As we begin our discussion with Vic and Melanie, we ask about the Casey Commission’s scope and potential impact on the social care sector. Both emphasise the urgency of action, noting that the industry's challenges are well understood and demand immediate solutions.
“There isn’t time to wait for a long and protracted discussion,” Rayner states. “The longer you leave it, the more complications arise because of the many difficulties facing the sector right now.”
Williams echoes this concern, stressing that “the fundamental issue is that we haven’t got enough money ... there’s not enough public sector funding to sustain the current adult social care model.” Both suggest that while the commission could shape long-term reform, many pressing workforce and integration issues can and should be tackled immediately.
“The workforce strategy, for instance, is something we don’t need a commission for,” Williams notes. “We know what we need to do [which is to] recruit more people, pay them fairly, provide career pathways ... so why wait?”
Rayner agrees that the commission must focus on the sector’s long-term sustainability and economic role. “Social care is one of the largest employers in many localities,” she points out, “but we don’t view it as critical infrastructure in the way that we could. Proper reform needs to recognise its contribution to economic growth.”
Balancing technology and human-centred care
A central question regarding the role of technology in social care is how it can enhance care without diminishing the essential human element.
Williams sees enormous potential for digital transformation but warns of implementation challenges. “It’s not just about having the technology,” she says. “You need infrastructure, training, and support so that it becomes embedded in everyday care.”
Rayner highlights the rapid shift in digital adoption: “We’ve seen a major move from digital care records to remote monitoring, AI-based falls detection, and back-office automation. But we must ensure that technology solutions are aligned with the people receiving care and the workforce delivering it.”
Social care is one of the largest employers in many localities ... but we don’t view it as critical infrastructure in the way that we could
Both note concerns about the government’s push for social care workers to take on more clinical responsibilities, such as monitoring vital signs. “That announcement irritated me,” Williams admits. “It assumed we aren’t already doing some of these things and ignored that every 15 minutes spent on a delegated health task is 15 minutes taken from social care.”
Rayner agrees that delegation needs careful structuring: “There’s potential for care workers to develop new skills, but it must come with proper training, supervision, and funding.”
Workforce crisis
The shortage of carers remains one of the most pressing issues in social care, with a vacancy rate of more than eight per cent and 131,000 posts left unfilled in 2023/24.
“The core problem is that social care isn’t seen as a professional career,” Rayner argues. “It’s framed in simplistic terms ... getting people out of bed, putting them back to bed rather than as the deeply skilled, life-changing work that it is.”
Williams agrees that recognition is critical. “We need to celebrate social care alongside the NHS. During [the pandemic] the message was ‘protect the NHS,’ but really, it should have been ‘protect people.’ That’s what social care does ... whether state-funded or privately paid for, it exists to protect people.”
Both advocate for clear career pathways and stronger links with the NHS. “Around 30 per cent of care workers and social workers move into the NHS, but there’s no structured support for that,” Williams notes. “We’re training their workforce, but they’re not investing in us.”
Rayner points out that social care offers many careers beyond direct care work. “It could be engineering, catering, gardening ... there’s a place for everyone in social care, but we don’t market it that way.”
Integrating social care with health
A longstanding challenge in social care is the need for better integration with the NHS. However, as Williams points out, “Most of social care doesn’t actually involve health. There are key areas where integration matters [including] mental health, learning disabilities and older adult care but we mustn’t assume that all social care needs to be part of a health-led system.”
Rayner argues that care providers must have a strategic role in shaping integration efforts. “You wouldn’t redesign hospital services without input from hospitals, yet discussions about health and social care integration often exclude care providers.”
Both acknowledge that financial constraints often hinder proper integration. “Right now, a lot of time is spent arguing about who pays rather than how we support people better,” Williams notes. She highlights positive examples, such as the NHS’ ‘neighbourhood health’ model, which focuses on local coordination.
Around 30 per cent of care workers and social workers move into the NHS, but there’s no structured support for that
Rayner mentions promising innovations, such as digital platforms, that improve hospital discharge coordination. “Some tech-driven solutions help streamline the process, but they need proper investment and implementation.”
What can policymakers do
As we near the end of our discussion, we turn to the role of policymakers in shaping the future of social care. Williams expresses frustration over delays in action: “There’s been a manifesto commitment of a National Care Service [and] fair pay agreement, but nothing has started yet.”
Rayner points out that political will exists but must be accompanied by financial commitment. “If you spent a fraction of one per cent of the social care budget on research and innovation, the savings down the line could be significant.”
On the question of cross-party support, both take a pragmatic stance. “The issue isn’t really a cross-party agreement,” Williams argues. “The Care Act had parliamentary support but was never fully implemented. The real challenge is Treasury backing. [Reform] will cost money, and that’s where this has repeatedly stalled.”
Rayner highlights the importance of ensuring the public understands the value of social care. “We need to shift the perception so that no MP can go into the next election without a commitment to sustainable social care. That’s how we make reform stick.”
Reflecting on our discussion, Rayner and Williams offer a clear view of social care's challenges and opportunities. From workforce sustainability to technological integration and policy reform, they outline a path forward that requires immediate action, not just long-term reviews.
What remains to be seen is whether the Casey Commission and the government can rise to the challenge and deliver the reforms that carers and those in need of care so desperately require.
