Social care experts widely see the Casey Review’s 2028 release date as a delay tactic and wonder if some businesses will even survive to see its conclusion.

Lizzie Wills, senior partner and head of private equity at GK Strategy, says: “Baroness Casey is widely trusted to lead independent government reviews – she is a really safe pair of hands and a very thoughtful and credible independent commissioner. But the timescale over which the review is intended to run has definitely provoked some conversations.

“The big question for people in the sector has been whether we really need another review when we know what all the problems in the system are. There is concern that Labour aren’t taking the issue of social care in a way which a lot of people in the adult social care sector would hope they would, given the size of its majority.”

Casey’s review of the social care sector will begin in April. It has been split into two phases: phase one assessing critical and medium-term improvements will conclude mid-2026 while phase two which will look at how to organise and fund care into the future will conclude in 2028 – a year before the next election is due.

The aims of the report are lofty: a National Care Service. However previous attempts at care sector reform – the 2010 attempt labelled the “death tax”, the 2011 Dilnot Commission, and the 2017 attempt labelled the “dementia tax” – have all died with a whimper.

Could this political name-calling be part of the rationale for a delay? Bhavna Keane Rao, health and social care consultant at BKR Care Consultancy, believes it could be.

She says: “I’m hoping it’s a cross-party discussion. Casey brings authenticity, and even though Labour has a huge majority, the Government doesn’t have a lot of political capital. It really needs to win hearts and minds – and if Labour ends up with egg on its face, it wants everyone else to have egg on their faces too to avoid a political mudslinging match. But then again, we should have used a lot of the recommendations from the Dilnot report. We didn’t.”

Wills agrees to an extent: “You’re going to need as much political consensus on this as possible, because the recommendations of the review are highly unlikely to be universally popular. This is a really thorny political issue, and you only have to look back to Theresa May and the “dementia tax” to see that.

“That’s why I have questions about the timing. If the report comes out with a year to go before the next election, I don’t believe the political consensus is going to hold. I would have wanted to have something ready for implementation no later than midway through the parliament, where it doesn’t necessarily become an election issue in the same way. If the Government can’t build consensus, it’s another 18 months wasted talking about the same things we’ve talked about for 20 years.”

Meanwhile, the prospects for the sector look grim. Jane Townson, CEO of the Homecare Association, says: “We are facing a massive disruption in April, because no one can afford the 10% increase in costs which comes from the rise in the national living wage and NI contributions. Although the average margin in home care is 7.6%, many don’t make anywhere near that much.

“For example, there is an employee-owned provider in the north of England where 98% of their payor mix is state-funded. They made a surplus of 1.5%. How will they face a 10% increase in costs? To make matters worse, local authorities are usually quite delayed in communicating their fee increases, which makes it very difficult to do any business planning, and most local authorities are they could only afford a 0-5% fee increase.

“Across home care, the situation is particularly acute because 79% of care is purchased by councils and the NHS. Those in the south may survive as they can levy more private pay, but I think they may even struggle to increase their private fees by 10%. I think it’s more likely they will have to adjust the hours they can provide to manage their wage bill. This may hamper growth.”

Townson points to the research by the Care Providers Alliance which suggests 22% of care providers will close due to the NI and living wage increases.

Jamie Stuart, deputy head of health and social care at Virgin Money, is more optimistic about the current state of the sector: “I still see a lot of very successful social care businesses making reasonably sustainable profits, huge amounts of investment coming into the sector, and lots of M&A. While the NI rise hasn’t helped the sector, I see a good year for deals ahead.

“I do think the 22% closure figure is overplayed to be honest. There will be some closures, but I’ve sat in conferences year-after-year where panellists say sub-30 bed homes are all going to fall out of the market. I’d be staggered if we lose a quarter of all homes.

“Ultimately the providers need to remember that they have the negotiating power. If a business has a resident in specialist care on £1,000 a week and the going rate is £2,000 a week, it is likely to hand back its contract or serve notice because the fee is too low, and the local authority won’t find anyone else to do it at £1,000 a week.”

Townson says the environment feels different from previous years: “This is coming on the back of multiple years of squeezing the sector, and I think we are too far below a minimum price for home care. The average local authority fee for homecare in England was £23.26 an hour in the summer, but we calculate from April we’ll need £32.14. That’s nearly a £10 difference.”

What are the solutions? The obvious one is that more funding is needed. Wills points out: “Baroness Casey may start talking about some of the funding issues pretty early on, because that is the do or die question. Who pays for this? How much do they have to pay and on what basis? I think if that is not dealt with until 2028, that’s going to be quite problematic. And I don’t think you can deal with a lot of the other problems without understanding the financial mechanisms that sit underneath this.

“I can’t see that the Casey recommendations are going to be a million miles away from what we had from Dilnot. There might be a bit of shift in terms of the thresholds that determine how much people are expected to pay and for how long. But I can’t imagine it’s going to be something that is wildly innovative in terms of a solution. If there was an easy fix to this problem, we’d have found it by now.”

Stuart says that while the Government is hesitant to do this, there are things which can be done: “Ultimately it comes down to putting funding in the right place, but I think you can solve some problems relatively cheaply by rearranging how we do things between the NHS and social care.

“Integration between the two hasn’t really happened. I don’t necessarily think it should be beyond the wit of man to be able to match up people requiring discharge from hospital with care settings when care home occupancy is 85 to 90%. This is also something which doesn’t require as much politics.”

Given the hesitancy for funding big projects, Stuart believes a free-at-the-point-of-use national care service is unlikely.

Townson says some councils, such as Sheffield, are already changing their systems to improve the way homecare is commissioned and purchased: “Other councils, though, are telling care providers to self-assess their quality and allowing them to join a framework of over 200 providers, all fighting for the lowest bid. Some even do that to the detriment of quality of care, such as considering the location of the provider, whether they can do the work safely etc.

“From a provider’s perspective this also causes problems because, if you have to bid for every person, you have no guaranteed income and can’t plan your business. It also makes it worse for care workers, as they have to be free for 105 hours a week but will only be guaranteed 25 hours a week work in that time.

“The way you solve that is by doing what Sheffield has done. Sheffield has fewer providers, split across geographic zones, and are therefore able to give providers 2,000-2,500 hours a week to organise the best they can – and the council is also paying providers 80% of planned hours in advance. This is not only better for providers and care workers, but also for the council and people being cared for, as it makes it easier to monitor quality of care. Waiting lists for care have vanished.”

She also says an additional tax, or social insurance, which accrues with compound interest like a pension, could be levied on people when they start working so that social care can be funded.