I have just spent the last couple of days in London and have held various conversations with colleagues in the social care world in England. It has been a busy few weeks – what with the ongoing disastrous intervention of the Chancellor and the uplift in National Insurance payments which still threatens to devastate the social care sector in Scotland, and plans for a Commission on Social Care in England being announced just last week.  It is the latter which I would want to focus on in this week’s blog.

Despite all the previous reports and commissions, research papers and independent analyses, the new Labour Government has decided to establish an independent commission to develop sustainable, long-term solutions for the adult social care system. Chaired by Baroness Louise Casey, the commission’s primary objectives include:

• Assessing current challenges by evaluating the existing social care framework to identify critical gaps and inefficiencies.
• Engaging stakeholders by collaborating with care providers, service users, and industry experts to gather diverse perspectives and insights.
• Proposing reforms by recommending actionable reforms to enhance the quality, accessibility, and affordability of social care services, and lastly if not critically,
• Ensuring sustainability by means of developing strategies to ensure the financial and operational sustainability of the social care system.

The Commission will operate in two phases with medium-term recommendations to be reported by mid-2026, focusing on addressing immediate challenges within the social care sector. Then there will be long-term solutions with full and final recommendations to be delivered by 2028, outlining comprehensive plans for the future of adult social care in England.

At the heart of all this according to Wes Streeting, the Health and Social Care Secretary is the desire to fulfil a manifesto commitment and to create a “National Care Service” to meet the needs of people and better integrates social care with the state-funded National Health Service.

A sense of déjà vu comes to mind. Indeed, my colleagues in England whilst welcoming the Commission have bemoaned the length of time it will take to get to any sense of final recommendations, and I cannot help but reflect of a social care ball being well and truly kicked into the long-grass of forgetfulness.

But what has intrigued me more than the mechanics and aspirations behind the new Commission is the way in which both politician and pundit, policy maker and social commentators, by in large have viewed the Commission. Specifically, the debate and discussion evidence yet again a myopic fascination with seeing the world of health and social care through an NHS lens. Indeed, this reflects a lot of similar discussion in Scotland – social care only ever seems to get a mention when the NHS is in crisis, or the extent to which it is seen as being able to support the priorities of the NHS.

I’ve often reflected on the tendency to see social care as the understudy to the NHS – a supporting act rather than a leading role in its own right. This perspective, however well-intentioned, is profoundly flawed and ultimately diminishes the critical contribution social care makes to individuals, families, and communities.

Even social care practitioners – me included – have at times sought to enhance and sell the value of social care to a uniformed audience – by using its role in assisting the NHS as the vehicle for that conviction. We are so wrong to do so – and that’s why I am increasingly convinced that we have to stop talking continuously about the NHS and to start selfishly, consistently advocating for social care absolutely in its own right.

Social care is not – and cannot be – simply a handmaiden to the NHS. It is its own sector, with its own identity, purpose, and values. And yet, we persist in framing social care primarily as a means to ease pressure on hospitals, to prevent delayed discharges, or to free up beds. This narrative is not just reductive; it is dangerous.

If the UK Government Commission becomes dominated by the political concern (and the public one) for the NHS, then we will take two steps backward into the past.

It is unashamedly time to robustly advocate for social care even if that means talking less about the NHS.

The heart of social care is relational, not transactional. It is about enabling people to live meaningful, independent lives. It is about dignity, choice, and human rights. Social care supports people not just when they are unwell, but throughout their lives, whether they are living with disability, managing long-term conditions, or simply seeking support to thrive in older age. It is not as so many English commentators have said in recent days – about the vulnerable – because that categorises and diminishes – it is rather about our most valuable citizens, of all ages and characteristics, of all needs and none, and what enables them to flourish and thrive in life and citizenship.

Unlike the NHS, which often intervenes in moments of acute crisis, social care is rooted in the rhythms of everyday life. It is about helping someone to get out of bed, to share a meal, to reconnect with a loved one. It is about companionship as much as care, empowerment as much as treatment. This is why it cannot and should not be judged purely in terms of how it serves the NHS’s objectives.

When we view social care solely through a medical lens, we risk losing sight of its wider purpose. We reduce people to patients and care to a clinical function. We forget that social care is about living – not just surviving.

This medicalisation of social care (which I moaned about a lot during the pandemic) also fuels structural inequalities. Funding decisions, workforce strategies, and political attention become skewed in favour of acute and secondary healthcare. Meanwhile, social care – despite employing more people than the NHS and supporting just as many lives – remains underfunded, undervalued, and misunderstood.

We have seen this imbalance starkly in recent years. While billions have been rightly poured into strengthening the NHS, social care has struggled with chronic underinvestment, rising demand, and a workforce crisis. The pandemic exposed the fragility of the sector, but instead of learning lessons, we have often reverted to seeing social care as an adjunct to the NHS rather than a pillar of society in its own right.

This lack of recognition has real-world consequences. It perpetuates low pay, poor conditions, and limited career pathways for the social care workforce. It fosters stigma and misunderstanding about what social care does and who it supports. And it weakens the case for long-term reform, leaving the sector stuck in cycles of crisis management and yet another damn Commission.

Most worryingly, it marginalises the people who rely on social care – those whose voices are too often drowned out in debates about targets, efficiency, and systems integration.

We need to shift the narrative. Social care must be recognised as a sector of equal value, complementary to but distinct from the NHS. It must be funded and supported in ways that reflect its transformative role – not just in keeping people out of hospital, but in enabling them to live the lives they choose.

All this requires the same things I have been talking about for aeons – a human rights-based approach where care is seen not as a commodity but as a fundamental part of a just society. It requires fair funding and an end to the chronic underinvestment in social care by Government providing long-term funding settlements that match the scale of need. An end to the cap in hand approach of social care providers and users to gather the leftovers from a bare fiscal table. It shouts out for the need to recognise the workforce and to treat social care staff as skilled professionals, with fair pay, proper training, and clear career pathways. And lastly and critically and at the heart of this piece it needs a mature public understanding where we shift public perceptions through education and advocacy, challenging outdated views that reduce care to charity or dependency.

The NHS will always be vital. But so too is social care. They are partners, not hierarchies. The more we invest in social care – not as a crisis response but as a foundation for well-being – the more we build a society where everyone is supported to live with dignity and purpose.

Social care doesn’t just save hospital beds; it saves lives in their fullness – their hopes, connections, and possibilities. That is why it deserves recognition, investment, and respect. It’s time we stopped viewing social care through the lens of the NHS and started seeing it for what it truly is: the beating heart of our communities.

Let’s value it. Let’s protect it. And let’s give it the future it deserves.

Donald Macaskill

Photo by Jason Leung on Unsplash