What does “outstanding care” really look like, and are services measuring what matters?

Across the UK, there is growing interest in what “outstanding” care really looks like. Recent work by the King’s Fund has brought renewed focus to this question, highlighting the importance of person-centred care, inclusive cultures, continuous learning and a clear focus on outcomes. 

What is striking is how familiar this feels. 

Across Wales, thousands of people have already told us what matters most when they access health and social care. That is what sits behind the People’s Principles: eight clear expectations about how care should feel, from dignity and respect, to timely support, clear communication and services that join up around people’s lives.  

There is a clear and encouraging alignment between what research is telling us and what people themselves are asking for. This matters, because it suggests the question is no longer what good care looks like, but whether people are consistently experiencing it. 

But there is also an important difference. 

Much of the current thinking about “outstanding” care describes what systems should aim to deliver - leadership, culture, improvement and innovation. All of this matters. 

The People’s Principles start from a different place. 

They describe care from the point of view of the person receiving it. They capture what it feels like when care works well, and - just as importantly - what it feels like when it doesn’t. 

That shift in perspective is important because however well-designed a framework is, there is always a risk that it becomes something organisations assess themselves against, rather than something people consistently experience. The People’s Principles anchor that definition back in something more concrete: whether people can access care in a way that works for them, whether they are listened to, whether they are kept informed, and whether services join up around their lives.  

In that sense, they provide not just a description of good care, but a way of judging whether it is being delivered in practice. 

This is particularly important in Wales. 

We have a strong policy and legislative framework. The ambition is clear: a system that is person‑centred, integrated and fair. The architecture is there.  

That ambition is reflected in the Duty of Quality, which requires services to consider not only safety and effectiveness, but also people’s experience, equity and timeliness in everything they do. It is reinforced through legislation such as the Social Services and Well-being (Wales) Act, which places voice and control at the centre of care, alongside a wider commitment to more joined‑up, long‑term approaches to public services through the Well-being of Future Generations (Wales) Act. 

And yet - as we consistently hear at Llais - people’s experiences do not always reflect this ambition. 

People still describe long waits without clear communication and letters arriving after their appointments. They tell us about having to repeat their story across services. They speak about barriers to access, whether that is language, travel and transport, or digital exclusion. They describe moments where they have no idea where to turn, did not feel listened to, or where decisions were made about them rather than with them. 

None of this is new. But it is persistent, even alongside examples of good and compassionate care across the system. This reflects the reality of a system under significant pressure, where staff continue to deliver care with commitment and professionalism, often in challenging circumstances. 

Experiencing good care 

If we increasingly agree what good care looks like, the question becomes a simple one: how do we know whether people are actually experiencing it? 

This is where Llais has a distinct role. 

Our starting point is not a model of what care should look like, but what people tell us about the care they receive. We listen at a local level, we analyse patterns regionally and nationally, and we bring those insights into the decisions that shape services. 

Crucially, we do this as an independent, statutory voice. 

Independence matters. It creates the conditions for people to speak openly, particularly those whose experiences have led to a loss of trust. It gives us the credibility to bring forward what people say, even when it is difficult to hear, in a way that supports improvement rather than apportioning blame.  

And it allows us to surface issues that may not yet be visible through performance data or formal reporting, the kinds of experiences that are easily missed when looking at performance data alone. 

Alongside this, our role is not just to gather insight, but to act on it. 

Through representations, we take what people tell us and present it directly to those responsible for planning and delivering services, in a way that requires a response. 

Increasingly, we are working to ensure that lived experience is seen alongside research, data and professional judgement, not as an add-on, but as a core part of how quality is understood and improved. 

This includes bringing insight directly into board and committee discussions, including quality and safety, and analysing themes from complaints advocacy and engagement to identify patterns that may not be visible through other routes. These insights are then used to inform representations at local, regional and national level, providing a clear line from people’s experience to action. 

This approach extends across both health and social care. 

In social care, we contribute to national discussions through advisory arrangements linked to the Office of Care and Support and bring insight into Regional Partnership Boards where decisions about integration and service design are made. Through programmes such as Community by Design, we are also helping to ensure that the voice of people shapes new models of care from the outset. 

Our engagement work brings us directly into communities across Wales too, creating space for people to share their experiences, including those who are less likely to be heard through formal routes. 

Taken together, this is about making lived experience a routine and visible part of how the system understands itself, not something that sits separately from it. 

There is an emerging consensus about what good care looks like. That is a positive step, and the People’s Principles play an important role in shaping that understanding. 

The next challenge is making sure this shared view is reflected in people’s everyday experience of care. That means not just describing quality, but testing whether it is consistently experienced in practice. 

Because ultimately, quality is not defined by frameworks or intentions alone, but by whether people feel listened to, respected and supported when they need care most. 

The People’s Principles provide a clear and practical lens through which the experience of care can be understood, assessed and improved. We will increasingly use them to ask a simple but important question: are services delivering what people expect? In that sense, they do not replace existing frameworks, but strengthen them by grounding them in the reality of people’s lives. 

And if that is what matters, then it should be what services measure, what they report, and what they use to drive improvement across the system.