Casey: Successive Governments Have Been 'Asleep at the Wheel' on England's Social Care System

On Wednesday, Louise Casey is due to stand before the annual national children and adult services conference and tell its delegates that England's adult social care system has been left to drift. Successive governments, she will say, have been "asleep at the wheel," and the result is that in effect "no one is in charge" of a system that provides vital services for millions of vulnerable people.

Casey, now Lady Casey, heads the social care commission and is preparing proposals for a major review of adult social care. Her argument, as previewed ahead of the speech, is that the system grew into a chaotic patchwork of local services with no clear vision behind it. What people receive depends on where they live: standards differ, so do assessment processes, and so do waiting times. The private care sector has become dominant, and regulation of services has often been ineffectual.

She will also point to what she describes as the absence of "system stewardship" in England. Without it, she will say, governments find it hard to target improvements or turn policy into practice on the ground. She contrasts this with comparable countries such as France, Germany and Japan. She is expected to call for a "new settlement" for care, built on values she believes the country still shares: decency, contribution, and a duty to care for neighbours, loved ones and ourselves.

The speech draws on research by the Nuffield Trust and the Institute for Government. It found that the lack of oversight and of a clear, coherent narrative is a significant weakness, made worse by the historically low visibility of social care among governments. That lack of clarity makes policy change slow and difficult. But the researchers also cautioned politicians against disruptive structural changes made without a clear purpose or political determination. In their words, no amount of reorganising governance structures will be enough without political impetus, and without resources, time and energy dedicated to social care.

Casey will also address the pandemic. She has written to the Covid-19 inquiry to say she agrees with its findings on social care. The inquiry, she will say, took apart the argument that a "protective ring" had been thrown around care homes. Many old people died without loved ones beside them, and many care workers left their jobs after what they had seen. "It is a national shame that this was allowed to happen," she is expected to say. "It should never happen again."

The inquiry's chair, Heather Hallett, said last month that the adult care sector had been treated as "something of an afterthought" during the pandemic, with 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.

The politics give the speech added weight. Andy Burnham, the prime minister, has embraced the Casey review and brought its completion forward to next year, 12 months sooner than the Starmer government had planned. The expectation is that a national care service plan will appear in Labour's next election manifesto. He has already said he would use savings from scrapping the state pension triple lock, beginning in the next parliament, to fund a care service modelled on the Scottish approach of free personal care, with individuals paying for "bed and board" costs. He also has ambitions to reform care funding and the workforce.

What to watch is whether Casey's findings next year translate into a funded, clearly owned plan, since the research she cites is blunt that structure alone will not deliver change without sustained political will.