Research for Casey Commission puts adult care accountability in focus

Research published by the Independent Commission on Adult Social Care on 11 November 2026 identifies fragmented responsibility as a central problem in England’s care system. Written by the Nuffield Trust and the Institute for Government, Governance in social care: Lessons for reform examines how national leadership, local decisions and service delivery fit together.

The researchers describe a system that developed through successive changes, with responsibility spread across government, councils and providers. Their review considers options for access, commissioning, market oversight, workforce planning and improvement. It draws on England’s history, a sector roundtable and approaches in other countries and public services. Read the research report.

The authors argue that any restructuring needs a clear purpose and that improvement and workforce planning need stronger support. Their analysis sets out choices and trade-offs for future reform. The Commission says it will make its final recommendations to government in summer 2027. Read the Commission’s announcement of 11 November 2026.

What this means for provider leaders

For a provider, unclear accountability can show up as a practical delay. A service may know that a placement needs a review but spend time finding the person authorised to arrange it. A concern spanning commissioning, health and social care can need several organisations to agree the next step.

Managers can make their experience more useful to reform discussions by documenting an anonymised example from start to finish. Record the decision needed, the organisations involved, the route used to raise it and the time taken to obtain a response. Explain what the delay meant for the service and what authority or information would have helped resolve it.

Ask who can make the decision

At the next partnership meeting, check that the service has an agreed route for matters requiring several agencies. Confirm who coordinates the response and how unresolved issues move to someone with authority to act. Bring recurring patterns into strategic discussions so partners can see where their processes need attention.

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