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Jon Rouse, chief executive of Stoke-on-Trent City Council, suggested Baroness Casey may not have a cure for the ailing care system yet, but she has grasped the scale and the breadth of the issues. He told The MJ: ‘She [Baroness Casey] showed an unflinching willingness to name all the elephants in the room and I think that is the right thing to do.’Rouse is more than familiar with the issues surrounding social care and all its elephants. Immediately prior to taking on the Stoke post six years ago, he was chief officer of Greater Manchester Health and Social Care Partnership – the integrated care system that was part of the Manchester devolution that has helped crystalise Andy Burnham’s view of the programme. Before that, Rouse was director general of social care and health partnerships at the Department of Health and Social Care. In short, he has seen the system from all angles. He lauded her ‘forensic’ approach, from talking to all the major players to her plan to pull in the public, of looking back to look forward. But despite failures to fix the system, he said he was ‘not in the camp that basically says social care has not been properly reformed since after World War Two’.The 2014 Care Act – started by Labour and finished by the coalition Government – moved the country from what had previously been a poor law model based on 19th century legislation – shifted the system forward significantly. Rouse said: ‘The problem is that it has never fulfilled its potential for two main reasons.’ Those are the lack of cash to deliver the full proposals including Dilnot, and the lack of integration. There is still a great divide between the NHS, social care, housing and welfare. A divide that has been recognised by Baroness Casey. ‘It’s all four of those things and the relationships between them that I think is the core of what Louise has got to resolve,’ he said.Like Casey, Rouse was adamant a National Care Service does not mean the NHS taking social care from councils – and it is not what Andy Burnham intended when he supported the proposals as health secretary. It would be ‘an absurdity’ that would push people further toward clinical solutions. ‘I think when he talked about a national health and care service,’ Rouse explained, ‘what he meant was that from the perspective of the individual, it should feel seamless.’Instead, he reverted back to the Care Act, legislation that recognised the need to offer personalised support, offering a light touch to those who need just a little assistance to reach their full potential.For Rouse, there is no excuse not to crack on. ‘We don’t need to wait for Louise to opine to get on with some of this. Place-based working and striving for neighbourhood health and care gives us the opportunity to road test what this can look like in reality,’ he told The MJ. ‘I can’t wait for the day when, in one of our neighbourhoods in Stoke, the family hub, the community lounge, the GP surgery… all are working seamlessly together.’

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ADULT SOCIAL CARE

Why councils must not wait

By Heather Jameson | 16 July 2026

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