Baroness Casey’s recent speech at the Nuffield Summit has rightly re-energised conversations about the deep, structural challenges at the heart of adult social care. She shines a stark light on a fragmented system that too often leaves people – and their families – navigating complexity, inconsistency, and unnecessary distress.
At More Than a Provider, a collaboration of values-driven, not-for-profit organisations supporting thousands of people with learning disabilities and autistic people across England, we see this everyday: despite the extraordinary efforts of support workers, families, and communities, the system is still not designed to help people live the ordinary, connected, meaningful lives they want.
This matters because when social care enables ordinary lives, it also delivers extraordinary value.
Commissioning: Leading the shift together
Like Baroness Casey, More Than a Provider (MTAP) highlights that commissioning is one of the most powerful and too-often overlooked drivers of whole-system performance. A more coherent, joined-up commissioning approach – one that is rooted in coproduction, that speeds up decision-making and cuts through unnecessary complexity – would immediately improve people’s experience of support. It would free up professional time, reduce avoidable crises, and create the stability that helps people thrive. For too long, commissioning has been shaped by short-term cost pressures, inconsistent fee-setting, and transactional procurement processes that add burden but rarely improve outcomes.
The result? Instability for providers, disruption for people, and a system overly focused on managing risk instead of enabling flourishing lives.
Not-for-profit organisations, especially those supporting people with learning disabilities and autistic people, have spent decades developing innovative and community-rooted models of support. But as More Than a Provider know from our experience the system does not consistently create the conditions for these models to thrive.
A call for a clearer, fairer, more confident system
Baroness Casey’s emphasis on clarity for people and families and on strengthening accountability is profoundly welcome. MTAP’s proposal for national fee parameters directly supports this aim – bringing transparency, fairness, and consistency to the funding of direct support.
Combined with greater transparency on funding flows, this would help address the instability that undermines people’s lives and the workforce that supports them.
MTAP, alongside others in the system is calling for a thematic review of adult social care commissioning by the CQC, helping to surface where commissioning practice supports quality, sustainability, independence – and where it falls short.
Beyond hours and tasks: commissioning for lives
MTAP sets out practical, no-cost and low-cost actions that align closely with Baroness Casey’s call for a more human, coherent system:
- Empowering trusted professionals to get decisions made sooner: Enable experienced provider staff to undertake reviews of people’s needs and outcomes, with appropriate oversight and review, so support can be adjusted quickly and crisis avoided.
- Reducing duplication in quality assurance: Align commissioner and provider monitoring so time is spent on improvement, not repeating the same checks in different formats.
- Commission for outcomes, not just hours and tasks: Start with what matters to the person – connection, independence, contribution, and belonging. When people are building a life, not just receiving a service, reliance on formal support often stabilises or reduces.
- Introduce ‘trusted provider’ status: for organisations with strong quality, ethics, and social value, streamline repeated procurement cycles and build long-term, collaborative relationships.
These are practical, achievable steps that need leadership and commitment but do not need to wait for major new investment.
The distinctive role of not-for-profit providers
Not-for-profit organisations bring a unique and powerful offer. Their surpluses are reinvested, not extracted. We build teams rooted in local communities and use public funds to fairly reward and develop colleagues. Our values centre on human rights, social justice and co production, with people and families shaping decisions.
When commissioning enables rather than constrains this way of working, not-for-profit organisations deliver extraordinary social value: people living in their own homes, flourishing in work and education, connecting with friends and family, contributing to their neighbourhoods, and shaping their own futures.
A moment of reckoning
Baroness Casey’s speech signals a moment of reckoning – political, moral and practical. And meaningful change can start now, within existing resources, when we work in partnership, build trust and stay focused on what matters to people, families, and communities.
The future of social care will not be shaped by structures alone, but by whether we are brave enough to commission for lives, not just services.
Above all, it means recognising a profound truth: when social care works well, it fades into the background of everyday life. What remains is not a service, but a life full of meaning, purpose, and connection.