Baroness Casey on Adult Social Care – Briefing Note on IfG Speech.

Overview

In her remarks at the Institute for Government conference, Baroness Casey set out a clear diagnosis of why successive governments have failed to reform adult social care. Her analysis places primary responsibility on political leadership, governance, and accountability, rather than on funding alone. She argues that social care has fallen between departments, lacked sustained political ownership, and been undermined by a system structurally oriented towards hospitals and crisis response.

These comments are an important signal of how her independent commission is likely to approach reform. They also highlight both opportunities and risks for the sector, particularly if structural reform is pursued without adequately addressing the material conditions in which care is delivered.

Casey’s Diagnosis: Why Reform Has Failed

1. Fragmented ownership and weak accountability

Casey argues that adult social care does not sit clearly with any single part of government. Responsibility is split across departments, allowing ministers to recognise the problem without being directly accountable for solving it. In practice, this has meant social care is often discussed but rarely prioritised in a sustained or decisive way.

This lack of ownership has also allowed difficult decisions to be delayed. Rather than confronting trade-offs, governments have relied on reviews, consultations, and short-term initiatives that create activity without delivering structural change.

2. A system designed around hospitals, not people

A central theme in Casey’s comments is the dominance of the NHS within health and social policy. She suggests that the Department of Health and Social Care functions, in reality, as a “National Hospital Service”, with policy, funding, and political attention overwhelmingly focused on acute care.

This has consequences for social care, prevention, and wider wellbeing. Where success is measured in hospital performance, social care is treated as secondary infrastructure, rather than as a core public service in its own right. This reinforces siloed thinking and weakens incentives to invest in community-based care.

3. Long-term delivery failure and “performative” policy

Casey is particularly critical of legislation and policy commitments that lack delivery mechanisms. She describes a pattern of passing laws without the funding, implementation plans, or political commitment needed to make them effective.

Her reference to the Care Act reflects this concern: ambitious in scope, but insufficiently backed by resources or enforcement, leaving local authorities and providers to manage expectations that could not be met in practice.

Across all three areas, her message is consistent: government has avoided making clear decisions and has instead relied on process, consultation, and legislative activity as substitutes for delivery.

What This Tells Us About the Commission’s Likely Approach

Taken together, these themes suggest a commission that will:

• Place accountability and political ownership at the centre of its analysis, potentially recommending clearer lines of responsibility within central government.
• Be wary of reforms built around broad consensus, and instead argue for clearer choices, even where these are politically uncomfortable.
• Challenge the dominance of acute care in national policy, and seek to elevate the status of social care within government decision-making.
• Use public engagement to build legitimacy for reform, particularly where recommendations involve trade-offs or limits.

However, the emphasis on governance over funding suggests that the commission may treat financial reform as necessary but insufficient, or as a second-order issue that follows structural change.

Implications and Risks for the Sector

While Casey’s focus on accountability and delivery addresses real weaknesses in the system, it also carries risks.

There is a danger that framing social care reform as “not just about money” is interpreted as meaning funding can be deferred. In reality, chronic underfunding has actively shaped the current system. Years of insufficient fees have constrained provider capacity, destabilised the workforce, and limited the quality and availability of care.

Structural reform that does not confront these realities risks becoming theoretical. Accountability mechanisms are only meaningful if the system has the resources to meet its statutory duties. Without sustainable funding, clearer governance alone will not prevent market exit, workforce shortages, or unmet need.