally come to depend on it. Initially, it can feel quite reassuring to know that people 'need' you and you are that trusted, go-to person. Eventually, you realise that being trusted to deal with everything has developed into being expected to deal with everything. No one has said you must be available evenings, weekends and holidays, but it has become an unwritten expectation. And then there's the 2am message... I'm sure most managers have encountered that one colleague who apparently doesn't sleep. I once worked with someone who regularly sent emails and Teams messages at two or three in the morning. Nothing urgent, just something they'd remembered, a question they wanted to ask or a piece of information they'd forgotten to pass on earlier. Now, I have absolutely no objection to someone working at whatever time suits them. If you want to catch up on emails at 2am, that's entirely your choice, but please don't assume the rest of us are awake too. The difficulty when you work in care is that you can't always switch your phone off completely. There may be a genuine emergency, and you need to be contactable. So the notification comes through, wakes you up, and you lie there telling yourself not to look at it. Obviously, you look at it! Now you've read it, you're thinking about it. You then remember something else you need to do, then something else, and before you know it, your brain has decided the working day has started. At two in the bloody morning! The person who sent the message has probably gone back to sleep, blissfully unaware that they've just ruined yours. I don't think people always appreciate the effect of contacting colleagues outside working hours, particularly when those colleagues have responsibilities that mean they can't simply make themselves unavailable. There's a difference between being contactable for an emergency and being accessible for every passing thought someone has in the middle of the night. A plea from me, please become familiar with the 'schedule send' function! Sometimes it's easier just to answer I think this is the part that gets overlooked when people talk about setting boundaries. It's easy to tell someone not to check their emails while they're on holiday. But what happens when they return? If you've been away for a week and come back to several hundred emails, decisions that haven't been made, issues that have been passed around and a list of people waiting to speak to you, the first few days back can be miserable. And you know that before you go. So you decide to spend fifteen minutes checking your inbox, answer a couple of straightforward questions, deal with something that might otherwise become complicated and reassure yourself that at least you won't be returning to complete chaos. Except fifteen minutes has a habit of becoming forty-five, and then before you know it, you are sunburnt but have got loads of work done. I don't think it's always a case of us not being able to switch off. It's because switching off completely can create more work when we return. That's always been my experience. Are we making ourselves indispensable? How much of this do we contribute to? When you've spent years being the person who sorts things out, stepping away isn't always easy. You know the service, the people, and you can often resolve something in five minutes that might take someone else a lot longer, so you just do it. And every time you do, you reinforce the idea that contacting you is the quickest and easiest solution. I don't think that's about wanting to be indispensable. In my experience, it's often the opposite. You want things to run smoothly and you don't want colleagues struggling unnecessarily. But there comes a point when being helpful can prevent other people from developing the confidence and authority to make decisions themselves. That assumes there's someone available to make those decisions in the first place. Not every manager has a capable deputy, sufficient senior support or arrangements for covering their absence. And telling someone to delegate when there's nobody to delegate to is about as useful as telling them to relax. I think we place far too much responsibility on individual managers to establish boundaries without always looking at the working arrangements around them. We tell them they need to take proper breaks, but have we made sure somebody else can make the decisions that need making? Are people genuinely authorised to act, or are they expected to hold everything until the manager returns? And most importantly, do senior leaders respect those arrangements themselves? It's difficult to persuade a manager that they shouldn't be checking emails on holiday when they're receiving messages from senior colleagues who know perfectly well they're away. Even if the message doesn't require an immediate response, the fact that it's arrived can create a sense that it needs dealing with. Especially when the sender is someone you report to. I don't think organisations deliberately expect their managers to work every waking hour, but I do think some have become accustomed to a level of availability that would be questioned in many other professions. Because managers continue to make it work, the problem remains largely invisible. I'm still working on it I'd love to finish this by saying I've learned to switch off completely, leave my phone alone and return from annual leave feeling wonderfully refreshed, but that's nonsense. I'm still answering the occasional email, still taking calls and still convincing myself that dealing with something now will make life easier when I get back. Sometimes it will, but I am becoming more conscious of how easily availability becomes an expectation, even when nobody has actually asked for it. I also think we need to be more realistic about what we're asking of Registered Managers and senior leaders. Care services need effective leadership outside normal office hours, and there will always be genuine emergencies. That doesn't mean the same person should be permanently available to deal with every question, problem or decision. Taking annual leave shouldn't require someone to choose between working while they're away and returning to an unmanageable workload. Rather than continually telling managers to set better boundaries, organisations should be asking why those boundaries are so difficult to maintain in the first place. As for me, I'm going to attempt to enjoy the rest of my holiday without checking my emails, well maybe...

Issue 016 | 16 October 2026 A slightly later briefing this week while I’m away, bringing together the developments I think matter most for leaders of adult social care services for older people in England. This week’s focus is workforce stability, delegated healthcare activity, a National Patient Safety Alert affecting blood ketone testing, and what recent CQC findings tell us about the difference between having assurance systems and knowing whether they are effective. This Week’s Headline Skills for Care Publishes Its 2026 Workforce Report: Retention Needs More Than Recruitment Skills for Care published The state of the adult social care sector and workforce in England, 2026 on 14 October, using data from 2025/26. The report examines workforce size and structure, recruitment, retention, pay, training and qualifications, international recruitment and factors associated with both staff turnover and CQC ratings. What Has Changed? The wider workforce picture has improved in some respects. Skills for Care reports that the adult social care vacancy rate fell to 6.2% in 2025/26, equivalent to around 96,000 vacancies on any given day and the lowest vacancy rate recorded in a decade. Filled posts increased by 1.4%, or approximately 22,000, although Skills for Care describes this as the slowest workforce growth in four years. The more interesting findings concern retention. Skills for Care identified five employment and development factors associated with lower turnover among care workers: competitive pay; guaranteed hours; training; relevant qualifications; and full-time employment opportunities. Where all five factors were present, care-worker turnover was 15.3%, compared with 34.3% where none were present. Management experience was also associated with workforce stability. Skills for Care reports that care-worker turnover reduced from 28.3% to 20.6% as registered-manager experience increased. The report also found associations between stronger CQC ratings and workforce characteristics including staffing ratios, pay, training opportunities, Care Certificate uptake and lower vacancy rates. These are associations rather than evidence that any individual factor causes a particular outcome. Why It Matters Recruitment remains important, but the findings strengthen the case for looking beyond vacancy numbers. Repeatedly replacing staff who leave is expensive, disruptive and can affect continuity for people receiving care. Workforce assurance should therefore consider whether experienced staff and managers are staying, not simply whether vacant shifts are being filled. For boards and senior leaders, workforce stability and quality improvement should not sit in completely separate conversations. Skills for Care’s analysis suggests there is value in considering employment conditions, training, leadership stability and quality outcomes together. Actions for Providers Review workforce information beyond the overall vacancy percentage. Look at turnover by service, role and length of employment, including how many people leave within their first year. Consider whether pay, contractual arrangements, training, qualifications, progression and management support are contributing to retention. Review registered-manager stability and succession arrangements. Where management turnover is high, consider whether the organisation understands the reasons rather than treating each vacancy as an isolated recruitment problem. Clinical Governance Delegated Healthcare Activities Are Now Being Measured Across Adult Social Care One of the notable additions to this year’s Skills for Care report is national data on delegated healthcare activities. Skills for Care reports that non-nursing staff undertake delegated healthcare activities in 59% of responding CQC-regulated services. An estimated 46% of direct-care workers in those services undertake delegated healthcare activities. What Has Changed? This is new workforce intelligence. Skills for Care defines delegated healthcare activities as activities that a regulated healthcare professional delegates to a colleague working in a non-regulated role. The figures provide a clearer indication of how significant these activities have become within adult social care delivery. Why It Matters For providers, the numbers reinforce the need to know what clinical activity is actually being undertaken across services. A competency document alone does not demonstrate that delegation remains safe. Governance needs to be clear about which activities are delegated, who made the decision to delegate, whether the individual remains competent, what supervision is available and what happens when the person’s condition changes. The issue is particularly important where care workers are supporting increasingly complex health needs outside traditional healthcare settings. Actions for Providers Identify the delegated healthcare activities currently being undertaken across your services. Confirm who holds professional responsibility for each decision to delegate. Review how competence is assessed, maintained and reassessed. Make sure staff understand when they should stop an activity and seek clinical advice. Consider whether incidents, changes in condition or concerns trigger review of the delegation arrangement. Patient Safety National Patient Safety Alert Issued for Nova Biomedical StatStrip Blood Ketone Test Strips A National Patient Safety Alert was issued on 13 October concerning Nova Biomedical StatStrip blood ketone test strips. The alert, NatPSA/2026/007/NSDR, was issued following quality issues affecting specified lots, associated quality-control failures and the manufacturer’s recall of affected stock. It was issued through the Central Alerting System to a range of organisations including social care providers registered with CAS. What Has Changed? The alert follows MHRA Device Safety Information issued on 9 October. Nova Biomedical has paused distribution of affected lots and advised that affected stock should not be used. The alert states that further lots failing quality-control testing should also be withdrawn. At the time the alert was issued, Nova expected new product to become available for shipment to the UK during the week commencing 26 October. This is an expected supply position rather than a guaranteed resolution date. The National Patient Safety Alert set: an action-underway deadline of 15 October 2026; and an action-complete deadline of 20 October 2026. Why It Matters Not every adult social care service undertakes blood ketone point-of-care testing. Where the equipment is used, however, the issue is potentially significant because affected stock should not be used and alternative testing arrangements may be required. This may be particularly relevant to nursing services and other settings where blood ketone testing forms part of an agreed clinical pathway or delegated healthcare activity. Actions for Providers Establish whether any service uses Nova Biomedical StatStrip blood ketone testing. Where it is used, ensure the responsible clinical lead has reviewed NatPSA/2026/007/NSDR and the manufacturer’s affected-lot information. Affected stock should be removed from clinical use in accordance with the alert, and alternative testing arrangements should be clear where blood ketone monitoring is required. Where the alert applies, ensure completion of the required actions by the specified deadline. Regulation and Quality Assurance CQC Findings Show Why Assurance Needs to Look Beyond the Dashboard Two CQC publications this week provide useful, contrasting examples of how staffing, culture and governance translate into people’s experience of care. Acer Court Care Home in Nottinghamshire was rated Requires Improvement in an assessment report published on 13 October. On 14 October, CQC announced an Outstanding rating for Assist Care Group – Surrey, a homecare service supporting adults including people living with dementia. What Has Changed? These are individual CQC findings. At Acer Court, CQC found that staffing levels matched the dependency tool being used to determine safe staffing. Despite this, people were sometimes left without staff oversight in communal areas or remained in their rooms for prolonged periods without safety checks. CQC also identified poor infection-control measures, damaged pressure-care equipment, medicines not always being administered as prescribed, including time-specific medicines, a culture in which some staff did not feel able to speak up, and governance systems that had either failed to identify or failed to address the concerns found during the assessment. CQC had served a warning notice on the provider on 15 September in relation to safe care and treatment, staffing and good governance. The Assist Care Group findings provide a useful contrast. CQC reported an average staff length of service of seven years and described leaders as monitoring day-to-day service activity and performance to drive improvement. When an increase in reported falls was identified, leaders sought staff views on potential causes and worked with them to make changes. CQC also found that staff had access to a support team while working in the community so that changes in people’s condition could be addressed in real time. Why It Matters A staffing tool can demonstrate that the calculated number of staff are rostered. It cannot, on its own, demonstrate that staff are deployed effectively or that people receive the supervision and support they require. The same principle applies to audits and dashboards. Their value lies in whether they identify emerging risks, support professional challenge and lead to improvement. The Assist Care Group findings also show the other side of assurance: using information such as falls data to understand why something is changing and involve staff in improving the response. Actions for Providers Review how staffing deployment is assured, not only whether rostered numbers match dependency calculations. Look at high-demand periods such as medicines rounds, mealtimes, evenings and shift handovers. Check whether time-specific medicines are being administered at the required times. Consider how confidently staff can raise concerns and what evidence exists that those concerns lead to action. Test whether audits and dashboards identify risks already visible to people receiving care, relatives and frontline staff. Where trends change, such as an increase in falls, examine whether governance processes move beyond counting incidents to understanding causes and evaluating action. Leadership Reflection Workforce Stability Is a Quality Issue One of the strongest messages from this week’s workforce report concerns the relationship between staff experience, employment conditions and the quality of care people receive. It is easy for workforce discussions to become dominated by recruitment numbers, vacancies and agency expenditure. Those figures provide only part of the picture. A service may have few vacancies while experiencing repeated changes in its workforce. Another may have a stable and experienced team but limited development opportunities or increasing clinical responsibilities that are not fully recognised. The findings concerning registered-manager experience are particularly important. Leadership develops through experience, professional judgement and an understanding of the people, staff and services involved. Repeated changes in management can disrupt continuity and make sustained improvement harder. There is therefore an organisational responsibility to create the conditions in which good managers can remain effective. We frequently talk about supporting and retaining care staff. We should be equally interested in what enables good managers to stay, develop and lead well. Five Things I’d Be Thinking About This Week Workforce retention: Are we looking closely enough at why people leave during their first year, and what encourages experienced staff to remain? Management stability: Are we supporting good managers to stay and develop, or repeatedly rebuilding the same management teams? Delegated healthcare: Could we clearly identify which activities are delegated, who authorised them and how competence and clinical oversight are maintained? Patient safety: Have we established whether the StatStrip blood ketone alert applies anywhere in our organisation? Governance: Are our staffing, audit and incident systems telling us what is actually happening in services, or mainly confirming that expected processes have been completed? Sources The state of the adult social care sector and workforce in England, 2026. — Skills for Care. Published 14 October 2026; data period 2025/26.https://www.skillsforcare.org.uk/Adult-Social-Care-Workforce-Data/workforceintelligence/Reports-and-visualisations/National-information/The-State-of-report.aspx New Skills for Care report identifies factors linked to better retention of care workers and higher quality of care — Skills for Care. Published 14 October 2026.https://www.skillsforcare.org.uk/news-and-events/news/new-skills-for-care-report-identifies-factors-linked-to-better-retention-of-care-workers-and-higher-quality-of-care Adult social care vacancy rate falls to lowest level in a decade as workforce grows — Skills for Care. Published 24 June 2026. Used to verify the 2025/26 vacancy and workforce figures carried forward into the October report.https://www.skillsforcare.org.uk/news-and-events/news/adult-social-care-vacancy-rate-falls-to-lowest-level-in-a-decade-as-workforce-grows Supply disruption for Nova Biomedical StatStrip blood ketone test strips – NatPSA/2026/007/NSDR — National Patient Safety Alert, National Supply Disruption Response. Issued 13 October 2026.https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103281 Nova Biomedical StatStrip ketone test strips: risk of disruption to blood ketone testing due to quality-control failures and supply interruption DSI/2026/013 — Medicines and Healthcare products Regulatory Agency. Published 9 October 2026.https://www.gov.uk/drug-device-alerts/nova-biomedical-statstrip-ketone-test-strips-risk-of-disruption-to-blood-ketone-testing-due-to-quality-control-failures-and-supply-interruption-dsi-slash-2026-slash-013 Acer Court Care Home – Assessment report AP28981 — Care Quality Commission. Published 13 October 2026.https://www.cqc.org.uk/location/1-319747838/reports/AP28981/overall CQC rates Surrey home care service outstanding — Care Quality Commission. Published 14 October 2026.https://www.cqc.org.uk/press-release/cqc-rates-surrey-home-care-service-outstanding Editorial Note This briefing reviews material developments published or substantively updated between 9 and 16 October 2026. This edition is being published one day later than usual. Official material from CQC, NICE, NHS England, GOV.UK, including DHSC and MHRA, and relevant sector sources was reviewed. Items have been included according to their practical relevance to providers of adult social care for older people rather than simply because they were published during the period. The Skills for Care findings about employment conditions, management experience, turnover and CQC ratings identify statistical associations. They should not be interpreted as proving that individual workforce factors cause a particular retention or regulatory outcome. NatPSA/2026/007/NSDR is a National Patient Safety Alert with an action-complete deadline of 20 October 2026. It applies specifically to the Nova Biomedical StatStrip blood ketone testing issue described in the alert. The CQC findings relate to individual registered services and are included for learning and assurance purposes. The Why It Matters, Actions for Providers, Leadership Reflection and Five Things I’d Be Thinking About This Week sections contain professional interpretation and practical considerations based on the cited evidence. Looking Ahead 22 October – Adult Social Care Finance Report DHSC has confirmed that Adult social care finance report, England: 2025 to 2026 will be published on 22 October 2026. The report will provide official statistics on adult social care expenditure and income across councils with adult social services responsibilities in England. This should be useful next week for understanding the wider financial and commissioning context, although national and local authority expenditure statistics should not be treated as evidence of the actual cost of delivering an individual care service. DHSC – Adult social care finance report publication announcement 29 October – Adult Social Care Survey DHSC has confirmed that Adult social care survey, England: 2025 to 2026 report will be published on 29 October 2026. The publication will provide official statistics on the outcomes and experiences of people aged 18 and over receiving long-term adult social care services in England. The findings will be worth reviewing once published, particularly for what they tell us about people’s experience of care, quality of life and the impact of services, rather than drawing conclusions before the data is available. DHSC – Adult Social Care Survey publication announcement

There are people in care services who become part of someone’s everyday life without ever being described that way. The maintenance person who stops for ten minutes because he and one of the residents both love racing cars. The domestic who knows exactly which pie someone used to buy from the local bakery and goes out of her way to get one because she knows how much they enjoy it. The kitchen assistant who remembers that someone likes their tea in a particular mug, or the receptionist who knows which relative rings every Sunday and notices when they do not. Those things can look small, but they are not small to the person receiving care. They are the moments that say, “I know you”, and not what your care or support plan says about you. I've seen more meaningful interactions happen with these people. Not because someone has been told to create a “person-centred moment”, but because a relationship has developed naturally and somebody has taken the time to remember what matters. For people receiving care, so much of life is organised around other people, meals and medications happen at certain times, support and appointments are planned, so these unplanned, authentic moments become so much more important, and the person is just that, a person, someone who has something valuable to contribute to a conversation. Kitchen teams, domestics, laundry staff, maintenance and reception often get to know people in a completely different way because their contact is ordinary and unforced. A domestic may know how someone likes their room, a kitchen assistant may remember the food they grew up with, and maintenance may know more about someone’s old hobbies than anyone realised simply because they have stopped and had a proper conversation. I probably appreciate these roles more because I have had to step into them myself over the years. I have ended up in the kitchen on Christmas Day, picked up a mop and bucket, and done the admin when there was nobody else to do it. I found some of those jobs harder than nursing, caring or being the manager, mainly because they were so far outside my comfort zone. It gave me a much better appreciation of just how much work goes on beyond what we usually think of as the “care” side of the service. Those roles are not in the background. They are part of what keeps everything together. People receiving care do not stop being interested in ordinary life just because they now receive this support. They still want to talk about football, cars, baking, gardening, music, grandchildren, holidays, old jobs, the weather and all the other things that make up a normal conversation. Quite often the person who gives them that conversation is not a nurse or care worker. It is the person fixing the wardrobe door, changing a light fitting, bringing in the post or clearing the breakfast things away. Those relationships can be incredibly important because they are not always built around a care task. They happen because two people find something to talk about, somebody remembers what was said last time, or a familiar face takes a few minutes to stop. That knowledge can be so useful too. Someone who sees the same person every morning may notice when they are quieter than usual, have stopped asking for something they normally enjoy or simply seem different. They are not there to make clinical judgements, but knowing someone well can often be the first clue that something has changed. What I would not want is for us to recognise the value of these relationships and immediately turn them into another responsibility. The point is not to make domestics, kitchen teams or maintenance staff do more. It is to recognise what they already bring to the service and make sure that, when they do notice something or know something important about a person, we actually listen. CQC reports pick this up too. In recent assessments, inspectors have highlighted services where staff knew people well, understood their preferences and routines, and adapted support around the individual. At Burlington Hall, relatives described staff knowing very specific personal preferences and forming distinct relationships with people. CQC also noted that staff knew people well enough to notice changes quickly and act on them. At Maristow Nursing Home, staff were able to talk confidently about people’s needs and preferences, including food preferences, and the kitchen stocked foods people specifically liked. That is exactly the point. Knowing somebody well is not just a nice extra; it is part of good care. And the people building that knowledge are not always the ones with “care” in their job title. Residents do not care what somebody’s job title is. What they remember is how that person makes them feel, whether they stop and talk to them, whether they remember the things that matter, and whether they treat them as an individual rather than a task to get through. That is probably why some of the strongest relationships in a service are with people whose role sits outside direct care. To the resident, they are not “maintenance”, “domestic” or “kitchen”. They are the person who knows about the racing cars, remembers the pie, notices when something is different and treats them like themselves. Care homes are people’s homes, and the people who make them feel like home are not only the people providing direct care. A lot of my work with providers is about governance, quality and improvement, but this is also what person-centred care in care homes looks like in practice. Good systems are important, but they should support the human side of care rather than squeeze it out. If you are reviewing culture, quality or what genuinely person-centred care looks like across your services, I can help with that too.

Issue 015 | 9 October 2026 This weekly briefing highlights significant developments affecting home managers, registered managers and senior leaders of adult social care services for older people in England. This week includes new investment in dementia research, workforce training developments, artificial intelligence regulation, telecare safety and CQC inspection findings. This Week’s Headline Government Announces £48 Million Dementia Research Partnership On 8 October, the government announced a £48 million partnership aimed at accelerating dementia research and improving access to clinical trials. The announcement includes £33 million of government investment through the Dame Barbara Windsor Dementia Goals programme, alongside funding from industry. The BARBARA Alliance will bring together researchers, charities, industry and people with lived experience to improve access to dementia research and address barriers to clinical trial participation. Dementia will also be an early priority for the new Health Data Research Service, supporting improved access to securely managed health and research data. What Has Changed? The announcement brings additional investment and a new research partnership aimed at improving access to clinical trials and accelerating the development of dementia treatments. The BARBARA Alliance will bring together researchers, industry, charities and people with lived experience to address barriers to participation in research. Why It Matters Dementia research has significant implications for the future of care and treatment, particularly as increasing numbers of people require support with complex needs. Improving access to clinical trials is important, particularly for people who may otherwise face barriers to participating in research. The involvement of people living with dementia and their families in research development should also help ensure that future priorities reflect their experiences and needs. Actions for Providers Providers may wish to ensure that people living with dementia and their families have access to reliable information about opportunities to participate in research, including the National Institute for Health and Care Research's Join Dementia Research service. Where people express an interest, staff should be able to support access to information and appropriate decision-making, including consideration of mental capacity where relevant. Workforce Skills for Care Launches New Statutory and Mandatory Training Bundle On 2 October, Skills for Care launched a new eLearning package through its Training Hub. The package covers eight topics aligned with Part 1 of its statutory and mandatory training guidance, including safeguarding, infection prevention and control, fire safety, health and safety, and moving and handling of objects and people. Additional modules cover the principles of medication administration and food hygiene, although the food hygiene module is not expected to become available until later in 2026. The bundle costs £39.50 and includes knowledge checks and certificates for individual modules. What Has Changed? Skills for Care has introduced a new training resource intended to support employers with induction and refresher learning. The package provides an additional option for organisations reviewing how they deliver essential learning. Why It Matters The package may be useful for providers seeking greater consistency in training across services, particularly where different homes currently use different learning arrangements. Training provision must continue to reflect the responsibilities of individual roles, the needs of people receiving support and the skills staff need to demonstrate in practice. Actions for Providers Providers reviewing their training arrangements may wish to compare the package with their existing provision, particularly where there are gaps or inconsistencies. Any decision to introduce it should consider whether it offers an improvement over current arrangements and how practical competence will continue to be assessed. Digital Care and Governance Government Accepts Recommendations on AI Regulation in Healthcare On 6 October, the government published its response to the National Commission into the Regulation of AI in Healthcare, accepting all 44 recommendations. The recommendations address the regulation of AI-enabled healthcare technologies, including product assessment, deployment, ongoing monitoring and the management of changes after technologies enter clinical use. The Medicines and Healthcare products Regulatory Agency will take forward further work on implementation. What Has Changed? The government has accepted the Commission's recommendations and identified priorities for developing the regulatory framework. Further work will focus on how AI-enabled medical devices are assessed and monitored throughout their use, including how changes to these technologies are managed. Why It Matters Adult social care providers increasingly use technologies that support clinical monitoring, assessment and decision-making. As these technologies develop, providers need assurance that they are appropriate for their intended purpose, that staff understand their limitations and that arrangements exist for responding to errors, unexpected results or system failures. The recommendations also reinforce the importance of ongoing monitoring, rather than relying solely on assurance obtained when technology is first introduced. Actions for Providers Where AI-enabled clinical technologies are in use, providers should understand the manufacturer's assurance arrangements, the system's intended purpose and the responsibilities of staff using it. Clinical oversight, incident reporting and arrangements for managing software changes should form part of existing governance processes. Digital Safety DHSC Publishes Guidance on Telecare and the Digital Telephone Switchover On 8 October, the Department of Health and Social Care published guidance for housing providers in England on safeguarding people who rely on telecare during the digital telephone switchover. The transition from analogue telephone networks to digital services is due to be completed by January 2027. The guidance highlights risks associated with analogue telecare and grouped living scheme alarm systems, which may become unreliable or stop working if they are not appropriately upgraded. It covers identifying affected equipment, information sharing, fire safety considerations and arrangements for upgrading systems. What Has Changed? DHSC has published additional guidance to support organisations responsible for telecare and alarm systems during the transition. The guidance addresses the identification of affected equipment and the arrangements needed to maintain people's safety as systems are upgraded. Why It Matters Although directed at housing providers, the guidance is relevant to adult social care organisations operating supported housing or services where people rely on analogue alarm and telecare equipment. These systems may be essential for summoning assistance, responding to emergencies and supporting independence. Failures during the transition could create significant risks, particularly where people depend on equipment to alert others when they need help. Actions for Providers Organisations responsible for telecare or alarm systems should confirm whether any equipment remains dependent on analogue telephone connections and whether appropriate upgrade arrangements are in place. Where equipment is provided or maintained by landlords or external organisations, responsibilities for testing, upgrading and maintaining safe arrangements should be clear. Quality and Governance CQC Highlights Personalised Care and Effective Learning at Outstanding Nursing Home On 6 October, CQC announced that Wisteria Lodge in Hampshire had been upgraded from Good to Outstanding following an inspection. The nursing home, which supports older people including people living with dementia, received Outstanding ratings for Effective, Caring and Well-led. Safe and Responsive remained Good. CQC highlighted staff understanding of people's individual histories, preferences and interests, alongside effective incident investigation and organisational learning. Inspectors found that incident findings informed changes to care plans, risk assessments and practice, while leaders used wider trends to help prevent recurrence. Why It Matters The findings provide a useful example of how personalised care and effective governance can be demonstrated through everyday practice and outcomes for people. They also highlight the importance of ensuring that incident investigations result in meaningful learning and improvements, rather than simply completing an investigation process. Actions for Providers The findings offer an opportunity to consider how effectively incident learning is translated into practice, particularly whether improvements can be demonstrated through changes in care and outcomes for people receiving support. Leadership Reflection This week's developments highlight several areas where national policy, emerging technology and established care practice intersect. The investment in dementia research offers opportunities to improve future treatment and access to research, while developments in AI regulation reflect the increasing role of technology in healthcare. For providers, the telecare guidance has more immediate practical relevance, particularly where people depend on alarm systems that may be affected by the digital telephone switchover. The CQC findings at Wisteria Lodge also provide a useful reminder that effective governance is demonstrated through what happens in practice, including how organisations learn from incidents and improve people's experiences. Five Things I'd Be Thinking About This Week Are people living with dementia and their families able to access reliable information about research opportunities where they express an interest? Would the new Skills for Care training package improve our existing provision, particularly across multiple services? Do we have appropriate clinical governance arrangements for AI-enabled technologies used in assessment, monitoring or decision-making? Are any alarm or telecare systems within our services dependent on analogue telephone connections, and are upgrade arrangements confirmed? Can we demonstrate that learning from incidents has resulted in improvements in care and outcomes? Looking Ahead 14 October — Skills for Care is scheduled to publish The State of the Adult Social Care Sector and Workforce in England 2026, including updated analysis of recruitment, retention, pay, training, qualifications and workforce capacity. 22 October — DHSC is scheduled to publish the Adult Social Care Finance Report, England: 2025 to 2026. 29 October — The Adult Social Care Survey, England: 2025 to 2026 is scheduled for publication. November to December — The Adult Social Care Activity Report, England: 2025 to 2026 remains subject to a provisional publication timetable following the previously announced delay. Sources GOV.UK — Government announces dementia research partnership, 8 October 2026 Skills for Care — New statutory and mandatory training bundle, 2 October 2026 Skills for Care — Statutory and mandatory training bundle MHRA — Government response to the National Commission on AI in Healthcare, 6 October 2026 MHRA — Healthcare Providers Explainer, 6 October 2026 DHSC — Telecare and the digital switchover: guidance for housing providers, 8 October 2026 CQC — Wisteria Lodge rated Outstanding, 6 October 2026 CQC — Wisteria Lodge assessment report Skills for Care — State of the Adult Social Care Sector and Workforce 2026 launch event Editorial Note This briefing covers significant developments reviewed between 2 and 9 October 2026. The information is drawn from government, regulatory and sector publications. The Why It Matters, Actions for Providers, Leadership Reflection and Five Things I'd Be Thinking About This Week sections provide professional interpretation of the developments and their relevance to adult social care providers. If there’s a particular issue, development or area of adult social care you’d like me to cover in a future briefing, please get in touch. I’m always interested in hearing what’s happening across the sector and the issues that matter to those delivering and leading care services.

Positive Risk-Taking: How Safe Is Safe Enough? Listen to Episode 3 “Is that really safe?” A reasonable question. Slightly less reasonable when the concern is based entirely on someone living with dementia, rather than knowing anything about the person or what they can do. In Episode 3 of Beyond the Audit, I look at positive risk-taking in adult social care and how easily our responsibility to keep people safe can become a reason to stop them doing things that matter to them. I reflect on a dementia service with its own workshop and tools, the assumptions we make about people’s abilities, and why years of experience don’t simply disappear when someone receives a diagnosis. I also explore how leaders can support thoughtful decisions about risk without making “just in case” the basis of somebody’s entire life.

I once worked in a dementia service that had a workshop, with tools and practical activities. When we were going through the registration process, I was asked whether that was really safe considering the client group. I remember being so irritated by the question, because it seemed to start from the assumption that dementia somehow made the whole idea questionable! The person who asked me with real shock, did not know if the people who would use the space had been working with tools for years, repairing, building, gardening, fixing things around the house or simply doing the sort of practical jobs that may have been part of their life. People don't suddenly lose all of that experience because they now have a diagnosis, and I let that person know this! Of course the risks needed to be considered. I would expect that in any service. But that is different from deciding that the activity itself is inappropriate because of the type of people receiving care, and I think that's why positive risk-taking gets difficult in practice. We are all quite comfortable with the phrase and nobody is going to stand up and say they are against choice and independence, but the difficulty arises when someone actually wants to do something that makes us nervous. That might be using tools, going out alone, having a drink, cooking, smoking, taking part in something physical, or simply making a decision we would not make for them. At that point, “keeping people safe” can start doing a lot of heavy lifting, and I get it. Providers are responsible for managing risk. Staff do not want people harmed, families worry and regulators expect services to know how to keep people safe. This is where we run the risk of removing the person’s freedom, choice and identity. The point of a good risk assessment is not to prove that something is dangerous. Most things in life are, to some degree. It is to work out what the actual risk is, what can reasonably be done to reduce it, whether the person understands the implications, and whether the remaining risk is proportionate to what they gain from doing it. To do this we need to view the person in front of us and not their diagnosis. Two people living with dementia may have completely different abilities, histories and levels of understanding. One may be perfectly capable of using familiar tools, another may not be. The answer should come from the individual assessment, not from a blanket view of what people living with dementia should or should not be allowed to do. That is where services can find themselves caught in the middle. The person wants to carry on doing something that matters to them, the family may be worried about the risk, safeguarding may want reassurance that the risk is being managed properly, CQC will expect the service to be able to explain its decision, and the provider quite reasonably wants to know that the position can be defended if something goes wrong. Put these all together and it can become much easier to say no than to work out how something might be possible and keep everyone happy. We talk a lot about person-centred care, choice and independence, but services can feel they are being pulled in the opposite direction as soon as there is a possibility of harm. The safest option for the organisation is not always the best option for the person, and sometimes the most restrictive decision is also the easiest one to explain afterwards, I see this often. The staff team really want to support the person, but the scrutiny and shocked questions, 'why on earth would you even consider this?' prevents them from doing so. That is where I think positive risk-taking needs more than a good risk assessment. It needs a culture that gives staff confidence to support sensible, considered choices without feeling that they are one adverse outcome away from being asked why they allowed it in the first place. Because in reality people can make perfectly reasonable decisions, the risks understood, the support appropriate, and something can still go wrong. That does not automatically mean the original decision was wrong. If someone has been involved, the risks have been properly considered, reasonable steps have been taken to reduce them and the decision reflects what matters to that person, then we should be able to confidently stand behind that decision even if the outcome is not perfect. Otherwise, we end up creating services where staff become frightened to support anything that carries uncertainty, because the safest thing for them professionally is to say no. That is not really person-centred care! There is also a danger that we start assessing risk from the organisation’s point of view rather than the person’s. What is easiest to defend? What is least likely to generate difficult questions? But I think we also have to ask what the person loses if we say no. Very likely their independence, identity, confidence or sense of purpose, and in my eyes those are the most significant risks. This is where advocacy comes in. The people who know the person well have a responsibility to speak up for what matters to them, particularly when someone looking in from the outside only sees the risk. A regulator, safeguarding professional or commissioner may see one part of the picture. They may not know that this person spent forty years working with tools, has always valued doing things for themselves, or becomes distressed when too much is taken away from them. That does not mean dismissing legitimate challenge, sometimes an outside view will identify something we have missed, and we should be open to that. Equally, we should not abandon a sensible, well-considered decision simply because somebody who does not know the person is uncomfortable with it. If we genuinely know the person, understand their wishes, have considered capacity where relevant, assessed the risk properly and put reasonable safeguards in place, then part of our role is to explain that confidently and stand behind it. I think managers and staff sometimes lose confidence at this point. They know why the decision makes sense for the person, but one raised eyebrow or one “why on earth would you allow that?” is enough to send everyone scrambling towards the safest possible option. We need to be better than that. Person-centred care occasionally means being prepared to say, professionally and with evidence, “I understand why you are concerned, but this matters to the person, this is how we have assessed the risk, and this is why we believe supporting them is the right thing to do.” The workshop is a good example for me. If we had simply decided that tools and dementia did not mix, it would have been very easy to justify on paper. Nobody could have accused us of taking a risk. But some of the people using that space would also have lost something that felt normal, familiar and meaningful to them. That is why I think “keeping people safe” needs handling carefully. It sounds entirely positive, and usually it is, but it can very easily become shorthand for removing anything that makes the rest of us nervous. And I think leaders have a responsibility here too. If we want staff to support positive risk-taking, then we have to back them when they make a sensible, defensible decision. We cannot talk about choice and independence, then make people regret supporting either of them the minute somebody asks a difficult question, that is how risk aversion grows. The irony is that the more frightened we become of risk, the easier it is to forget that people receiving care are still entitled to make choices we may not make ourselves, and here's a thing, they are not required to live their lives according to what makes the rest of us comfortable! Positive risk-taking is not about being relaxed about safety. It is about being confident enough to balance safety with somebody’s right to live a life that still feels like their own, and sometimes being prepared to advocate for that when other people would find it easier to say no.

Issue 014 | 1 October 2026 This weekly briefing highlights significant developments affecting home managers, registered managers and senior leaders of adult social care services for older people in England. This week includes the government’s announcement on the National Care Service, alongside developments in workforce, digital care, national data and clinical safety. This Week’s Headline Government Announces Plans for a National Care Service On 29 September, the government announced that it intends to establish a National Care Service in the next Parliament, including free personal care for older people based on need rather than ability to pay. The government has said the National Care Service would be introduced in phases, with its scope increasing as funding, workforce and provider capacity develop. Baroness Louise Casey’s Independent Commission on Adult Social Care will make recommendations on how and when the service could be developed. The Commission’s report is due in summer 2027. The government has also announced that the State Pension Triple Lock will remain in place until April 2030. It proposes changing the arrangement after that date, with savings from the revised system intended to contribute towards funding the National Care Service. What Has Changed? The government has now made a policy commitment to establishing a National Care Service in the next Parliament and to providing free personal care for older people based on assessed need. The detailed model has not yet been determined. Key questions remain around eligibility, commissioning arrangements, provider payment mechanisms, the role of local authorities, the scope and phasing of the service, and how sufficient workforce and provider capacity will be developed. The Independent Commission will make recommendations on implementation, and further policy detail will therefore be required before providers can fully assess the operational and financial implications. There is currently no change to existing charging, eligibility, contracting or commissioning arrangements. Why It Matters The proposals could eventually result in significant changes to how adult social care for older people is funded and commissioned. For providers, the eventual impact will depend on the detailed design of the National Care Service, including eligibility, payment arrangements, commissioning responsibilities and the pace at which free personal care is introduced. The government has acknowledged that implementation will need to develop alongside workforce and provider capacity. Actions for Providers No immediate operational change is required as a result of the announcement. Senior leaders should monitor the development of the National Care Service and the work of the Independent Commission. Organisations undertaking longer-term strategic planning should consider potential implications for service models, workforce requirements, commissioning relationships, publicly and privately funded care and future capacity. Providers should avoid making operational or financial assumptions about the future model until further detail is published. Workforce New Adult Social Care Workforce Plan and National Pension Scheme Announced On 30 September, the government announced that a new adult social care workforce plan is expected to be published by the end of 2026. The government also announced what it describes as the first national collective pension scheme for adult social care workers. A new national champion for unpaid carers will also be appointed. The government has positioned these measures as part of the development of the future National Care Service. What Has Changed? The commitment to publish an adult social care workforce plan by the end of 2026 provides a further indication that workforce reform will form part of the wider National Care Service programme. The announcement of a national collective pension scheme could also have implications for providers and the employment offer within adult social care. However, detailed information about how the pension scheme will operate has not yet been published. Why It Matters Workforce capacity is directly linked to the government’s ability to expand access to adult social care. Providers will therefore need to follow the workforce plan alongside developments relating to recruitment, retention, pay, training, career pathways and workforce capacity. Further information about the proposed pension scheme will be needed before providers can assess its employment, financial or administrative implications. Actions for Providers No immediate change to existing pension arrangements is indicated by the announcement. Providers should monitor publication of the workforce plan and further details of the proposed pension scheme. Senior teams should maintain a clear understanding of their existing workforce position, including vacancy rates, turnover, retention, training and competency, progression arrangements and pension participation, to support assessment of future workforce proposals. Digital Care and Governance DHSC Publishes New Adult Social Care Digital Guidance On 29 September, the Department of Health and Social Care published a new collection of guidance and resources supporting digital transformation in adult social care. The collection covers: Digital Social Care Records; artificial intelligence; digital skills; digital leadership; smartphones and devices; secure email and internet connectivity; and choosing and managing technology suppliers. The guidance also provides a national definition of a fully digitised care provider. A Care Quality Commission registered provider is considered fully digitised where it: uses an assured Digital Social Care Record solution; and meets the ‘standards met’ level of the Data Security and Protection Toolkit. DHSC states that not being fully digitised will not automatically lower a Care Quality Commission rating. However, where paper-based systems limit a provider’s ability to deliver or evidence safe and effective care, this could affect inspection outcomes. Why It Matters The guidance provides providers with a clearer national benchmark against which to review digital arrangements. Digital governance extends beyond whether a service uses electronic care records. Providers need assurance around information security, staff capability, devices, data quality, system selection and the appropriate use of emerging technology. The new Adult Social Care Digital Skills Framework identifies seven areas of digital capability: using technology to support person-centred care; technical skills for using technology; communicating using technology; using and managing data; being safe and secure online; ethical use of technology; and digital learning, development and wellbeing. The framework includes skills expected of all staff and additional skills for people in supervisory, management, leadership, digital champion and care technology roles. Artificial Intelligence in Adult Social Care DHSC has also published specific guidance on the use of artificial intelligence in adult social care. The guidance covers potential uses including care planning and assessment, data analysis, administration, meetings, business planning, human resources and auditing. Where artificial intelligence is used to support care planning, a member of care staff must review the resulting care plan to ensure it is accurate. DHSC also states that providers must comply with data protection legislation when using artificial intelligence. Personally identifiable information should not be entered into free or online artificial intelligence tools where the organisation has no contractual assurance about how the information will be protected or used. DHSC recommends human review of artificial intelligence-generated outputs and advises organisations to consider having an artificial intelligence policy, including where the organisation’s position is that staff should not use artificial intelligence for work purposes. Actions for Providers Providers should review the new guidance against existing digital governance arrangements. This should include: confirming that the organisation uses an assured Digital Social Care Record solution where applicable; checking current Data Security and Protection Toolkit status; reviewing digital skills within induction, supervision and staff development; reviewing governance for smartphones and other devices used for care; confirming arrangements for information security and data protection; establishing clear organisational expectations for the use of artificial intelligence; ensuring human review of artificial intelligence-generated outputs; and ensuring staff understand what information must not be entered into public or free artificial intelligence tools. Data and Planning Adult Social Care Activity Data Publication Delayed On 29 September, the Department of Health and Social Care changed the publication date for the Adult Social Care Activity Report, England: 2025 to 2026. The report had been scheduled for publication on 22 October 2026. DHSC states that the release has been delayed because of a processing error and the need for further quality assurance. The current provisional publication window is November to December 2026. The Adult Social Care Client Level Data quarterly update to June 2026 has also been delayed. It had been scheduled for 1 October and now has a provisional publication window of October to November 2026. DHSC has separately confirmed that the identified processing error affects its latest published client-level figures up to March 2026. It is investigating the extent of the error and will publish corrected figures if it determines that this is proportionate under its revisions and corrections policy. The Adult Social Care Finance Report, England: 2025 to 2026 remains scheduled for publication on 22 October. Why It Matters There is no additional reporting requirement for individual providers. However, organisations using national adult social care datasets for benchmarking, strategic planning, commissioning discussions or governance reporting should be aware of the identified processing error and revised publication timetable. Previously published client-level figures up to March 2026 should be used with appropriate caution while DHSC investigates the issue. Actions for Providers Update governance and planning calendars where the Adult Social Care Activity Report had been scheduled for review in October. Where client-level data up to March 2026 have been used within analysis, benchmarking or strategic planning, note the DHSC processing issue and review conclusions when DHSC provides further information or corrected figures. Ensure national data used within governance reports are clearly identified by source and publication date. Clinical Governance MHRA Issues Advice on Filters for Parenteral Nutrition The Medicines and Healthcare products Regulatory Agency published its September Safety Roundup on 29 September. The roundup includes advice on the administration of parenteral nutrition in all care settings. The MHRA advises that all parenteral nutrition solutions should be administered using a filter with a pore size no larger than 1.2 micrometres. Where an aqueous or lipid-free parenteral nutrition solution is being administered, use of a 0.2 micrometre filter is considered good practice where available. The advice follows adverse incidents associated with the administration of parenteral nutrition without a filter, including an embolism resulting in death. Filters and administration sets should be changed with each new parenteral nutrition container, taking account of the parenteral nutrition shelf-life, local infection-control requirements and filter shelf-life. Integrated filters are preferred, although add-on filters are considered a suitable alternative where infection-control guidance is followed. Actions for Providers Services supporting people receiving parenteral nutrition should: review current clinical protocols; confirm that appropriate filters and administration sets are available; check staff training and competency; clarify responsibilities between the care provider and specialist healthcare teams; ensure local infection-prevention requirements are reflected in practice; and update local guidance where necessary. The September MHRA Safety Roundup also includes the patient hoist and sling National Patient Safety Alert covered in Issue 012. There has been no material change to the actions previously reported, so it is not repeated here. Leadership Reflection This week’s developments operate across different timescales. The National Care Service announcement establishes the government’s intended direction for adult social care reform, but significant detail remains unresolved. There is no immediate change to current provider charging, contracting or commissioning arrangements. The new DHSC digital guidance has more immediate relevance. It provides providers with updated national guidance covering Digital Social Care Records, digital capability, devices, information governance and artificial intelligence. The delay to national adult social care statistics should also be reflected where organisations use these datasets for benchmarking, governance reporting or strategic planning. Providers should distinguish between developments requiring action now and announcements that require monitoring as further policy and implementation detail emerges. Five Things I’d Be Thinking About This Week Do our senior leaders understand what has actually been announced about the National Care Service and what remains to be determined? Does our organisation meet DHSC’s current definition of a fully digitised care provider? Do we have clear governance for staff use of artificial intelligence, including data protection and human review? Are any governance, benchmarking or planning reports relying on adult social care data affected by the DHSC processing error? If we support anyone receiving parenteral nutrition, have we reviewed our arrangements against the latest MHRA advice? Looking Ahead 11 October — registration closes for invited households wishing to express an interest in joining the Independent Commission on Adult Social Care’s Public Panel on Care. 14 October — Skills for Care will launch The State of the Adult Social Care Sector and Workforce in England 2026, including updated analysis of workforce size and structure, recruitment and retention, demographics, pay, training, qualifications and future workforce forecasts. 22 October — the Adult Social Care Finance Report, England: 2025 to 2026 remains scheduled for publication at 9:30am. October to November — provisional publication window for the delayed Adult Social Care Client Level Data quarterly update to June 2026. November to December — provisional publication window for the delayed Adult Social Care Activity Report, England: 2025 to 2026. By the end of 2026 — the government says it intends to publish a new adult social care workforce plan. Summer 2027 — Baroness Louise Casey’s Independent Commission on Adult Social Care is due to report. Sources GOV.UK — Prime Minister Andy Burnham sets out plans for a new National Care Service Published 29 September 2026https://www.gov.uk/government/news/prime-minister-andy-burnham-sets-out-plans-for-a-new-national-care-service GOV.UK — Adult social care workforce announcement Published 30 September 2026https://www.gov.uk/government/news/support-for-families-and-babies-rolled-out-to-all-family-hubs Department of Health and Social Care — Digitising adult social care Published 29 September 2026https://www.gov.uk/government/collections/digitising-adult-social-care Department of Health and Social Care — Becoming a fully digitised care provider Published 29 September 2026https://www.gov.uk/guidance/becoming-a-fully-digitised-care-provider Department of Health and Social Care — Using AI in adult social care Published 29 September 2026https://www.gov.uk/guidance/using-ai-in-adult-social-care Department of Health and Social Care — Adult social care digital skills framework Published 29 September 2026https://www.gov.uk/government/publications/adult-social-care-digital-skills-framework/adult-social-care-digital-skills-framework Department of Health and Social Care — Adult social care activity report, England: 2025 to 2026Updated 29 September 2026https://www.gov.uk/government/statistics/announcements/adult-social-care-activity-report-england-2025-to-2026 Department of Health and Social Care — Adult social care client level data, England: quarterly update to June 2026Updated 29 September 2026https://www.gov.uk/government/statistics/announcements/adult-social-care-client-level-data-england-quarterly-update-to-june-2026 Department of Health and Social Care — Adult social care client level data, England: quarterly update to March 2026https://www.gov.uk/government/statistics/adult-social-care-client-level-data-england-quarterly-update-to-march-2026 Department of Health and Social Care — Adult social care finance report, England: 2025 to 2026Publication scheduled for 22 October 2026https://www.gov.uk/government/statistics/announcements/adult-social-care-finance-report-england-2025-to-2026 Medicines and Healthcare products Regulatory Agency — MHRA Safety Roundup: September 2026Published 29 September 2026https://www.gov.uk/drug-device-alerts/mhra-safety-roundup-september-2026 Skills for Care — The State of the Adult Social Care Sector and Workforce in England 2026 launch event14 October 2026https://www.skillsforcare.org.uk/news-and-events/Events/October/The-state-of-the-adult-social-care-sector-and-workforce-in-England-2026-Launch-event.aspx Editorial Note This briefing covers significant developments reviewed between 25 September and 1 October 2026. The National Care Service section distinguishes between the government’s stated policy commitment and the detailed delivery model, which has not yet been determined. The Independent Commission on Adult Social Care is due to make recommendations on implementation in summer 2027. The Why It Matters, Actions for Providers, Leadership Reflection and Five Things I’d Be Thinking About This Week sections provide professional interpretation of the verified source material for adult social care providers.