A report commissioned by Baroness Louise Casey's team has concluded that adult social care in England is a "fundamentally fragmented system" with no-one in charge overall. The findings are set to be presented by Baroness Casey in a speech to social care leaders in Liverpool on Wednesday, where she will call for "a new settlement for care".
Governments 'asleep at the wheel'
In her address at the National Children and Adult Services Conference (NCASC), Baroness Casey is expected to say: "Successive governments have been asleep at the wheel. In research we're publishing today the lack of 'stewardship' of social care comes through clearly. No-one is in charge."
She is also expected to add: "Together, we can build 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."
The research, which examined how social care is organised and led, is the first in a series of reports intended to inform Baroness Casey's final report. Her Independent Commission on Adult Social Care, which began last summer, has been investigating the problems facing the care system in England with a plan for creating a National Care Service. The final report and comprehensive recommendations are due to be published in summer 2027.
Covid-19 failings branded 'a national shame'
Baroness Casey is also set to brand the pandemic failings, which saw Covid-19 "spread like wildfire" in care settings where many older people died without family at their bedsides, as "a national shame".
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. It is a national shame that this was allowed to happen. It should never happen again."
A report by the UK Covid-19 Inquiry last month stated that the care sector was "an afterthought" and dismissed then-health secretary Matt Hancock's claim made in May 2020 about a so-called protective ring around care homes at the start of the pandemic as "unfounded".
Complex system with no single point of responsibility
The latest report, carried out by the Nuffield Trust and the Institute for Government think tanks, has concluded that adult social care in England is currently "a complex system where responsibilities are spread between central government departments and across a range of arm's-length bodies; between national and local government; and between government and a vast array of non-public sector providers".
The report adds: "Decision-making processes can be opaque and a single point of responsibility for overall oversight and stewardship is lacking. The consequences of this complexity and lack of clarity were highlighted during the Covid-19 crisis, and while that event forced some positive change, there remains a fundamentally fragmented system that lacks a coherent sense of direction."
The report points out that while there are more than 1.5 million social care staff, England is the only one of the UK's four nations with no mandatory register of care workers. The current make-up of the sector means private providers "dominate" in a pattern that has "emerged in a largely uncontrolled and unintended way".
Unlike NHS care, social care is not free at the point of use, and high costs sometimes mean people are forced to sell their homes to pay for what they need. People with savings worth more than £23,250 are not entitled to help with the cost of care from their local council.
The document warns of "poor transparency" around fees paid to and charged by providers, with people who have to pay for their own care charged, on average, 40 pc more for the same service than people whose care is arranged by their council.
The authors state that social care reform "requires political will and bravery to make the choices necessary to create a new national care service", warning that the "prominence and level of priority" Andy Burnham has given to social care "and the momentum he has created by accelerating the Casey Commission, needs to be maintained".
The prime minister has proposed an NHS-style system for everyone in England. He has acknowledged "difficult decisions" could be needed on tax but has insisted fixing the current problems in social care in England could save the NHS billions of pounds a year.
Experts call for clear vision
Report co-author Natasha Curry, from the Nuffield Trust, said its research showed the "governance of England's social care system is confused and complex". She added: "Overlapping and unclear roles leave dangerous uncertainty around who is responsible for important decisions, contributing to the inertia around reform England has struggled with for decades. The serious consequences of this were laid bare during the Covid pandemic. There is not a singular 'correct' way of organising a care system – other countries vary in their approaches – but we need a clear vision on how to untangle the chaotic structure the sector has currently."
Stuart Hoddinott, associate director at the Institute for Government, described a system which has been formed "haphazardly and with little clear planning". He added: "That has been exacerbated by successive governments ducking politically unpalatable decisions for decades. That has scattered responsibility for the sector across and outside government in a way that few would design from scratch."
