Care Cannot Be a Commodity

The central argument

Britain should not pre-empt the Casey Commission’s final recommendations. But neither should it suspend action while people with learning disabilities continue to experience fragmented healthcare, weak accountability and care markets in which public money can be extracted without transparent evidence of public value.

We should wait for the report but not for permission to care better

The Commission must be allowed to gather evidence, test competing proposals and reach independent conclusions. This paper does not claim to speak for the Commission or presume its recommendations.

Waiting for the report cannot mean withholding professional judgment. Frontline nurses, care workers, people with learning disabilities and families already know where many daily fractures lie: information that does not travel, reasonable adjustments treated as optional, staffing instability and responsibility passed between institutions.

What the present crisis reveals

The test of the system is the life experienced by the person—not whether a placement remains open or a rota is technically filled.

• Fragmentation has become normalised across health, care, housing and commissioning.
• Reasonable adjustment is still treated as an exception rather than a safeguard.
• The workforce is asked to carry risk without enough stability, supervision or specialist development.
• Regulation can become episodic while harm and warning signs are continuous.

Profit provision and the public interest

Independent provision is deeply embedded in adult social care, and many responsible providers reinvest, innovate and deliver compassionate support. But publicly funded care must carry a public-interest obligation.

The question is not simply whether profit exists. It is whether financial return is demonstrably compatible with care quality, workforce stability, resilience and value for the taxpayer.

A reform compact for learning disability care

The paper proposes ten practical reforms for a more accountable system.

• A named accountable leader for every person’s care.
• A statutory right to supported communication and trusted involvement.
• A national care passport that works across settings.
• Commissioning for outcomes rather than occupied beds or completed hours.
• Full financial transparency for publicly funded providers.
• A public-interest test for ownership and major transactions.
• Continuous assurance rather than inspection by snapshot.
• A professionalised and retained workforce.
• Board-level accountability for mortality and avoidable harm.
• Reform and measurement co-produced with people and families.

The standard must be dignity with proof

The country can listen to the Commission and act at the same time. Compassion without governance is not enough, and growth without stewardship is not success. Providers must evidence their values through staffing, finances, leadership and outcomes.

Mary Ajewole writes in a personal professional capacity as a frontline nurse and founder and Chief Executive of Rhymacare. Rhymacare is a specialist community healthcare company in development and has not yet commenced regulated care services.