Casey Commission tasked with producing plan for ‘national care service’ by 2026

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The 2026 report will be followed by a further report, due by 2028, setting out longer-term recommendations for the sector, according to the Department of Health and Social Care’s (DHSC) terms of reference for the commission, published today.

The Independent Commission into Adult Social Care, headed by crossbench peer and renowned government troubleshooter Baroness (Louise) Casey, started its work this week.

The plan to set up the commission sparked criticism from social care organisations, after it was announced in January, due to its three-year timeframe being seen as far too long to develop a plan for a sector under under severe immediate pressures and facing significant future challenges.

10-year plan must be delivered in 2026

However, the DHSC remit makes clear that the first phase of the Casey Commission’s work – reporting in 2026 – must set out a plan for reforming adult social care that would be “phased in” over 10 years, with phase two then making longer-term recommendations.

The phase one plan would be based on a “national conversation” designed to build public consensus on how to best meet the population’s current and future needs,  a “data-driven deep-dive” into how well existing council and NHS funding for the sector is being used and “a commonly agreed picture” of the problems currently faced by the sector.

The DHSC has asked the commission to set out a plan for a “national care service” but, as with Labour’s 2024 election winning manifesto, the meaning of this concept is not spelt out.

Government objectives for Casey Commission

However, the terms of reference do set specific goals for the commission’s 2026 plan:

• Its recommendations should be “pragmatic”, “affordable” and deliverable within the constraints set by the government’s forthcoming spending review, which will set public expenditure limits from 2026-29.
• They should aim to “deliver tangible improvements” to the quality of services, make adult social care more “productive” and “preventative” and give people who draw on care and their carers and families more “power in the system”.
• They should also aim to support the NHS by reducing “unnecessary hospital admissions” and delayed discharges, in order to help the DHSC meet its target for 92% of patients waiting for non-urgent treatment to start this within 18 weeks of a referral and deliver a “neighbourhood health service“.

Treating older and disabled people’s services separately

The DHSC has also asked the Casey Commission to consider older people’s care and provision for working-age disabled adults separately, “recognising these services meet different needs”.

It is not clear whether this heralds a plan that would initiate a more formal split between the two types of service, which are currently delivered under a single system operated by local authorities.

The plan for the commission’s 2026-28 work is much briefer and vaguer. The terms of reference state that it should “look at the model of care needed to address demographic change, how services must be organised to deliver this and discuss alternative models that could be considered in future to deliver a fair and affordable adult care system”.

‘Hearing from those with lived experience’

The commission has appointed a core team and started reviewing the evidence base around adults’ services, said the DHSC. Earlier this week, Casey met with carers, disabled people, advocates and campaigners to learn about their experience of the current care system.

“It was important that the first act of this commission should be about hearing from those with real, lived experience of the current social care system,” she said.

“I want to make sure everyone has the opportunity to contribute to this important work, shaping a social care system that supports people to lead fulfilling, dignified and enriched lives.”

Third commission on social care reform in three decades

The Casey Commission is the third independent commission on social care reform in England to be created over the past three decades.

It follows the Royal Commission on Long Term Care for the Elderly, set up by the New Labour government to examine the short and long-term options for developing a sustainable funding system. While some of its recommendations, delivered in 1999, were accepted, ministers rejected its key proposal of introducing free personal care for those aged 65 and over.

Eleven years later, the coalition government established the Dilnot Commission, to examine how to deliver a fair, affordable and sustainable funding system for social care in England.

Its proposals – chief among them a cap on people’s lifetime liabilities for personal care – were accepted and enacted through the Care Act 2014. However, despite successive governments promising to introduce versions of the commission’s proposals, these plans have all been dropped, most recently by the current Labour administration.

Commission ‘faces challenging task’

Sector bodies welcomed the launch of the commission and the publication of its terms of reference, but voiced concerns about its capacity to tackle immediate pressures and whether the government would provide adequate funding to implement meaningful reform.

For the Local Government Association, community wellbeing board chair David Fothergill said: “The commission faces a challenging task, with its work taking place amidst a landscape of budgetary and practical obstacles which must be overcome if we are to build a system we can all be proud of.

“Key issues the commission must address include establishing a far greater emphasis on prevention, earlier action and support. Likewise, tackling the recruitment and retention challenges facing the workforce must be a priority.”

‘Immediate investment required’

Association of Directors of Adult Social Services president Jess McGregor said that ADASS welcomed the “depth and breadth of the commission’s terms of reference”.

“We particularly welcome the focus on the boundary between social care and the NHS, where we know public money is not always being used to best effect, often at the detriment to people’s health and wellbeing,” she added.

“Local councils are already under considerable pressure, trying to provide more care to people despite facing shrinking budgets, so while we recognise the broader financial challenges the government faces, immediate investment into adult social care is required.”

Social work expertise ‘must be fully recognised’

The British Association of Social Workers (BASW) England said that “the knowledge, skills and expertise of social workers must be fully recognised throughout the commission’s work”.

“Social workers play a vital role in adult social care, particularly in promoting rights-based, person-centred care and support planning, using professional judgement to balance individual needs, safeguarding duties, and the promotion of independence.”

It also urged the commission to place “equality, rights-based approaches, and social justice at the heart of its work, ensuring that reforms address the structural inequalities and discrimination that too often shape people’s experiences of adult social care”.

‘Lack of political courage, not of solutions’

The Homecare Association said the commission needed to “address the immediate financial instability caused by rising provider costs”, exacerbated by the government’s decision to increase national insurance contributions for employers.

It should also engineer a “drive to outcomes-based commissioning, replacing a system that currently rewards time and volume over quality and impact”, and recommend investment in “fair pay for care workers “underpinned by a fair price for care from public commissioners”

Chief executive Jane Townson said: “We are not short of policy solutions; we are short of political courage. Will this Labour government step up to the plate? We hope so – we need action now.”

Fellow provider body Care England issued a similar message, with chief executive Martin Green saying: “This commission must not become another exercise in managing decline or pushing reform into the political long grass.”

‘A once-in-a-generation opportunity’

Social Care Institute for Excellence chief executive Kathryn Smith described the Casey Commission as a “once-in-a-generation chance to build consensus across the public, politicians and the social care sector to secure a system that helps people live the lives they want – in homes they love, connected to their communities, with control and dignity”.

“With issues including unmet care needs, workforce shortages and financial strain on local authorities and providers, the social care sector is in desperate need of a robust plan for change.”

King’s Fund senior fellow Simon Bottery said the commission offered “a real opportunity to truly reform fundamental issues, such as the very tight means test, which is the critical factor in ensuring people in need can access care”.

However, he warned: “The challenge may be whether the government is willing to act more urgently – or indeed at all – to implement these reforms. It will be essential that the government commits to providing the necessary funding to implement the reforms the commission recommends.”

Casey ‘must champion best practice’

The Voluntary Organisations Disability Group (VODG), which represents charitable social care providers, said the commission “cannot ignore the very significant challenges impacting people’s ability to access the support they need, how and when they choose”.

Its chief executive, Rhidian Hughes, added: “There is a great deal of innovation, partnership and outcomes-based activity underway, but it remains in pockets, and we need the commission to champion best practice as well as spotlight where change is needed most.”

Carers Trust and Carers UK both welcomed the commission’s launch and called for it to prioritise support for carers within its work.

Carers Trust chief executive Kirsty McHugh said carers “[needed] meaningful reform urgently”, adding: “While successive governments have failed to act, millions of unpaid carers have been left to plug the gaps by looking after friends and family at home. Many are at breaking point and being pushed into poverty by having to give up work because of their caring responsibilities.”