CASCAIDr CIC’s Ten Points for Saving Adult Social Services and Social Care

A public statement on what adult social care reform must actually deliver

• Written by and for carers, disabled people, older people, advocates, council, NHS and hospital staff, care providers 
• Intended for journalists, civil servants and elected representatives in local and central government to read, understand and act upon.

Introduction

Adult social care is the system of support that helps older people, mentally or physically disabled people, and people with long-term health conditions to live safely and with dignity — whether that means help getting washed and dressed, support to live independently in one’s own home, or supported accommodation, or getting full-time care in a residential or nursing home setting. 

It’s different from the benefit system and crucially different from the NHS: it is run by local councils, it is subject to means-testing (so many people have to pay something, or everything, towards it themselves), and it is governed by a law called the Care Act 2014, which sets out legal rights that are supposed to protect everyone who uses it.

In practice, those legal rights are very often not honoured. Everyone working in and affected by the system knows that that is the truth. 

Assessments take too long. Care plans are left to provider staff to flesh out. People’s relatives  – even the relatives of people who lack mental capacity to speak up for themselves are often told the outcomes of all the thinking steps that the Care Act requires for very solid reasons, without being properly involved. Family members are quietly expected to fill the gaps. 

And the professionals who are supposed to administer all of this well-intentioned practical and financial support are not being held to the legal standards that Parliament actually set. 

Even elected local councillors have not been vocal about it, no doubt because they’ve always come from the same political parties as have been running the government at any given point in the last 20 years, since things started to go awry.

Even respectable journalists have found it difficult to spend the time to understand the hugely layered complexity underlying the issues, depriving them of the easy soundbites, or something ‘televisual’ that is essential for ‘cut-through’, for this centrally important public service. That’s a service which any of us could find ourselves needing, tomorrow, and for which there is no insurance market, unless it’s going to be lucrative enough for institutions to get on board.

Andy Burnham, the new Prime Minister, has promised reform and has spoken about bringing forward the conclusions of the Casey Commission, an independent review of adult social care that was set up to report in stages, with the biggest decisions on funding not expected until 2028, very close to the next General Election.

His speech was a fine one, and a moving one, to anyone who cares about this aspect of our society.  One could not help but think it is the hill he is prepared to die on, and applaud that sort of optimism and integrity. 

In our view, Mr Burnham and the Commission could focus on the ten points below, as part of the Big Conversation launched today with the public. These are not small print. They are the difference between a system that follows the law and one that continues to fail people every single day. 

We have drawn every one of these ten points directly from what members of the public told us mattered most, in our own research.

We call on government to commit to all ten of these, in full, and on a clear timetable — not just the ones that are cheap or easy to announce.

CASCAIDr CIC’s 10 Practical Suggestions for before, during and after the Casey Commission’s Big Conversation 

1. Impose Timelines on Care Act Decision-Making

2. Stop Assuming Families Will Cope

3. Pay for Care at Realistic Rates

4. Fix the Boundaries 

5. One National Pair of Forms

6. Show Commissioners (and the Public) the Money over the Longer-Term

7. Any New Care Funding Settlement Must Work for Everyone, Not Just Those with Property Wealth

8. Stop Announcing Ambition and Deferring the Decision 

9. Fund Independent Advocacy Properly

10. Acknowledge That the Law Must Bind Whoever Runs the System

The Suggestions in Detail – and the Reasons Behind Them

1. Impose Timelines for Care Act Decision-Making

– for assessment of people’s needs, with a beginning and an end, even if there’s a short pause in the middle for prevention and reduction and pulling in ‘assets’ and ‘strengths’…. 

Virtually anyone who may need care or support is entitled to a needs assessment from their local social services council, regardless of their financial circumstances. Most people have no idea what a social work trained person can do for them, however. 

The complaints watchdog, the Local Government and Social Care Ombudsman, says four to six weeks is long enough for the assessment, in the vast majority of cases. 

In reality, people routinely wait six months or more just for the assessment to begin — before any help is even agreed.

This delay is not just frustrating. Until an assessment is done and eligibility is decided, the council’s legal duty to actually help someone does not apply. 

So the wait itself is doing real harm; the rationing of assessment is unlawful because councils are legally required to provide sufficient staff for the discharge of social services functions, and councils fondness for just having “conversations” about the person’s problem and pointing enthusiastically to some free or cheap preventive solutions which may or may not exist locally, is not what the Act provides for. And of course CQC does not regulate councils’ assessment times when ‘assuring’ us all of their performance, because it is merely an arm’s length central government agency, whose hands are also tied.

Suggestion: A realistic time limit on every assessment, in every setting — whether someone is in hospital, at home, or still privately financing their own needs.  In the acute hospital setting, this needs to be hard wired into Discharge to Assess national guidance and the DHSC needs to enforce compliance with ICBs’ commissioning strategies when arranging hospital services for an ICS. In the community setting, time needs to run from the conclusion of taking a person’s details down. Any pause for prevention and reduction or reablement strategies needs to be written down, so that the person knows where they are, in the Care Act journey.

2. Stop Assuming Families Will Cope

There is no law that forces a relative to provide care for a family member, even if they live in the same house. Yet ICBs and Councils very often simply assume that family members will step in, and reduce the formal support on offer accordingly.

If someone keeps caring only because the alternative — poor quality or non-existent professional care — is worse, that is not free and willing choice. It is the system quietly relying on people who have no real option, and the law does not allow this – but people are in a position to be manipulated. 

This impacts on women, more than it does on men, and is a national scandal. England needs its women to work to pay joint mortgages, but nobody seems to have grasped this simple economic fact. Care and support work (and social work) needs to be seen to be a means to get young people into work which can take them a very long way, supporting the regeneration of the economy.

Suggestion: Official national guidance including a chapter on carers’ rights, so carers KNOW that they have a choice and can get support to carry on caring, in their own right. Honesty that there is no human right to go on caring forever, just because one promised one’s Dad he would not have to go into a care home, ever. If it costs the state an excessively large amount to do that, if it’s not the only way he could be cared for, everyone else would end up thinking that that was unfair.

3. Pay for Care at Realistic Rates, Not Council-Commissioned Rates…

…foisted onto a sector that remains ignorant of its own central importance to those organisations actually tasked with the statutory duties!

ICBs and Councils are allowed to consider their own budgets when working out how to meet someone’s needs, but the law does not allow them to simply say needs cannot be met because money is tight, or to expect unpaid family carers to do more to fill the gap.

Many people are given a budget under the Care Act which is a figure plucked out of thin air, and for which there is no evidence basis that it would cover the actual commercial cost of meeting need. 

Those who arrange their own care using a direct payment (money given by the council instead of a care package, or by the NHS as a personal health budget in cash) often find the rate they’re given is too low to actually attract anyone remotely suitable, in terms of skills and experience.

The benchmark for sufficiency – the “quality local market rate” (referenced already in the Guidance) cannot just mean whatever price the NHS or a Council has managed to negotiate through their own bulk purchasing efforts and resorting to reverse ‘auctions’ with desperate providers, unaware of the legal framework as to where the duty lies.

Suggestion: A clear statement of what councils and ICBs are allowed to take account of and the context of the rest of their obligations, so that we all understand that an adequate and defensible service is what must be costed, not an aspirational one which will never be good enough for some people. One can always refuse the State’s help, if one thinks one can do better, and one has the money and the grey matter to organize the service. 

4. Fix the Boundaries 

… Housing, Health, and Care must stop fighting each other

People fall through the gaps between housing law, NHS law, and social care law every day, and they personally pay the price in delay, confusion, and cost-shifting between different public bodies, who each say it is someone else’s responsibility. 

Mr Burnham’s best move so far has been pulling together a Ministerial Group to help Baroness Casey bring her review’s conclusions forward by a whole year. That’s the best chance of joined up government, and not at risk of scuppering by the Chancellor.

This jostling between agencies’ responsibilities is to some extent the intention of Parliament, but it’s not made explicit. The Care Act is a statute of residual help, when there’s nothing and nobody else with a higher duty. 

The statutes come with a hierarchy, in-built, which the Guidance does not make understandable for staff and the public. We need a line between health and social care, especially if some of it is going to remain chargeable, but some social care for some people is going to be made free. That line is not ONLY delineated by the concept of ‘primary health need’ for Continuing NHS Healthcare recipients: there’s also the concept of inputs which are not feasibly able to be regarded as ancillary or incidental to adult social care by dint of their nature, and not just the context and timing of their delivery. The benefit for the DHSC of keeping all of this foggy and allowing blame to be diluted, must now be stopped.

The same hierarchy issue exists as between Housing and Social Services. A Court of Appeal case (Campbell, 2024) said that ordinary housing must NOT be delivered by way of a social services package (regardless of need) because that is just enabling disabled people to jump the Housing queue. The exceptions (we can think of at least 3 cohorts of people who need to receive their non-care home housing through social services) need to be spelled out, and not wait for another piece of litigation.  Nobody even knows if the same principle applies to the NHS when providing a CHC package for a person who has formally qualified for CHC!

Section 117 Mental Health Act aftercare trumps both the NHS Act and the Care Act. The Ombudsman has issued at least 15 reports saying that ordinary housing is often needed for those clients by way of aftercare, (albeit based on a totally unclear principle) but councils everywhere are hoping that they can just ignore this. This has got to stop, too. 

A new tenancy law change (buried in the Renters’ Rights legislation) now allows supported housing providers to seek to evict someone using evidence about their care not working or not being funded. That would be evidence supplied by the very same organisation that is deciding what those needs are in the first place, or the one delivering them, for money, as a provider.

That is a conflict of interest built into the system, collapsing the tenuous distinction between housing with care (requiring a domiciliary level of registration with CQC), and care together with accommodation (a care home requiring a heightened registration for what is a managed environment, not just a care package).

Separately, Disabled Facilities Grants — the funding that pays for essential adaptations like stairlifts, ramps, or accessible bathrooms — have been capped at the same £30,000 limit since 2008. That limit is now worth roughly a third less in real terms, and the official clock for how quickly someone should get help only starts ticking once much of the real-world delay (created by a national shortage of Occupational Therapists) has already happened.

Whoever ends up running new, more joined-up health and care services must be properly trained in the legal frameworks of both the NHS and social services itself, not just responsible for the budget.

Every new joint health body should have its own Monitoring Officer — the same kind of lead governance role that every council is already legally required to fund. Their job is to flag unlawful or unfair decisions for the organisation’s leadership, before they cause the distraction of complaints and litigation. 

People should also be able to get free, accurate advice and information about all of this: a promise of a national, funded, advice and information service, for putting social services law online, but also in accessible language. This was a promise made years ago by government, when we were last considering funding reform, in 202223 – one which has simply been allowed to disappear from the agenda.

Suggestions: Explicit provision as to where housing, health, special education and social care responsibilities begin and end; reconsideration of the due process for people with impaired mental capacity before evictions based on evidence about the care plan not working or being sustainable; a raised, inflation-linked Disabled Facilities Grant limit with a fair, clearly nationally defined start date for the waiting-time clock; mandatory legal framework training for all staff involved in ratifying and supervising Care Act and CHC decision making; a Monitoring Officer for every joint health and care body; and a properly funded, genuinely accurate national advice and information line.

5. One National Pair of Forms

…one national Needs Assessment Form and one Care Plan, every time.

Once someone is assessed as eligible for care (adult people), or support (adult people’s carers), a written care plan is a legal requirement, not an optional extra. Even before it was put INTO the Care Act, the Courts had said it was the bedrock of accountability about the thinking as to why the person’s needs compelled a particular response. 

The assessment is already done through NATIONALLY applicable criteria – that is not the problem. Yet formal statutorily-required care plans are very often missing altogether, or are effectively written by the care provider – the one who’s hoping to be funded, as a favour to the council. The same problem affects NHS Continuing Healthcare plans and section 117 Mental Health Act aftercare plans.

After a contracts officer (who is never a social worker) has done the deal, for a price the council can afford, the recommended plan may never be issued, to enable proper checking by the person or their family.

It may never be formally adopted, even, but just remain foggy, by dint of the price ‘negotiation’ behind the scenes. That may lead to a watering down of the inputs that the client and their family never know about, and yet outcomes-based commissioning has been vaunted as if it were the best thing for those needing the services.

Without a proper, checked care plan, there is no way to know whether someone’s needs are genuinely being met, even on paper. The alternative outcome is an unlawful assumption has quietly been made that a family member will fill the gap between what the provider genuinely needs to attract a decent workforce, and make a profit (or just break even, these days), and the arbitrarily low figure asserted by the council as what it said it could afford to pay…

Suggestion: A single, standardized Care Act national assessment form and care plan template, to be used everywhere, and a proper, ratified formal individualised care plan for every person (even where this means local councils have to move away from expensive software systems they have already invested in – working out what is ‘enough’ to meet need and what it should realistically cost must remain a social work function, or else what are they for?). 

6. Show Commissioners (and the Public) the Money – 

… over the longer term, on time, with Fair Pay hard-wired into the formula

Government has already promised billions of pounds of extra funding for adult social care over the next few years, and is carrying out a review of how funding is shared out between councils. But councils are routinely left waiting for the actual detail of what they will receive, sometimes with money arriving in last-minute, one-off instalments, by way of plasters for running sores, rather than reliable multi-year budgets.

Separately, government has announced the UK’s first Fair Pay Agreement for care workers, which is a welcome step – and one mentioned by Mr Burnham today, to make social care into a proper and desirable career path. 

But if the money given to councils, and the budgets awarded to individuals, is not increased to match this new pay floor, the extra cost will simply be passed on to care providers, to families, or will show up as care that people need, but do not get. 

The last government and local government representatives could not even agree whether the Chancellor’s own hike of employers’ NICs was being covered or not, for services which councils have been told to buy in, rather than deliver, themselves. This simply will not do. 

Spending at the scale needed “will only happen if we unhook social care from the rest of local government finance and introduce new sources of revenue” — i.e., ring-fencing care funding entirely outside general local government finance, a more structural fix than Casey has authority to float, we think.

Suggestion: A clear, multi-year funding timetable for councils, published well in advance, with the cost of fair pay for care workers fully and separately funded — not quietly absorbed into existing, already-stretched budgets.

7. Any New Care Funding Settlement Must Work for Everyone

… Not Just Older People With Property Wealth

Whatever the merits of a levy on one’s estate, or a hypothecated insurance-style contribution, or a Scots model (with collectively agreed fees and a cap on profit) for a much larger country, all previous discussions that have ended up being too expensive for government have not been specific about funding for working-age disabled people. 

A national care service implies to many that there should be no charges at all, but then one would need to define what care and support ARE, and no doubt distinguish between the two, and make domestic help chargeable, to pay for full on ‘care’. 

This won’t go down well in England, where we’ve embraced ‘support’ as being within the meaning of the Care Act, as the modern way of looking at what helps people’s wellbeing – that gloriously ordinary life that people say that they want, despite their conditions and disabilities. 

For younger adults, though, should charging for care come out of benefits income, if that is all they are ever likely to have, if genuinely unable to work? 

In fact, roughly half of all social care spending already goes on working-age adults and people disabled from birth – many of whom were also failed by the education system and have had far less chance across their lives to build up savings or assets than someone who becomes disabled later in life.  The National Framework for free NHS continuing health care makes no mention of autism or autistic people’s needs. This cannot be justified any longer.

If the benefits which people rely on ARE to continue to be assessable, to help pay for non-working people’s care charges and they are not protected against rising prices, people are quietly made poorer year on year by the very system that is supposed to support them.

Suggestion: Full, honest clarity on how working-age and lifelong-disabled people will be charged for care alongside any new cap, threshold, tax, levy or other initiative for paying for the nation’s care, with the benefits and allowances used to pay those charges properly protected against inflation — so it’s not just older people’s homes and savings protected.

8. Stop Announcing Ambition and Deferring the Decision 

…It’s NEVER Going to Win Votes, But It CAN Be Structured So As Not To Lose Them!

A speech about the direction of reform is not the same thing as a decision about how it will actually be funded. We need to put a stop to the fundamental deceit running from the top of the system right to the bottom at the moment regarding funding for the Care Act.

The Casey Commission’s own published timetable after appointment by and for the Cabinet Office was obliged to save the hardest funding decisions for 2028 – and Mr Burnham hasn’t explained how it can possibly be brought forward by a whole year.  

His point that we should not be leaving difficult subjects for a referendum in the form of a general election is a good one. But CASCAIDr would say that we should not test the water by virtue of online comments – the general public need to be properly informed by the media before they have something to say, All the principles and values needed for adult social care are IN the Care Act, so the Big Conversation risks being a public engagement gloss placed over a timetable that is now more hurried and potentially less public, because of the input of the Ministerial Group announced today.

Mr Burnham has refused to be drawn on what the government might do about funding, or tax rises, pointing out that there’s no point of a cross-party debate or a big conversation if the government just tells the public what’s going to happen. 

The media’s approach to reporting these issues in an ignorant and scare-mongering way was called out and criticised repeatedly – the point being that the risk of needing social care applies to everyone.

The cross-party origin, and cross-party abandonment, of care funding reform

The Care Act 2014 was built on the Law Commission’s review and the Dilnot Commission’s 2011 report, and received the consensus of all three main parties during its passage through Parliament under the coalition. Its funding reform provisions — the cap on care costs and a more generous means test — were legislated with cross-party agreement, and all main parties accepted the recommendation to implement them from April 2016 at the 2015 general election, including the Conservatives who then won a majority.

That majority government immediately began the pattern that followed for the next decade. In July 2015, only months after winning outright, it postponed the cap from 2016 to 2020, citing cost and lack of an insurance market. It was delayed again and effectively parked indefinitely. 

Boris Johnson, with an 80-seat majority in 2019, made “fixing the crisis in social care once and for all” his very first pledge as Prime Minister on the steps of Downing Street, then in 2021 legislated a fresh version of the cap at £86,000, due to start October 2023. The Conservatives delayed it again to October 2025 — and in 2024, the incoming Labour government, scrapped the plan altogether, citing a fiscal overspend inherited from the Conservatives, with Dilnot himself calling the abandonment “a tragedy”. Money which councils had already been given to prepare for the change had, by then, simply been absorbed into general financial pressure – another sticking plaster.

So the full sequence is this: cross-party legislation in 2014, delayed by a Conservative majority in 2015, re-legislated then delayed again by a Conservative majority in 2021-2023, then abandoned outright by a Labour government with its own large majority in 2024. Three different governing configurations, one Coalition and two single-party majorities of different colours, each had the power to fund it and each chose not to. The Local Government Association’s own ten-year review explicitly names “the politicisation of adult social care” as having rendered “prospects for cross-party consensus on a way forward… virtually non-existent” even though the framework itself was never seriously contested.

Suggestion: A firm, publicly dated commitment to when actual funding decisions — not just the general direction of travel — will finally be made. 

We think that the Big Conversation being run by the Commission will benefit from linkage to the Ministerial Group and a specific group of civil servants experienced in funding reform impact assessment, so that the Commission’s Review can work through all the options for funding the sort of system the government wants.  

9. Fund Independent Advocacy Properly

Some people need help from an independent advocate to understand and take part in the process of being assessed for care — this is a legal right. It’s part of the system of governance of adult social care, since there is no appeal and no practical route to court for judicial review. It’s needed because people do not KNOW their own rights, and will often be at a point of crisis when needing to challenge a social services’ staff member’s assumption or suggestion. 

Funding for these advocacy services is no longer ring-fenced, meaning councils can quietly squeeze it. The result is the underfunding of the crucial legal literacy of those still able to win a bid to do it. 

As people become less willing to become advocates, because of the complaints, conflict and criticism, advocacy organisations themselves are running out of advocates, and are sometimes left deciding who “deserves” support. This should never be their call to make. Merely having a relative does not obviate the need for an advocate!

Suggestion: Ring-fenced, protected funding for advocacy, with councils barred from delegating the decision to anyone else to decide who “deserves” it. Extension of standard contracts to assist with complaint-making, and other associated work for people deprived of their liberty as well as receiving care from the NHS or the local Council.

10. The Law Must Bind Whoever Runs the System

… Even If The Care Act Is One Day Run Through The NHS

Whoever ends up legally responsible for adult social care in future — a council, an NHS body, or some new combined structure such as favoured in Manchester — must be bound by the same basic and long-established public law rules: decisions must be lawful (within the legal framework put in place by Parliament), not so reasonable that no other body would dream of making the same decision if it was properly advised; fair, in terms of due process in proportion to the importance of the decision, and compliant with people’s human rights, properly understood in light of case law – regardless of which organisation happens to be holding the responsibility on any given day.

This is not a dry legal technicality. It is the only thing that reliably stops good political intentions turning into bad outcomes for real people, once the cameras and CQC have moved on.

Suggestion: Enforcement of a culture across both the NHS and social services, whereby compliance with the legal framework is the hill that professionals need to be prepared to die on — not treated as an inconvenient detail for attention only when someone complains – and even then, only if they’d qualify for legal aid for judicial review.

Other commentators’ views lack this focus on the legal framework, strong though they are on funding reform and how it’s managed in other countries. 

Andrew Harrop’s 2023 Fabian Society report “Support Guaranteed” (with Ben Cooper) argued for transforming adult social care into a national public service — national leadership and accountability, a “one workforce” approach to pay and careers, and proper integration with health and housing — while keeping local delivery. Notably, his 2023 proposals included starting universal support with people disabled from birth or early in life, rather than beginning with older people. His position is that since 2024 DHSC has not done enough on social care reform — the Casey Commission has been used as an excuse not to bring change now,” and separately that the sector “was just standing still” despite modest real funding growth of about 3% a year since the pandemic under both parties. He put a concrete number on what’s needed: spending needs to rise from roughly £30bn to £45bn over the next decade, and separately, in June 2026, he cited a need for an additional £15bn over ten years, although it’s not clear if these are overlapping asks.

Simon Bottery’s King’s Fund report, “Fixing Social Care: The Six Key Problems and How to Tackle Them” (originally 2019, updated October 2025), sets out a “social contract” model where the state shoulders most of the financial responsibility but individuals contribute if they can afford to, explicitly designed to pool risk and reduce catastrophic personal costs. This is functionally closer to a Dilnot-style risk-pooling logic than to Mr Burnham’s reported personal preference for a fully free NHS-style system, and it’s worth noting because it comes from one of the most cited independent voices in the sector, not a political actor with electoral incentives. 

His March 2026 King’s Fund blog with Kate Jopling on “joined-up” sector leadership, reflecting on early efforts to bring adult social care leaders together toward reform suggests the sector itself recognises the fragmentation that has always blocked real progress towards integration. 

Only legal framework awareness across Health AND Social Services, and a new commitment to accountability in the NHS and social services can overcome the cultural differences that make integration toxic.

CASCAIDr CIC

29 July 2026

Belinda Schwehr

bzschwehr@cascaidr.org.uk