In The News
Can social care finally achieve lasting reform?
The UK’s adult social care system is facing yet another review, as the government launches the Casey Commission, an independent inquiry into the future of social care.
Chaired by Baroness Louise Casey, the commission is expected to lay the foundations for a National Care Service and deliver long-term solutions to a sector struggling with chronic underfunding, staff shortages, and rising demand.
But with its final recommendations not due until 2028, many fear this latest initiative could become yet another stalled attempt at reform, leaving the sector in crisis while policymakers deliberate.
A system in crisis
The commission’s announcement comes at a time when adult social care is at breaking point. The Skills for Care 2024 State of the Sector Report highlighted (again) a workforce crisis in the sector, with 131,000 vacancies and a vacancy rate of 8.3 per cent three times higher than the wider economy. Meanwhile, over 400,000 people are stuck on waiting lists for care assessments and services, with thousands forced to rely on overstretched family members or expensive private alternatives.
Care homes and home care providers are also facing severe financial pressure, exacerbated by rising costs, funding shortfalls, and government immigration policies that have restricted international recruitment. Applications for Health and Care Worker visas have fallen 81 per cent in just a year, further worsening staff shortages.
Given this urgent reality, many are questioning whether the Casey Commission’s slow timeline can deliver the immediate support the sector so desperately needs.
Is it too slow?
Government ministers have framed the Casey Commission as a bold step towards a fairer, more sustainable care system. Care Minister Stephen Kinnock described it as an opportunity to “tackle both the immediate issues and the fundamental challenges” required to put social care on solid footing for the future.
The commission aims to build cross-party consensus to avoid the cycle of short-term political fixes that have plagued the sector for decades. Its findings will be used to shape a National Care Service, mirroring the principles of the NHS but tailored to the specific needs of adult social care.
Despite this ambition, sector leaders worry the review will come too late to prevent further damage.
Caroline Abrahams, Charity Director at Age UK, voiced these concerns, calling the commission “a positive step, but far too slow.” She warned that if the government does not act before the final report, “older people and their families could be waiting until the 2030s for meaningful improvements.”
The case for action
The question now is why the government insists on waiting when previous commissions and reports have already outlined the key areas for reform.
Critics argue that successive governments have delayed reform by undertaking further reviews, rather than acting on the needs of the sector has made clear, such as:
Addressing low pay and poor working conditions to attract and retain staff.
Ensuring local councils receive adequate funding to prevent care providers from going under.
Creating a system where social care and health services work seamlessly to avoid hospital backlogs and delayed discharges.
Expanding the use of digital tools and assistive technologies to improve efficiency and care quality.
The sense that the solutions are broadly known is a view echoed by Sir Andrew Dilnot, who led a previous government review into care funding in 2011. He has argued that Baroness Casey could deliver recommendations within a year rather than waiting until 2028, calling the delay “a matter of political will, not necessity.”
A familiar political pattern?
The government insists the Casey Commission is not a way to kick the issue into the long grass. Health Secretary Wes Streeting has defended the approach, stating:
“We are already taking action to improve social care while laying the groundwork for long-term reform.”
The government has announced some short-term funding increases, including an £86 million boost to the Disabled Facilities Grant and plans to train care staff in basic health assessments to support NHS demand. However, these measures are widely seen as piecemeal, failing to address the sector’s structural weaknesses.
Opposition figures have been less optimistic, with Foyle MP Colum Eastwood calling the commission’s long timeline “a recipe for paralysis.” He warned that vulnerable people will be left waiting “while politicians push the crisis further down the road.”
There is another concern. Completing Phase 2 as late into the Parliament as currently planned would both miss the chance for it to impact the spending review in 2027 and will come at a period when political parties will be focused on the upcoming general election.
Both Andy Burnham and Theresa May before the 2010 and 2017 elections know through painful experience that such timing is far from ideal for fostering a serious cross-party dialogue on funding social care.
What next?
The first interim report from the Casey Commission is expected in mid-2026, but for many within the sector, that’s not soon enough.
With cross-party discussions set to begin next month, the challenge will be keeping pressure on policymakers to act before 2028. For decades, adult social care has been treated as a secondary concern—overshadowed by the NHS and left to struggle with inadequate funding and workforce shortages.
The real test for the Casey Commission will not just be its findings, but whether the government finally commits to action or simply adds another report to the growing pile of ignored recommendations.
Interview: Vic Rayner, Chief Executive of the National Care Forum, and Melanie Williams, President of the Association of Directors of Adult Social Services
As Labour announces the Casey Commission, we sit down with Vic Rayner and Melanie Williams who offer their insights on the urgent challenges facing care. In a wide-ranging discussion, they address the scope and potential impact of the Casey Commission, the pressing workforce crisis, and the need for immediate reforms rather than prolonged deliberations.
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.
