Autumn has seen many potential reforms to adult social care policy with consultations, legislative developments, and strategic reports shaping the future of the sector. This has included workforce pay reform, mental health legislation, scrutiny of the Terminally Ill Adults Bill, and the long-awaited Covid-19 Public Inquiry findings.
This update explores some of the key changes and opportunities to influence future policy and practice.
Learning from the past
The Covid-19 Public Inquiry continues to examine the pandemic’s impact on adult social care. Cathie Williams, former CEO of ADASS, gave evidence in July, highlighting the need for better infrastructure, preparedness, and national coordination. Recommendations include creating a ‘reservist task force’ similar to the advisory groups set up to advise the social care sector Covid-19 support task force and ensuring government accountability for readiness plans.
As part of the Inquiry’s Every Story Matters initiative, it has also collected over 46,000 individual stories, shedding light of the impact of the pandemic on people with care and support needs and their families, unpaid carers and social care practitioners. These stories aim to inform future policy and help ensure that lessons are learned.
Further information, such as hearings, are available on the Covid-19 Inquiry’s YouTube channel.
Legislation reform in motion
Terminally Ill Adults (End of Life) Bill under review
The Terminally Ill Adults (End of Life) Bill, informally known as the Assisted Dying Bill, which would allow terminally ill adults who have fewer than six months to live to apply for an assisted death, is under scrutiny by a special House of Lords committee. Applications would have to be approved by two doctors and an Assisted Dying Review Panel comprising a social worker, senior legal figure and a psychiatrist. To be eligible to apply for an assisted death a person would need to have capacity (in accordance with the Mental Capacity Act 2005) to decide to end their own life.
The Bill includes safeguards such as mandatory training for professionals, mental capacity assessments, and the right for social workers to opt out of involvement.
While many professional bodies remain neutral, groups representing disabled people have voiced strong opposition, with Disability Rights UK’s warning that assistance to die ‘should not be easier to access than assistance to live’.
Mental Health Bill nears completion
The Mental Health Bill completed its report stage and third reading in the House of Commons on 14 October as it moves towards becoming law, seven years after Simon Wessely’s Independent Review of the Mental Health Act. It is a wide-ranging bill that amends and modernises the Mental Health Act (MHA) 1983.
The Bill’s overarching aims are to:
- Strengthen the voice of patients.
- Add statutory weight to patients’ right to be involved in planning their own care.
- Increase scrutiny of detention, so that it is not implemented unnecessarily or for any longer than is necessary.
- Limit use of the MHA to detain autistic people and people with a learning disability.
- Four underpinning principles: The MHA Code of Practice will be amended to incorporate four principles that should inform decisions under the Act.
- Choice and autonomy: involve patients in decision-making and consider carers’ views.
- Least restriction: minimise restrictions on liberty so far as is consistent with patient wellbeing and public safety.
- Therapeutic benefit: treatment should be effective and appropriate.
- The person as an individual: treat patients with dignity and respect and consider their attributes and past experiences.
- Learning disability and autism: The Bill will modify the definition of ‘mental disorder’ in the MHA by introducing new definitions of ‘autism’, ‘learning disability’ and ‘psychiatric disorder’. The term ‘psychiatric disorder’ will not cover autism or leaning disability.
This means that autistic people and those with a learning disability can’t be detained for compulsory treatment under Part 2 of the MHA or made subject to a community treatment order unless they have a co-occurring psychiatric disorder.
This measure aims to tackle what the National Autistic Society has referred to as the ‘human rights scandal’ of more than 2,000 autistic people and people with a learning disability being subject to lengthy detentions that do not provide therapeutic benefit. - Detention and CTOs (Community Treatment Orders): The Bill will amend the criteria for detention under Part 2 of the MHA and for renewal of detention. Detention criteria will require (i) that the person poses a risk of ‘serious harm’ to themselves or others, and (ii) the assessing clinician will be required to consider the ‘likelihood’ that the harm would occur. (In its explanatory notes (p. 17), the government says guidance on these new tests will be included in the revised code of practice.) The Bill also amends the criteria for the use of CTOs to align with these changes.
- Advance Choice Documents (ACDs): ACDs allow patients who may be at risk of detention to set out, when they are well, their wishes and feelings that may be relevant to their later care and treatment. The Bill places a duty on health commissioners to proactively make arrangements for people to be informed of their ability to make an ACD and to be supported to make one.
- Human Rights Act: A new clause introduced by the government during Commons committee stage will extend the remit of the Human Rights Act (HRA) 1998 so that private providers of mental health services, including after-care services under s.117 of the MHA, will have to act compatibly with the HRA when those services have been commissioned by local authorities or the NHS.
Several organisations have called for the Bill to go further in tackling racial disparities in mental health care. Responding to publication of the annual MHA statistics, which showed that Black people are over eight times more likely than white people to be subject to a CTO, Mind called for further amendments to the Bill to place time limits on CTOs and to tackle inequalities directly at a local and national level.
Amending the Deprivation of Liberty Safeguards
A Supreme Court case is seeking to amend the Deprivation of Liberty Safeguards Code of Practice. The proposed changes would mean a departure from the acid test in Cheshire West and Chester Council v P UKSC 19 and aim to allow adults to give valid consent to their confinement, even if they lack capacity, thus avoiding the need for deprivation of liberty authorisation under Article 5 of the European Convention on Human Rights (ECHR).
The case was heard on 20 October 2025, and the ruling (for which the judgment has not yet been handed down) could have significant implications for both Northern Ireland and the rest of the UK.
Building strategic reforms
Independent Commission on Adult Social Care
Baroness Casey is chairing an Independent Commission on Adult Social Care, which will recommend how to reform the adult social care system. It will call for evidence over the coming months as the Commission prepares to make recommendations on how to plan for and implement a ‘National Care Service’.
The Commission will report in two phases – medium-term reforms by 2026 and long-term transformation by 2028. It aims to make adult social care more ‘productive’, ‘preventative’, and person-centred, with a focus on funding flows, accountability, and integration with health services.
Sector bodies ADASS and the Local Government Association (LGA) have welcomed the initiative, but stress the need for urgency. They’ve called for the Commission to review the Care Act 2014, explore integration beyond health (including housing and employment), and ensure reforms are grounded in lived experience.
The 10 Year Health Plan
The government’s 10 Year Health Plan envisions a shift from hospital-based care to community-based Neighbourhood Health Services. This service aims to deliver care as close to people’s homes as possible, moving care out of hospital wherever possible.
Key to this will be multidisciplinary neighbourhood teams that will include social workers, occupational therapists, nurses, GPs and health visitors, among others, offering integrated support in local communities.
The government’s vision is that Neighbourhood Health Services will eventually be open 12 hours a day, six days a week. In time, they will offer support with wider issues that impact people’s health and wellbeing, such as debt advice and employment support.
While 43 pilot area sites have been announced, details on implementation and social care integration remain limited. A programme lead in each area will work with existing services to set up the new service, focusing initially on supporting people with long-term conditions. Early services will target ‘working class areas’ with the lowest life expectancy and longest waits.
The plan also promises a renewed focus on prevention, expanded use of personal health budgets and digital transformation.
It promises a new standard for developing care plans. Currently only one in five people with a long-term condition has a care plan, but the government target is for 95% by 2027. Plans will be co-created with the individual and will cover ‘holistic needs’ not just ‘treatment’.
The plan also envisages a major increase in the use of personal health budgets (PHBs). Around 180,000 people currently have a PHB, but the government’s aim is to double this figure by 2028-29, with 1 million people benefitting from a PHB by 2030.
In 2026, the government will introduce a first wave of ‘modern service frameworks’, including a framework for mental health (including ‘severe and enduring mental illness’) and ‘the first ever service framework for frailty and dementia’. This will be directly influenced by the Independent Commission on Adult Social Care. These will identify ‘challenge areas’ where innovative ideas and products may be needed.
Looking ahead
The Mental Capacity Act 2005 (MCA) has two statutory Codes of Practice, one for the main body of the MCA, and one for the Deprivation of Liberty Safeguards.
A draft code consolidating both parts was consulted on in 2022 but was not taken forward. Professionals must have regard to the Codes of Practice but must depart from them where they have been superseded by caselaw. 39 Essex Chambers has published an unofficial guide to the ones that are most significantly out of date.
The government intends to launch a consultation in 2026 on Liberty Protection Safeguards to improve safeguarding for people aged 16 and over.
These recent policy developments reflect a sector in transition – grappling with longstanding challenges and looking for opportunities for reform. The autumn budget may offer proposals to enact change.
What is safeguarding adults? Brief Guide (2025)
Safeguarding adults is about people and organisations working together to stop abuse and/or neglect happening to adults who are less able to protect themselves. This Brief Guide explains some of the ways that people might be abused and what to do if you have concerns.
Policy Updates
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