Successive governments have failed to give adult social care the strategic attention it deserves, leaving the sector to develop haphazardly without proper oversight or planning, according to Baroness Louise Casey, who heads an independent commission reviewing the system in England.
Speaking to the Today programme on Radio 4, Baroness Casey described the contrast between social care and the NHS, which was deliberately designed when it was established in 1948. According to BBC News, she said care services for older people and adults with disabilities had instead been developed in a largely uncontrolled and unintended way, resulting in a postcode lottery where the quality and availability of support varies significantly depending on where people live.
The commission's research reveals that England stands apart internationally for lacking a coherent system of stewardship for social care. Countries such as France and Germany have established clearer governance structures, yet England's fragmented approach leaves responsibility scattered across multiple government departments, arm's-length bodies, local authorities, and private providers with no single point of overall oversight, according to a Nuffield Trust and Institute for Government report published on 11 November 2026.
Why are self-funders paying more?
People who pay for their own care face significantly higher costs than the rates councils negotiate on behalf of those entitled to state support. Self-funders are charged on average 40% more than the fees councils pay for the same services, creating a two-tier system that penalises those without means-tested eligibility.
What does the Covid inquiry reveal?
The recent Covid inquiry report into social care exposed the consequences of this fragmented system. The inquiry found that the care sector appeared to be treated as an afterthought in the early stages of the pandemic, allowing the virus to spread rapidly through care homes. Baroness Casey described the findings as
"so awful" and "a national shame", and linked these failings directly to decades of undervaluation and neglect.
The pandemic exposed how unclear responsibilities and fragmented oversight had left the sector vulnerable. According to the Independent, the report notes that some positive changes followed the pandemic, but the system remains fragmented, with 153 councils holding social care responsibilities and short-term contracting and budget pressures continuing to drive variation and inefficiency in how services are commissioned.
How fragmented is the workforce?
The scale of the sector masks deeper structural problems. More than 1.5 million social care staff work across approximately 19,000 employers, yet England is the only UK nation without a mandatory register of care workers, leaving the workforce largely unregulated and unaccountable.
What role do private providers play?
The market is dominated by private providers, yet the regulator—the Care Quality Commission—lacks the authority to enforce meaningful change. Baroness Casey characterised the regulator as being a
"spectator at the site of a car crash", unable to prevent the problems that accumulate across the fragmented system.
What is the government's position?
Prime Minister Andy Burnham has identified social care as one of his key priorities, though the Casey commission was established by the previous Starmer government. Baroness Casey called for a new approach grounded in shared values.
"Together, we can build a new settlement for care,"she said.
"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."
This commitment follows earlier work by Burnham to build cross-party consensus on social care reform, while Casey has previously called for urgent reforms including a safeguarding board, dementia tsar, and fast-track support for patients with motor neurone disease.
What happens next?
Baroness Casey will address a conference of social care leaders on the day of her remarks. Her final recommendations for services for older people and adults with disabilities are expected to be published in summer 2027, following a public consultation process that has been shaping the future funding and delivery of social care.
Key Facts
- England lacks a single point of oversight for social care, unlike France and Germany, which have clearer governance structures
- Self-funders pay on average 40% more for care than councils pay for the same services
- More than 1.5 million care workers are employed across 19,000 employers, with no mandatory national register in England
- The Covid inquiry found care homes were treated as an afterthought in the early pandemic response, allowing rapid virus spread
- Final recommendations from the Casey Commission are due in summer 2027
