Successive Governments “Asleep at the Wheel” on Social Care

Successive governments have been accused of being “asleep at the wheel” over adult social care, following new research which highlighted a fundamental lack of leadership, accountability and strategic direction across the sector.

Baroness Louise Casey, chair of the Independent Commission on Adult Social Care, delivered the criticism in a speech to social care leaders at the National Children and Adult Services Conference in Liverpool, where she called for a “new settlement for care” and warned that England had no one clearly in charge of the system.

Baroness Casey said care services for older people and adults with disabilities had been developed in a mainly uncontrolled and unintended way, unlike the careful design of the NHS in 1948, and suggested a postcode lottery had developed with different levels of services available depending on where people live.

The speech coincided with the publication of research commissioned by the Independent Commission and undertaken by the Nuffield Trust and the Institute for Government. Its findings suggested that England was an international outlier, with no clearly defined arrangements for the overall stewardship and direction of adult social care.

The findings expose how fragmented responsibilities, short-term funding, low prioritisation by successive governments, and inconsistent commissioning leave people facing unequal access to support and services, struggling to plan for the future. It describes the current system as existing off the back of “incremental and, at times, accidental developments that stem from the absence of a ‘design moment”.

Comparisons with countries including France, Germany and Japan highlighted how England lacked the coherent national oversight and accountability structures found elsewhere.
Different assessment processes, standards and waiting times meant that people’s experiences of the care system could differ considerably across the country.

Scale of Challenge

The scale of the challenge was underlined by the fact that more than 1.5 million people worked in adult social care in England, across approximately 19,000 employers.
England was also the only UK nation without a compulsory register of care workers, further illustrating the fragmented approach to oversight and workforce regulation.

Baroness Casey’s intervention also came against the backdrop of the final report from the UK Covid-19 Inquiry’s investigation into the pandemic’s impact on social care.
In a letter to the Inquiry’s chair, Baroness Heather Hallett, she expressed herself as “deeply horrified, but unfortunately not surprised” by the findings, which highlighted how care home residents and the staff looking after them had been treated as an “afterthought” during the pandemic.

Inquiry Recommendations

The Inquiry exposed serious shortcomings in the protection afforded to care home residents, including the discharge of hospital patients into care settings without adequate knowledge of their Covid status, placing vulnerable people at risk.

More than 43,000 people died from Covid-19 in UK care homes between March 2020 and July 2022.

Baroness Casey supported the Inquiry’s recommendations for social care, stressing that the Government could begin acting on them without delay.

She also challenged the assertion that a protective ring had been placed around care homes during the pandemic, highlighting the devastating consequences for residents, families and the workforce.

Many older people had died without their loved ones beside them, while numerous care workers had subsequently left their jobs after witnessing the events unfold.

“National Shame”

Describing what had happened as a “national shame”, she warned that the failures must never be allowed to happen again.

Her call for a new settlement for care was based on shared values of decency, contribution and a collective duty to look after others, arguing that the sector required more than another organisational restructure.

The findings also raised questions about the Government’s proposed National Care Service and the wider debate over how adult social care should be funded, managed and delivered.

While structural reform remains an important part of the discussion, the Commission’s research suggested that simply reorganising responsibilities would not address the underlying problems without sustained political commitment, clear accountability and adequate resources.

The Independent Commission on Adult Social Care is due to publish its recommendations next summer, with its work expected to inform the future direction of one of the UK’s most important public services.

Accountability

Andrew Pike, Deputy Director of Campaigns, Policy and Public Affairs at Dementia UK said: “Baroness Casey is right: successive governments have failed social care. Families affected by dementia are living with the consequences of this. Today’s newly published research from the Casey Commission reinforces the clear need for leadership and accountability.

“Dementia must be central to social care reform. People living with dementia, and their families and carers, need reliable support, wherever they live.

“Coordinated care from named professionals and timely specialist access; proactive, personalised support from diagnosis to end of life; and dedicated support for families and unpaid carers are essential. Nobody should face dementia alone.”

Chronic Underfunding

Professor Martin Green OBE, Chief Executive of Care England, said: “Baroness Casey is right. Successive governments have been asleep at the wheel. People who need care, their families and those who support them have lived with the consequences for years. The report does not say that the independent sector has failed, but that the independent sector has stood up when successive governments have failed and provided a diverse range of services in spite of chronic underfunding and inconsistent and restrictive commissioning practices.

“The consequences of this lack of stewardship is that councils struggle to balance their books, providers struggle to make inadequate fees cover the care people need, and families struggle to understand why support available in one area cannot be found in another. The research directly feeds into Lady Casey’s characterisation of equitable social care provision as being the ‘Sixth Beveridge Giant’ that any citizen should expect the government to provide for.

“Our own research has documented how those pressures build. Local authority funding continues to fall behind costs. Funding available for training, better pay and improvements are squeezed while decisions around minimum wage increases, and the local authority budgets that must deliver them, are often made in relative isolation in a siloed government that has treated social care as the NHS’ poor relation rather than the core public service it should be.”

Opportunity to Change

Gerard Crofton-Martin, Interim Chief Executive of the Social Care Institute for Excellence (SCIE), said: “One of the biggest lessons from the past is that reform cannot simply be legislated into existence. The report makes clear that national infrastructure is needed to make lasting improvements.

“The Casey Commission offers a genuine opportunity to change course. But building a National Care Service will take more than a bold vision and a sustainable funding settlement. It will require a serious, long-term commitment to helping a complex and fragmented sector deliver better, more equitable social care which will improve people’s lives.

“Among the lessons for reform cited in the report is the important role of an independent, credible organisation like SCIE, trusted by the care sector, to lead sector improvement and innovation. The report calls for enhancing this role and strengthening its place as part of the National Care Service’s core infrastructure.

“We’re at a turning point for social care, and reinforcing the foundations for lasting improvement must be at the heart of the government’s plans. SCIE stands ready to play its part in driving this ambition forward. Our work developing national standards of care, which will establish greater consistency and fairness as part of a National Care Service, shows that we need not wait for policy reforms to begin tackling the care system’s myriad challenges, such as inequitable access to care.”

Responding to the findings, Hannah Morgan, Senior Director, Product and Innovation at QCS, said: “The Casey Commission’s focus on strengthening governance in adult social care is timely and welcome. However, meaningful reform must go beyond organisational structures and regulatory compliance and promote continuous improvement, clear accountability and informed decision-making, with the experiences of people receiving care and frontline staff at its heart.

“Lasting reform must be underpinned by stronger support for providers, effective workforce planning, clearer expectations, consistent guidance and sustainable funding. Providers need the confidence, resources and practical support to deliver high-quality care, alongside the stability to plan for the future.

“Ultimately, the success of reform must be measured by the difference it makes to people’s lives and the quality of care they receive.”