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.

Issue 013 | 24 September 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, with a focus on what has changed, why it matters and what providers should be considering in practice. This Week’s Headline Reasonable Adjustment Digital Flag Deadline Is Now Less Than a Week Away The deadline for full implementation of the Reasonable Adjustment Digital Flag (RADF) remains 30 September 2026 for NHS and publicly funded health and social care services in England. The flag is a national, visible marker on a person's record which identifies reasonable adjustments they may require when accessing publicly funded health and social care services. NHS England confirms that organisations within scope must have processes to identify, record, flag, share, meet, review and update reasonable adjustment needs. By 30 September 2026, organisations within scope must be able to share, read and write reasonable adjustment information via NHS England’s National Care Records Service. What Has Changed? The standard itself is not new this week, but the compliance deadline is now immediate. There has been some confusion within the sector about the deadline following proposed changes during August and September. The current published deadline for full compliance remains 30 September 2026. The requirement applies to NHS and other health and social care services that are publicly funded, including independent and voluntary-sector organisations providing publicly funded services. Why It Matters Providers need to consider both their internal arrangements for reasonable adjustments and their readiness to share this information through the national system. NHS England describes implementation in two phases. Phase 1 requires organisations to use their own systems and processes to identify, record, flag, share, meet, review and update reasonable adjustment information locally. Phase 2 requires organisations to ensure their technical systems and software suppliers have engaged with NHS England to begin technical integration with the Reasonable Adjustment Digital Flag through the National Care Records Service. Providers therefore need assurance about their own processes, staff awareness and recording arrangements, as well as clarity about the readiness of their digital systems and software suppliers. Actions for Providers Confirm whether the services provided by the organisation fall within scope, particularly where placements or care packages are publicly funded. Identify who is accountable for implementation and oversight. Check whether current care-record systems can identify and clearly flag reasonable adjustments and whether staff know where this information should be recorded. Confirm with software suppliers what arrangements are in place for RADF integration and whether they have registered their software on NHS England's national supplier interest list. Review how reasonable adjustments are identified on admission, assessment and review, including communication requirements, accessible information, sensory needs, environmental adjustments, additional time and support from carers or advocates. Check that records describe the reasonable adjustment required rather than simply recording a diagnosis, disability or impairment. Review information-sharing arrangements. The updated standard uses implied consent for sharing information through the flag. People can object to their information being shared, and the Mental Capacity Act 2005 should be considered where capacity is relevant. Maintain evidence of implementation, including actions taken, staff awareness and engagement with digital system suppliers. Future of Adult Social Care Independent Commission Begins Recruitment for Public Panel on Care The Independent Commission on Adult Social Care, chaired by Baroness Louise Casey of Blackstock, announced on 21 September that households across England were being invited to register for its Public Panel on Care. The panel forms part of the Commission's wider Big Conversation on Care. Around 125 people will ultimately be selected from those who register. Participants will meet in person and online between November 2026 and April 2027. What Has Changed? The announcement marks a further stage in the Commission's evidence-gathering work. Households have been selected at random and people aged 18 and over living at an invited address can register an interest. The final panel will be selected to broadly reflect the population of England. The panel will consider questions about what care is, who should receive it and how care should be funded. Registration closes on 11 October 2026. Why It Matters The Independent Commission was established to make recommendations about the future of adult social care in England. The Public Panel is one part of its evidence-gathering programme and will contribute public views and experiences to the Commission's work. For providers, the Commission remains an important development to follow as its evidence gathering progresses and recommendations begin to emerge. At this stage, the Public Panel does not represent a change in government policy or funding arrangements. Actions for Providers Continue to follow the Commission's evidence-gathering work and opportunities for sector engagement. Consider what organisational evidence could contribute to future consultations or calls for evidence, particularly around demand, outcomes, workforce, commissioning and integration with health services. Include evidence from people using services, families and frontline staff when contributing to consultations where appropriate. Distinguish between evidence being considered by the Commission, recommendations subsequently made by the Commission and any future government policy decisions. Data and Planning October Will Bring Two Significant National Social Care Data Releases DHSC has confirmed that the Adult Social Care Activity Report 2025 to 2026 and Adult Social Care Finance Report 2025 to 2026 will be published on 22 October 2026. The activity report will include national information on requests for support, provision of care services and reviews of care and support plans. The finance report will provide information on adult social care expenditure and income in councils with adult social services responsibilities, including long- and short-term care. Why It Matters These are national statistical publications rather than new provider reporting requirements. Together, the reports will provide updated information about demand for adult social care, the support being provided and local authority expenditure and income. For providers, the findings may provide useful context alongside local information about demand, commissioning activity, fees and service development. Actions for Providers Review the publications when released and consider both national findings and relevant local authority data where available. Consider the findings alongside organisational information on referrals, occupancy, dependency, workforce and service demand. Use relevant evidence to support strategic planning and commissioning discussions where appropriate. Leadership Reflection This week's most immediate operational priority is the Reasonable Adjustment Digital Flag deadline on 30 September. Providers within scope need assurance that reasonable adjustments can be identified, recorded, reviewed and shared appropriately, alongside clarity from digital system suppliers about national integration arrangements. The work of the Independent Commission on Adult Social Care is also moving further into evidence gathering. As this develops, providers will need to distinguish between emerging discussion, recommendations made by the Commission and confirmed government policy. The October activity and finance publications will provide further national evidence on demand, provision and local authority expenditure. These should be considered alongside local and organisational information when reviewing service demand, commissioning and future planning. Five Things I'd Be Thinking About This Week Are we on track to meet the Reasonable Adjustment Digital Flag requirements by 30 September? Have we confirmed our digital system supplier's position on RADF integration? Can we evidence how reasonable adjustments are identified, recorded, communicated, reviewed and met in practice? Are we following the Independent Commission on Adult Social Care and identifying relevant opportunities to contribute evidence? Are we ready to use the October activity and finance data alongside our own information when reviewing demand, commissioning and future planning? Sources NHS England — What is the Reasonable Adjustment Digital Flag?Accessed 24 September 2026 https://www.england.nhs.uk/learning-disabilities/improving-health/what-is-the-reasonable-adjustment-digital-flag/ NHS England — The Reasonable Adjustment Digital Flag action checklist: what you need to do to achieve complianceAccessed 24 September 2026 https://www.england.nhs.uk/long-read/the-reasonable-adjustment-digital-flag-action-checklist-what-you-need-to-do-to-achieve-compliance/ NHS England Digital — Reasonable Adjustment FlagAccessed 24 September 2026 https://digital.nhs.uk/services/patient-flags-service/reasonable-adjustment-flag NHS England Digital — DAPB4019: Reasonable Adjustment Digital FlagAccessed 24 September 2026 https://digital.nhs.uk/data-and-information/information-standards/governance/latest-activity/standards-and-collections/dapb4019-reasonable-adjustment-digital-flag Department of Health and Social Care — Thousands invited to register for Public Panel for Independent Commission on Adult Social CarePublished 21 September 2026 https://www.gov.uk/government/news/thousands-invited-to-register-for-public-panel-for-independent-commission-on-adult-social-care Department of Health and Social Care — Adult Social Care Activity Report, England: 2025 to 2026Publication scheduled for 22 October 2026 https://www.gov.uk/government/statistics/announcements/adult-social-care-activity-report-england-2025-to-2026 Department of Health and Social Care — Adult Social Care Finance Report, England: 2025 to 2026Publication scheduled for 22 October 2026 https://www.gov.uk/government/statistics/announcements/adult-social-care-finance-report-england-2025-to-2026 Editorial Note This briefing covers material developments reviewed between 18 and 24 September 2026. The Reasonable Adjustment Digital Flag information standard predates this reporting period but is included because its 30 September 2026 full-compliance deadline is now less than one week away and remains the current published deadline. The Independent Commission Public Panel is part of an evidence-gathering process. It does not represent a government policy decision or indicate what the Commission will ultimately recommend. The Adult Social Care Activity Report and Adult Social Care Finance Report are scheduled national statistical publications. They do not introduce new reporting requirements for individual adult social care providers. 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 verified source material. Looking Ahead 30 September — Reasonable Adjustment Digital Flag full-compliance deadline NHS and publicly funded health and social care providers within scope are required to achieve full implementation of the information standard by this date. 11 October — Public Panel on Care registration closes People living in households that have received an invitation to participate in the Independent Commission's Public Panel on Care have until 11 October to register their interest. 22 October — Adult Social Care Activity and Finance reports DHSC is scheduled to publish the 2025/26 national activity and finance reports, providing updated information on adult social care activity, expenditure and income. If there is a regulatory update, guidance document or sector issue you would like featured in a future edition of the Adult Social Care Briefing, I'd be pleased to hear from you.

When Poor Practice Becomes “Just How We Do Things Here” Listen to Episode 2 “We’ve always done it like that.” Usually said with complete confidence. Occasionally followed by, “CQC were fine with it last time.” Which is reassuring, particularly when last time was four years ago. In Episode 2 of Beyond the Audit, I look at how poor practice becomes normalised in health and social care ,not necessarily because people don’t care, but because shortcuts, workarounds and small compromises gradually become simply “how we do things here”. I talk about the gap between work as imagined and work as done, what leaders inadvertently tolerate, why excellent compliance figures don't necessarily mean excellent practice, and why dealing with the person involved in an incident doesn't always deal with the underlying risk.

I've reviewed rather a lot of care plans recently, and I've discovered that person-centred care is apparently much easier than I thought. Take a fairly generic sentence, insert the person's name, and there we are. Person-centred. "Susan likes to be offered a choice of drinks." Excellent. We've established Susan drinks. What I still don't know is what she actually likes, how she makes her choice or whether she needs any support to do so. Those are probably the bits I'd find useful if I were actually looking after Susan. The same applies to writing everything in the first person. I've read plenty of care plans containing phrases such as "I like staff to support me with my personal care." Perhaps they do, but I'm yet to meet many people who naturally describe getting washed and dressed as "being supported with my personal care". Writing I instead of they doesn't automatically make something person-centred either. What matters is whether the record actually reflects the person. Could I actually care for this person from their care plan? That's one of the tests I use when reviewing care records. If I walked into the service tomorrow, knew nothing about the person and had to support them safely, would their care plan actually help me? I should be able to understand what matters to them, rather than simply finding a list of tasks that need completing. I need to know how they communicate, including how I might recognise that they're uncomfortable, frightened, in pain or simply fed up. Their usual routines should be clear, along with the things they enjoy, the things they dislike and the things guaranteed to put them in a bad mood before breakfast. Just as importantly, the care plan should tell me what the person can do for themselves. Person-centred care isn't about documenting everything staff can do for somebody. Sometimes it's about knowing when to leave well alone and give the person the time, support or equipment they need to do something themselves. By the time I've read the care plan, I should have some sense of the person behind it. I should know what a good day looks like for them and what might indicate that something isn't right. I should also understand which decisions they make themselves, how they make them and what support they might need. And that's where some of the mental capacity assessments I've been reading become a problem. "Has dementia. Lacks capacity." I've seen variations of this far too often and, I'll admit, it's something that really annoys me. It's much more than poor wording. A diagnosis of dementia doesn't, in itself, mean somebody lacks capacity. Neither does a learning disability, brain injury, mental health condition or difficulty communicating. Yet you still come across records where a diagnosis seems to have become shorthand for a conclusion about someone's ability to make decisions. The Mental Capacity Act is clear: we must start with the presumption that a person has capacity. Where there is reason to question capacity, we aren't assessing whether somebody simply "has capacity" or "lacks capacity" in general. We're considering their capacity to make a specific decision at the time it needs to be made. Which is why an assessment headed "mental capacity regarding care and treatment" doesn't really get us very far. Which care? Which treatment? What exactly is the person being asked to decide? Whether somebody agrees to take a particular medicine is a decision. Whether they consent to the use of bed rails is another. Where they live may be another entirely. Each involves different information and different consequences, so one broad assessment can't conveniently cover everything because it's easier for the paperwork. What did we actually do to help them decide? Before concluding that somebody cannot make a decision, we should be able to see what was done to help them make it themselves. That might mean explaining something differently, using pictures or other accessible information, choosing a better time of day, making sure glasses or hearing aids are available, involving someone who understands how the person communicates or simply giving them more time. And of course, none of this works particularly well if we don't actually know the person. If somebody communicates through gestures, behaviour, facial expressions or a communication aid, that should be reflected in how we assess their capacity. If they become overwhelmed when given lots of information at once, perhaps giving them lots of information at once isn't the best way to establish whether they understand it. "Information explained to resident" doesn't tell me very much about what actually happened. I want to know what information was given, how it was explained and how the person responded. If they didn't appear to understand it, I want to see whether another approach was tried. Otherwise, it's very difficult to tell whether we've supported the person to make the decision or simply told them something and recorded that we did. I've also seen a surprisingly short journey between "capacity questioned" and "best interests decision made", with very little recorded about what happened in between. There should be rather more to it than that. A completed form can still be a poor assessment Having an MCA form in the person's records is obviously important. But the presence of the form doesn't, on its own, tell us whether the assessment was any good. One phrase that crops up in various forms is some version of "unable to understand, retain, weigh or communicate the information." But that's essentially repeating the functional test back at me. I still don't know what actually happened. I want to be able to see what information the person was given, what they understood and whether they could retain it for long enough to make the decision. If there were difficulties using or weighing that information, the assessment should explain what those difficulties actually were and how the person communicated their views. The record should allow somebody else to follow the assessor's reasoning. Otherwise, all we really have is a conclusion with a form wrapped around it. There is another important point here too. A person making a decision we think is unwise isn't evidence that they lack capacity. If questionable decisions were enough to trigger a finding of incapacity, I suspect most of us would have had an MCA completed at some point, I know I would have several! When the records don't agree with each other This becomes particularly obvious when you review the whole care record rather than individual documents. One section says the person makes their own choices. Somewhere else it says the family make decisions for them. There's an MCA saying they lack capacity, although it's difficult to work out exactly which decision was assessed. Then you find a best interests decision in another part of the system and, just to keep things interesting, another care plan says the person has consented to something. Individually, those records can look perfectly respectable. Read them together and it becomes very difficult to establish what the person can actually decide for themselves, yet staff are expected to use this information to provide care. Family involvement is another area where records can become muddled. Families of course often know the person really well and their contribution can be invaluable, particularly when we're trying to understand someone's wishes, feelings, beliefs and values. But being someone's daughter, son, husband or wife doesn't automatically give you authority to make decisions on their behalf. We need to be clear about the person's capacity for the particular decision, whether anybody has legal authority to act for them and, where they don't, how the family is being consulted as part of the best interests process. If the record doesn't clearly explain what the person decides independently, where they need support to make a decision and where a proper best interests process is required, we shouldn't be particularly surprised when staff interpret things differently. Person-centred care planning doesn't mean writing more Some of the longest care plans I've reviewed have told me surprisingly little about the person. Pages and pages of generic text don't become more useful simply because we've added another ten. Copying the same information into four different sections doesn't make it four times as important either, although it can make finding the useful bit significantly more irritating. A good care plan needs enough detail to support safe and consistent care, but that information needs to tell staff something useful. It should help them understand the individual, recognise their preferences, support their independence and communicate with them in a way that works. It should tell us what matters to the person as well as what professionals have decided matters for them. If capacity is in question, the person doesn't suddenly disappear from the process either. Their wishes, feelings, values and beliefs remain relevant. They should still be involved as far as possible, and we should still be supporting them to make the decisions they are able to make. Read it as though you've never met them When auditing care plans, it's very easy to concentrate on whether all the expected sections have been completed. I understand why we do it, but completion isn't really the test I'm interested in. I want to know whether, having read the record, I actually know anything meaningful about the person. Could I support them in a way they would recognise as their care? Do I understand what they can do for themselves, what matters to them and how they communicate their choices? And if somebody has questioned their capacity, can I work out exactly which decision was being assessed, what was done to help them make it and how the eventual conclusion was reached? If I can't, adding their name another six times probably isn't going to fix it. Person-centred care isn't about how often the person's name appears in the care plan. It's whether I can actually find the person in it.

Issue 012 | 18 September 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, with a focus on what has changed, why it matters and what providers should be considering in practice. This Week’s Headline National Patient Safety Alert Issued on Hoists and Slings The Medicines and Healthcare products Regulatory Agency (MHRA) issued a National Patient Safety Alert on 16 September 2026 covering all types of patient hoists and slings. The alert applies to those responsible for the use, purchase or maintenance of patient hoists across acute and community healthcare organisations, care homes, nursing homes and care services supporting people in their own homes, as well as equipment providers. What Has Changed? MHRA has reviewed serious incidents involving people falling from hoists or slings during transfers and repositioning. Between 1 January 2015 and 31 December 2025, MHRA received 22 reports of incidents with a fatal outcome involving patient hoists during routine transfers. These incidents occurred across hospitals, care homes and people's own homes and were not associated with a single manufacturer, model or care setting. The alert identifies recurring factors including: damaged, worn, missing or incorrectly assembled attachments; incompatible hoist and sling combinations; damaged or incorrectly seated sling loops; ineffective pre-use checks; inadequate or overdue maintenance, servicing or examination under the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER); use of the wrong size or type of sling; insufficient staff training and competency assessment; and failure to follow manufacturers' instructions for use. All actions within the alert must be completed by 16 September 2027. MHRA requires organisations to address pre-use checks, compatibility of equipment, equipment management and maintenance, and staff training and competency. Why It Matters This is a formal National Patient Safety Alert, rather than general moving and handling guidance. MHRA states that implementation should be coordinated by an executive leader or, in organisations without an executive board, an equivalent senior accountable person such as a registered manager or responsible individual. One particularly important area is compatibility. Providers need to know that the particular sling being used is suitable for the hoist and attachment system rather than assuming that because both pieces of equipment are individually maintained they are safe to use together. The alert also requires effective pre-use checks and specifically addresses secure attachment before the person is fully lifted. Actions for Providers Identify who is accountable for implementing the alert and monitoring completion. Review all hoists and slings currently in use, including equipment used by staff supporting people in their own homes. Confirm and document which hoists and slings are compatible, using manufacturers' instructions for use. Check that equipment inventories identify maintenance, servicing, LOLER examination and replacement arrangements. Review arrangements for removing equipment from use when defects, overdue examinations or other safety concerns are identified. Check that pre-use procedures reflect the MHRA alert, including confirming attachment points are secure before a person is fully lifted. Review moving and handling training and competency assessment against the actual hoists and sling types staff use. Make sure staff know when to stop using equipment, escalate concerns and report incidents and near misses. Commissioning and Market Development £91 Million Fund Includes Adult Social Care Transformation Projects The Ministry of Housing, Communities and Local Government announced £91 million on 15 September 2026 for transformation projects across 14 councils in England that are already receiving Exceptional Financial Support. The funding is intended to support councils to transform high-cost services, including adult social care. £41 million is allocated across 2026/27 and £50 million across 2027/28. What Has Changed? This is targeted funding for specified councils and projects. It is not a national adult social care funding allocation. Examples with direct adult social care relevance include: Redbridge, where funding will support home-based technology intended to identify and prevent falls and help people remain independent; and Brighton & Hove, where work includes closer integration between reablement and NHS services, aimed at supporting people home sooner and reducing the need for higher levels of care. The Government says the programme is intended to modernise high-cost services and help councils move towards more sustainable arrangements. Why It Matters The funding itself is limited to the councils named in the announcement, but the types of projects being supported may provide useful commissioning intelligence for providers. They reflect continued interest in areas such as prevention, independence, technology-enabled support, reablement and closer working between health and social care. For providers, this may become relevant when demonstrating the value and outcomes of services to commissioners. Actions for Providers If you operate in one of the funded areas, monitor local commissioning and partnership opportunities arising from the projects. Review whether your quality and performance information demonstrates outcomes as well as activity. Consider how clearly you can evidence maintaining independence, preventing deterioration and supporting timely discharge. Where technology-enabled care is introduced, ensure governance covers consent, information governance, escalation arrangements, equipment failure and evaluation of effectiveness. Use evidence of outcomes and service impact in commissioning and fee discussions where relevant. Workforce Adult Social Care Workforce Survey 2026 Skills for Care and DHSC are encouraging people working in adult social care in England to take part in the 2026 Adult Social Care Workforce Survey. The survey is being conducted by Ipsos, in partnership with Skills for Care and the University of Kent, on behalf of the Department of Health and Social Care. It is open to people working in care-related roles across adult social care in England, including people working in residential and domiciliary care, managers and regulated professionals. What Has Changed? On 16 September 2026, Oonagh Smyth, Chief Executive of Skills for Care, published a call for people working in adult social care to participate in the survey. The survey asks about: pay and employment conditions; workload and wellbeing; workplace experience; training and career development; what encourages people to remain in adult social care; and what may make people consider leaving. Managers and employers are being encouraged to share the survey with staff and allow time for them to complete it during working hours. Voluntary responses are confidential and are not shared with individual employers or workplaces. Why It Matters The survey is intended to provide evidence about the experience of the adult social care workforce and inform future decisions about workforce support, including areas such as pay, training and career development. For providers, the areas covered are also useful prompts for internal workforce assurance. Vacancy and turnover figures tell part of the story, but they do not necessarily explain why staff stay, leave or struggle. Actions for Providers Make staff aware of the survey and provide reasonable opportunity to participate without directing or influencing responses. Review whether your own workforce information goes beyond vacancy and turnover figures. Look collectively at exit interviews, supervision themes, sickness, agency use and staff feedback. Check whether development opportunities described in workforce plans are accessible to frontline staff. Use recurring workforce themes to inform retention, supervision and development planning. Funding Watch ADASS Publishes Autumn Budget Submission ADASS published its submission to HM Treasury's Autumn Budget 2026 call for evidence, with the publication last updated on 17 September 2026. ADASS says the submission covers areas where it believes government could stabilise and invest in adult social care ahead of the independent commission on adult social care led by Baroness Louise Casey. What Has Changed? This is an ADASS submission to government, not a government funding announcement and not confirmation that any of the proposals will be adopted. Its relevance is that Directors of Adult Social Services are formally setting out their position on adult social care funding ahead of the Autumn Budget. Why It Matters Providers with significant local authority-funded business remain exposed to councils' financial position, commissioning decisions and fee-setting arrangements. The ADASS submission is therefore useful context for understanding the funding debate ahead of the Budget, but providers should distinguish clearly between sector representations and confirmed government policy. Actions for Providers Continue to model workforce and operating cost pressures ahead of 2027/28 fee discussions. Understand the proportion of organisational income dependent on local authority-funded placements or packages. Maintain clear evidence of actual service costs and sustainability pressures for commissioning and fee discussions. Avoid building unconfirmed funding proposals into budgets until government decisions are announced. Leadership Reflection This week's most immediate operational development is the MHRA hoist and sling alert. The alert is useful because it goes beyond having a moving and handling policy or current LOLER documentation. Providers need assurance that the specific equipment being used together is compatible, that pre-use checks are effective and that staff competency reflects the equipment they actually use. The wider commissioning, workforce and funding developments point to another continuing theme: providers increasingly need good evidence about outcomes, workforce stability and sustainability, rather than relying only on activity or compliance data. Five Things I'd Be Thinking About This Week Can we evidence that the hoist and sling combinations currently in use have been checked for compatibility? Do our pre-use hoist checks reflect the new MHRA National Patient Safety Alert? Are staff assessed as competent with the actual equipment they use in practice? Can we demonstrate outcomes such as maintaining independence, prevention and reduced escalation rather than simply recording activity? Do we understand why staff stay with us and why they leave? Sources National Patient Safety Alert: Patient hoists and slings (all types): risk of death and serious harm from falls (NatPSA/2026/005/MHRA)Medicines and Healthcare products Regulatory Agency Published and issued 16 September 2026 https://www.gov.uk/drug-device-alerts/national-patient-safety-alert-patient-hoists-and-slings-all-types-risk-of-death-and-serious-harm-from-falls-natpsa-slash-2026-slash-005-slash-mhra National Patient Safety Alert Supporting Information. Patient hoists and slings: incidents and case examples. Medicines and Healthcare products Regulatory Agency Published 16 September 2026 https://www.gov.uk/government/publications/national-patient-safety-alert-supporting-information-patient-hoists-and-slings-incidents-and-case-examples/national-patient-safety-alert-supporting-information-patient-hoists-and-slings-incidents-and-case-examples Councils' high-cost services to be transformed through £91m fund Ministry of Housing, Communities and Local Government Published 15 September 2026 https://www.gov.uk/government/news/councils-high-cost-services-to-be-transformed-through-91m-fund Have Your Say: Shape the Future of Working in Adult Social Care Department of Health and Social Care Social Care Blog — Oonagh Smyth CBE, Chief Executive, Skills for Care Published 16 September 2026 https://socialcare.blog.gov.uk/2026/09/16/have-your-say-shape-the-future-of-working-in-adult-social-care/ Adult social care workforce survey 2026Skills for Care Current survey page, accessed 18 September 2026 https://www.skillsforcare.org.uk/Get-involved/Adult-social-care-workforce-survey-2026.aspx ADASS submission to the Autumn Budget 2026Association of Directors of Adult Social Services Last updated 17 September 2026 https://www.adass.org.uk/documents/adass-submission-to-the-autumn-budget-2026/ Winter planning 2026/27 – expectations and assurance NHS England Published 17 July 2026; publication page updated 22 July 2026 https://www.england.nhs.uk/publication/winter-planning-2026-27-expectations-and-assurance/ Editorial Note This briefing covers material developments reviewed between 11 and 18 September 2026. The MHRA hoist and sling alert is a formal National Patient Safety Alert and contains actions for organisations within scope to complete by 16 September 2027. The £91 million local government funding announcement relates to 14 specified councils and should not be interpreted as a general adult social care funding settlement. The Adult Social Care Workforce Survey is voluntary and does not introduce a new provider reporting requirement. The ADASS Budget submission represents the position of ADASS and is not government policy, confirmed funding or an agreed Budget measure. 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 verified source material. Looking Ahead 30 September — Winter Planning Assurance NHS England's Winter planning 2026/27 – expectations and assurance was originally published in July. It is included here because the 30 September 2026 assurance deadline is now approaching, rather than because it is a new publication this week. NHS England requires ICBs and NHS providers to submit board assurance statements by 30 September. The guidance says local winter plans should be developed jointly across NHS services, local authorities, social care and the third sector and includes expectations around sufficient social care and intermediate-care capacity, discharge arrangements and infection prevention and control in care homes and the wider care sector. This does not create an NHS board-return requirement for individual care providers. However, providers should understand their local winter escalation, discharge, capacity and infection-control arrangements and know how concerns will be escalated when local pathways are under pressure. https://www.england.nhs.uk/long-read/winter-planning-2026-27-expectations-and-assurance/ If there is a regulatory update, guidance document or sector issue you would like featured in a future edition of the Adult Social Care Briefing, I'd be pleased to hear from you.

Moving to a digital care management system can make a huge difference. Better access to information, less duplication, clearer oversight, easier auditing and, hopefully, an end to trying to decipher somebody's handwriting from three weeks ago. There is, however, a fairly important catch. If your care plans were poor before you went digital, putting them on a tablet won't magically make them better. If staff don't understand what good recording looks like, giving them a device won't fix that either. And if managers weren't properly checking the quality of records before, being able to produce reports at the touch of a button doesn't necessarily mean the information behind them is any good. CQC inspection findings show both sides of this rather well. In some services, digital systems have supported significant improvements in care planning and oversight. In others, inspectors have found missing information, contradictory records and staff struggling to use newly introduced systems. Going digital is the easy bit. Making sure the information in the system is accurate, useful and actually reflects the care being delivered takes rather more work. CQC isn't inspecting your tablet CQC doesn't endorse or recommend a particular digital social care record system. Inspectors aren't there to assess how clever the software is either. They are interested in the information recorded, how it is used and whether it is stored and shared appropriately. Regulation 17 hasn't disappeared because you've stopped using paper. Records still need to be accurate, complete and up to date. There are very good reasons for making the change. CQC identifies benefits including recording information at the point of care, responding more quickly when people's needs change, safer information sharing and better quality monitoring. Of course, buying the system doesn't automatically deliver any of that. You still need decent information in it, staff who know what they're doing and managers who actually use what the system is telling them. A digital care record system doesn't give you assured care records. That bit is still your responsibility. Crown House Care Home in Oakham, Rutland is a useful example of what good can look like. In an assessment published in June 2026, CQC reported that the provider had invested in a new digital care planning system and found a “marked improvement” in the care plans and risk assessments reviewed. Records were more detailed, person-centred and reflective of people's needs, with clearer guidance for staff and improvements in the use of tools including MUST and Waterlow. The software wasn't responsible for everything. The provider had made wider improvements to training, auditing, medicines, consent and governance. What is useful about this example is that the system was supporting those improvements, with much more detailed and person-centred information available to staff and leaders. This is where digital records really can make a big difference. Managers could see what was happening, risks were easier to pick up and the information was there to support better oversight. Much more useful than having to tell an inspector, “I know it's on the system somewhere,” while everyone starts frantically searching for it. When the transition doesn't go quite so well St Margarets Nursing Home in Fraddon, Cornwall provides an equally useful example for different reasons. CQC found the provider had recently introduced a digital care planning system, but care plans lacked information about people's current needs and health conditions. More concerningly, risks that had previously been assessed hadn't made it into the new system. Important information had been lost during the transition and the provider hadn't identified it. Data migration isn't an administrative exercise when the information being moved tells staff how to keep somebody safe. There were practical problems too. Signal coverage was poor in parts of the service and some staff told inspectors they sat near the office to complete their records. Entries were brief and didn't demonstrate that planned care had consistently been provided. A later CQC assessment, published in March 2026, found considerable improvement. Care plans had been reviewed and updated, staff could use the digital system effectively and records accurately reflected the support people received. It's a useful example because the problem wasn't simply “digital records don't work”. Once the implementation and quality of the records improved, so did the evidence. An older CQC example from Madeira Lodge Care Home in Littlestone-on-Sea, Kent, highlights another risk. CQC found some records on paper, some electronic and some duplicated across both, and the information didn't always match. There may be perfectly legitimate reasons to retain some paper records, but if one version says one thing and another says something different, which one is the member of staff supposed to follow? Another older example, Dovecote Residential and Nursing Home in High Spen, Tyne and Wear, gives us another variation. CQC found that an electronic records system couldn't accommodate the complexity of some people's needs and staff hadn't received sufficient training and support. Information was missing and poor record keeping placed people at risk of inappropriate treatment. This is why choosing a system needs a bit more thought than whether it looked impressive during the demonstration. It needs to cope with the people you actually support, be configured properly and work for the staff who'll be using it at 2am, not just the person demonstrating it on a laptop. Digital doesn't automatically mean integrated A provider can be completely digital and still have care planning in one system, medicines in another, incidents and safeguarding somewhere else, audits on another platform, training records in a separate system and workforce information somewhere else again. Each system may be perfectly good at what it does. The difficulty comes when none of them talks to the others. A fall may be recorded in the care system and then entered again in the incident system. A medicines incident may sit within eMAR but require another report elsewhere. A change in dependency might affect staffing without reaching the system used for workforce planning. Before long, managers and senior leaders are piecing together several different datasets to understand what is happening in one service. That isn't only irritating duplication; it creates risk. Information can be missed, recorded differently or updated in one place but not another. Add multiple usernames, passwords and permissions and staff can spend an impressive amount of time logging in and out of systems that were supposed to make their working lives easier. This is something worth considering at procurement rather than discovering afterwards. There is an Assured Solutions List specifically for digital social care records, with the systems on it having been assured by NHS England against the required capabilities and standards. It's a sensible place to start when choosing a system, but I'd still want to know how well it will work with everything else you're already using. A good care planning system is rather less helpful if staff then have to log into three other systems and enter the same information again. I'd want to understand whether the care management system can integrate with eMAR, share information safely with health partners and provide APIs where information needs to feed into wider governance and reporting. I'd also want to know what will still need entering manually somewhere else. If you're investing in several systems, work out how the information is going to move between them before you buy them, not afterwards. There is work happening to improve this. The Minimum Operational Data Standard (MODS) sets a common standard for how key information is recorded in digital social care records, helping to make information more consistent and easier to share between systems. Since July 2026, suppliers on the Assured Solutions List have been required to comply with it. We shouldn't need a member of staff to be the human API, copying the same information from one system into another and hoping nothing gets lost along the way. Before everybody gets their login A lot of attention naturally goes into the practicalities of go-live: devices, passwords, training, Wi-Fi, data migration and making sure someone knows who to ring when nobody can log in at 7.15 on Monday morning. I'd spend just as much time looking at what is actually going into the system. Are the existing care plans accurate enough to migrate? Have assessments been reviewed? Are current risks properly reflected? Does the information describe the person as they are now, rather than six months ago? This is also the time to decide where information will live. If the new system records weights, MUST, falls, wounds, behaviours and planned care, decide which existing trackers and forms can stop. Otherwise, you've bought a system designed to reduce duplication and celebrated by creating some more. Training needs to go beyond teaching staff where to click. Someone can know exactly which button records a meal, fluid intake or repositioning and still produce a poor care record. Managers need to understand how to find exceptions, overdue care, changes in risk and trends. They need to know which reports are useful, what the information is actually telling them and when something needs further investigation. Greater connectivity with health information brings opportunities too. GP Connect can, where the necessary requirements are met, give authorised social care staff access to relevant information from a person's GP record. That can save staff having to contact the GP practice for information that may already be available to them, but access to more information is only useful if staff understand what they're looking at and act on it appropriately. What I'd check in the first 30 days I wouldn't wait months for a formal audit to discover whether implementation has worked. During the first month I'd sample records regularly and look at: whether assessments, risks, care plans and planned care agree with each other; whether important information survived migration; whether staff are recording meaningful information rather than simply clicking tasks complete; missed or late planned care and whether it is being followed up; whether changes in weight, falls, wounds, behaviours, medicines or other risks result in review and action; whether managers are looking at missed care, exceptions and emerging trends rather than relying on completion percentages; whether staff are still keeping unofficial paper records, spreadsheets or separate trackers; whether the same information is being entered into several systems and, if so, whether it matches; whether managers can find important information quickly; and what the system now allows managers to see that they couldn't see before. That last one is worth asking. If the answer is nothing, I'd want to know why. When CQC wants to see the evidence It is worth thinking about CQC access before an inspection. If your records are digital, inspectors may need access to the system and CQC's guidance covers options including guest or read-only access where this is available. I've come across quite a bit of confusion about this, particularly around whether inspectors should be given their own login, whether somebody needs to sit with them and what level of access they should have. Don't leave that decision until inspection day. Agree how access will be managed, make sure it is covered within your information governance or inspection arrangements and, importantly, make sure the managers who are likely to be there actually know what those arrangements are. Managers should also be comfortable navigating the system during an inspection. If CQC wants to follow a concern through from an incident to the risk assessment, care plan, monitoring and action taken, that information shouldn't require a small search party to find it. Good digital records can make an inspection considerably easier because the evidence is there and you can actually find it. Of course, that works both ways. Poor care planning, missed interventions, risks that haven't been followed up and reviews that haven't happened are rather easier to find too. Moving from paper to digital is a good opportunity to do more than change where information is recorded. Clean up the information, remove duplication, make sure assessments actually inform care, think about how your systems integrate, train managers to use the data and start checking quality from day one. Because a very expensive digital care management system containing a poor care plan is still a poor care plan. You've just spent considerably more money finding a new place to keep it.

Published 10 September 2026 This Week’s Headline Health Bill Moves to the House of Lords The Health Bill completed its Commons stages this week and moved to the House of Lords. DHSC also published an impact assessment and equality impact assessment on 9 September covering proposals relating to visiting and the involvement of other people in care decisions. What Has Changed? The Bill would amend the Care Act 2014 so that local authorities, when carrying out relevant functions, would have regard to: the importance of people being able to involve others in decisions and those people receiving appropriate information and support; appropriate opportunities to receive visitors; and for people living in care homes, appropriate opportunities to take trips outside the home. The Bill also proposes a duty on Integrated Care Boards to promote appropriate opportunities for people receiving accommodation through relevant ICB arrangements to receive visitors. For providers, Regulation 9A remains the existing direct regulatory requirement relating to visiting and accompanying in care homes. The new development is therefore the proposed extension of these considerations into wider local authority and ICB responsibilities. Why It Matters The proposals reinforce the importance of maintaining relationships, supporting involvement in decisions and enabling people to remain connected with life outside the home. They are also relevant from a commissioning perspective because these issues would sit more explicitly within the responsibilities of local authorities and ICBs if the Bill is enacted in its current form. Actions for Providers Review whether important relationships and community connections are reflected in care planning. Check that any restrictions on visiting or leaving the home are individualised, proportionate and regularly reviewed. Make sure relatives, representatives and advocates are appropriately involved in decision-making. Use Mental Capacity Act processes where a person may lack capacity for a specific decision. Continue to monitor the Bill as it progresses through Parliament. CQC CQC Inspection Highlights Gaps Between Recorded Care and Practice CQC published the outcome of its first inspection of Brushwood House in Liverpool on 9 September 2026. The service was rated Inadequate overall and across all five key questions and placed in special measures. CQC identified breaches relating to safe care and treatment, medicines management, staffing, dignity and respect, consent, person-centred care, nutrition and hydration, safeguarding and governance. What Has Changed? There has been no change to regulation. The inspection findings included: call bells going unanswered for up to 20 minutes; a resident record showing that breakfast had been eaten when inspectors found the meal untouched; one person having been without prescribed medication for more than three weeks; medicines being hidden in food without appropriate processes being followed; people with identified choking risks not always receiving food and drink at the required texture; required repositioning not consistently taking place and records being incomplete; medicines belonging to different people not always being stored separately and securely; and audio-enabled CCTV being used in communal areas without appropriate safeguards. Why It Matters The findings demonstrate the importance of validating information within care records and audits against actual care delivery. They also show how concerns across medicines, nutrition, staffing, consent and record-keeping can indicate wider weaknesses in governance and oversight. Actions for Providers Include resident-level trace audits within routine quality assurance. Compare care plans and records with direct observation and staff knowledge. Review covert medicines arrangements, including capacity and best-interest decision-making. Check that texture-modified diet and fluid requirements are consistent across care plans, staff guidance and kitchen information. Review call-bell response monitoring where delays are identified. Check governance arrangements where CCTV or audio monitoring is used. Validate high audit scores against incidents, complaints, observations and other quality intelligence. Digital Governance Government Publishes AI Risk Management Toolkit The Department for Science, Innovation and Technology published an AI Risk Management Toolkit on 8 September 2026. The toolkit is intended to support organisations involved in designing, operating, procuring or delivering products that use artificial intelligence. What Has Changed? The toolkit provides a structured approach to identifying, assessing, treating and monitoring AI-related risks. It covers areas including risk ownership, risk appetite, likelihood, impact, controls and monitoring. The toolkit does not create a new CQC requirement or adult social care statutory obligation. Why It Matters AI is increasingly being used within organisational systems and by individual staff. For adult social care providers, this creates potential governance issues where AI is used in areas such as care planning, assessments, complaints, incidents, investigations, safeguarding, recruitment and quality assurance. The key issue is ensuring that use of AI sits within existing information governance, risk and assurance arrangements. Actions for Providers Identify where AI tools are currently being used within the organisation. Include AI within information governance, procurement and supplier assurance processes. Set clear organisational rules for staff using public AI tools, including how personal, confidential and commercially sensitive information should be handled. Define where human review is required before AI-generated information is used. Be particularly cautious where outputs could influence care, safeguarding, risk or employment decisions. Ensure accountability remains with the organisation and the person making the decision. Leadership Reflection This week’s developments highlight the importance of testing whether systems and records accurately reflect what is happening in practice. The CQC inspection findings show that completed records and established systems do not, on their own, provide assurance about the quality of care being delivered. The same principle applies to wider governance. Policies, audits, digital systems and management information are useful only if leaders can be confident that they reflect people’s actual experience. Five Things I’d Be Thinking About This Week Do our care records accurately reflect the care people are actually receiving? Are important relationships and community connections properly reflected in care planning? Do our quality assurance processes include enough direct observation and resident-level sampling? Do we know where AI is currently being used across the organisation? If our audits and records say everything is fine, what are we doing to validate that independently? Sources Health Bill — HL Bill 52, as brought from the Commons UK Parliament9 September 2026 Health Bill Parliamentary documents Health Bill: promoting visiting - impact assessment Department of Health and Social Care9 September 2026Health Bill: promoting visiting - impact assessment Health Bill: promoting visiting - equality impact assessment Department of Health and Social Care9 September 2026Health Bill: promoting visiting - equality impact assessment Regulation 9A: Visiting and accompanying in care homes, hospitals and hospices Care Quality Commission Current regulatory guidance CQC Regulation 9A guidance CQC takes action to protect people at Liverpool care home Care Quality Commission9 September 2026 CQC Brushwood House publication AI Risk Management Toolkit Department for Science, Innovation and Technology8 September 2026 AI Risk Management Toolkit AI Risk Management Toolkit: guidance Department for Science, Innovation and Technology8 September 2026 AI Risk Management Toolkit guidance The reasonable adjustment digital flag action checklist: what you need to do to achieve compliance NHS England Current implementation guidance NHS England Reasonable Adjustment Digital Flag action checklist Editorial Note This briefing covers material developments reviewed between 4 and 10 September 2026. The Health Bill remains proposed legislation and the provisions discussed may change as it progresses through Parliament. The Brushwood House findings relate to one CQC inspection and do not represent a change to regulation or evidence about the wider sector. The AI Risk Management Toolkit is cross-sector government guidance and does not create a new adult social care regulatory requirement. 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 verified source information. Looking Ahead Reasonable Adjustment Digital Flag — 30 September 2026 NHS England states that NHS and other publicly funded health and social care services within scope must fully implement the Reasonable Adjustment Digital Flag information standard by 30 September 2026. Providers within scope should ensure that processes are in place to identify, record, flag, share, meet, review and update reasonable adjustment needs and that the required digital capability is being addressed. The Health Bill will continue through the House of Lords. I will return to it when there is a substantive development affecting adult social care providers. If there is a regulatory update, guidance document or sector issue you would like featured in a future edition of the Adult Social Care Briefing, I'd be pleased to hear from you.

Someone is at work one day and then suddenly they are “no longer in the business.” I've grown sick of hearing that phrase! I've had people approach me to help them navigate what can be a pretty awful process. I'm not an employment lawyer and don't pretend to be, so my role has largely been helping them get their thoughts together, talking things through and signposting them to their union or proper legal advice. Maybe that's why the phrase “no longer in the business” bothers me so much. We are talking about a person who may have worked for an organisation for years, managed teams, supported colleagues and dealt with all the difficult stuff that comes with working in care. And they may not have actually left. They may have been suspended while something is investigated, yet colleagues are told they are “no longer in the business” and the person themselves may be told not to discuss what has happened. I understand confidentiality, but what I struggle with is when confidentiality becomes isolation. Imagine being told not to contact the people you have worked with every day, some of whom have become trusted friends over the years. You don't know what they have been told, what they think has happened or whether you will ever go back. Your work phone and email have been blocked or disconnected, your normal routine has disappeared and so has contact with people who may have been an important part of your support network. What do we think that does to someone's mental health? Particularly when they haven't been found to have done anything wrong. Of course organisations need to suspend people in certain circumstances while concerns are investigated. That may be necessary to protect the people using the service, the investigation, other staff or indeed the person who has been suspended. Temporarily stepping somebody away from work can absolutely be the right decision. But suspension is supposed to be a neutral act while the facts are established. It shouldn't feel like the punishment has already started before anyone has decided whether there is actually anything to answer, and I have seen it feel very much like that. Then there are the residents and families. Someone they may have known and trusted for years is suddenly not there. Depending on their role, that person may have been the one they went to when they were worried, the person who knew their history or simply a familiar face they expected to see when they came through the door. Residents and families aren't daft. They notice when someone who has been a big part of a home suddenly disappears. Yet everyone can end up playing a strange game of secret squirrel because nobody is quite sure what they're allowed to say. Clearly, the details of an employment matter are confidential and should remain so. But there is a difference between respecting someone's confidentiality and behaving as though they never existed. It can leave families wondering what has happened, staff feeling awkward when they're asked questions and residents without any real explanation for why someone important to them is suddenly no longer around. For people living with dementia, learning disabilities or anyone who relies heavily on familiarity and trusted relationships, an unexplained change like this can be particularly difficult. We talk a lot about continuity of care and relationships in social care. That shouldn't suddenly stop mattering because the person who has disappeared happens to be an employee. There is an impact on the staff who remain too. If managers or colleagues disappear, are suspended or leave following a process, other people will draw their own conclusions. If they have seen someone challenge a decision and then find themselves under scrutiny, it is hardly surprising if they think a little more carefully before saying what they really think. We need staff to raise safeguarding concerns, report mistakes, challenge poor practice and question decisions they don't agree with. We need managers who are prepared to say, “I don't think this is right”, including when the person they are saying it to is more senior than them. We can't keep telling people to speak up while creating workplaces where they have to consider what speaking up might mean for them personally. If an organisation has repeated suspensions, grievances, negotiated exits, long-term sickness, managers leaving after relatively short periods or experienced people repeatedly leaving, at what point does somebody stop looking at each one as a separate employment matter and ask why it keeps happening? Every one of those decisions may have been justified. But if the pattern were falls, medication errors, safeguarding concerns or complaints, we wouldn't keep looking at each event separately. At some point we'd look for a common factor. Why wouldn't we do the same with our workforce? If five managers leave, maybe five managers really were the problem. But I'd want to be very sure before accepting that as the explanation. I'd also want somebody with enough independence to ask the question properly. I've also been on the other side of this. In senior roles I've been expected to manage people in ways that haven't always sat comfortably with me. I've followed decisions that weren't necessarily the decisions I would have made myself, and with hindsight there are things I would do differently. It is probably one of the reasons self-employment suits me. I can challenge something when I don't think it is right, say so when I think we're losing sight of the person involved and, importantly, decide that I don't want to be part of something that doesn't sit comfortably with my own values. That doesn't mean I shy away from difficult decisions. Far from it. I've suspended people, managed serious performance concerns and dealt with situations where dismissal was absolutely the right outcome. You can do all of that properly without forgetting that the person sitting opposite you is still a person. People get things wrong. Performance isn't always good enough and behaviour can be unacceptable. An investigation can quite rightly lead to disciplinary action or dismissal. But an allegation is not a fact. Suspension is not a finding of guilt. Someone challenging a senior decision doesn't automatically make them difficult, and being more senior doesn't mean your version of events should be the only one that gets heard. There is a lot of talk about staff wellbeing in social care. We have employee assistance programmes, wellbeing initiatives and plenty of advice telling people to look after their mental health. Maybe we need to pay a bit more attention to whether the way we manage people is contributing to the very problems we're then offering them support for. Deal with concerns properly, investigate them fairly and hold people accountable where that is necessary. Protect people when they need protecting, but don't lose sight of the person on the receiving end of the process. And if an organisation repeatedly finds itself saying that yet another person is “no longer in the business”, somebody really does need to ask why.

Issue 010 | 3 September 2026 A weekly briefing highlighting significant developments affecting leaders of adult social care services for older people in England, with a focus on what providers need to know and what they should be considering in practice. This Week’s Headline DBS Publishes New Eligibility Guidance for Adult Social Care Roles The Disclosure and Barring Service published new eligibility guidance on 1 September 2026, alongside an updated version of its guidance specifically for adult social care roles. The guidance is intended to help organisations determine whether roles are eligible for Basic, Standard, Enhanced or Enhanced with Adults’ Barred List DBS checks. What Has Changed? DBS has reorganised and expanded its eligibility guidance from 1 September, including new guidance specifically for roles working with adults. The updated adult social care guidance covers a wide range of roles, including healthcare professionals, care workers, shared lives, adult social workers, transport and auxiliary roles such as cleaners and maintenance staff. This is particularly useful because DBS makes clear that eligibility depends on the role and activities being undertaken. Changes to someone's role or the activities they carry out can affect the level of check that is applicable. This should not be interpreted as a change to the definition of regulated activity with adults. The practical development this week is the publication of refreshed guidance to help organisations make the correct eligibility decision. Why It Matters Most providers will already have established DBS arrangements, but this is worth checking because roles do not always fit neatly into a standard recruitment matrix. DBS confirms that organisations need to consider factors including who the role interacts with, where the work takes place, the activities undertaken and, where relevant, how frequently those activities take place. For regulated activity with adults, this includes providing healthcare by, or under the direction or supervision of, a regulated healthcare professional and providing specified forms of personal care. This is particularly relevant where roles have developed over time, staff work across different services, healthcare activities are delegated, or ancillary staff and contractors have regular contact with residents. Actions for Providers Take a sample of roles from your recruitment or DBS matrix and check them against the new DBS guidance, particularly where duties are less straightforward. Check roles that have changed over time and make sure the DBS eligibility decision still reflects what the person actually does. Look specifically at care staff undertaking healthcare activities, ancillary staff, activities staff, volunteers and regular contractors rather than assuming the same check automatically applies to everyone working within a care setting. Make sure job descriptions provide enough detail to support the DBS eligibility decision. Check that recruitment teams know where to find the new DBS eligibility guidance rather than relying solely on historic organisational practice. Resident Health RSV Vaccination Eligibility Expanded from 1 September From 1 September 2026, the NHS RSV vaccination programme has expanded to include previously unvaccinated people aged 65 to 74 who are immunosuppressed or have chronic respiratory disease as defined within the national programme. Well-controlled asthma alone is not included within the chronic respiratory disease group. The wider programme includes everyone aged 75 and over and any adult residing in, or moving into, a care home for older adults. What Has Changed? The new element from 1 September is the addition of the two clinical risk groups for people aged 65 to 74. Eligibility for all adults living in older people's care homes was introduced from 1 April 2026. UKHSA confirms that adults aged 18 to 74 already resident in care homes for older adults who have not previously received an RSV vaccination are eligible. Admission to an older people's care home is also identified as an opportunity to confirm vaccination status and offer vaccination where the person remains unvaccinated. The programme is year-round, there is no upper age limit, and people currently require a single dose. Why It Matters The September expansion is particularly relevant to homecare, supported living and other community services supporting people aged 65 to 74 who may now fall within the additional clinical risk groups. For older people's care homes, it is also worth checking that the wider care-home eligibility introduced in April has translated into practice. A resident does not have to be 75 to qualify simply because they are living in an older people's care home. Actions for Providers Make RSV vaccination status part of the normal vaccination information collected on admission or transfer into an older people's care home. Check whether residents who have not previously received an RSV vaccination have been identified and offered access through the NHS programme. For community-based services, make sure teams are aware that some people aged 65 to 74 with chronic respiratory disease or immunosuppression are newly eligible from 1 September. Where residents need support with consent or decision-making, ensure normal Mental Capacity Act processes are followed. Record vaccination status and outcomes clearly enough that the position is readily available to those supporting the person. Workforce Development More Level 5 Leadership Qualifications Added to the Learning and Development Support Scheme DHSC updated the Adult Social Care Learning and Development Support Scheme on 1 September 2026, including further Level 5 leadership and management qualifications within the eligible course list. What Has Changed? The current list now includes new Level 5 Diploma in Leading and Managing an Adult Social Care Service qualifications from Pearson, FuturU and Qualifi. The maximum reimbursement shown for each is £1,565 for qualifications paid for between 1 April 2025 and 31 March 2027. The £1,565 figure is a maximum reimbursement amount, not an automatic payment. Employers can claim evidenced expenditure up to the published maximum, and overall funding is limited. Why It Matters This could be particularly useful for providers developing deputies, registered managers and future service leaders. The main LDSS funding is available for eligible non-regulated adult social care staff in England. DHSC specifically confirms that this includes deputy managers and CQC-registered managers. Eligible employers must provide an adult social care service, directly employ care staff in England and have an up-to-date Adult Social Care Workforce Data Set account. There are also specific claim timescales. For qualifications, reimbursement is split between a 60% claim when the qualification has started and been paid for, and the remaining 40% following completion. Actions for Providers Check planned Level 5 leadership qualifications against the current LDSS eligible list before committing organisational funding. Review deputies, aspiring managers and others already identified through succession or development planning who may benefit. Check both the exact qualification and awarding organisation rather than assuming any Level 5 adult social care qualification will be eligible. Make sure your ASC-WDS account is up to date if you intend to claim. Check the claim and evidence requirements at the point of enrolment rather than trying to reconstruct the evidence afterwards. Leadership Reflection There is a fairly simple theme running through this week's updates. National guidance changes, eligibility expands and funding becomes available, but none of that necessarily means it reaches the people who could benefit from it. A recruitment team can continue requesting the same DBS checks because that is what it has always done. A resident under 75 can miss an RSV vaccination because somebody assumes they are too young. A deputy manager can be enrolled on a qualification without anyone checking whether funding is available. Good governance does not mean turning every update into a new policy, audit or action plan. Sometimes it is simply making sure the right information reaches the right person and checking that practice has changed where it needs to. Five Things I’d Be Thinking About This Week Do our DBS decisions reflect what people actually do within their roles rather than simply their job titles? Have any roles changed since our current DBS matrix was developed? Do our older people's care homes know which residents have and have not received an RSV vaccination? Who are the deputies and aspiring managers we should be developing now rather than waiting until we have a registered manager vacancy? Before we pay for another qualification, have we checked whether LDSS funding is available? Sources https://www.gov.uk/government/publications/eligibility-for-roles-working-with-adults https://www.gov.uk/government/publications/dbs-guidance-leaflets/dbs-checks-for-adult-social-care-roles https://www.gov.uk/government/publications/dbs-guidance-leaflets/regulated-activity-with-adults-in-england-and-wales https://www.gov.uk/government/publications/respiratory-syncytial-virus-rsv-programme-information-for-healthcare-professionals/rsv-vaccination-of-older-adults-information-for-healthcare-practioners https://www.gov.uk/government/publications/adult-social-care-learning-and-development-support-scheme/learning-and-development-support-scheme-for-the-adult-social-care-workforce-a-guide-for-employers https://www.gov.uk/government/publications/adult-social-care-learning-and-development-support-scheme/eligible-training-courses-and-qualifications Editorial Note This briefing covers material developments reviewed up to 3 September 2026. The DBS material is refreshed eligibility guidance and has not been presented as a change to the legal definition of regulated activity with adults. The September RSV change relates specifically to the addition of eligible clinical risk groups aged 65 to 74. The wider eligibility of adults residing in, or moving into, older people's care homes took effect from 1 April 2026 and is included because of its direct relevance to care-home providers. LDSS reimbursement is subject to eligibility, evidence requirements, claim timescales and available funding. Maximum reimbursement figures should not be interpreted as guaranteed payments. 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 verified source information. Looking Ahead The adult phase of the 2026/27 seasonal flu vaccination programme begins on 1 October 2026. September is therefore a useful point for providers to make sure resident vaccination arrangements, staff access routes, consent processes and recording arrangements are organised. The Government's current timetable also places regulations establishing the Adult Social Care Fair Pay Agreement Negotiating Body in October 2026, subject to parliamentary processes. I will return to this when the regulations themselves are published and there is something new for providers to act on.

Published: 27 August 2026 A weekly briefing highlighting significant developments affecting leaders of adult social care services for older people in England, with a focus on what has changed, why it matters and what providers should be considering in practice. This Week’s Headline UKHSA Publishes New Infection Resource for Adult Social Care The UK Health Security Agency (UKHSA) published a new resource on 26 August 2026, Infection in adult social care: resources and sources of support. The resource is specifically for adult social care in England and brings together information on health protection, infectious diseases, outbreaks, infection and colonisation, multidrug-resistant organisms and sources of specialist advice and support. It does not introduce new infection prevention and control requirements. Its purpose is to bring together and explain existing health protection arrangements and guidance for adult social care. Why It Matters The resource provides managers with a useful single point of reference when dealing with infection concerns. It explains some of the terminology and responsibilities that can cause confusion, including the difference between notifiable diseases and organisms, infection and colonisation, and the roles of care providers, registered medical practitioners, laboratories and health protection teams. For providers, the practical question is whether managers know what to do when infection concerns arise, who to contact and where to obtain appropriate advice. What Providers Should Do Share the new UKHSA resource with managers and IPC leads and add it to existing IPC resources. Check that local contact details for the UKHSA Health Protection Team and community infection prevention and control service are current and easy to find, including any local out-of-hours arrangements. Check the respiratory infection reporting route for your area. The UKHSA online acute respiratory infection reporting service currently covers East Midlands, East of England, London, South West, Yorkshire and the Humber and West Midlands. Other regions should use their local arrangements. Test manager knowledge using a simple scenario. If two residents developed similar infectious symptoms within a short period, would the manager know what to do and who to contact? Review your most recent outbreak to establish whether concerns were recognised promptly, appropriate advice was obtained and actions were recorded and reviewed. Use the resource when questions arise about colonisation, multidrug-resistant organisms or notification responsibilities rather than relying on historic practice. Workforce Watch Fair Pay Agreement Moves to Its Next Stage The Government updated its Plan to Make Work Pay and Employment Rights Act implementation timeline on 25 August 2026. The current timetable says regulations establishing the Fair Pay Agreement Adult Social Care Negotiating Body in England will be brought forward in October 2026, subject to parliamentary processes. The negotiating body will form part of the mechanism through which the Adult Social Care Fair Pay Agreement is developed. The Government has previously confirmed that negotiations for the 2028–29 financial year are expected to begin around April 2027, with the first agreement intended to take effect in April 2028. Why It Matters The Fair Pay Agreement is moving from policy development towards implementation. For providers, particularly those with significant local-authority-funded provision, this is becoming increasingly relevant to workforce and financial planning. The eventual impact could extend beyond frontline care-worker pay because changes at the lower end of the pay structure may affect differentials for senior carers, deputies and other roles. There is still considerable detail to come, but providers can start understanding their own position now. What Providers Should Do Map current pay rates and differentials across care workers, senior carers, nurses, deputies and other key roles. Understand your funding mix, including the proportion of income from local authorities, NHS-funded care and self-funders. Consider the wider cost implications of future pay increases, including employer National Insurance, pension contributions and maintaining appropriate differentials between roles. Include the Fair Pay Agreement in workforce and financial planning for 2027–28 onwards. Review the October regulations when published, particularly for further detail about the negotiating body and implementation arrangements. Hospital Discharge Discharge Remains Under Scrutiny NHS England published updated Discharge Ready Date (DRD) guidance and scenarios on 20 August 2026. The guidance is intended to improve clarity and data quality around the point at which an acute inpatient is considered ready for discharge. NHS England states that the update is not intended to introduce new mandatory reporting requirements. It does not create a new reporting requirement for care homes. CQC also published its 2025 Adult Inpatient Survey findings on 26 August 2026, based on the experiences of more than 58,000 people across 130 acute and specialist NHS trusts in England. CQC found that involving families and carers in discharge planning and obtaining care following discharge remain areas where people experience difficulty. Why It Matters for Care Homes Care homes are frequently at the receiving end of hospital discharge arrangements, and the increasing focus on discharge data makes good provider records useful. A vacant bedroom does not necessarily mean a service has the staffing, skills, equipment or clinical capacity to safely meet an individual's needs. Where an admission or return cannot proceed, providers should be able to clearly evidence why and what needs to happen before the person can be safely accepted. What Providers Should Do Review your last five hospital admissions or returns. Check when the referral arrived, what information was provided, when the decision was made and what caused any delay. Record exactly what is preventing an admission or return. This might include medication, equipment, wound information, moving and handling requirements, an updated assessment or clarification of changed needs. Record safe capacity, not simply bed availability. Where a person cannot be accepted, make the reason clear. Track recurring discharge problems such as missing medicines, incomplete documentation, equipment delays or unexpected changes in dependency. Review early hospital readmissions to identify whether discharge arrangements contributed or whether there are recurring themes. Escalate repeated problems using evidence. If the same issue occurs regularly, quantify it and use that information in discussions with hospitals, commissioners and local system partners. Leadership Reflection There is a huge amount of information coming into care services, and not every publication needs to result in another policy, audit or action plan. This week's updates are a good example. The UKHSA resource gives managers a useful reference for something they already need to manage well. The Fair Pay Agreement is moving closer and needs to feature in longer-term workforce planning. Hospital discharge remains an area where good provider evidence can help identify recurring problems and support conversations with system partners. Good governance should help turn that information into something useful: what do we need to know, what do we need to do and what should we keep an eye on? For managers, that is far more useful than simply receiving another link to another document. Five Things I’d Be Thinking About This Week Would our managers know what to do if they suspected an infectious disease outbreak tomorrow? Are our local infection reporting contacts current and easy to find? Do we understand our current pay structure well enough to model the impact of future Fair Pay Agreement arrangements? When we cannot accept somebody from hospital, can we clearly evidence why? Are recurring hospital discharge problems being identified and escalated, or are we dealing with the same issues one case at a time? Sources UK Health Security Agency — Understanding and managing infection in adult social care Published: 26 August 2026 UKHSA – Understanding and managing infection in adult social care UK Health Security Agency — Report an outbreak of acute respiratory infection in an adult social care setting Published: 15 January 2026Last updated: 21 May 2026 UKHSA – Report an outbreak of acute respiratory infection Department for Business and Trade — Plan to Make Work Pay and Employment Rights Act: timeline update Updated: 25 August 2026 Government – Employment Rights Act implementation timeline Department of Health and Social Care — Fair pay agreement process in adult social care: government response DHSC – Adult Social Care Fair Pay Agreement government response NHS England — Discharge Ready Date (DRD) guidance and scenarios Published: 20 August 2026NHS England – Discharge Ready Date guidance and scenarios Care Quality Commission — Adult inpatient survey 2025Published: 26 August 2026 CQC – Adult inpatient survey 2025 Editorial Note This briefing covers developments verified up to 27 August 2026. The UKHSA infection resource brings together information and existing health-protection arrangements for adult social care. It does not introduce a new infection-control regime. The Government's current timetable says regulations establishing the Adult Social Care Negotiating Body are due to be brought forward in October 2026, subject to parliamentary processes. The NHS England Discharge Ready Date guidance relates to NHS recording and reporting and does not create a new reporting requirement for care homes. The CQC Adult Inpatient Survey is included because of the relevance of its discharge findings to adult social care providers. The Why It Matters, What Providers Should Do, Leadership Reflection and Five Things I’d Be Thinking About This Week sections contain professional interpretation of the verified primary-source information. Looking Ahead The Government's current timetable says regulations establishing the Fair Pay Agreement Adult Social Care Negotiating Body are due in October 2026, subject to parliamentary processes. The next Adult social care provider statistics, England: quarterly update to August 2026 is scheduled for publication by DHSC on 3 September 2026. If there is a regulatory update, guidance document or sector issue you would like featured in a future edition of the Adult Social Care Briefing, I'd be pleased to hear from you.

Duty of Candour, Saying Sorry and Why Fault Isn't Always the Point. Duty of Candour continues to cause confusion, particularly when it comes to apologising. I have lost count of the number of times I have heard some version of, “But if we've done nothing wrong, why are we saying sorry?” It's a reasonable question. We are rightly careful about what we say following a significant incident, particularly when an investigation is ongoing or there may be safeguarding, regulatory or legal implications. The difficulty comes when that caution makes people reluctant to acknowledge what has happened at all. Falls are a good example because I have reviewed many of them over the years. A person falls and sustains an injury, sometimes a significant one, and naturally the circumstances need to be reviewed. There have been occasions where that review has found that the person's risks were known, the assessment and care plan were appropriate, agreed measures were in place and staff had done what was expected of them. Sometimes people fall despite appropriate care and risk management. There have also been falls where the review has identified something very different. Perhaps agreed support wasn't provided, an identified risk hadn't been acted upon or there was information that should have prompted a change in the person's care. The outcome may look similar, but the circumstances are very different. This is why it is important to understand what actually triggers the statutory Duty of Candour rather than assuming that every serious injury does, or alternatively assuming that it only applies when somebody has made a mistake. For adult social care providers, Regulation 20 sets out a specific definition of a notifiable safety incident. There are criteria that need to be met, including that something unintended or unexpected occurred during the provision of the regulated activity and that the relevant harm threshold was reached. Fault is not the test, and the seriousness of an outcome on its own doesn't necessarily tell us whether the statutory duty applies. I think this is where some of the confusion about saying sorry begins. We tend to associate an apology with accepting that we have done something wrong, when that isn't necessarily what an apology means. If someone tells me that something terrible has happened in their life and I say, “I'm so sorry”, nobody assumes I am accepting responsibility for causing it. I am acknowledging what has happened and how it has affected them. I don't think that basic human response should disappear because we happen to be having the conversation in a regulated care service. The legal position supports that distinction. Section 2 of the Compensation Act 2006 provides that an apology does not, of itself, amount to an admission of negligence or breach of statutory duty, and CQC guidance is also clear that saying sorry is not the same as admitting fault. Of course we still need to be careful about what we say. If an investigation hasn't established what happened, we shouldn't speculate, make promises about its outcome or tell a family that something should have been prevented when we don't yet know whether it could have been. There may also be occasions when police involvement, safeguarding enquiries, Coroner's processes or potential legal proceedings mean advice is needed about communication. None of that prevents us from being human. A person may be frightened, in pain or facing a significant change in their independence. Their family may be angry, distressed or worried about what happens next. Those feelings are real whether the investigation ultimately identifies failings or concludes that the care provided was appropriate. I think we sometimes become so focused on whether we are “allowed” to say sorry that we forget what the person in front of us is actually hearing. A very carefully worded conversation that avoids acknowledging their distress may protect nobody and can leave a family feeling that the organisation simply doesn't care. There is a difference between saying, “I'm very sorry that this has happened and that you've been injured. We are looking carefully at what happened and will keep you informed,” and telling someone, “We're sorry, this should never have happened,” before you have established whether that is actually true. That difference is professional judgement. There is also a wider point here. Not every incident will meet the statutory threshold for Duty of Candour, but that doesn't mean our responsibility to communicate openly and compassionately disappears. Regulation tells us when the statutory requirements apply. It shouldn't be the thing that determines whether someone's experience and feelings are acknowledged. Where the statutory Duty of Candour does apply, saying sorry is only one part of it. There are requirements around notifying the relevant person, providing an account of what is known at the time, explaining what further enquiries are appropriate, providing reasonable support and following up appropriately in writing. As an investigation progresses, further information may become available and communication may need to continue. This is another area where I think practice can sometimes become too focused on demonstrating that the process has been completed. A Duty of Candour letter on the file may provide evidence that a requirement was followed, but it doesn't necessarily tell us whether the person or family felt listened to, whether their questions were answered or whether they understood what happened. For me, that is where the regulatory and moral elements of Duty of Candour come together. We absolutely need to understand Regulation 20, recognise when the statutory duty applies, document what we have done and seek advice when circumstances require it. We also need to remember why the duty exists in the first place. People deserve openness when something has happened in their care. They deserve an honest explanation of what we know, an honest acknowledgement when we don't yet know the answer and appropriate communication as more information becomes available. They also deserve to have the impact on them acknowledged. That doesn't require us to accept fault where none has been established. It requires us to recognise that saying sorry can simply mean that we are sorry for what someone is experiencing. There is an important difference between admitting responsibility and showing compassion. We should be confident enough in our governance, our investigations and our professional judgement to know the difference. The reflections in this article are drawn from my professional experience in health and social care. Duty of Candour requirements depend on the circumstances of each incident and the applicable regulatory definitions. Providers should refer to current CQC guidance, their own policies and seek appropriate professional or legal advice where necessary.