The government has published the terms of reference for Baroness Casey of Blackstock’s independent commission into adult social care. The commission will form part of the critical first steps towards delivering a national care service.
The commission, announced in January, formally began earlier this week with a meeting between its chairwoman, Baroness Louise Casey, and those with lived experience in the sector.
The terms of reference set out that the commission will report directly to the Prime Minister and will be split over 2 phases:
Phase 1 (medium term)
The purpose of the first phase of the commission is to set out the plan for how to implement a national care service, a government manifesto commitment. This should report in 2026.
The commission should start a national conversation about what adult social care should deliver for citizens and build consensus with the public on how best to meet the current and future needs of the population. It will consider older people’s care and support for working age disabled adults separately, recognising that these services meet different needs.
The commission should produce tangible, pragmatic recommendations that can be implemented in a phased way over a decade. It will aim to make adult social care more productive, preventative and to give people who draw on care, and their families and carers, more power in the system.
The commission should seek to understand the current adult social care landscape and identify a commonly agreed picture of the problems faced, before making recommendations for medium-term improvements, building on work being undertaken by the Department of Health and Social Care (DHSC).
The focus will be to support the delivery of the health mission, in the context of ongoing reforms relating to the NHS, local government and the Employment Rights Bill and Fair Pay Agreement for care workers, and deliver tangible improvements for the public with regards to adult social care.
The commission’s work on medium-term reform will be a data-driven deep-dive into the current system. It will focus specifically on existing funding for local authority adult social care services, together with NHS funding for services at the interface of health and care (for example, intermediate care), and whether they are being best used.
It will seek to identify what changes can be made to funding flows and accountability mechanisms to improve quality and productivity. It will recommend reforms that help government to hit the 18-week standard for elective care and deliver a neighbourhood health service – by reducing unnecessary hospital admissions and addressing delayed discharges. The commission’s recommendations must remain affordable, operating within the fiscal constraints of Spending Review settlements for the remainder of this Parliament.
Phase 2 (long term)
The second phase should then make longer-term recommendations for the transformation of adult social care, reporting back by 2028. This should build on the commission’s medium-term recommendations to look at the model of care needed to address demographic change, how services must be organised to deliver this and discuss alternative models that could be considered in future to deliver a fair and affordable adult care system.
Baroness Casey will lead work fully independently with DHSC as the lead sponsor department and be based in the Cabinet Office.
The commission must also work closely with relevant other government departments, including HM Treasury, the Ministry of Housing, Communities and Local Government and the Department for Work and Pensions to discuss findings. All relevant government departments will co-operate fully, be transparent and provide all data and analysis needed to support the commission.
Professor Fiona Carragher, Alzheimer’s Society’s Chief Policy and Research Officer, said:
“Around one million people are living with dementia in the UK, making them one of the biggest groups relying on social care.
“Dementia is progressive and there is no cure. It affects people in different ways so it is essential that care is tailored to the individual. Around 70% of care home residents aged over 65 in England are living with dementia, yet only 29% of care home staff have received any dementia-specific training. This means that in a huge number of cases care home staff are unable to provide the tailored care that people with dementia deserve and rely on.
“Alzheimer’s Society is pleased to hear that Baroness Casey’s Commission is beginning to make progress, and we stand ready to offer our support and expertise. The Commission urgently needs to find solutions to some of the long-standing issues in adult social care such as the lack of dementia-specific training, high staff turnover and a lack of support for unpaid carers.
“People living with dementia must be able to easily access affordable, high-quality social care that meets their specialist needs, delivered by a well-trained and fairly-paid workforce. Baroness Casey must keep dementia front and centre to her Commission – we simply cannot fix social care without fixing dementia care.”
Cllr David Fothergill, Chair of the LGA Community Wellbeing Board, said:
“Today’s (02/05/25) announcement marks a crucial starting moment in securing the best possible future for adult social care.”
“Positive and meaningful reform of adult social care is something we should all be interested in. At its best, it helps adults live the lives they want, plays a crucial role alongside other public services, such as the NHS, and is a major employer in communities across the country.”
“However, the Commission faces a challenging task, with its work taking place amidst a landscape of budgetary and practical obstacles which must be overcome if we are to build a system we can all be proud of.”
“Crucial to achieving the Commission’s objectives will be drawing on the vast experience of councils, who play an essential role in designing and delivering these services in collaboration with many local partners. Most importantly, the views, experiences and hopes of people who draw on care – and their loved ones – must sit at the heart of this work.
“Key issues the Commission must address include establishing a far greater emphasis on prevention, earlier action and support. Likewise, tackling the recruitment and retention challenges facing the workforce must be a priority. This will require looking at pay, and a fully funded Fair Pay Agreement is part of the solution, but focus must also be given to training, development, and progression for the workforce, with local government’s critical role in the Adult Social Care Negotiating Body clearly recognised.”
“Lastly, while we recognise the Commission’s timescales, we urge the Government to revisit these to reflect the urgency of the situation, and the reality that people and organisations have already waited long enough for real change.
