NHS has ‘hollowed out’ community care, says government adviser

The NHS has “hollowed out” community and primary care and become a “national hospital service”, according to the influential lead of a government review of social care.

Baroness Louise Casey, who is chairing an independent commission on reforming social care reporting to the prime minister, made her comments during a speech at the Nuffield Trust’s annual summit today. 

During her address she also criticised integrated care boards for paying private firms “to find ways to cut how they pay out Continuing Healthcare budgets” and allowing them to take a profit if they were successful. She said this was “quite astonishing”.

The respected Whitehall trouble-shooter warned ministers she would be “watching” them to make sure Continuing Healthcare funding was not “sucked up into the world of acute hospitals”.

She said: “It is my belief that we really have a national hospital service, not a national health service, and that may feel tough and may feel unfair, but that’s what it looks like to me…

“As the NHS has evolved, it has withdrawn from the community, reducing the number of beds they offer other than for acute or specialised care, putting many more staff into hospitals whilst hollowing out the staff numbers in community and primary care provision.”

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Source: HSJ, 5 March 2026