The Question Nobody Is Asking About the National Care Service

Somewhere in Britain this morning, a woman in her eighties got up four times in the night. Her kitchen kettle has not boiled since yesterday lunchtime. Her movement around the house has been slowing for three weeks. In a month she will be in A&E after a fall, and a hospital discharge team will begin an assessment that captures none of it.

That gap, between what is happening in someone's life and what any professional can see, is where the social care crisis actually lives. And it is the gap the new Prime Minister will need to close if his ambitions for care are to mean anything.

A pledge worth taking seriously

Andy Burnham has said he is willing to spend political capital on social care, and that he has no intention of joining the long list of Prime Ministers who left the issue in the too-hard pile. Having spent his career arguing that care should be valued as highly as the NHS, he now has the office to act on it. Whatever shape a national care service eventually takes, the intent is real, and the sector should engage with it seriously rather than waiting to be consulted.

Our contribution to that engagement is a question we think is being skipped. The policy conversation is already turning to integration, shared records and joined-up systems. All of that is needed. But records can only be shared if they exist, and the most important information about a person's wellbeing is generated in the one place the system cannot see: at home, between visits, in the ordinary rhythms of daily life.

Assessments are photographs. Lives are films.

Almost everything the care system knows about a person comes from assessments, and an assessment is a photograph: one day, one conversation, often taken at the worst possible moment, in hospital or in crisis. Decline does not work like that. A urinary tract infection announces itself in disturbed nights long before confusion sets in. Falls risk builds through changing movement patterns. The early signs that someone is struggling to cope show up in kitchens and hallways weeks before they show up in referrals.

None of this is captured in any record the NHS or a local authority holds, which means a national care service built purely on sharing existing records will be a system for circulating photographs while the film plays on unwatched.

The frustrating thing is that watching the film no longer requires anything intrusive. Discreet, consent-led sensors, no cameras, no wearables to remember, nothing for the person to operate, can pick up exactly these patterns and turn them into insight a care team can act on. We work with providers doing this today. When it is done well, carers arrive informed instead of guessing, families get reassurance built on evidence, and the intervention happens before the ambulance rather than after it. That is prevention as a practice rather than a paragraph in a white paper.

None of it works if the kit will not talk

There is a condition attached to all of this, and the sector needs to hear it as much as the government does: interoperability. Insight from the home is only useful if it can flow into care records, alarm receiving centres, housing systems and clinical workflows without being trapped inside one supplier's walled garden. A prevention system built on proprietary silos is not a prevention system. It is a collection of dashboards nobody joins up.

Which makes it all the more dispiriting that in the very week the Prime Minister took office promising to fix social care, some of the sector's major telecare suppliers have been trading public blows with each other. Whatever the rights and wrongs of any individual dispute, the spectacle is unseemly, and it damages the one thing this moment demands: the confidence of commissioners, providers and government that this industry can behave like a partner in reform. Every public spat tells Whitehall that the sector cannot be trusted to put people before market share. The companies involved should reflect on how that looks to the families and frontline teams their products are supposed to serve.

The answer is not for suppliers to like each other. It is for their systems to work with each other, through open standards, published integrations and a shared acceptance that no single vendor will ever own the whole picture of a person's life. The suppliers who embrace that will be the ones still standing when a national care service takes shape.

What the sector should ask for

If the Prime Minister is serious, and we believe he is, then providers, commissioners and housing partners should be putting four things in front of his government now.

First, that prevention funding follows evidence of decline, not just diagnosis. The current system pays reliably once someone has fallen and unreliably for everything that could have stopped the fall. Real-world data from people's homes gives commissioners a way to fund earlier and prove the return.

Second, that social care's own data counts. Providers and housing organisations hold continuous insight into independence, risk and daily life that no hospital record contains. In any integrated system, that insight should flow both ways, with social care shaping the shared picture rather than simply receiving whatever the NHS chooses to pass on.

Third, that interoperability becomes a condition of public money. If a device or platform cannot share its data through open standards, it should not be commissioned with public funds. Nothing would concentrate supplier minds faster, and nothing would do more to end the behaviour we have seen this week.

Fourth, that technology choices stay honest. The sector has been burned before by systems bought on promises and abandoned in cupboards. Whatever national framework emerges must keep people in control of their own information and work for providers of every size and digital starting point, not just the largest groups with transformation teams. This is precisely why we built Creating Better as a vendor-independent advisory: the right answer starts with the person and the service, never with a product.

The film is already rolling

The woman with the unboiled kettle does not need a restructure. She needs someone to notice this week, not next month. The technology to notice exists, it is affordable, and providers across the UK are quietly proving it works. What has been missing is a government willing to make prevention more than rhetoric.

Mr Burnham says that government has arrived. We intend to hold him to it, and to help any care, health or housing organisation that wants to be ready when it does.

Harry MacLean is the Founder and Managing Director of Creating Better. He has spent his career making complicated things simpler and broken things better, and he has not finished yet.