'No One Is in Charge': England's Social Care System in Chaos

By Daniel Okafor

Successive governments in England have been "asleep at the wheel" on social care, Louise Casey, head of the social care commission, will warn on Wednesday. Her verdict is blunt: in effect, "no one is in charge" of a system that serves millions of vulnerable people.

Casey is preparing proposals for a major review of adult social care. Her critique describes a chaotic patchwork of local services with no clear vision behind it. Care standards, assessment processes and waiting times differ depending on where people live. The private care sector has grown dominant, and regulation of services has often proved ineffectual, she will say.

What does England lack that other countries have?

England has no clear "system stewardship" for social care, Casey will argue. That gap makes it hard for governments to target improvements or turn policy into practice. She points to comparable countries — France, Germany and Japan — as systems that manage what England does not.

Casey is expected to call for a "new settlement" for care, "one based on values I still believe this country shares: decency, contribution and a duty to care for our neighbours, our loved ones and ourselves".

Her intervention carries political weight. She calls the present moment a "moment of reckoning", and Andy Burnham has ambitions to introduce a new national care service with reformed funding and workforce terms.

The prime minister has embraced the Casey review and accelerated its completion to next year — 12 months faster than the Starmer government originally envisaged. The expectation in Westminster is that a national care service plan will appear in Labour's next election manifesto.

The funding route is already mapped. The prime minister has announced he would use savings from scrapping the state pension triple lock, starting in the next parliament, to invest in a care service modeled on the Scottish approach of free personal care. Individuals would pay "bed and board" costs.

What did the Covid-19 inquiry find?

Speaking at the annual national children and adult services conference on Wednesday, Casey will say she has written to the Covid-19 inquiry agreeing with its findings on social care.

She is expected to say: "The Covid-19 inquiry took apart the argument that a 'protective ring' had been thrown around care homes during the pandemic. Many old people died without their loved ones by their side. Many care workers left their jobs after what they had seen."

She will add: "It is a national shame that this was allowed to happen. It should never happen again."

The inquiry chair, Heather Hallett, last month described the adult care sector during the pandemic as "something of an afterthought", with care home residents and staff given insufficient protection. More than 43,000 people died from Covid-19 in UK care homes between March 2020 and July 2022.

Why has reform been so slow?

Casey draws on research by the Nuffield Trust and the Institute for Government. It found that the lack of oversight and a "clear coherent narrative" in English social care is a "significant weakness", made worse by the historically low visibility of social care among successive governments. The same lack of clarity, the research found, made policy change difficult and slow.

But the researchers also issued a warning to politicians: avoid disruptive structural changes without a clear purpose or political determination.

"One last and inescapable point is that successful reform of social care requires political will and bravery to make the choices outlined throughout this report," the research said.

It added: "No amount of reorganisation of governance structures or processes will be sufficient in the absence of political impetus to drive through change and dedicate resources, time and energy to social care. Maintaining social care visibility and priority within the government's agenda will be essential."

The test now falls to the government. Casey delivers her findings next year, and the manifesto question — whether a national care service gets funded through pension reform — will decide if this reckoning produces change or another report on a shelf.