Successive governments in England have failed to provide consistent leadership over the adult social care system, leading to a chaotic patchwork of local services without a unified vision, Louise Casey, head of the Social Care Commission, is set to warn.
Casey, who is preparing proposals for a major review into adult social care, said the result has been an absence of clear accountability — effectively 'no one is in charge' of a system serving millions of vulnerable people across England.
Fragmented and uneven service delivery
People’s experiences of care vary significantly depending on their location, with differences in assessment processes, standards, and waiting times. The private sector's share of provision has grown, but regulation remains often ineffectual, according to Casey.
Lack of system stewardship
The UK lacks a defined ‘system stewardship’ for social care, making it difficult for governments to implement targeted improvements or translate policy into practice — unlike in countries such as France, Germany, and Japan that have established clear oversight structures.
Covid-19 inquiry findings echoed
Speaking at the annual national children and adult services conference on Wednesday, Casey said she has written to the Covid-19 inquiry agreeing with its conclusions about social care. She condemned the failure during the pandemic to protect residents and staff, noting many older people died without loved ones by their side and numerous care workers left after witnessing trauma.
The chair of the Covid-19 inquiry, Heather Hallett, described the sector as 'something of an afterthought' in 2023, citing insufficient protection for both residents and staff. More than 43,000 people died from COVID-19 in UK care homes between March 2020 and July 2022.
Call for a new settlement
Casey will advocate for a ‘new settlement’ in social care grounded in shared values: decency, contribution, and a duty to care for neighbours, loved ones, and oneself.
The review has gained political momentum with Prime Minister Keir Starmer’s government accelerating the process by twelve months — bringing completion to next year — ahead of Labour's next election manifesto. The prime minister plans to use savings from scrapping the state pension triple lock starting in the next parliament to fund a national care service model inspired by Scotland’s approach, where individuals pay only for 'bed and board' costs while personal care is free.
Research highlights systemic weaknesses
A report by the Nuffield Trust and the Institute for Government identifies a lack of oversight and a ‘clear coherent narrative’ as significant weaknesses in England’s social care system. This has made policy change slow and difficult to implement.
The research warns against disruptive structural reforms without clear purpose or political determination: 'No amount of reorganisation of governance structures or processes will be sufficient in the absence of political impetus to drive through change', it states.
Casey emphasized that successful reform requires both political will and bravery, with sustained government visibility and prioritization essential to achieving meaningful progress.