Balancing Short-Term Crises with a ‘Fit for the Future’ Vision: Could Keir Starmer Succeed in Social Care Reform Where Others Have Failed?

As the Labour party begins to crystalise its core policies in anticipation of a general election next year, a clearer picture is emerging of the party’s plans for a national care service. At an ambulance station in Essex last week, Sir Keir Starmer set out the third chapter of his vision for Britain, this time outlining the path to an NHS ‘fit for the future’. Given its prominence in the Labour party’s flagship missions for government, many are reassured that health and social care reform has been afforded a central position in Labour’s bid for power. The party’s commitment to a bold programme of transformation in the sector to achieve sustainability is welcomed, but the evergreen questions of funding and logistics remain largely unanswered.

At the centre of Starmer’s vision for social care is a characteristically pragmatic commitment to long-term reform. This approach is a welcome change to the sector, which has suffered from a long legacy of unequal local funding allocations and stalled attempts at reform with each change of government. In line with the Labour Party’s central campaign to ‘make Britain work for working people’, Starmer stressed that ‘a fair deal for our carers’ is at the heart of his party’s vision for sector reform. Labour’s commitment to ‘better standards at work, more progression, more training, more rights, and […] pay’ reiterates the party’s recent pledge to deliver improved working conditions and national outcomes via a national care service.

Starmer’s promise to ‘provide joined up care in the community’ has also been positively received as a reiteration of Labour’s 10-year plan ‘to shift the focus of healthcare out of the hospital and into the community’. His championing of multi-disciplinary teams to ‘bring fragmented services together’ indicates Labour’s appetite to advance the ongoing integration of health and social care. This willingness to work within, and build upon, the existing ICS framework is a relief to sector specialists who, suffering from ‘change fatigue’ feared further major structural reforms with the instalment of a new opposition government.

However, whilst Starmer has been broadly praised for his pledge to end the ‘sticking plaster crisis management’ approach to health and care, key questions remain surrounding his solutions to the immediate crises. Spokespeople across the sector have raised concerns over the party’s omission of plans to boost local authority funding budgets, which are urgently required to improve access to publicly funded social care. The Nuffield Trust has estimated that less than half of older people with care needs are currently receiving support, with nearly one third of requests for local government funding denied care. These unmet needs are exacerbating pressures on an estimated 10.6 million unpaid carers across the UK, as well on the NHS services that treat the consequences of unaddressed and escalating care needs.

Starmer also evaded questions of how the party would fund its extensive reforms in the longer term. Although he stressed that ‘money is of course part of the answer’, Starmer cautioned that the exact shape of Labour’s strategy would be dictated by the public finances that his government inherits. As such, Starmer’s promised breakdown of the party’s spending plans will be keenly anticipated by providers and the public alike ahead of the election next year. Chris Thomas, head of the IPPR Commission on Health and Prosperity, summarised this attitude with his urges for Labour to outline ‘a plan for investment alongside these bold reforms to help make such an aspirational target believable’. Likewise, Chief Executive of the NHS Confederation, Matthew Taylor, warned that ‘money is a hugely significant barrier to improvement and we need to see specifics on what a boost to funding would look like’.

Overall, Starmer’s public health and social care pledges have given hope to many that an elected Labour government would deliver the vision and stability urgently required to transform social care services. Before then however, greater clarity on Starmer’s short term solutions and detailed funding model will be crucial in demonstrating that his ‘clear, measurable goals’ are more than aspirational rhetoric alone.

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