England’s adult social care system has no single point of overall responsibility, research commissioned for Baroness Louise Casey’s review has found, as she prepares to accuse successive governments of being “asleep at the wheel”.

Casey is expected to call for “a new settlement for care” at the National Children and Adult Services Conference in Liverpool on Wednesday. Her warning links fragmented oversight to the pandemic failures that left vulnerable residents inadequately protected and many dying without loved ones beside them.

The research, conducted by the Nuffield Trust and the Institute for Government, describes responsibilities scattered across Whitehall departments, arm’s-length bodies, councils and non-public providers. Decision-making can be opaque, it finds; despite some improvements prompted by Covid-19, the system remains “fundamentally fragmented” and lacks coherent direction.

That diagnosis goes beyond funding. More than 1.5 million staff work across about 19,000 employers, yet England alone among the UK’s four nations has no mandatory register of care workers. Private providers dominate through a pattern the report says developed in a largely uncontrolled and unintended way.

For people needing care, weak transparency has a direct financial dimension. Those paying privately are charged, on average, 40% more for the same service than those whose care is arranged by councils. Unlike NHS treatment, social care is not free at the point of use. People with savings above £23,250 receive no council help with care costs, and some must sell their homes.

Last month, the UK Covid-19 Inquiry found that social care had been “an afterthought”. It rejected as “unfounded” then-health secretary Matt Hancock’s May 2020 claim of a protective ring around care homes. Inquiry chairwoman Baroness Heather Hallett said: “Quite the opposite was true.”

The inquiry found that hospital patients were discharged without their infection status being known, while protecting the NHS sometimes came at care users’ and providers’ expense. Visiting bans left some homes “becoming prisons” and residents feeling abandoned. Casey is expected to call these failures “a national shame”; she has written to Hallett backing swift action on the recommendations.

Nuffield Trust co-author Natasha Curry described confused governance. Institute for Government associate director Stuart Hoddinott blamed haphazard development compounded by decades of governments avoiding politically unpalatable decisions.

The report calls for political courage to create a national care service and maintain the momentum Prime Minister Andy Burnham has generated by accelerating Casey’s commission. Burnham has acknowledged difficult tax decisions may be necessary, while arguing reform could save the NHS billions of pounds annually. Those savings remain a claim, not a demonstrated result. Casey’s reform recommendations are due by next summer.