11/03/2026
A Moment of Reckoning
Adult social care faces a “moment of reckoning”, says Baroness Casey. England’s adult social care system is approaching a “moment of reckoning”, according to Baroness Louise Casey, who has warned that decades of piecemeal policy have left the system fragile, fragmented and increasingly unable to meet the needs of an ageing population.
Speaking at the Nuffield Trust Summit on 5 March, the chair of the government-commissioned Independent Commission on Adult Social Care delivered a stark assessment of the current system and set out the scale of reform she believes is required.
Her intervention marks an early milestone in the Commission’s work, which is expected to produce its first recommendations later in 2026, followed by a longer-term plan for reform in 2028.
A system without a founding moment
In her speech, Baroness Casey argued that adult social care has never had the kind of defining settlement that created other pillars of the welfare state.
“Unlike the NHS or indeed the benefits system, social care has never had its own ‘creation moment’,” she said.
“No moment when the nation decided what it was for, what people should expect or who should pay, and how.”
Instead, she suggested that the system has evolved through decades of incremental changes.
“We inherited a system shaped for a very different age, held together with add-ons and work arounds, sticking plasters and glue,” she said, warning that the country now faces the “moment of reckoning” that has long been avoided.
Her speech painted a picture of a system characterised by fragmented responsibilities, underfunded services and low-paid staff, with families often left to navigate complex arrangements on their own.
The divide between health and care
A central theme of the speech was the longstanding structural divide between the NHS and social care.
Baroness Casey praised the NHS as “one of the best things this country has ever built”, but argued that the separation between health and care services has created confusion and inefficiency.
This divide, she suggested, leaves many people experiencing disjointed support as they move between hospital, community health services and social care provision.
Experts have long warned that this lack of integration contributes to delays in hospital discharge, gaps in support for people living with complex conditions, and increased pressure on families and unpaid carers.
Immediate priorities for reform
While the Commission’s full recommendations are still to come, Baroness Casey outlined a number of areas where she believes urgent action is needed.
These include improving support for people with dementia and motor neurone disease, strengthening adult safeguarding arrangements, and addressing delays in accessing home adaptations and equipment.
The Commission has also highlighted the potential role of a “care passport” to help people with serious conditions move more quickly through assessment processes and receive support without repeated reassessments.
More broadly, Baroness Casey said the review will seek to define the purpose of social care more clearly — including what people should be able to expect from the system and how it should be funded.
A national conversation
Another key element of the Commission’s approach will be a wider public discussion about the future of social care.
Policy experts say this may be essential if reform is to succeed where previous attempts have struggled. Efforts to overhaul the funding and structure of social care have repeatedly stalled amid political disagreement and public concern about costs.
The Commission is expected to engage with people who use services, unpaid carers, providers, local authorities and health professionals as part of this process.
Reaction from the sector
Initial responses from across the care sector have broadly welcomed the Commission’s willingness to confront the scale of the challenge.
Sarah Woolnough, Chief Executive of The King’s Fund, said the speech provided a “sound analysis of the broad social and demographic issues facing social care” and could provide “a stable launchpad for a thorough and radical review of the current failing system.”
Carers UK also highlighted the importance of recognising the role of unpaid carers. The organisation noted that every day around 600 people leave work to take on caring responsibilities, often because formal support is unavailable.
Meanwhile, provider organisations said the description of a fragmented and difficult-to-navigate system would resonate strongly with those delivering and relying on care services.
Gerard Crofton-Martin, Interim Chief Executive of SCIE (Social Care Institute for Excellence), said:
“Baroness Casey has brought welcome clarity to the scale of the challenge facing social care. Her framing of the sector’s pressures—demographic change, growing complexity of need, and a system built through ‘add-ons and workarounds’—will resonate with many across the sector. The Commission’s extensive engagement with organisations, practitioners and people with lived experience is encouraging, and we look forward to working with Baroness Casey and the Commission as this important work progresses.
“Her call for a moment of reckoning and renewal is an important one. Social care has never had the kind of design moment that shaped other parts of the welfare state. If we are serious about reform, we need to be honest about the pressures created by demographic change and rising complexity of need, and clear with the public about what a future system of care and support should provide.
“We also welcome the focus on strengthening safeguarding. The proposal to establish a new National Safeguarding Board could help ensure that learning is shared and responsibilities are clearer across the system. This is an important step to ensuring that safeguarding is everyone’s responsibility.”
What happens next?
Baroness Casey’s commission has been tasked with recommending comprehensive reform of England’s adult social care system.
Its work will take place in two phases: an initial report expected in 2026 setting out early priorities for reform, followed by a longer-term funding and structural plan due in 2028.
With demand for care rising rapidly and financial pressures mounting across local authorities and providers, many in the sector believe the stakes could hardly be higher.
As Baroness Casey told the summit, the country must now decide what kind of social care system it wants for the future — and how it is prepared to deliver it.
