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Will a national care service fix our broken system?

Labour’s proposal might help bring some attention back to social care and the government’s failed reforms


Shadow Secretary of State for Health and Social Care, Wes Streeting, has said that Labour aims to launch a National Care Service (NCS) inspired by the creation of the NHS. The Fabian Society are to look at how the service would be funded and structured, with the aim of building the foundations of a NCS during Labour’s first term in parliament.

Despite promising to fix’ social care, the current government has done very little to reform it, while pressures continue to mount on the system and those who draw on support. The spotlight shone brightly on care during the pandemic but things quickly moved back to the way things were before with social care again almost invisible in public discourse. Labour’s alternative proposals might help bring some attention back to social care and the government’s failed reforms. But is a NCS the answer?

It’s worth noting that several people, organisations, and campaigns have called for a NCS over the years. Despite the common calling card, these proposals often offer entirely different visions of what social care should look like.

In our view, access to publicly funded social care, like the NHS, should be free at the point of need. If we pooled these risks at a societal level, spreading the costs of social care so that those with the broadest shoulders carry the most weight, we could guarantee access to social care in the same way that we guarantee access to healthcare. If this is what they mean by inspired by the NHS’, then we are off to a good start.

But national must not mean uniform or top down. Some have expressed concerns that the national’ in NCS implies that Labour might be looking to a standardised service run from Westminster, or a model in which social care is integrated into the NHS itself. The current social care system is already too standardised. Care, especially home care, is often based on the delivery of predefined tasks based on the basics of survival, such as getting washed and dressed. This is too restrictive and leaves little room for people’s autonomy to direct their own support. As Social Care Futures argue, using social care services at the moment can mean that things about our lives that we value are changed without our say, or lost altogether’.

As we set out in our recent report, co-published with the Women’s Budget Group, a core goal of social care reform should be to shift from a model that delivers minimal life and limb’ care, to one that supports people’s wellbeing and independence. This means help[ing] people to achieve the outcomes that matter to them in their life’, rather than a standard list of basic tasks. Achieving this requires services that have the flexibility to respond to people’s needs and aspirations and put those using services in control. Centralising care or placing it in the control of the NHS and its medical model is not likely to help. In our view, local authorities, working collaboratively with people needing support and providers that share their aims, are best placed to organise and deliver care of this kind.

But even in a situation where social care continues to reside with local government, there a number of areas in which more and better intervention from national government is needed. The first is in raising and distributing funding. The increasing reliance of local authorities on local sources of revenue over the past decade has disadvantaged deprived areas with a lower tax base and higher levels of need for publicly funded social care. Therefore, responsibility for funding social care should be transferred from local to central government.

The second is setting and enforcing standards. Local variation in the provision of social care should be a positive response to local priorities and local assets, not the result of inconsistencies in availability or quality. People needing support should be able to expect the same high standards of care, and social care workers should be able to expect the same high standards of working conditions, no matter where they live.

Labour’s proposals are not yet clear, and we will have to wait to hear the recommendations of the Fabian review before we know exactly what they mean by a NCS. If the national’ refers to central government supporting local delivery with funding and national standards, then count me in. We look forward to hearing more.

Image: iStock

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