baroness casey has warned that England’s system for supporting older and disabled people is “cobbled together and confusing, ” and urged immediate action. Her interim priorities include a national adult safeguarding board, a full-time dementia tsar, and a fast-track social care passport for people diagnosed with motor neurone disease (MND). The chair of the independent commission on adult social care says a rapid stock-take is needed so policymakers can stop papering over systemic failures.
Baroness Casey’s six immediate actions
In public remarks and a letter to the Health and Social Care Secretary, Baroness Louise Casey, chair of the independent commission on adult social care, set out six urgent measures designed to relieve the most acute pressures on people who need care. The package includes establishing a national adult safeguarding board, appointing a full-time dementia tsar, scaling up dementia trials, and creating a fast-track passport for people diagnosed with MND to cut through repeated assessments and means tests.
baroness casey framed these proposals as emergency triage for a system that, she said, “means some needs are barely met at all, and others are met late and in piecemeal and random ways. ” The commission has met more than 400 people with lived experience and hosted evidence sessions with unpaid carers, frontline practitioners, providers, local authorities and NHS workers as part of that interim assessment. The first report is set to be published later this year, with a final report due in 2028.
Why a ‘moment of reckoning’ matters now
baroness casey has described a “deep and fundamental divide” between health and social care that is invisible to the public but shapes outcomes. She warned that the imbalance in pay and terms between NHS staff and care workers makes council-run social care financially fragile and leaves attempts by hospital trusts to deliver care uneconomic because NHS staff receive better pay and conditions.
Her language has been blunt: social care is held together with “add-ons, workarounds, sticking plasters and glue, ” and families are spending “hours and hours and weeks and weeks” trying to arrange care. She highlighted that care workers often earn less than the minimum wage and are frequently not paid for travel or holidays, while those diagnosed with MND face multiple assessments and means tests in the days after diagnosis. Reflecting on the wider historical frame, she argued the country has not yet had a Beveridge-style creation moment for social care and faces “seismic changes” in how it supports vulnerable people.
Expert perspectives and implications for policy
Baroness Louise Casey, chair of the independent commission on adult social care, said: “This divide between what is care and what is health does not exist to the public. It is our divide. ” She also asked pointedly about those with MND: “If we can’t look after people that get the diagnosis of motor neurone disease, which is one of the most brutal and predictable diseases, using this collective NHS and social care system, who can we look after?”
Wes Streeting, Health Secretary, has stated he will no longer accept a social care system “built on poverty pay and zero hours contracts, ” underscoring the political pressure on ministers to act. Baroness Casey has stressed that implementing fair pay commitments must be matched by oversight to ensure taxpayers’ money “is being spent well, and being spent properly. ” She has urged cross-party support and called for politicians to stop treating social care as a political football.
The immediate measures she recommends are intended to be practical fixes that can be switched on quickly while a wider stock-take determines the long-term architecture of care. Establishing a national safeguarding board and a dementia tsar would create dedicated institutional levers; fast-track passports for MND would remove avoidable bureaucratic delay for people with short life expectancy. Taken together, the moves aim to rebalance power between the NHS, local authorities and the people who rely on services.
As the commission prepares its interim report and engages the public in a proposed national conversation, significant questions remain about political will, funding mechanisms and workforce reform. Will ministers embrace a formal stock-take and secure the cross-party consensus Baroness Casey says is necessary to deliver durable change? baroness casey has put the demand plainly — the system needs a reckoning; the next step is whether decision-makers will act.
