A National Care Service,  for everyone

Ben Cooper, Senior Researcher at the Fabian Society

In 2009, the idea of a National Care Service was born. Since those dying days of the last Labour government, the party has repeatedly re-committed to the idea.

Yet since 2010, there has been little coherent thinking on how to deliver a National Care Service in England – or what it should offer the 10 million people directly involved in the adult social care system. With the publication of Support Guaranteed by the Fabian Society, we now have the first comprehensive and independent plan for a National Care Service.

Much has changed in adult social care since Labour was last in office 13 years ago. A severe funding squeeze has left many people going without any support, or receiving assistance that is inadequate to meet their aspirations for life.

This has hit coastal and rural communities hard because they have an older than average population, and sparsity means the cost of providing support is much higher – especially in people’s own homes. The County Council Network found a long-term reduction in social care provision in rural areas, with county councils witnessing 272 care home closures since 2020. Family members have been forced to pick up the pieces, often at significant personal cost.

Frontline social care workers also struggle with low pay and unfair working conditions, resulting in a severe recruitment and retention crisis – which the then-Chief Medical Officer in 2021 identified was particularly acute in coastal areas. No matter where we live this social care emergency means that we all lack the security of knowing support and care will be available when we or our family need it.

Many voters want to see adult social care fixed. Fabian Society-YouGov polling conducted last year found 24 per cent of respondents in rural England, and 20 per cent in English and Welsh coastal towns, considered improving social care services as one of their top three priorities for the next Labour government. For both rural England and coastal towns, improving social care was the third most popular policy choice offered – below only improving NHS services and investing in renewable energy (although for coastal towns, social care was joint third with reducing crime and increasing police numbers). 

Delivering on the public’s desire to tackle the social care emergency requires policymakers to face up to reality. We currently spend £20bn a year on a social care system that does not work for anyone, not least in rural and coastal communities. More funding will be needed, but just pouring more money into a broken system is not the solution. If any area of public policy needs an end to ‘sticking plaster’ politics, it is adult social care.

That is why a National Care Service is essential. It will be a fundamental change in how we deliver adult social care, with a guarantee of service at its heart. Support and care will be provided to any adult who needs assistance, because of their health needs or disability, to live independently and well. The National Care Service will help people live where they choose, in the place they call home, with the people they love, doing the things they want, in the communities that matter to them.

No longer will people be forced to rely on their health and wellbeing reaching a crisis point before support is provided. Nor will the level of support and care received be dependent upon where a person lives. Support will be seamlessly integrated with housing, the NHS, DWP and other community provision whenever necessary. The current postcode lottery in adult social care that hurts people living in coastal and rural communities will come to an end. Everyone will have peace of mind, security and confidence for the future knowing that the National Care Service will be there if they need it. 

Yet there can be no National Care Service unless we support those who work in the sector. Exploitative and unfair employment practices must come to an end quickly – with higher pay and fairer terms and conditions. By working with unions and employers, the next Labour government should ensure that the social care workforce is adequately rewarded, recognised publicly, and empowered to deliver high-quality support for everyone. And because social care is such a large employer in coastal and rural communities, improving pay and conditions will benefit coast and countryside. 

Every one of us will have a role to play in the new service, as it is delivered through thousands of partnerships at national, community, and street level. Decisions will be made at the most local level possible because, as rural and coastal communities know, decisions made in Whitehall alone often do not reflect the reality on the ground. Seamless support requires local decision making because communities are best placed to understand how different services should be integrated, rather than centrally in Whitehall. Individuals requiring support should have the greatest say and choice in how social care is delivered because what support looks like for an older person in an isolated coastal village will be different to support for a working-aged disabled person in London. A top-down system would struggle to enable support to fit around what people want and need to live a good life.  Good care goes hand in hand with effective devolution to all parts of the country.

 A National Care Service cannot be implemented overnight. The financial and economic challenges that will be inherited by the next Labour government are too great.  And ‘big-bang’ reform, done on the quick and on the cheap, will hurt the hundreds of thousands of disabled and older people that social care should support.

But a failure to act at all would also hurt disabled and older people, their families, and those working in social care. That is why the Fabians have set out this roadmap to a National Care Service, which might take 10 or more years to complete. We will need steady, purposeful and relentless reform over a decade to deliver the change that is needed in adult social care. In doing so, Labour can improve the lives of thousands of people in rural and coastal communities across England.

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