Accountability structures in social care are critical. They facilitate democratic decision-making, responsibility and the equitable distribution of benefits. This study examines how innovation and technology are implicated in such structures. In the UK, innovation and technology researchers have predominantly imagined care as service provision, with accountability structured through paternalistic and technocratic configurations of people, materials and knowledge. Aligning with incumbent policy and interests, these structures neglect significant groups of actors and issues, with implications for ongoing vulnerabilities in the sector. This study empirically identifies diverse possibilities for how innovation could reconfigure accountability structures in inclusive, participative and less neglectful ways.