The National Care Service Report

Written by David Brindle – Healthcomms Advisor and Former Guardian Social Affairs Editor 

He didn’t exactly outstay his welcome. At the much-anticipated launch of a blueprint for Labour’s planned national care service, shadow health and social care secretary Wes Streeting stayed barely 45 minutes, reading his contribution carefully from a script and taking just one question. He apologised for leaving early but didn’t say why.

To say that his contribution was measured would be an overstatement. “There will be no well-meaning wishful thinking before the election only to see promises broken by contact with the hard realities of government,” he said. “That would only add insult to injury.”

Some in the audience felt short-changed, their disappointment fuelling suspicions that Streeting sees no votes in social care and is focused almost exclusively on the NHS. But others understood his reticence, knowing that the Conservatives are seeking any hint of unfunded spending promises on Labour’s part and that the longer he remained on the platform, the greater the risk of a loose word or even of a vaguely encouraging response to a question about money.

There’s history, too: in 2010, Labour’s general election defeat was ascribed at least in part to a bitter row over its so-called “death tax” plan to finance social care; in 2017, the tables were turned when the Tories’ loss of their overall majority was put down to confusion over what was branded their “dementia tax”. You can see why Wes was wary.

Nevertheless, it’s a sad reflection on the state of our politics that debate on one of the most pressing issues of the day has to be suppressed in this way, especially as the blueprint in question – Support Guaranteed: the roadmap to a National Care Service – has much merit and is arguably the most comprehensive and practical plan for social care reform in 25 years of assorted efforts.

The 64-page report was commissioned by Labour from the Fabian Society thinktank and funded by the Unison trade union. It has been written by Andrew Harrop, the society’s general secretary, and Ben Cooper, a senior researcher who himself lives with a disability. There is clear and welcome input from people who draw on care and support.

Much of the report’s thrust is to dispel fears: that a national care service would be part of, or a highly centralised equivalent of, the NHS; that there would be early and disruptive reform of charging arrangements; and that there would be no place for for-profit care providers. None of these would apply.

Instead, there would be measured movement to a still localised system under a national brand over a period described by Cooper as “at least 10 years”, with priority given to establishing consistency of services across England and to improving pay, conditions and career paths for care workers.

Provision of care and support would remain a mixed economy, but providers would need to be “licensed” by demonstrating ethical values and transparent tax arrangements, and there would be a growing role for non-profit operators. In return, all providers would be guaranteed greater stability of contract income.

One especially welcome theme is the importance of social care to the economy. This is rarely recognised but, as the report points out, social care already accounts for one in every 20 jobs and every additional £1bn invested in it creates an estimated 50,000 jobs. What’s more, these are typically roles that appeal to women and care workers’ wages are spent overwhelmingly in the local communities where they live.

So far, so good. But while there are as many as 48 recommendations in the report, there remain some glaring gaps. There are no price tags attached – Harrop said at the launch that this was outside the Fabians’ brief but that in any case the cost would be relatively small in the context of overall government spending – and the thorny issue of regulation of care workers (opposed by many disabled people who employ their own personal assistants) is ducked. Whether there should be compulsory professional registration should go to open consultation, the report says.

The idea of a cap on personal liability for care costs, as recommended by the Dilnot Commission in 2011 and delayed ever since, is given as only one of a number of options for funding reform to coincide with launch of a National Care Service in perhaps 2028, the 80th birthday of the NHS. With Prime Minister Rishi Sunak studiously avoiding any commitment on a new date for the cap, observers increasingly sense that as a policy it is dead.

Asked after Streeting’s early exit from the launch event if he thought social care could expect the sort of funding boost from Labour that most experts say is needed – something like £7bn extra a year – Harrop was frank. “There won’t be the sort of money that the sector needs in the first one or two years of a Labour government,” he said. “It may not be great in year one and two, but there should be a direction of travel.”

After more than two decades of policy drift for social care, a direction of travel would of itself be a win.

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