No-one in charge on adult social care, review leader to warn

Governments have been “asleep at the wheel” on social care, the leader of a review into reform of the sector is expected to say as new research concludes it is a “fundamentally fragmented system” with no-one in charge overall.

Baroness Louise Casey is also set to brand failings in the pandemic which saw Covid-19 “spread like wildfire” in care settings where many older people died without family at their bedsides as “a national shame”.

A report by the UK Covid-19 Inquiry last month stated that the care sector was “an afterthought” and rubbished then-health secretary Matt Hancock’s claim made in May 2020 about a so-called protective ring around care homes at the start of the pandemic as “unfounded”.

Inquiry chairwoman Baroness Heather Hallett said: “Quite the opposite was true.”

Her report found that vulnerable care home residents were left with “insufficient protection” as patients were discharged from hospitals without knowing if they had the virus and that the mantra of protecting the NHS “sometimes came at the expense of the users and providers of care”, with care homes “becoming prisons” for some amid visiting bans and many residents feeling “abandoned”.

Baroness Casey, in a speech to a gathering of social care leaders in Liverpool on Wednesday, will call for “a new settlement for care”.

Speaking at the National Children and Adult Services Conference (NCASC), she is expected to say: “The Covid-19 Inquiry took apart the argument that a ‘protective ring’ had been thrown around care homes during the pandemic.

“Many old people died without their loved ones by their side. Many care workers left their jobs after what they had seen.

“It is a national shame that this was allowed to happen. It should never happen again.

“Successive governments have been asleep at the wheel. In research we’re publishing today the lack of ‘stewardship’ of social care comes through clearly. No-one is in charge.

“Together, we can build a new settlement for care. One based on values I still believe this country shares: decency, contribution and a duty to care for our neighbours, our loved ones and ourselves.”

A report, commissioned by Baroness Casey’s team and carried out by the Nuffield Trust and the Institute for Government think tanks, concluded adult social care in England is currently “a complex system where responsibilities are spread between central government departments and across a range of arm’s-length bodies; between national and local government; and between government and a vast array of non-public sector providers”.

It added: “Decision-making processes can be opaque and a single point of responsibility for overall oversight and stewardship is lacking.

“The consequences of this complexity and lack of clarity were highlighted during the Covid-19 crisis, and while that event forced some positive change, there remains a fundamentally fragmented system that lacks a coherent sense of direction.”

The report points out that while more than 1.5 million social care staff work across around 19,000 employers, England is the only one of the UK’s four nations with no mandatory register of care workers.

The current make-up of the sector means private providers “dominate” in a pattern that has “emerged in a largely uncontrolled and unintended way”.

Unlike NHS care, social care is not free at the point of use and high costs sometimes mean people are forced to sell their homes to pay for what they need.

People with savings worth more than £23,250 are not entitled to help with the cost of care from their local council.

The report warned of “poor transparency” around fees paid to and charged by providers, with people who have to pay for their own care charged, on average, 40% more for the same service than people whose care is arranged by their council.

The report stated that social care reform “requires political will and bravery to make the choices necessary to create a new national care service”, warning that the “prominence and level of priority” Prime Minister Andy Burnham has given to social care “and the momentum he has created by accelerating the Casey Commission, needs to be maintained”.

Mr Burnham has previously acknowledged “difficult, difficult decisions” could be needed on tax but insisted fixing the current problems in social care in England could save the NHS billions of pounds a year.

Report co-author Natasha Curry, from the Nuffield Trust, said its research showed the “governance of England’s social care system is confused and complex” while Institute for Government associate director Stuart Hoddinott described a system which has been formed “haphazardly and with little clear planning”.

Mr Hoddinott added: “That has been exacerbated by successive governments ducking politically unpalatable decisions for decades. That has scattered responsibility for the sector across and outside government in a way that few would design from scratch.”

Baroness Casey – whose report on recommendations for sector reform is due by next summer – has also written to the Covid inquiry to tell Lady Hallett she was “deeply horrified, but unfortunately not surprised” by the findings.

She said: “I wholeheartedly agree with your recommendations and join you in urging Government departments to act on them quickly.”

Published: 11/11/2026 by Radio NewsHub