The Independent Commission on Adult Social Care, chaired by Baroness Louise Casey, was established to consider how the adult social care system should be reformed and to make recommendations to the Government. A key part of its work is building a national conversation about what adult social care should deliver and how we should meet future needs.
Launched in July 2026, the Big Conversation on Care is asking people across England to think about some fundamental questions: what is care, what should we expect from a care system, who should receive the most help and who should pay for what? The Commission says the conversation will help shape its recommendations for a future National Care Service.
For care professionals, these questions are reflected in everyday practice: whether someone receives the support they need, how much choice and control they have, whether families are coping and what happens if help arrives too late.
The Big Conversation on Care
The conversation focuses on the values and principles we should all expect from a care system and who should be eligible for support. These questions link to the principles in the Care Act 2014, which puts individual wellbeing at the heart of local authority care and support duties, including dignity, protection from abuse and neglect, control over day-to-day life and relationships. The Big Conversation, however, is asking people to consider what they believe the principles of a future system should be.
With regards to eligibility, the conversation is asking questions about whether support should be determined primarily by a person’s level of need and how the system should respond as people’s needs change. It is also asking what role a person’s financial circumstances should play in the level of support they receive and what individuals, families, communities and the state should be expected to contribute.
The Care and Support Alliance (CSA), a coalition of more than 50 organisations representing older people, disabled people and unpaid carers, is involved in the Big Conversation through its advisory steering group. Its members have set out nine outcomes for social care, including high-quality support, choice and control, protection of rights, recognition of unpaid carers, a skilled and valued workforce, action on unmet need and sustainable funding. The CSA states that eligibility should be based on need rather than age, diagnosis, postcode or ability to pay.
The Casey Commission’s work is being carried out in two phases, with the first focusing on medium-term reform and the second looking at the longer term, with the final phase due to report by 2028. The Commission is examining the current system, funding, the relationship between health and social care and how care might become more preventative, while giving people who draw on care, their families and carers more influence over their care.
The online phase of the Big Conversation closed on 23rd September 2026 after attracting hundreds of thousands of votes and thousands of ideas. The conversation is continuing through a Public Panel on Care, bringing together around 125 people from different backgrounds and communities to consider the issues. The online platform is expected to reopen in the new year.
The Commission is not presenting a finished model; instead, it is asking people who draw on care, unpaid carers and care workers to help explore the choices involved. Ultimately, it asks, what should people be able to expect when they need care and support and how should we decide who receives it?
There have been many attempts to reform adult social care. But too often, the public has not been sufficiently involved in the fundamental questions: what do we want from social care, what should we expect from it, and what choices and trade-offs are we prepared to make? That is why the Big Conversation on Care is welcome and long overdue. As the three Co-Chairs of the Care and Support Alliance (CSA), and members of the Big Conversation’s advisory steering group, we want to help ensure the experiences and ambitions of people who draw on care and support, and unpaid carers, are at the heart of that debate. The CSA brings together more than 50 charities representing and supporting older people, disabled people and unpaid carers. Drawing on that breadth of experience, our members have agreed nine outcomes for social care, setting out what a good system should mean in people’s lives. Our starting point is that social care is not one service or type of support. It might mean personal care that enables someone to live with dignity at home, support to work or participate in their community, or residential care that enables someone to live safely and well. We want a system where everyone can get high-quality support when they need it, with genuine choice and control over their lives. People’s rights must be upheld wherever they live, with accessible information, advocacy and meaningful recourse when things go wrong. It also means confronting unmet need. Too many people receive too little support, no support at all, or only get help once they have reached crisis point. Moreover, it means recognising and supporting unpaid carers, rather than assuming families will simply fill the gaps when formal support is unavailable. Good care also requires a skilled, compassionate and properly valued workforce, and technology that improves people’s lives rather than simply replacing services. Crucially, it requires sufficient, sustainable, long-term funding. Without that foundation, rights, choice and prevention risk becoming aspirations rather than people’s everyday experience. These principles must shape who is eligible for support. Eligibility should be based on need, not age, diagnosis, postcode or ability to pay, and should recognise the full diversity of older people and working-age disabled adults who need care and support. Ultimately, the test of reform is not what the system promises, but what people experience: can everyone who needs care and support get it, when they need it, and live the life they choose – with dignity, independence, choice and control? Our nine outcomes represent a shared ambition from across a diverse alliance. They are the standard we believe any future care system must meet. Caroline Abrahams CBE, Emily Holzhausen CBE and Jackie O’Sullivan, Co-Chairs of the Care and Support Alliance (CSA) Email: [email protected] LinkedIn: @Care-and-Support-Alliance Visit the Casey Commission website for the latest information on how you can contribute your insights and experiences to the Big Conversation on Care. Then, share your thoughts on this month’s Into Perspective by leaving a comment.Nine outcomes for social care