Baroness Louise Casey is expected to warn that responsibility for adult social care in England is too fragmented, as research prepared for her independent commission examines who oversees the system as a whole.
Casey is due to address the National Children and Adult Services Conference in Liverpool on Wednesday, 11 November. In advance remarks, she is expected to argue that successive governments have allowed the system to develop without sufficiently clear direction and to call for a new settlement for care.
The warning comes alongside research commissioned by her team from the Nuffield Trust and the Institute for Government. The study looks at the way decisions about care are made and how responsibilities are shared. It is separate from the commission’s eventual recommendations for reform.
Who is responsible for care?
The researchers describe a complex network rather than a service directed by a single organisation. Responsibility is spread across central government departments, other national bodies, local authorities and a wide range of organisations outside the public sector.
They say decision-making can be difficult to see and that there is no single point of responsibility for the oversight and stewardship of the system overall. In her prepared remarks, Casey is expected to sum up that concern by saying that “no one is in charge”.
Stewardship in this context means more than managing an individual care service. It concerns the broader question of who sets a coherent direction, understands how the different parts fit together and takes responsibility for the system as a whole.
The research argues that the lack of clarity makes policy change difficult and slow. It also warns that reorganising structures alone will not be enough without political commitment and the time, energy and resources needed to make improvements.
What it means for people using services
Adult social care can include support from a paid carer at home, equipment and adaptations, supported living or a place in a care home. It is used by people with different needs, including disabled adults and older people.
The system also differs from NHS care in how it is funded. People can arrange their own support, while those seeking council help can have their care needs assessed. A financial assessment helps determine whether the council will contribute to costs. Some support is available free, including certain forms of NHS-funded care.
Casey is expected to highlight differences in people’s experiences depending on where they live, including variations in assessments, standards and waiting times. The research also identifies poor transparency around fees charged by providers.
The study notes the scale of the workforce: more than 1.5 million social care staff work across around 19,000 employers. Private providers have become dominant, according to the research, but the pattern has developed without a clear overall plan.
Reform and the pandemic’s lessons
Casey is also expected to refer to the UK Covid-19 Inquiry’s earlier report on the care sector. Published in October, that report found that the sector had been treated as an afterthought and that care home residents had received insufficient protection during the pandemic.
In the remarks prepared for the conference, she is expected to say that many older people died without loved ones at their side and that some care workers left their jobs after their experiences. She has written to the inquiry in support of its recommendations.
The commission is examining how adult social care should be reformed, with its recommendations due by next summer. The governance research is intended to inform that work; it is not itself a final reform plan, and the forthcoming speech should not be mistaken for changes already put into effect.
