In April 2025, the government formally launched an independent commission led by Baroness Louise Casey to consider reform of the adult social care sector and development of a National Care Service (NCS) in England.
Unlike the NHS, adult social care is almost entirely provided by private companies, the end result of a privatisation process that began in the 1980s. These companies make vast profits, some of which flows out of the country. Details of long-term care can be found here.
The Casey Independent Commission launched
Reform of adult social care in England and development of a National Care Service (NCS) faces many hurdles, including a workforce crisis, the effect of many years of underfunding, and a press that has almost always wilfully misinterpreted any reform proposals. As a result the badly needed reform of the sector has been a can kicked down the road by every government for the past 30 or so years.
Privatisation of the service began in the 1980s and now adult social care is almost entirely provided by private companies. As a result, any government wanting to make reforms also has the added complication of negotiating with the large private care sector. These companies have for many years made millions in profit, which in several cases has flowed out of the country, often to tax havens. This is profit that the private companies are not going to give up easily.
In April 2025, Starmer’s government formally launched an independent commission to look into reform of adult social care in England. The task force, led by cross-bench peer Louise Casey, will develop plans for a new national care service.
The process will have two phases. The first, which will identify critical issues and recommend medium-term improvements, will be reported in 2026. However, phase two, which will examine how to organise care services and fund them for the future, will not be reported until 2028.
What has been reported so far
Since the Commission launched, Baroness Casey and the Independent Commission have met with more than 400 people with lived experience of receiving or delivering care, visited councils, social care providers and NHS workers across the country.
The Commission has also hosted evidence sessions with people working across adult social care including unpaid carers, frontline practitioners, providers, local authorities, NHS workers, and sector representative organisations. The Commission has also set up an online evidence portal where anyone can submit their insights, experiences and ideas for change directly to the team.
In a March 2026 speech, Lady Casey said the social care system, unlike the NHS, had never had “its own creation moment” but “we inherited a system shaped for a very different age, held together with add-ons and work arounds, sticking plasters and glue. Without ever having the moment of reckoning we now need.”
She set out how there is currently a reliance on cobbled together underfunded services relying on low-paid care workers, a lack of ownership and accountability, and a deep divide between health and social care which leaves families to navigate alone.
Baroness Casey also confirmed she has written to the Secretary of State for Health and Social Care asking the Government to take six immediate actions on dementia, motor neurone disease and adult safeguarding due to the urgency of the reform needed in these areas.
This includes asking the Government to scale up dementia trials, appoint a new Dementia Tsar, set up a new National Safeguarding Board to protect vulnerable adults, and to introduce a new fast-track, social care passport for people diagnosed with motor neurone disease.
2028 is too long to wait for answers
Although sector organisations welcomed the Casey commission, there was unanimous concern that 2028 is far too long to wait for major change in social care, particularly for funding, and that things need to be done now to protect services.
At the time the Casey commission was announced The Association of Directors of Adult Social Services (ADASS) president Melanie Williams warned:
“unfortunately, the timescales announced are too long and mean there won’t be tangible changes until 2028.” Adding that “significant and immediate investment is required to enable adult social care to simply standstill.”
Frustration is not just with the timescale. Organisations involved and commentators feel that we have been here before, not just once or twice but many times over in the previous three decades. The information and ideas needed for reform are already out there, so why is another commission needed?
An analysis by The Health Foundation found that over the past 27 years, there have been two government commissions, one shorter government-commissioned review, three independent commissions, five white papers and 14 parliamentary committee inquiries on social care reform.
Added to this have been numerous other independently commissioned reports on social care from organisations involved, such as ADASS and think-tanks.
As Director of Policy at The Health Foundation, Hugh Alderwick, noted:
"The adult social care system in England desperately needs reform after decades of political neglect and underfunding. So the government’s promise of a plan for social care is welcome. But we have been here before. The past three decades have seen a long line of reports and reviews making recommendations for social care reform, including from government commissions like the one announced today. The result has been delays and broken promises."
And with so many reports available, is there really anything more to find out?
As Melanie Williams from ADASS noted:
“We already know much of the evidence and options on how to reform adult social care, including our independently commissioned Time to Act report, and worry that continuing to tread water until an independent commission concludes will be at the detriment of people’s health and wellbeing.”
Will a new leader change things?
In June 2026, it became clear that Andy Burnham will almost certainly become the new leader of the Labour Party and Prime Minister. Burnham has signalled he would overhaul England’s social care system in the first year of being in charge if he became prime minister. Burnham has also suggested he would seek more radical and urgent change.
The Care Association Alliance (CAA), the national voice of local care provision in England, called on whoever forms the next government to make the reform of adult social care funding an immediate priority. It also called on Andy Burnham to honour the commitments he has made to the sector.
The CAA urged him to stand by those words: to bring forward the timetable of the Casey commission and to commit to a fundamental overhaul of how care is funded, starting with the introduction of a national funding settlement.
What is wrong with the UK’s social care sector
Local authorities are statutorily required to provide adult care services, but over 30 years of funding cuts to local authorities budgets means that they are struggling to cope. There has also been an increase in the number of people requiring care: in 2015/16 there were 1.8 million requests for help by 2024/25 this had risen to 2 million requests.
The sector is struggling with a workforce crisis made worse by Brexit and several immigration decisions made by previous governments as well as the current one.
In addition, recent policies have not helped the sector and could actually lead to the collapse of much social care, according to an analysis by The Nuffield Trust sent to the government in November 2024.
Tax and wage rises announced in a 2025 budget mean the care sector faces an extra £2.8bn cost burden from April 2025. The report warned that the consequences would devastate vulnerable and older people who rely on care services. Local authorities echoed these concerns, as did care home providers.
The work done in the previous commissions and inquiries primarily focused on five difficult areas for social care: the charging system, funding, workforce, service delivery, and integration with the NHS.
Paying for care - how much and for how long?
One of the most contentious issues is the health care component of social care costs, which is considered a political minefield. Most commissions and reviews have proposed reforms to reduce healthcare costs for people and increase the number of people accessing publicly funded healthcare. Politicians, in turn, have baulked at the cost of such reforms and done little to change things.
Suggested reforms have varied – from making the existing system more generous by adjusting the means and need tests for accessing publicly funded support or limiting individual care costs by capping them by time or the amount paid through to universal access to social care, free at the point of use like the NHS.
One of the most widely known proposals was made in the July 2011 Fairer Care Funding report from a Government Commission, often known as the Dilnot report, after Andrew Dilnot, chair of the commission. The report proposed a lifetime cap on individual care costs, an increase to the asset threshold for accessing residential care and free support for people entering adulthood with care needs. The Dilnot Commission’s recommendations to cap care costs and extend the means test were introduced as part of the Care Act 2014, but these have never been implemented due to successive government’s concerns over costs, most recently by Labour.
How should social care be funded?
Also, a political minefield, funding reform for social care, has been looked at and then put to one side by successive governments for over 20 years. This is no longer an option, according to a report by The Nuffield Trust in November 2024, which warned that the system is close to breaking point with devastating consequences for vulnerable and older people.
Over the past quarter of a century most commission and committee reports have called for an increase in social care funding and for funding to be put on a more sustainable long-term footing, rather than often ad-hoc short-term funding increases to address crises.
Suggestions for the source of increased social care funding have included general taxation, increasing national insurance contributions for people aged 40 years and older and means-testing winter fuel payments to fund social care.
Workforce issues
The care system is nothing without staff, and the current structure has done little or nothing for decades to encourage good rates of pay, training opportunities, and good working conditions. The result is a system with a crisis in workforce recruitment and retention. In March 2025, there were an estimated 111,000 vacant posts across the whole adult social care sector, according to Skills for Care.
Over the years, government committees have made calls for a national strategy to recruit, retain and develop the workforce. Other measures revolve around targeted recruitment actions, lowered visa requirements, measures to ‘professionalise’ the workforce, and improvements to terms and conditions.
In July 2024, Skills for Care, the workforce development body for adult social care in England, published the first ever adult social care sector Workforce Strategy. The previous Conservative government had refused to develop a strategy or be involved, so Skills for Care, in collaboration with a number of other organisations, went ahead without government involvement.
The Workforce Strategy covers the next 15 years and is designed to complement the NHS plan, published in June 2023. As in the NHS plan, the strategy covers attracting and retaining staff, training, and transformation. The publication came at the same time as a joint report from The Nuffield Trust and the Health Foundation that calls for the introduction of national pay banding to tackle low pay in adult social care and encourage key workers to stay in the industry.
Integration of social care with the NHS
Reform of the NHS over recent years has focused on integrating care, with the introduction of integrated care systems. This has included a step towards closer working with the social care system.
Several commissions and inquiries on social care have identified options to improve coordination and integration with health care services. The most ambitious ideas propose moving to a single health and social care system, with a joint budget and single commissioning bodies to plan and purchase local services. Back in 2010, the Labour Manifesto contained plans for a National Care Service similar to the NHS. In 2020, the public services union Unison renewed the call for a national care service, releasing a strategy document, Care after Covid, to make the case for a radical shakeup.
Other proposals from commissions and committees have called for support for coordination between local authorities and NHS bodies, such as requiring joint workforce planning or expanding shared care records. Recent select committees have also included specific recommendations on the role of social care in integrated care systems (ICS), which were established in 2022.
The private sector - will it make reform difficult?
An issue that the numerous government commissions and committees have not addressed closely to date is the actions of private companies in the adult social care market. Privatisation of the social care system began in the 1980s and there is now little state-owned provision.
Integration with the NHS, which is state-owned and free to access, with the social care system dominated by for-profit companies, many of the largest of which are owned by companies overseas, could prove to be a difficult hurdle in any reform process.
Local authorities are paying vast sums to private companies, who are not necessarily providing even an adequate service or paying their workforce adequately.
Back in 2016, the Centre for Health and Public Interest (CHPI) reported on the consequences of the privatisation finding that “both the quality of care in adult social care and the terms and conditions of the workforce have declined over the past two decades as a result of privatisation.”
An investigation by The Guardian in 2022 found that almost half a billion pounds has been spent buying beds in the worst care homes in England in the last four years, driving profits for private investors while residents suffer unsafe treatment.
To make matters worse, a few large operators are making profits but funnel them to private equity investors overseas, whilst others are in difficult financial positions and struggling to remain financially viable. As a whole this makes for a highly unstable market, one where borrowing is high, staff pay is low and tight cost controls are in place.
For a detailed look at private equity see our dedicated page here.
Will 30 years of inertia end
The impact of all the reports on government policy over the past 30 or so years has been limited, and the problems in social care that existed in the 1990s/2000s continue and have become worse.
Whilst funding and media attention have flowed to the NHS and its problems, social care received little attention and increased funding.
The blame for this lack of action and the current crisis situation lies with politics and politicians. What was needed was a cross-party agreement, but historically, there has been little willingness to actually achieve this and bring about reform. Added to this has been the eagerness of certain strands of the media to misinterpret ideas to produce misleading headlines that scare the public and the result is the crisis social care now faces.
