Ministers have been 'asleep at the wheel' on adult social care - Baroness Casey's damning critique

Successive governments have been “asleep at the wheel” with adult social care in England resulting in a failing system where “no one is in charge”.

That is the message to be delivered today by Baroness Louise Casey, chair of a commission looking into how to reform social care, at the National Children and Adult Services Conference.

Baroness Casey will also criticise the government’s response to the sector during the pandemic and publish a report looking at options for reforming social care.

She will say: “Successive governments have been asleep at the wheel. In research we’re publishing today the lack of stewardship of social care comes through clearly. No one is in charge.”

On the government's treatment of adult social care during the pandemic, she will say: “The Covid-19 Inquiry took apart the argument that a ‘protective ring’ had been thrown around care homes during the pandemic. 

“Many old people died without their loved ones by their side. Many care workers left their jobs after what they had seen.

“It is a national shame that this was allowed to happen. It should never happen again."

In a letter sent to the Covid-19 Inquiry today, Baroness Casey says lack of governmental oversight over social care during the pandemic was “a national shame”.

Module 6 of the inquiry recently accused ministers of treating the sector as an “afterthought” in its final report.

Fixing social care has been given top priority Andy Burnham. In one of his first major speeches, the prime minister berated parliament’s “major dereliction of public duty” that has resulted in successive government’s kicking reform into the long grass.

Reinforcing Labour’s election manifesto pledge, he committed to creating a National Care Service. He also brought forward the timeline for the Casey Commission to report its final recommendations from 2028 to next year. 

In her first speech as chair of the Independent Commission on Adult Social Care earlier this year, Baroness Casey described an “anxiety-laden and confusing system” held together with “sticking plasters and glue”.

She said it needed its own Beveridge-style “creation moment” to define what it is for, what to expect from it and who should pay for it and how.

Today's report, Governance in social care: Lessons for reform, was written by the Nuffield Trust and Institute for Government and looks at the "trade-offs" for various options for fixing the system.

It warns successful reform will require “political will and bravery”, adding: “No amount of reorganisation of governance structures or processes will be sufficient in the absence of political impetus to drive through changes and dedicate resources, time and energy to social care.” 

Lessons from other countries

The report looks at other models and approaches to social care globally.

It notes examples where social care has been given greater political priority, backed by resource and legislation, such as France, Germany and Japan.

By contrast, it describes efforts by the UK government to raise the profile of social care as “largely symbolic”.

The current eligibility criteria for state funding of social care based on both needs and financial means was “quite distinct on the world stage”, said the report.

Most countries based eligibility for state-funded care on need alone, with some adopting a means test to ascertain how much, if anything, individuals should pay.

A lack of a standardised eligibility criteria was also an issue, says the report, resulting in a postcode lottery of provision. It says: “The result is that people with a care need might have very different experiences depending on which council they reside in, and many have access to very different levels of public funding or support for the same level or scope of need.”

Germany, Japan and Australia have adopted a nationwide eligibility criteria. The report speculates this is likely to be a “central pillar of a National Care Service” in England.

Better governance over private sector providers of care is also needed, says the report. Examples from other countries include nationally set fees and levels of care.

England’s over-reliance on the private sector for delivery, which has "emerged in a largely uncontrolled and unintended way", should be looked at too, says the report.

It adds: “The Commission and the government may wish to take an explicit position on the balance of public, not-for-profit, and for profit provision, and whether social care is a sector where profit from public funding is tolerable – as the government under the previous prime minister announced for the children’s care sector with the intention to set profit caps for private providers.”

Lack of a national workforce strategy was a significant problem resulting in “persistent vacancy issues” and regional variations in recruitment and retention and support.

Creation of a national workforce oversight body could be one answer to this, said the report.

The report says creation of a new government department for adult social care or a non-executive agency or “arm’s-length body” to run the system should be considered.