Adult social care system held together with “add-ons and work arounds, sticking plasters and glue”: Baroness Casey

Baroness Casey has been tasked by the Government with recommending comprehensive reforms to the adult social care system in England.

This will be undertaken in two phases - with the first report to be published in 2026 and the final phase reporting back by 2028. 

In a speech this week at the Nuffield Trust Summit (5 March), Baroness Casey said: “Unlike the NHS or indeed the benefits system, social care has never had its own creation moment. No moment when the nation decided what it was for, what people should expect or who should pay, and how. 

“Instead, we inherited a system shaped for a very different age, held together with add-ons and work arounds, sticking plasters and glue. Without ever having the moment of reckoning we now need.”  

She stated that a “national conversation” would be needed to seek backing from the public who pay for health and social care through their taxes, but might not actually know what social care is.

She also described a “deep divide” between health and social care - which leaves families to navigate alone.  

Meanwhile, Baroness Casey confirmed she has written to the Secretary of State for Health and Social Care asking the Government to take six “immediate actions” on dementia, motor neurone disease and adult safeguarding, due to the urgency of the reform needed in these areas.

This includes asking the Government to scale up dementia trials, appoint a new ‘Dementia Tsar’, set up a new National Safeguarding Board to protect vulnerable adults, and to introduce a new fast-track, social care passport for people diagnosed with motor neurone disease.

Responding to the speech, the Department for Health and Social Care confirmed in correspondence that it will “take forward the recommendations”.

Secretary of State for Health and Social Care Wes Streeting wrote: “I strongly welcome the focus on the need to protect vulnerable adults and ensure services are safe, effective and high quality.

“[…] My department will create a new national safeguarding board and undertake an urgent review of adult safeguarding statutory duties and powers as you recommend.

“To make immediate progress, the department will set up a new national safeguarding board, chaired by the Chief Social Worker - reporting directly to the Minister of State for Care.”

Responding to the announcement from Baroness Casey, Cllr Louise Gittins, Chair of the Local Government Association, said: "Stabilising and reforming adult social care so it can best support people is one of the most urgent challenges we face as a society. Baroness Casey is right to recognise the need to elevate the true value and purpose of care and support nationally. It is encouraging that she has strongly signalled for this to be a core foundation behind her proposals for the sector’s future.

“A focus on safeguarding people who draw on care and support is vital to creating a prevention-focused and person-centred system. There is a strong role for local government in ensuring that people’s rights under the Care Act 2014 continue to improve. We look forward to seeing the proposals in more detail.

“We are engaging closely with councils, the care workforce, and people with lived experience through our ‘Care where we live’ conversation series to inform the shaping of a future system that enables people to draw on dignified care and support, when and where they need it. Sustainable resourcing of adult social care remains key to successful system reform.”

ADASS President Jess McGregor said: “This speech shines a welcome light on adult social care – an issue that has been missing from our national debate for far too long. It was encouraging to hear these difficult questions addressed directly, including how we support an ageing population and ensure that everyone can access the care and support they need. 

“Many of the issues raised today are ones Directors of Adult Social Services see every day in our communities. When adult social care is overlooked nationally, there are real consequences for people and families who rely on support to live their lives with dignity and independence. ADASS stands ready to work with Louise Casey and her team as they explore practical solutions ahead of their first report. 

“Louise Casey is right to highlight how adult safeguarding has been overlooked by successive governments. In our communities there are tragic examples of abuse, neglect and avoidable harm. This happens when warning signs are missed, vulnerabilities are misunderstood or support arrives too late. An inevitable consequence of an underfunded social care system is that too many people are not protected and come to harm. Too often this critical area of work has received too little national attention, despite the profound consequences. 

“A new national safeguarding board could play an important role in raising the profile of this work, strengthening accountability, elevating the role of social work and ensuring serious concerns about harm are consistently addressed. With the right leadership, resources and partnership across government and local services, we can build a system that better protects and supports people. 

“When so many older people drawing on care and support are living with dementia, it is right that this receives focused national attention. We welcome the focus on new treatments, better services and a new dementia tsar. This could help to improve the lives of people living with Dementia, reduce their need for social care, bring greater visibility and drive a more coordinated approach across government. 

“To make real progress, we also need much stronger collaboration between healthcare and local government. The support people need rarely fits neatly into organisational boundaries, and it works best when the NHS and councils work together with trust, shared purpose and a clear focus on the person needing care."

Baroness Casey’s speech can be watched in full here.

Lottie Winson