Last Updated on November 11, 2026

New research on the governance of social care has been published by the Independent Commission on Adult Social Care. The research, commissioned by Baroness Casey and conducted by the Nuffield Trust and Institute for Government (IfG), shows England is an international outlier. Compared to comparable countries like France, Germany, and Japan, it has no clear 'system stewardship' for social care.

The research also sets out how England's social care system was never deliberately designed like the NHS was in the 1940s.

Baroness Casey says it was instead built in increments and accidents, resulting in:

• A social care sector dominated by private providers in what the research describes as a 'largely uncontrolled and unintended way'. Previous Nuffield Trust research described the Care Quality Commission's role as being like a 'spectator at the site of a car crash'.
• Two people with the same condition having different experiences depending on where they live: different assessment processes, different waits and different levels of support.
• People paying for their own care being charged, on average, 40% more for the same service than people for whom care is arranged by their council.
• More than 1.5 million social care workers across around 19,000 employers, but England being the only country in the UK without a mandatory register of care workers.

The research is part of a series of reports into England's adult social care sector that will be published by the Commission. The research aims to help to inform the work of the Commission, which will make its final recommendations to Government in summer 2027.

Speaking at the National Children and Adult Services Conference today to share the research findings, Baroness Casey is expected to say, 'The Covid-19 Inquiry took apart the argument that a "protective ring" had been thrown around care homes during the pandemic. Many old people died without their loved ones by their side. Many care workers left their jobs after what they had seen. It is a national shame that this was allowed to happen. It should never happen again.

'Successive governments have been asleep at the wheel. In research we're publishing today the lack of "stewardship" of social care comes through clearly. No one is in charge. Together, we can build a new settlement for care. One based on values I still believe this country shares: decency, contribution and a duty to care for our neighbours, our loved ones and ourselves.'

Commenting on the research findings, Natasha Curry, Deputy Director of Policy at the Nuffield Trust, and the report's co-author, said, 'Compared to the other countries we looked at, the governance of England's social care system is confused and complex. Overlapping and unclear roles leave dangerous uncertainty around who is responsible for important decisions, contributing to the inertia around reform England has struggled with for decades. The serious consequences of this were laid bare during the Covid pandemic.

'There is not a singular "correct" way of organising a care system – other countries vary in their approaches – but we need a clear vision on how to untangle the chaotic structure the sector has currently. The Casey Commission now has the opportunity to tackle these weaknesses head on. Looking to international examples is a solid starting point, as governance arrangements in other systems allow for more strategic approaches to things like workforce planning and regulating organisations that provide care.'

Stuart Hoddinott, Associate Director at IfG, said, 'The system for governing adult social care in England has evolved haphazardly and with little clear planning. That has been exacerbated by successive governments ducking politically unpalatable decisions for decades. That has scattered responsibility for the sector across and outside government in a way that few would design from scratch.

'While no system is perfect, and all come with trade-offs, the adult social care sector is unusual compared to other services in England. There are lessons from those services, about how to improve accountability or better design funding flows, that could provide a template for social care reform. [Andy] Burnham's personal commitment to reform alongside his devolution agenda provides the opportunity to better align the sector's form with the Government's desired function.'

Professor Martin Green OBE, Chief Executive at Care England, said, 'Baroness Casey is right. Successive governments have been asleep at the wheel. People who need care, their families and those who support them have lived with the consequences for years. The report does not say that the independent sector has failed, but that the independent sector has stood up when successive governments have failed and provided a diverse range of services in spite of chronic underfunding and inconsistent and restrictive commissioning practices.

'The consequences of this lack of stewardship is that councils struggle to balance their books, providers struggle to make inadequate fees cover the care people need, and families struggle to understand why support available in one area cannot be found in another. The research directly feeds into [Baroness] Casey's characterisation of equitable social care provision as being the "Sixth Beveridge Giant" that any citizen should expect the Government to provide for.

'Our own research has documented how those pressures build. Local authority funding continues to fall behind costs. Funding available for training, better pay and improvements are squeezed while decisions around minimum wage increases, and the local authority budgets that must deliver them, are often made in relative isolation in a siloed Government that has treated social care as the NHS' poor relation rather than the core public service it should be.

'Independent providers want to help build the future care service that the people the already support deserve. This report gives the Commission a strong basis to move from diagnosis to design, and Care England wants to work constructively with Baroness Casey to help shape a settlement and a National Care Service that works for people, families, staff and providers.'

Read the research by the Nuffield Trust and IfG on governance in social care here.

In other news, a new report argues that Government's proposed National Care Service must address the financial 'injustice' currently faced by self-funders.