Last year, the Labour Party re-confirmed their intention to implement a National Care Service (a 2010, 2017, and 2019 election manifesto commitment) should they succeed in winning the next general election (due to take place in the next year).
The announcement raised mixed feelings across a sector which has been subject to all manner of promises and proposals, many of which have failed to come to fruition – whilst those that were implemented have failed to deliver the meaningful, long-term impact that is required.
To capture these feelings, and explore how a National Care Service could work in England, Labour (with Unison funding) commissioned the Fabian Society to undertake an extensive consultation. The call for evidence opened in July 2022 and the final report has now been published.
The Fabian Society’s report, Support Guaranteed: The Roadmap to a National Care Service explores how England could move towards a National Care Service. It sets out the current social care landscape and the need for wholesale reform to an ailing sector after what it describes as ‘thirteen wasted years’ of Conservative government.
The report is extensive, having been based on evidence submitted by a broad range of individuals and organisations right across the sector. It defines ten basic principles needed at the heart of a National Care Service and includes 48 detailed proposals across a series of building blocks: the ‘roadmap’ to reform.
What does this mean for Labour and Social Care in England?
Firstly, it is worth noting that nothing is going to change overnight, even if Labour were to win the next general election.
Speaking at the launch of the report on Thursday morning, Wes Streeting, Shadow Secretary of State for Health and Social Care, set out very clearly that “this is advice, not policy… this is the beginning of a conversation, and we need to keep having that conversation with the people who use care and support.”
Furthermore, and as acknowledged in response to a question at the report’s launch event, should Labour choose to turn the roadmap’s advice into policy if elected, there would still be two to three years where the immediate priority was to stabilise the system, and begin co-production of further policies in the vision.
What’s more, the crucial question of how much this reform programme will cost – and how it might be paid for – goes unanswered. This is a deliberate omission and is acknowledged by the report’s writers as being beyond the remit of the consultation. They acknowledge that funds must be diverted to social care – potentially by re-balancing existing tax and spend commitments – but state that for too long, the thinking about how to improve social care has been linked directly to costs, revenue raising, and a focus on who should pay what, which has fundamentally presented a barrier to change.
Instead, the report argues, we should first examine how everybody can access the care and support they need. This is perhaps an understandable distinction to make for a report which puts the issue of easily accessible person-centred care as the absolute non-negotiable priority for any steps to reform.
Nonetheless, in a sector with a £6.1 billion funding gap (driven by care costs increasing £8.5 billion over the past decade while revenue increased only £2.4 billion) people will be forgiven for feeling disappointed that no costed plan to bridge this gap and improve the system has yet emerged. It is one thing to leave to the side how the money needed to deliver reform should be raised, but quite another to not even cost out a fundamentally transformative reform programme.
So, the extent to which the Labour party will adopt the report’s recommendations and vision for reform as part of their policy pledges remains to be seen and will almost certainly be largely hindered by practicalities of funding. Speaking at the report’s launch on Thursday morning, Wes Streeting did commit to producing a fully costed manifesto in which all social care pledges are “realistic about what we can deliver in our first term as a Labour government”.
Indeed, today’s report was perhaps so expansive in its scope – and therefore cost – that it has placed Labour in a difficult position. Having commissioned the report, it was notable that Streeting failed to concretely commit to any of its recommendations when speaking earlier today. The ‘arms length’ nature of Labour’s response was also manifested by Streeting physically leaving the event at the earliest opportunity, and before the Q&A. The lack of fanfare around the report’s launch, repeated assertions that this was not Labour policy, and the absence of any national political journalists could all point to Labour wanting to distance themselves from some of the hard truths the report has highlighted.
For now, we will have to wait and see how Labour thinking on this will evolve as we head to a general election, and how many of the report’s recommendations make it to the Labour manifesto.
Yet, despite Labour’s distance, the report and its recommendations make a strong case for their belief that funding (however necessary) is not a sufficient response if it doesn’t go hand-in-hand with system-wide change. By increasing accountability and policy-setting responsibility at national levels of government, the report argues an environment will be created where that funding is produced at the scale needed.
What could a National Care Service in England look like?
The report answers many of the questions that were raised when Labour announced its intentions for a National Care Service – including what a National Care Service should and should not seek to do:
· Workforce would be the priority, and a fair workforce settlement would be introduced immediately, with a national minimum wage for care and significant improvements to employment conditions within the sector.
· Notably, the report does not recommend that charging reform be addressed as a priority, given the multiple financial pressures facing the wider economy. Instead, it argues this should be looked at gradually in conjunction with other reforms, while implementing reform proposals already on the table including some of the charging reforms that were delayed in 2022.
· Equally, the NCS model would not result in an ‘NHS takeover’ of social care services, or be at odds with highly personalised local care.
· Introducing a consistent name and brand across the entire sector would create an institutional identity and this in turn will boost and sustain reform.
The report provides an encouraging understanding of the issues affecting the sector and meets these head on with a vision of how local authorities can be empowered to operate more flexibly with providers within a consistent framework of national standards setting. This approach would be underpinned by a National Care Service ‘constitution’ which outlines what individuals can expect wherever they live in England.
The vision for reform would have a significant impact on the way that local authorities interact with independent providers in their area. Though there is ‘no prospect of a quick transition from today’s landscape of mainly independent provision to public only delivery’, the recommendations would bring about ‘a fundamental shift to a different relationship between private and public care service delivery’.
In a practical sense, this would entail:
· Long-term public service ‘licences’ with robust standards and accountability relating to the quality of care, ethical workforce practices, and financial standards.
· Councils and providers would work together in the new system to innovate and raise standards, identify needs and plan future provision as well as boosting local workforce capacity and skills.
· Public provision of care services will gradually increase over the long term, but each local area will be tasked with finding the right balance between private and public delivery.
What is striking from the language and principles throughout the report and its recommendations is the close adherence to values and person-centred approaches, and commitment to co-design and co-production. It was known that the Labour Party were working closely with the change movement Social Care Future, and their vision is clear throughout – including in the fundamental definition of what social care should do (“we all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing things that matter to us”). This comes closer to reflecting much of the ‘on the ground’ sentiment than any policy recommendations seen in a long time.
A lot still remains to be seen as to the impact the Fabian Society report will have – but many of the principles and recommendations in the report could realistically be adopted by any Government seeking to reform social care.
If Labour do win the next election, that will be the starting point of what they choose to do with the recommendations in the Fabian Society’s report, which begin with a recommendation for further consultation and co-design. However, in commissioning such a report and aligning so closely with a vision of whole-system reform and Social Care Futures rhetoric, Labour have certainly built a platform of accountability to deliver where others have failed. The question now is, will that accountability will come back to bite them?