Casey calls for ‘moment of reckoning’ on adult social care as government backs reforms

Baroness Louise Casey has called for a national “moment of reckoning” on adult social care, warning that the sector has never had a defining reform comparable to the creation of the NHS in 1948.

Speaking at the Nuffield Trust summit on 5 March, the chair of the Independent Commission on Adult Social Care said the current system had evolved through decades of piecemeal change rather than a clear national settlement.

“Unlike the NHS or indeed the benefits system, social care has never had its own creation moment,” said Louise Casey. “No moment when the nation decided what it was for, what people should expect or who should pay, and how.”

She said the sector had instead inherited a system “shaped for a very different age”, held together by “add-ons and workarounds, sticking plasters and glue”.

The comments come nearly a year after the government asked Casey to lead an independent commission examining the future of adult social care in England. The review, which began in April 2025, is expected to publish its first report in 2026, with final recommendations due in 2028.

Alongside the speech, Casey wrote to the health secretary calling for six immediate actions in three areas she described as urgent: adult safeguarding, dementia and motor neurone disease.

On safeguarding, she warned that successive governments had “abdicated responsibility” for ensuring robust national oversight of abuse and neglect of vulnerable adults. She argued that serious safeguarding failures are often treated as isolated local problems, meaning systemic issues are repeatedly missed.

Casey has asked the government to establish a new national safeguarding board chaired by the Chief Social Worker and reporting to the minister for care. The body would review safeguarding adult reviews, identify national risks and commission thematic investigations.

She also called for an urgent review of adult safeguarding duties and powers to determine whether existing legislation provides sufficient clarity and authority in high-risk cases.

The commission chair also highlighted dementia as an area where the system lacks urgency despite the scale of the challenge.

“Preparation needs to be made for future clinical breakthroughs,” she wrote, arguing that dementia is too often treated as an inevitable part of ageing rather than a neurological condition requiring a coordinated national response.

Her recommendations include scaling up dementia drug trials, accelerating progress on a new modern service framework for dementia and frailty, and appointing a national dementia lead to drive reform across health and care.

The letter also proposes a fast-track “passport” for people diagnosed with motor neurone disease (MND) to ensure quicker access to assessments, care and housing adaptations. Casey said people with the rapidly progressive condition were currently forced to navigate the same systems as everyone else despite their urgent needs.

Around 5,000 people in the UK live with MND at any given time, and the condition often progresses quickly.

Tanya Curry, chief executive of the Motor Neurone Disease Association, welcomed the recommendation.

“A third of people diagnosed with MND die within 12 months, and too often care and support are delivered far too late,” she said. “People with a disease as devastating as MND should never have to fight to access the services they need.”

Meanwhile Hilary Evans-Newton, chief executive of Alzheimer's Research UK, said stronger action was needed on dementia.

“Dementia is the UK’s leading cause of death—so why isn’t it a national priority?” she said. “Every year we delay prioritising dementia costs lives and costs the UK billions.”

Responding to Casey’s proposals, health secretary Wes Streeting said the government would move ahead with several of the recommendations.

Writing to the commission chair, Streeting said the Department of Health and Social Care would establish a new national safeguarding board chaired by the Chief Social Worker and reporting directly to the minister for care.

He also confirmed an urgent review of adult safeguarding duties and powers would be undertaken to determine whether additional statutory authority is required.

Streeting said dementia was “one of the greatest challenges of our time” and confirmed officials were reviewing proposals for expanding dementia clinical trials. He also said a new national leadership role on dementia would be created within the Department of Health and Social Care to drive progress across the system.

The government has also agreed to develop a fast-track process for people diagnosed with motor neurone disease to speed up assessments and access to care.

Streeting acknowledged the scale of the problems facing the sector, saying social care had been placed in the “too difficult” pile for too long.

“The issues facing adult social care are complex and deep-rooted,” he wrote. “While there have been plenty of good ideas for how to improve social care, we have lacked the broad political and national consensus needed to ensure reforms stand the test of time.”

Since launching last year, the commission has gathered evidence from more than 400 people with experience of receiving or delivering care, including unpaid carers, frontline practitioners, local authorities and providers.

Casey plans to launch a national public conversation later this year as part of the review’s first phase, aiming to build wider consensus about the future of adult social care and the creation of a potential national care service.

She said the immediate proposals were “modest changes” but reflected deeper structural problems in the system, including a divide between health and social care, a one-size-fits-all approach to support, and a lack of national accountability.

“Taking these immediate actions will not fix those fundamental problems,” she wrote, “but they will be an important step forward and offer a vital lifeline to people who do not have time to wait for us to act.”