Note: This article was first published in the August/September edition of Care Markets under the headline 'Renewed appetite'.
The Casey Commission - formally known as the Independent Commission on Adult Social Care - was established by the UK government in April 2025, its purpose being to develop a long-term plan for reforming England's adult social care system and to lay the foundations for a National Care Service.
The Commission was created against a backdrop of growing concern about unmet care needs, workforce shortages, rising costs, and increasing pressure on NHS services. In the 15 months it has been active, those pressures have continued on an upward trajectory.
Changing timelines
The original plan was for the Commission to report in two phases with Phase One, due to report in 2026, focusing on identifying practical reforms that can improve social care within existing financial constraints and over the medium term. Phase Two was originally scheduled to report by 2028 and is intended to address the longer-term transformation of the care system, including funding, organisation, and the overall design of a National Care Service. Phase Two has now been brought forward as part of Andy Burnham's plans for tackling social care challenges.
Until the prime minister's policy speech on 29 July, there was perhaps a sense from many operating in the sector that the Casey Commission was doing valuable work but the pace of the review was too slow. Other policy changes have repeatedly impacted on the social care sector while not being the primary target of those policies; and this has created increased pressures, particularly in relation to financial and workforces challenges. Other areas in need of reform, such as regulation and commissioning arrangements, weren't moving forward quickly enough. The speed of the review has now changed, with a revised timetable in place requiring the Commission to report in full by 2027, twelve months ahead of the original timetable.
As part of the policy announcement, Burnham described England's current social care system as "fundamentally unfair", arguing that reform had been postponed for too long because politicians were unwilling to confront difficult decisions. He linked social care reform directly to the future sustainability of the NHS, warning that health service pressures cannot be solved without fixing care provision. This point has been raised by many within the sector for some time, but further recognition is undoubtedly a positive.
Burnham also identified three immediate priorities for the future of social care: accelerating the Casey Commission's work; developing a comprehensive workforce plan; and pursuing cross-party discussions to build lasting political consensus. He indicated that difficult funding decisions may be required and refused to rule out major structural reforms or new funding arrangements.
What does this mean for those operating within the social care sector now, particularly when considered alongside broader changes already in motion, such as changes to the regulatory assessment regime and ongoing private sector investment interest?
Emerging themes and recommendations
Although the Commission's full Phase One report has not yet been published, several consistent themes have emerged from its work so far. Each should be considered in the broader context of prioritising a system which holds people in receipt of care at its heart, providing greater opportunities for those people and their families to influence how care is designed and delivered.
The first key theme is the need for social care to have a more preventative focus - investing earlier to help people remain independent at home, avoiding crises that often result in hospital admissions or long-term care requirements. Better prevention is also seen as critical to reducing pressure on the NHS, both in terms of avoiding unnecessary hospital admissions and avoiding unnecessary extended stays in hospital when suitable community-based support cannot be found.
Second, it is exploring ways to improve productivity and accountability within existing funding arrangements. The Commission is examining how local authority funding and NHS funding at the health and care interface are used, and whether resources can be deployed more effectively to improve outcomes. This is an area which those navigating the sector, whether as individuals in receipt of care or as providers, have been aware of, and persevered with for some time. Questions in relation to how funding is allocated - at times in a very siloed manner - and how eligibility criteria are determined are complex. When coupled with variations in commissioning practices across local authorities and generally short-termist decision making (to fit within political cycles), improvements in funding arrangements are an obvious area for improvement.
It is also likely that the broader structure of the market, including the role of independent and voluntary sector operators, will come under scrutiny. Neither the latest government announcement or the findings of the Commission so far has given specific indications on this point. Reforms are expected to look at value for money for tax payers, as well as the realistic levels of investment needed to support innovation and delivery of genuinely high-quality support that is fit for the future. As a result, independent sector providers may face increased scrutiny in relation to their own financial modelling, governance and accountability.
Third, workforce reform is a major priority. Evidence submitted to the Commission consistently highlights recruitment difficulties, low pay, limited career progression, and high turnover rates. The Commission's work aligns with wider government plans, including the national Fair Pay Agreement (FPA) and initiatives in relation to professional development and stronger career pathways for care workers.
Wider regulatory reform
While the recent announcement has been a headline moment, there is, of course, significant wider change already in motion within the sector. This includes the planned FPA as well as the latest re-write of the CQC's regulatory regime, following well-documented challenges with the single assessment framework.
The CQC's latest update on the future of regulations (published in Spring 2026) and the latest proposed inspection frameworks (published in the Summer), bring increased focus on outcomes and impact on individuals, rather than documentation, which is consistent with the Casey Commission's objective of keeping people at the heart of the sector. This is also a return to greater transparency in how services will be inspected, and better understanding of specific sector specialisms to produce reports which are more meaningful and user friendly.
For providers, this is likely to mean an ongoing focus on gathering a broad spread of evidence beyond that which is gathered on the date of inspection, demonstrating strong use of technology and innovation to support service delivery. Highly rated providers will also be expected to demonstrate their contribution to the wider social care system through collaboration with other stakeholders, including commissioners and the NHS - again, very much in keeping with the Commission's findings and stated government objectives.
Building momentum
Many details remain undecided, yet the combination of the Casey Commission's work, the current appetite for progress within the CQC, and the prime minister's renewed political commitment represents the most significant opportunity for meaningful adult social care reform in more than a decade.
Whether this leads to lasting change will depend on the government's willingness to drive change through quickly by acting on the Commission's recommendations and secure the public and cross-party support that previous reform efforts lacked.
A number of challenging questions still need to be answered - particularly around funding and implementation - but there is clearly a renewed appetite for reform and a stronger sense of momentum, both of which should be regarded as positive developments for the sector.
