Meaningful Change for Adult Social Care

Drawing on recent work within the Adults Implementation team, Ruth Muncaster, Senior Implementation and Improvement Officer at CareCubed, reflects on developments currently shaping the sector and considers how better information can improve outcomes for people who draw on care and support.  

Adult social care is entering a period of meaningful change. Alongside discussions about funding, workforce development and service improvement, there is an equally important conversation about how we make better decisions. For me, that means bringing together two things that are sometimes considered separately: a strong understanding of cost analysis and providing person-centred care. Recognising that it is not money vs the person, but getting the best for the individual by understanding what is being purchased.

From Deprivation to Restriction: Understanding the AGNI Decision

One of the most significant legal developments in recent months has been the Supreme Court decision in AGNI.

Importantly, AGNI does not change the Mental Capacity Act 2005 (MCA) in relation to restriction. The principles of capacity, best interests and least restrictive practice remain exactly as they were before. What has changed is how deprivation of liberty is assessed.

The decision moves away from the straightforward definition of Deprivation of Liberty established through Cheshire West and returns to a more nuanced, multifactorial approach. Rather than relying on a single test, decision-makers are required to consider the overall circumstances of an individual’s situation when determining whether a deprivation of liberty exists.

The practical implications are likely to be considerable. Many individuals who would previously have been considered deprived of their liberty under the Cheshire West Acid test will no longer meet the deprivation of liberty threshold, although it will still apply. However, it would be a mistake to interpret this as meaning that restrictions could well have less scrutiny.

Restrictions on a person’s liberty must still be necessary, proportionate and demonstrably linked to a person’s needs and best interests. The legal safeguards that surround restrictive practice remain firmly in place. This means that Deprivation of Liberty Safeguards will apply less often, but the practice for Restriction of Liberty will be picked up through other structures, and safeguards will have changed to 100,000s of people.

In practice, this may place greater emphasis on commissioners, contract managers, reviewers, and quality assurance. Where formal deprivation of liberty safeguards are no longer triggered, organisations will still need to satisfy themselves that restrictions are lawful, justified and regularly reviewed.

There is also ongoing discussion within the sector about how concepts such as compliance and tacit consent should be understood. Whilst AGNI specifically concerns questions of confinement, there are understandable concerns about how aspects of the judgement may be interpreted more broadly. As with any significant legal development, careful application will be essential.

How Understanding Cost Improves Understanding Care

Before joining CareCubed, I used the system as a commissioner. At the time, I assumed it was primarily a financial tool. What surprised me was how much it revealed about the actual delivery of care.

Meaningful cost analysis requires a detailed understanding of support arrangements. Staffing structures, 1-to-1 support, therapeutic interventions, behavioural support approaches, occupational therapy input, and specialist provision all contribute to the overall cost of a service. It is difficult to understand one without understanding the other.
Through that process, I often found information that was not fully reflected within support plans or review documentation. Providers frequently described specialist support, additional resources or enhanced approaches that were contributing to positive outcomes but were not always visible elsewhere in the system.

This matters because robust commissioning depends on understanding both what is being funded and what is being delivered.

Where higher costs are attributed to specialist provision, commissioners need to understand how that provision benefits the individual and whether those benefits are reflected within assessed outcomes and support planning. Equally, providers should be able to demonstrate the value of the support they are delivering.

Used well, cost information becomes more than a financial exercise. It creates a richer picture of support, enabling commissioners, social workers, and providers to have more informed considerations about need, outcomes, and value.

Creating Visibility Through Better Intelligence.

Recently, I have focused on helping organisations navigate the post-AGNI landscape and develop a shared understanding of restrictive practice.

One area of interest is understanding how commissioned support is delivered in practice. Although CareCubed is primarily viewed as a costing tool, the information collected can also provide valuable insight into support arrangements, staffing models, and the extent to which services may incorporate restrictive elements.

The visibility can support decision-making. Rather than relying on assumptions, local authorities and providers can work from a clearer understanding of current practice and explore whether arrangements remain proportionate, person-centred, and aligned with intended outcomes.

The CareCubed team has been exploring ways of strengthening the information gathered through annual uplift processes. While development work is ongoing, the aim is to improve the consistency and quality of information available regarding staffing models and support delivery.

The intention is not to create additional work; rather, it is to support more productive conversations between providers and commissioners by ensuring decisions are informed by a shared evidence base.

Many providers are already delivering high-quality and innovative support. Better information can help ensure that activity is properly evidenced, recognised, and understood.

Turning Data into Transformation

Many of the proposed reforms to Adult Social Care require significant investment in workforce development and service improvement. Achieving those ambitions is dependent on understanding of how resources are currently used and whether existing investment is delivering the sought-after outcomes for those supported.

Good data alone does not create change, yet it can enable organisations to ask better questions. Where resources are not aligned with outcomes, opportunities may exist to redesign support. Where services are delivering positive outcomes, organisations can better understand what contributes to success and how good practice can be replicated elsewhere.

Meaningful reform is rarely driven by a singular initiative. It tends to emerge through the cumulative effect of better information, better decision-making, and greater organisational learning.

Building a Care Workforce Pathway for Adult Social Care

One of the most important developments already underway is he growing recognition of adult social care as a skilled profession. The sector is dependent on a workforce that can support people with complex needs, enabling independence, managing risk, and promoting quality of life. These responsibilities require knowledge, judgement, and expertise.

For this reason, workforce development is viewable as part of good commissioning practice. When commissioning arrangements are clear, sustainable, and funded appropriately, organisations are better positioned to invest in recruitment, training, development, and retention. In turn, skilled and stable workforces are more likely to deliver positive outcomes for the people they support.

Meaningful Support, Better Lives

Discussions about commissioning and reform only matter because of how they impact the lives of people. Support should be commissioned with purpose. Focus should be not only on the number of hours provided, but what these hours achieve. Too often, support planning can become risk management dominated. While risk management is important, we must recognise that people have interests, aspirations and relationships. Support should create opportunities for people to grow and develop towards the lives they want to lead, not only to protect them from harm.

Person-centred commissioning is critical; when support is genuinely aligned with the individual’s outcomes, there is broader benefit across the system. When people experience greater independence and improved quality of life, providers can deliver support more sustainably through skilled staffing, and commissioners gain greater confidence that resources are used effectively.

This does not mean all situations are straightforward or that there is a single model that works for all. Adult social care is rarely this simple. However, consistent focus on rights, evidence and individual outcomes provides a solid foundation for navigating the reforms that come next.

CareCubed supports transformation with data that supports good practice. From a Social Work perspective, CareCubed training has helped teams understand costing, collaborating and provision. In the words of a Transitions Social Worker:

“The CareCubed training has given me a much clearer understanding of what should be offered in a residential placement, not just what it costs. That insight has strengthened how I work with the brokerage team, making it much easier to spot when things do not quite add up, when we are being overcharged, or when a service does not match what is actually being provided.  

CareCubed has also helped me prepare for quality assurance panel meetings, because I can properly justify and explain what is being offered and why it is right for the service user – this has helped me to plan in a more outcomes-focused way, because using it changed the way I look at both supported living and residential placements altogether.”

The care sector faces a great many challenges and hurdles, but the experience of CareCubed’s implementation team shows that innovation and teamwork can navigate these challenges and generate positive outcomes for the whole commissioning cycle.