The Health and Social Care Committee recently held an evidence session with Baroness Louise Casey, Chair of the Independent Commission on Adult Social Care, alongside Sarah Coskeran, Deputy Director of the Commission. The session provided an update on the Commission’s progress and offered a clear indication of the emerging direction of travel for social care reform in England.

A commission already well advanced

Baroness Casey confirmed that the Commission is significantly progressed in its work. It has already carried out extensive engagement, including cross-party discussions, visits to local areas, and conversations with people working across health and social care.

The Commission has also reviewed more than two decades of previous reform attempts, examining 22 major reviews, White Papers, Green Papers and commissions dating back to 1997. This has helped identify why past efforts have struggled to deliver lasting change.

While the final report is expected by 2028, Baroness Casey indicated that recommendations could be published earlier where possible. She also confirmed that an interim report will be produced this year, setting out practical changes that could be implemented in the shorter term.

Resetting the conversation on social care

A central theme of the evidence session was the need to fundamentally reset how social care is discussed and understood.

Baroness Casey argued that reform has repeatedly stalled because there has never been a clear and honest public conversation about what social care is, what people should reasonably expect from the state, and what responsibilities individuals and families may carry alongside public provision.

To address this, the Commission plans to launch a major public engagement programme, designed to gather views on how care should be funded, delivered and understood. This reflects a growing recognition that sustainable reform will require public agreement as well as political will.

Towards a more integrated system

The Commission’s evidence strongly suggested a move towards greater integration between health and social care.

Baroness Casey noted that people do not experience the NHS and social care as separate systems, yet policy and funding structures continue to treat them independently. She indicated that the current divide has become too rigid and that future reform is likely to focus on closer alignment, potentially moving towards a more unified “health and care” model.

A recurring concern was the complexity of the current system. Families often face multiple assessments, different funding routes and unclear eligibility criteria. In some cases, charities have stepped in to fund navigation services simply to help people understand how to access publicly funded support.

The Commission’s direction of travel points towards simpler processes, clearer entitlements and a system that is easier for the public to navigate.

Making better use of existing resources

Baroness Casey also emphasised that meaningful reform cannot rely solely on additional funding. Instead, she highlighted the importance of using existing resources more effectively.

This includes reducing duplication between services, improving hospital discharge processes, and strengthening coordination between NHS and local authority services. The evidence suggested that better integration and reduced fragmentation could improve outcomes without necessarily increasing overall spending in the short term.

Strengthening the role of local government

The relationship between the NHS and local government was a key theme throughout the session.

Baroness Casey expressed concern that local authorities are often treated as secondary partners, despite their central role in delivering care and supporting communities. She also questioned recent changes that have reduced local government representation in integrated care structures, suggesting this could undermine efforts to improve coordination.

She argued that effective reform requires treating local government, primary care, community health and social care as equal partners, rather than as extensions of acute hospital systems.

A shift towards care closer to home

The Commission also supported a shift towards prevention and care delivered closer to people’s homes and communities.

However, Baroness Casey cautioned that when health systems talk about integration, this often means internal NHS restructuring rather than genuine partnership with social care and local government. She stressed that true reform will require a cultural shift, not just structural change.

Dementia as a system-wide priority

Dementia was highlighted as a major area requiring greater focus. Baroness Casey described it as one of the most significant challenges facing the system and suggested that it has not received sufficient sustained attention in recent years.

She confirmed that Government plans to appoint a dementia lead, often referred to as a “tsar”, to improve coordination and accountability across services. The Commission also indicated that future frameworks for dementia care need to be clearer, more practical and better connected to what people experience after diagnosis.

Workforce, unpaid carers and system pressures

The Commission acknowledged the importance of the social care workforce, while noting that some reforms are already being progressed through Government policy, including changes to employment conditions and moves towards fair pay arrangements.

There was also recognition of the growing role of unpaid carers. Baroness Casey highlighted that longer life expectancy and increasing levels of complex need mean families are providing more care than ever before. While many are willing to do so, she stressed that the system does not always provide sufficient support, particularly around respite care and practical assistance.

Testing new models of care

The session also considered alternative approaches to delivering social care, including models that offer more generous provision of home-based support. While these approaches are of interest to the Commission, Baroness Casey and Sarah Coskeran emphasised that there are no simple conclusions and that different models need to be assessed as part of a wider system rather than in isolation.

Local government reform and system coherence

Baroness Casey also reflected on wider local government reform, suggesting that structural changes such as unitary authorities could create opportunities to align housing, health and care more effectively.

However, she also warned that ongoing reorganisations across both the NHS and local government risk creating instability if they pull services in different directions. She emphasised the importance of stable, recognisable local geographies that the public can understand and relate to.

What this means for reform

Overall, the evidence session points towards a reform agenda focused on simplicity, integration and accessibility. Key themes include:

• A more joined-up health and care system
• Clearer entitlements and simpler access to support
• Stronger role for local government in planning and delivery
• Better support for unpaid carers
• A more professional and valued care workforce
• Greater focus on prevention and community-based care

Our position

As part of the Later Life Ambitions campaign, we welcome the update from the Commission. In particular, we support efforts to reduce fragmentation, improve integration between health and care, and strengthen the role of local government in delivering support.

However, it is clear that reform cannot wait until the end of the decade. The pressures on families, carers, providers and the NHS are already significant, and the system is struggling to keep pace with demand.

We believe that social care reform must be treated as an urgent national priority. That means moving beyond repeated reviews and towards practical, early action that improves access, simplifies pathways and ensures people can get the care they need when they need it.

The evidence session reinforces a simple reality. The question is no longer whether reform is needed, but how quickly it can be delivered and whether the system can be made to work for the people who rely on it every day.