The Casey commission could help get to the root of key problems in social care and build political momentum

In January 2025, the UK government announced that an independent commission is to be set up on social care in England led by Louise Casey, a crossbench peer. The commission will explore problems facing social care and provide recommendations for creating a “national care service.”1 The announcement has elicited considerable (tending towards negative) response.2 Some query the basis for a commission, calling it a “cop out” in light of the urgent need for funding and reform.3 Others decry the long duration, with the commission expected to finally report by 2028, and point to a field already crowded with many similar exercises.4

I view things somewhat differently. I agree that social care cannot afford to wait but suggest that the necessary change must be profound and that the commission can be justified as a way of proceeding. The organisational and funding issues are substantial, but we must recognise that reform in complex situations such as this will be successful only if it is based on achieving consensus about the nature of the problem and securing the political momentum to tackle it.

Everyone would agree that social care is beset by problems. The system is organisationally too complex with many structural weaknesses, including lack of confluence with the NHS, fragmentation in service provision, and a heavy reliance on market based providers. These have created problems in service distribution, accessibility, and affordability leading to considerable unmet need. There is also the huge issue of underfunding and failure to meet rising demand. Sceptics have directed their attention to these matters, questioning whether a commission is needed to resolve them. But the counterargument is that these could have been sorted out earlier if there weren’t major barriers to reform.

What are the main blockages? I see two overriding ones: the main decision makers and interest groups do not agree on the problem or the solution and there is a clear lack of political momentum. Successive Conservative-led governments largely avoided the issue. The Labour party has long committed to a national care service, but the current government now seems less sure, hence the commission. The Liberal Democrats are alone among the main parties in making social care reform one of their key policy commitments.5

The political landscape is more complicated still as there are many others with a stake in social care—public and private service providers, local authorities, paid workers, unpaid carers, service recipients, those with unmet need—and they approach reform with contrasting demands and needs. The providers want more resources, the commissioners want better value for money, the workers want better pay and recognition, unpaid carers want more support, and those in need of or receiving care want more options and more affordable and accessible services. This lack of consensus is mirrored in public opinion. Only 5% of people in England think the government has the right policies for social care.6 We do not know what the British public actually wants from social care. The deeply embedded techno-rational approach—solve the most urgent problems and move on—will not suffice in this situation.

The approach set out in the press release on the commission suggests an understanding of the need for political momentum. It makes reference to building cross-party consensus and also states a plan to “work with people drawing on care and support, families, staff, politicians and the public, private and third sector to make clear recommendations for how to rebuild the adult social care system to meet the current and future needs of the population.”7 Some of these are voices that are not routinely heard in commissions or get crowded out by better resourced interest groups. But inclusion is not necessarily good in itself. If it is to be successful, the commission must bring people together for the purpose of tackling difficult questions around the value of social care in our society, how we support and pay for it, and what is a fair deal for unpaid carers and those who need care.

This turns the spotlight on the commission’s methods of working. Here I suggest that it take a leaf out of the 1999 royal commission on long term care for the elderly, led by Stuart Sutherland. That commission’s methodology involved holding public hearings around the country8 and bringing together panels consisting of different stakeholders, including politicians. These can be fora that build solidarity and common interest. Above all the Casey commission must produce a design for a sustainable, fair, and equitable social care system and do so in a way that puts the “social” back into social care.