Introduction

England's adult social care system has developed without a coherent national plan, leaving older adults and people with disabilities facing uneven support depending on where they live. That is the central warning from Baroness Louise Casey, who leads the independent commission reviewing care services across the country.

Speaking ahead of a major address to social care leaders, Casey described decades of inaction by successive governments and said the sector has been treated as an afterthought compared with the NHS. Her commission is set to publish final recommendations next summer.

What Happened

Casey told the BBC that adult social care in England was never deliberately designed the way the NHS was established in 1948. Instead, services grew in an uncontrolled and unintended way, producing what she called a postcode lottery in which two people with identical needs can receive different assessments, waiting times, and levels of support based solely on their location.

The review also highlighted a significant funding gap. People who pay for their own care are charged, on average, 40% more than the rates local councils pay for state-supported residents. Casey said services such as home adaptations, help with washing, and assistance getting out of bed are simply not valued enough by policymakers.

She was especially critical of the Care Quality Commission, describing the regulator as a "spectator at the site of a car crash." Meanwhile, the market remains dominated by private providers, and England stands out internationally for lacking a clear system of stewardship for social care, unlike countries such as France and Germany.

Why This Matters

The warnings come alongside findings from the recent Covid inquiry, which concluded that the care sector was effectively overlooked during the early stages of the pandemic, allowing the virus to spread rapidly through care homes. Casey described those findings as "so awful" and "a national shame."

Without a clear national framework, families face uncertainty about costs and quality. Self-funders in particular bear a heavy financial burden, while the absence of consistent standards means the quality of care can depend on a person's postcode rather than their needs.

Key Takeaways

  • Baroness Louise Casey says successive governments have been "asleep at the wheel" on adult social care in England.
  • The care system lacks the deliberate design given to the NHS in 1948, resulting in a postcode lottery of services.
  • Self-funders pay on average 40% more than councils for comparable care arrangements.
  • England has no clear national stewardship for social care, unlike France and Germany.
  • The Care Quality Commission was criticised for playing only a passive role in overseeing the sector.
  • Final recommendations from the independent commission are expected next summer.

Conclusion

Casey ended her remarks with a call for a "new settlement for care" built on decency, contribution, and a collective duty to support neighbours, loved ones, and oneself. Whether future governments act on that vision remains to be seen, but the review makes clear that the current system is unsustainable without major reform.