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Taking to the Local Government Association conference stage in Bournemouth, Baroness Louise Casey of Blackstock delivered a stark, but compassionate, diagnosis of the current state of social care.In short: it is straining under its own weight and gasping for breath. And at the heart of the problem, she argued, is a false divide – a system that treats care and health as separate worlds when, for the people caught in the middle, they are one and the same.Baroness Casey, who is leading the charge to revive the care system, has always been a staunch supporter of local government. Her speech – and her Commission on Social Care – continue to champion the sector, but it is her passion for people that crystallises the real issues.The diagnosisAmid a speech that acknowledged the imbalance between local government and the monolithic NHS, the rising demand and the dwindling finances, it was the human and humane stories that stood out.There were stories of people robbed of dignity, given medical interventions over basic assistance, pushed towards welfare payments when they needed support – and rejected when their needs were too complex, or their bank balance was too high.As mental health and neurodiversity diagnoses soar, so have personal independence payments and working-age adult social care costs have overtaken elderly care budgets for the first time. Money has focused on supporting people through welfare over helping them into work. What was laid out in the post-war period is now outdated. The health, welfare and social care system is on life support.Baroness Casey highlighted 22 separate reviews since the last Labour Government took office in 1997 but they have not attempted to take the temperature of the public: to ask what the state should provide and how much people are willing to pay for it. It is a crucial question. After all, the so-called ‘death tax’ helped bring down former Prime Minister Theresa May.A Big Conversation was the one concrete announcement in Baroness Casey’s speech. She was widely praised for her astute diagnosis of the problems in social care, but she left the audience frustrated at the lack of a cure.What Casey wants insteadPressed on what shape that new deal with the public should take, Casey was clear it is not about restructuring. Speaking to The MJ after her speech she explained she does not believe the system needs ‘new, new, new’ structures. ‘What is needed is a much better service to the public that they understand – where you couldn’t see the fault line between what is care and what is health,’ she said.‘You’ve got medical treatment over here, you’ve got care over here, and in the middle of it, you’ve got the person’s health... the bit in the middle is health, really, or in modern parlance nowadays, would be wellbeing.’Councils, she argued, need to occupy that middle ground – the wellbeing services that protect people from having to access hospital services and more advanced care in the first place.She was equally clear that a potential National Care Service is not a new monolith to match the NHS, and nor is it about moving care from local government to health. It is not reinventing the wheel or creating new structures, but improving what already exists.A national care service, she explained, would look more like the existing system of local government. ‘We do actually effectively run a national council service through a load of different local authorities,’ she said. ‘It’s just we don’t call it a national council service.’The interface with the public is where it matters most – offering advice at a national ‘front door’, in the way the NHS does with its 111 phone line. ‘The public are much more aware of helping themselves using their phones... and we’re not,’ she said. ‘There isn’t even a simple portal anywhere nationally that explains what might happen.’By its nature, care is local and needs to remain so, but too often, health services attempt prevention work with local authorities and the voluntary sector as an afterthought, and without the funding to support them.The political backdropIdentifying where the demand is coming from, and offering help at source, is essential, Casey argued: ‘We’re spending more money on adult working age, and I want to know who those people are and what’s driving up that demand.’ For the first time, adult working age spend has overtaken elderly care as personal independence payment claims have spiked – a trend Casey pointed to as evidence that demand is being funnelled into welfare rather than tackled at its root. As Baroness Casey spoke to the LGA conference, The Times reported that 100,000 people with ADHD are now on disability benefits, up 40% since Labour came to power. Mental health need is rising sharply, while the surge in special educational needs and disabilities demand among children is beginning to transition into the adult care system as they turn 18.Local and central government need to stop plugging the gaps, Casey said, and instead identify what is driving demand and tackle it at source – with far more effort going into helping working age adults into work and towards independence, ‘so they can live good lives’. With Andy Burnham poised to take over as Prime Minister, he has already pledged to stick within the fiscal rules, raising the question of what that might mean for the future of care. Casey, however, was optimistic – and adamant that he has not yet got the job. ‘If you look at the last budget, if you look at some of the spending reviews, they have all stayed within those fiscal rules, but there has been flex,’ she said. ‘There are always options in life for governments to choose what money they stop spending, what money they start spending, and when they switch spending.’‘When you’re in government, you can pretty much get a lot done. There are always choices, even if they’re hard choices, about how you spend your money and what you do.’Whether that flexibility will be enough to bridge the divide Casey describes – between what is called health and what is called care, when for most people it is simply one continuous experience – remains the question her Big Conversation will need to answer.

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SOCIAL CARE

Casey's corrections for care

By Heather Jameson | 16 July 2026

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