Adult social care policy is starting a journey of significant change.
This year has brought a series of important developments, including early recommendations from the Independent Commission on Adult Social Care Reform, implementation of the Mental Health Act 2025, the future of the Terminally Ill Adults (End of Life) Bill, and other developments relating to mental health, autism and ADHD.
This update explores some of the key changes and opportunities to influence future policy and practice.
Adult social care reform
Reform of adult social care: Government acts on early recommendations from Baroness Casey
We recently outlined our response to Casey’s recommendations at Research in Practice.
The government has agreed to set up a new National Safeguarding Board to be responsible for policy on adult safeguarding at a national level, including learning national lessons from Safeguarding Adult Reviews, and to undertake an urgent review of statutory adult safeguarding duties. The move is in response to early recommendations from Baroness Casey, Chair of the Independent Commission on Adult Social Care Reform.
Baroness Casey set out recommendations for ‘immediate action’ in a letter to the Health Secretary Wes Streeting. She also set out her emerging vision for social care reform in a speech to the Nuffield Trust Summit two days later.
Baroness Casey called for a national reckoning on adult social care equivalent to Beveridge’s vision for the welfare state and the founding of the NHS in 1948. Unlike the NHS and benefits system, social care has never had its ‘creation moment’, she said.
Baroness Casey has called on the government to:
- Set up a new National Safeguarding Board chaired by the Chief Social Worker. Responsibilities will include reviewing Safeguarding Adult Reviews to identify national risks and commissioning thematic reviews. Early actions should include updating the criteria for what triggers an escalation of safeguarding concerns beyond the local level.
- Urgently review adult safeguarding statutory duties and powers to determine whether the existing framework provides sufficient clarity and leverage in high-risk situations. This may include clarifying what triggers section 42 inquiries.
- Appoint a full-time Dementia Tsar with national responsibility for driving forward prevention, treatment and dementia care.
- Create a fast-track ‘passport’ for people with Motor Neurone Disease (MND) so that anyone with a diagnosis of MND, which is a predictable and life-limiting condition, is not subject to repeated slow assessments and lengthy waits for support. For example, a passport might entitle someone with MND to prioritised care and support within a specified timeframe (e.g. 28 days) from diagnosis.
Read the Health Secretary’s response to the recommendations.
ADASS has also published a briefing on adult safeguarding that was developed to inform the Commission. It discusses the system pressures facing councils and sets out the reforms that ADASS believes are required to make sure every adult at risk of abuse or neglect gets the support they need.
The Commission is due to report back to the government in two phases. A first report will be submitted later this year, and the final report will be sent to the Prime Minister in 2028. The Commission has already hosted a series of evidence sessions with families, practitioners and sector organisations.
Baroness Casey will be launching a ‘national conversation’ with the broader public during 2026. She has stressed the need for an:
honest conversation [with the public about] what they want a National Health Service and a National Care Service to look like.
In the meantime, anyone – including practitioners – can submit their personal experiences or ideas for change directly to Baroness Casey’s team via the commission’s online portal.
The King’s Fund launches programme on social care reform
The King’s Fund has launched a programme of work on social care reform. It aims to bring together research evidence, public insight and sector leadership to help turn the consensus on the need for reform into ‘meaningful change’. As a first step, the think tank has published a report exploring public attitudes to social care. Not my priority: How the public sees social care highlights a fundamental challenge:
While the public deeply values care when it affects them personally, social care often struggles to compete for attention in national debate.
Mental health
Implementing the Mental Health Act 2025
The Mental Health Act 2025 aims to reform and modernise the Mental Health Act 1983 and received Royal Assent on 18 December. Some changes have come into force from February 2026, with most coming into law on later dates.
The Act is intended to strengthen the voice of patients, including their right to be involved in planning their own care, and to ensure that compulsory detention is only ever used when necessary and for no longer than necessary.
But while the Act introduces significant changes to the legislative framework for mental health care, the government expects full implementation to take up to ten years. This is because of the time needed to train the workforce and to ensure that sufficient community support is in place.
The British Association of Social Workers (BASW) has issued a short briefing setting out what the new legislation means for social workers. The NHS Confederation has also published a briefing focusing on the implications for health providers.
Changes include:
- The Act introduces a ‘serious harm’ test to clarify the level or risk that a person must present to be detained. Detention criteria will require that the person poses a risk of ‘serious harm’ either to themselves or someone else, and the assessor would also have to consider the likelihood that the harm would occur. Guidance on these tests will be included in the revised code of practice.
- Autism or a learning disability will no longer be grounds on their own for detention under the Act. Autistic people and those with a learning disability can only be detained if they have a co-occurring mental health condition that itself meets the legal criteria for detention.
- The Act reduces the initial detention period from six months to three months. Reviews must also take place more often: detention can be renewed for a further three months (down from six) and then for six months (down from 12 previously).
- The previous role of ‘nearest relative’ is to be replaced by a ‘nominated person’ chosen by the person themselves. The nominated person can be chosen by a patient at any time when they have capacity or competence to make the choice. The nominated person will have the same rights as nearest relatives have had, but they will also have the right to be consulted on care and treatment plans and to object to a community treatment order.
Speaking during the Bill’s third reading in the House of Lords last November, Mental Health Minister Baroness Merron said the government’s first priority is to draft and consult on a new code of practice. In drawing up the draft code, the government will work with people with lived experience and their families, as well as professional bodies, providers and commissioners. The code of practice will then be subject to a full public consultation later this year before final publication in 2027
Mental health, autism and ADHD: Review into trends and inequalities
In December, ministers announced the launch of a short review of prevalence, trends and inequalities associated with mental health, ADHD and autism. The review is being led by Professor Peter Fonagy and is due to report in the summer. Findings will inform development and implementation of the government's 10 Year Health Plan.
The review will investigate which factors may lie behind the increases in prevalence of mental health conditions, ADHD and autism. It will also look at inequalities in personal experience and access to support. The review will also consider the effectiveness of short versus long-term interventions, including to improve quality of life.
The review will address the needs of adults, children and young people, and the final report will include separate chapters relating to adults and children/young people. Recommendations will be aimed at central government and the health system, including related services such as social care. The review team has also been asked to take account of the findings of the independent ADHD Taskforce, which reported in November (see below).
The British Association of Social Workers (BASW) has welcomed publication of the final report of the ADHD Taskforce. The taskforce estimated the overall costs of failing to treat ADHD as £17 billion, including spending on benefits, health and social care services and lost tax revenues. According to the report, between three and four percent of adults in England have ADHD.
In an online article for the BASW, social worker Daisy Long, who herself has ADHD, highlights the need for social work to prioritise adult ADHD ‘which remains under-recognised and under-supported’. She calls on adult social workers to:
- Recognise ADHD in adults, in particular the crossover with mental health difficulties, substance use and housing instability.
- Advocate for workplace adjustments, access to benefits and community support tailored to the needs of adults.
- Challenge the myth that ADHD is something young people grow out of.
In light of the government’s legal duty to develop a new autism strategy from summer 2026, the House of Lords appointed a dedicated select committee last year to look at:
- How well the Autism Act 2009 has been working.
- How it might work better.
- What the current autism strategy has achieved.
The committee published its findings in November 2025. The report called on the government to expand mandatory training for public-facing staff, to reduce autism assessment waiting times and to incentivise services to provide integrated early support for Autistic people. But its main recommendation was that the government should work with Autistic people to develop a new autism strategy ready to launch in July 2026 when the current strategy expires.
When it appeared in January, the government's response was met with dismay by autism charities who labelled the response ‘unacceptable’. An alliance of autism charities accused the government of making only ‘vague commitments’ rather than act on the committee’s recommendations:
We see no evidence that the government intends to develop a new national autism strategy or do anything meaningful in compliance with the Autism Act or in response to the House of Lords inquiry.
Assisted dying
MPs urge Prime Minister to allow time to enact the ‘Assisted Dying Bill’ in the next parliamentary session
The Terminally Ill Adults (End of Life) Bill, often referred to informally as the Assisted Dying Bill, looks certain to not pass into law before the current parliamentary session ends in May.
Although the Bill was passed by the House of Commons last June, opponents of the Bill tabled more than 1,200 amendments when the bill reached its committee stage in the House of Lords in November. By late March, only around half of those amendments had been debated, with just two days remaining of the 14 allocated to consider the Bill in the current session.
The Bill, introduced as a private member’s bill by Kim Leadbetter MP, would allow terminally ill adults with fewer than six months to live apply for an assisted death. To be eligible for an assisted death, a person would have to have capacity (in accordance with the Mental Capacity Act 2005) to decide to end their own life. Social workers would have the right to opt out of any involvement in the process.
Unlike government bills, a private member’s bill cannot be carried over into the next parliamentary session. In March, more than 100 Labour MPs wrote to the Prime Minister urging him to ensure that time is made available in the next parliamentary session for the Bill to be re-introduced and the House of Commons given the opportunity to decide whether or not to enact the proposed legislation. A further 50 MPs from other parties are also thought to have written to the Prime Minister in support of the Bill.
Other developments
Neighbourhood Health Services
ADASS has published a policy statement on Neighbourhood Health Services, a cornerstone of the government's 10 Year Health Plan. The government’s vision is for multidisciplinary neighbourhood teams, including social workers, offering integrated care and support in local communities.
The ADASS statement describes the plans as an opportunity for a ‘paradigm shift’ in health services that can also help to ‘transform’ local government by enhancing service delivery and community empowerment:
By strengthening connections between statutory services and communities and addressing social determinants of health, we can create a more holistic and responsive system, paving the way for a healthier, more equitable future.
In March, the Department of Health and Social Care published a Neighbourhood Health Framework. This aims to support Integrated Care Boards, local authorities and their local partners in their early systems thinking on how to deliver on neighbourhood health.
Reflecting on Baroness Casey’s recommendations for government
The Casey Commission aims to reform adult social care in England, laying the groundwork for a National Care Service. Lisa Smith and Melika Malone-Lee reflect on Baroness Louise Casey's recommendations for government in a new blog.
Shaping the future of adult social care policy
Autumn has seen many potential reforms to adult social care policy with consultations, legislative developments, and strategic reports shaping the future of the sector. This update explores key changes and opportunities to influence policy and practice.
Poverty and working across the life course
April 2026 marks the lifting of the two-child limit – a major victory for those who fought for its removal. But poverty continues to affect people’s lives and more remains to be done to tackle it.