Baroness Casey should ignore her remit if she wants to improve social care

The health and social care secretary, Wes Streeting, has appointed Baroness Casey to lead a commission to make recommendations and build consensus on how to reform the adult social care sector in England. She will begin in April and has been asked to publish an initial report in 2026 setting out the key problems facing the sector and ideas for how to make medium-term improvements. A final report, due by 2028, is to make longer-term recommendations, including on the model of care, organisation of services and funding. 

Setting up another review of social care was a cop out

Casey is a good choice to lead such a commission. She has the credibility that comes from a long track record of successfully tackling difficult issues, including rough sleeping and families with complex needs, and will make an excellent advocate for her recommendations. But despite her talent, the decision to appoint her was a cop out. With a 150+ Commons majority and most likely more than four years until an election, Labour could have just got on with it. 

The problems – and indeed answers – are well understood, including by ministers: a commitment to “a programme of reform to create a National Care Service” appeared in the party’s 2024 election manifesto. And there have been countless reviews and inquiries into social care, including one published as recently as 2023 by the Fabian Society ⁴ https://fabians.org.uk/a-national-care-service-for-all/ with a strikingly similar remit to Casey’s review. This is unsurprising given that it, like Casey’s, was also commissioned by Wes Streeting, then the shadow health and care secretary. 

As so often with supposedly intractable policy problems the stumbling block is political will far more than a lack of convincing evidence about the problem or potential solutions. Fixing social care will be expensive and the decision about who should pay will, in the short-term, be unpopular. But in the long term – and Starmer has talked often of a decade of renewal under Labour – there will be little more damaging to trust in this government than it being seen to repeatedly duck hard choices as critical public services continue to struggle. 

Casey should rewrite her remit

There is no substitute for political determination. But there is plenty that Casey can do to encourage politicians to act. The first is to strategically ignore the remit she has been set.In doing so, she would be following the example of the most impactful independent commission of the 21st century: the Pensions Commission. Tasked in 2002 with looking solely at private pensions, the three commissioners unilaterally re-wrote their terms of reference, arguing that it was not possible to properly assess private provision without also considering its interaction with state pensions. 

Likewise, the remit Casey has been given makes little sense. Phase 1 is meant to set out recommendations for effective reform in the medium term, but she must somehow do that before considering models of care, service organisation and funding, all of which are not meant to be addressed until Phase 2. 

Casey is much more likely to bring about lasting change if she uses her first report to set out her vision for the care system, the probable cost of delivering this and, critically, the options for paying for it. Phase 2 could then focus on producing a final recommendation for how to address the difficult question of funding. No answer is going to satisfy everyone, but Casey can build a coalition of support for her recommendation, and reduce the political costs of action, through consensus building activities such as public deliberation and extensive engagement with service users, providers and pressure groups. 

This too would mirror the approach taken by the Pensions Commission. Its first report argued that people would have to work longer, private pension saving would have to increase or taxes would have to rise if pensioners weren’t to become poorer. Adair Turner, the commission’s chair, famously called out anyone proposing a solution that dodged any of these as ‘a charlatan’. Casey, a similarly forthright public speaker, should not shy away from using equally robust language about today’s politicians to help drive home her message.

Casey should act fast and secure Treasury buy-in 

Casey should carefully consider the timing of her reports. Finishing Phase 2 in late 2027 would mean missing the opportunity to influence the spending review planned for that year and publishing at a time when all parties will be gearing up for the next election. As Andy Burnham and Theresa May found out ahead of the 2010 and 2017 elections respectively, this is the worst possible time to have a grown-up cross-party conversation about how to fund social care. 

Instead, Casey should aim to publish an initial report by the end of this year, with her final recommendations coming in 2026. This is eminently achievable given how well-trodden the social care debate is and the speed at which similar policy reviews have been completed. 

Cross-party engagement is crucial, and it is welcome that Streeting has written to opposition parties asking them to participate in the commission. Even if political consensus proves elusive, Casey should seek early and extensive engagement with the Conservatives and Liberal Democrats in particular, as the two largest opposition parties. But perhaps her most important stakeholder is the chancellor. Previous efforts to reform social care, including the Dilnot inquiry, have been undermined by a lack of buy-in from the Treasury. 

To succeed where others have failed, then, Casey must provide a sellable case – one that is practical and politically realistic – for how reforms can be paid for.