3 hours ago
England’s “creaking” adult social care system is confusing and impenetrable to the people that rely on it and held together with “sticking plasters and glue”, the head of a government-commissioned review has said in a withering critique.
Louise Casey said the country faced a “moment of reckoning” over its failure to effectively and fairly meet the needs of Britain’s ageing population and rising numbers of people with chronic conditions such as dementia and Alzheimer’s.
In a frank and often passionate speech, Casey said society needed to face up to the major challenge of overhauling an underpowered system in which “some needs are barely met at all and others are met late and in piecemeal and random ways”.
Casey, who has been tasked with putting policy flesh on the government’s manifesto commitment to set up a national care service, said her review was examined through “the lens of the adult and their family who need social care”.
“The challenge for all of us is to get this right and it is a collective one. How do we ensure that care and support is available for those who need it in a fair, dignified way that reflects the nation and the values that we hold dear today? It is a moment of reckoning. It is a moment of renewal,” she said in a speech on Thursday.
Casey, a former social campaigner and senior civil servant best known for chairing national inquiries into issues such as homelessness, the Metropolitan police and grooming gangs, was commissioned by the government in January 2025 to carry out a major two-part review of adult social care.
She said adult social care had never had a “Beveridge moment” – a reference to William Beveridge, the postwar architect of the welfare state – and the nation had never had an honest debate about how it could provide support and care for an older and sicker population.
Despite at least 22 major reviews of social care over three decades, care reform had never had the political backing it needed, she added.
Years of fragmented changes and underinvestment had left adult social care underpowered and fragile, delivering often inconsistent services that left people and families who needed help confused and anxious, she said in a speech to health and social care leaders on Thursday.
Services had been cut during years of austerity, while provision was dependent on what she called the exploitation and underpayment of care workers. Social care was the poor relation of the NHS, and the two services often failed to work together.
With conditions such as dementia and Alzheimer’s, artificial definitions of which services counted as healthcare and which were social care had led to institutional “bunfights” over who footed the bill, she said, “with families picking up the pieces”.
This divide between care and health “does not exist to the public”, she said: “It is based on our divide, based on definitions and categorisations that satisfy each institution. Not the public. It is not about what is best for the patient or the person.”
She contrasted the failure of the NHS and social care to respond to the “seismic challenge” of dementia and Alzheimer’s with the “brilliant determination and energy” that those services had brought to tackling cancer.
She urged the health secretary, Wes Streeting, not to wait for her report but to straight away invest in dementia trials, create a full-time “dementia tsar”, and fast-track care for people diagnosed with motor neurone disease (MND).
The first phase of the Casey review, due this year, will set out plans for a national care service. The second phase, expected to report in 2028, will examine how to build and fund a system to cope with the country’s care needs.
A Department of Health and Social Care spokesperson said it had accepted Casey’s proposals on dementia and MND. “This is about moving faster, cutting through delay and building a social care system that works for everyone,” they said.
Caroline Abrahams, charity director at Age UK, said: “This is arguably the first time that someone as senior, respected and independent as Baroness Casey has been prepared to tell the truth about the state of social care in our country.”
The Nuffield Trust’s deputy director of policy, Natasha Curry, said: “With time ticking for this government, the commission needs to act quickly and build on the momentum for change.”
