The leader of a review into reform of the social care sector will use a speech on Wednesday to attack successive governments for being “asleep at the wheel” on social care.
Baroness Louise Casey is expected to deliver the warning at a gathering of social care leaders, as new research commissioned by her team concludes the sector is a “fundamentally fragmented system” with no-one in charge overall.
She will also brand the failings in the Covid-19 pandemic, which saw the virus “spread like wildfire” in care homes and many older people die without family at their bedsides, as “a national shame”.
Baroness Casey is due to address the National Children and Adult Services Conference (NCASC) in Liverpool.
She will use the speech to call for “a new settlement for care”.
She 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.”
The research, carried out by the Nuffield Trust and the Institute for Government think tanks, concluded that adult social care in England is currently “a complex system where responsibilities are spread between central government departments and across a range of arm’s-length bodies; between national and local government; and between government and a vast array of non-public sector providers”.
It added: “Decision-making processes can be opaque and a single point of responsibility for overall oversight and stewardship is lacking.
“The consequences of this complexity and lack of clarity were highlighted during the Covid-19 crisis, and while that event forced some positive change, there remains a fundamentally fragmented system that lacks a coherent sense of direction.”
The report points out that more than 1.5 million social care staff work across around 19,000 employers. But England, it notes, is the only one of the UK’s four nations with no mandatory register of care workers.
The current make-up of the sector means private providers “dominate” in a pattern that has “emerged in a largely uncontrolled and unintended way”.
Unlike NHS care, social care is not free at the point of use.
High costs sometimes mean people are forced to sell their homes to pay for what they need.
People with savings worth more than £23,250 are not entitled to help with the cost of care from their local council.
The report warned of “poor transparency” around fees paid to and charged by providers.
It found that people who have to pay for their own care are charged, on average, 40 per cent more for the same service than people whose care is arranged by their council.
The report said that social care reform “requires political will and bravery to make the choices necessary to create a new national care service”, warning that the “prominence and level of priority” that Prime Minister Andy Burnham has given to social care “and the momentum he has created by accelerating the Casey Commission, needs to be maintained”.
Mr Burnham has previously acknowledged “difficult, difficult decisions” could be needed on tax.
But he has insisted that fixing the current problems in social care in England could save the NHS billions of pounds a year.
Report co-author Natasha Curry, from the Nuffield Trust, said its research showed the “governance of England’s social care system is confused and complex”.
Institute for Government associate director Stuart Hoddinott described a system which has been formed “haphazardly and with little clear planning”.
Mr Hoddinott added: “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.”
Baroness Casey’s report on recommendations for sector reform is due by next summer.
She has also written to the Covid inquiry to tell Lady Hallett she was “deeply horrified, but unfortunately not surprised” by the findings.
She said: “I wholeheartedly agree with your recommendations and join you in urging Government departments to act on them quickly.”
Her intervention follows a report by the UK Covid-19 Inquiry last month, which stated that the care sector was “an afterthought”.
The inquiry rubbished a claim made in May 2020 by then-health secretary Matt Hancock about a so-called protective ring around care homes at the start of the pandemic, dismissing it as “unfounded”.
Inquiry chairwoman Baroness Heather Hallett said: “Quite the opposite was true.”
Her report found that vulnerable care home residents were left with “insufficient protection” as patients were discharged from hospitals without knowing if they had the virus.
It also found that the mantra of protecting the NHS “sometimes came at the expense of the users and providers of care”, with care homes “becoming prisons” for some amid visiting bans and many residents feeling “abandoned”.
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