Adult social care is under huge pressure across the UK. Since devolution, adult social care systems in England, Scotland and Wales have diverged but face many of the same challenges: rising demand, increasing complexity of need, escalating costs, market instability, workforce challenges and limited financial resources and capacity to meet all these pressures.

Despite these differences, a National Care Service (NCS) model has been proposed in each country as a way to build a fairer, high-quality and financially sustainable social care system. Yet, as the three nations take different routes towards that ambition, their experiences raise important questions about what it really takes to reform adult social care.

Each country is at a different stage of its NCS journey. In Scotland, the Scottish Government spent three years trying to establish a NCS before dropping the flagship policy in January 2025, largely due to sector opposition. In Wales, the National Office for Care and Support is nearing the end of phase one of its implementation plans, though the ultimate direction of the policy remains uncertain. In England, the Casey Commission has been established by the Labour Government to set out a 10-year plan to implement a NCS (see Baroness Louise Casey's article) but there is the risk it could meet the same fate as all the other social care commissions that have come before it.

These different trajectories raise an important question: what can each country learn from each other's NCS experiences?

With the collapse of Scotland's NCS and the launch of the Casey Commission in early 2025, there was a clear opportunity to explore this question. The Chartered Institute of Public Finance and Accountancy (CIPFA) and the Local Government Information Unit (LGiU) have since published a series of three briefings examining progress towards establishing NCSs across the UK. They can be accessed on the CIPFA and LGiU websites.

The first briefing tracked the development of NCS policies in England, Scotland and Wales from their inception to the present day. The second examined lessons from the Scottish and Welsh experiences, asking what went wrong in Scotland, where the policy was ultimately dropped, and what appears to be working in Wales, where the project continues.

The final briefing, published earlier this week, draws on these lessons to identify principles for effective adult social care reform and sets out recommendations for next steps in England, Scotland and Wales.

But what exactly is meant by a ‘national care service'? Our research shows there is no single definition across the UK.

A clear timeline is essential to reduce uncertainty and experience suggests that iterative reform is more effective than ‘big bang' structural change. Adult social care reform must also take a whole-system, place-based approach, recognising that reforming social care is fundamentally intertwined with reforming local government.

In Scotland, the NCS meant removing responsibility for social care from councils and transferring to a new national body overseen by Scottish ministers.

In Wales, the precise role of the National Office for Care and Support is still evolving, although the long-term ambition is to deliver care that is free at the point of need. In England, the Labour Party's 2024 manifesto indicated that a NCS would be national standards with local delivery, but it is the Casey Commission that will ultimately shape the model.

Given these differences, our research concludes that the term ‘national care service' is a politically convenient brand that evokes a treasured institution (the NHS) and provides a compelling narrative for reform where previous framings have struggled to gain traction.

It is for this reason that, rather than focusing on how to establish a NCS in name, the final briefing identifies principles for achieving effective adult social care reform at a national scale. These principles are: answer the funding question, build consensus, develop a timeline, embed place, prioritise prevention, evidence better outcomes and keep the workforce central.

To take these principles in turn, financial and business cases must be robust, making a clear argument for a financially sustainable system that delivers higher-quality care. Governments also need to build and maintain consensus across the system if reform is to succeed.

A clear timeline is essential to reduce uncertainty and experience suggests that iterative reform is more effective than ‘big bang' structural change. Adult social care reform must also take a whole-system, place-based approach, recognising that reforming social care is fundamentally intertwined with reforming local government.

Prevention should also be prioritised to improve long-term outcomes for individuals, while proposals must clearly demonstrate how they will improve the experiences of people who draw on care and support. Finally, the workforce must remain central to reform if the system is to become sustainable.

Last week, at the Nuffield Trust Summit 2026, Baroness Casey called for a national conversation on the adult social care contract. CIPFA will not only closely engage with this discussion, but also hope that it proceeds with urgency. The challenge now is not simply to talk about reform, but to act on the lessons already emerging from across the UK.

William Burns is CIPFA social care policy adviser