Labour-commissioned report sets out plans for National Care Service

The Fabian Society has published proposals on how to deliver Labour’s ambition to create a National Care Service in England.

The report sets out how a care service could work, including a variety of options around care charging. However, the authors rejected plans for free personal care, the main adult care proposal in Labour’s 2019 election manifesto.

Despite being commissioned by Labour and trade union Unison, the report also constitutes independent advice rather than a statement of labour policy. 

Among the key proposals are better terms and conditions for care workers, a universal non-means-tested service, and a right to independent living.

Speaking at the report’s launch, Labour’s shadow Health Secretary Wes Streeting said: ‘People who receive and deliver care have been let down time and again by broken Tory promises.’

He added that the adult care workforce crisis had to be addressed first, with 165,000 current vacancies.

The Fabian Society warned that simply pumping in more money would not be enough to address the crisis in adult care, arguing the service needed comprehensive reform not just extra spending.

In addition, the report accepted the need for an immediate injection of funding immediately after the formation of a Labour government in order to ‘stabilise’ the adult care system. This would be aimed at improving staff pay to reduce vacancies, and reducing the handing back of care packages by providers.

However, the report’s main proposals would be phased in over ten years, with the National Care Service itself not launched until 2028. Co-author Andrew Harrop, General Secretary of the Fabian Society, said this was because the crisis-hit system could not absorb huge investment all at once and had to be built over time.

But the phasing of investment means many of the current problems in the adult care system could last for years into a Labour government.

‘There is a reality that there won’t be the sort of money that the sector needs quickly in the first one or two years of a new government,’ Harrop told Social Care Today. He said that the pace of the plans would depend on the state of the economy and public spending.

The report makes 48 recommendations, including:

1. Support will be available to everyone, regardless of their means, and at an earlier stage as their care and support needs develop. Disabled people and unpaid carers will be automatically referred to the service.
2. Citizens’ rights will be spelled out in a co-produced National Care Service constitution and people will have control and choice over the support they get. Disabled and older people will have a new right to choose where they live and to take part in society. Unpaid carers will be asked how much they wish to care and will have a new right to short breaks. A formal appeal process will be introduced.
3. The National Care Service will offer end-to-end support under a shared brand delivered together by national government, local councils and licensed care providers. Independent providers will be fairly funded but expected to operate as part of a public service with new standards on care quality, workforce and financial conduct.
4. A sector-wide Fair Pay Agreement will be negotiated including a sector minimum wage and minimum employment conditions. People employed by contracted National Care Service providers will have national pay bands and employment terms designed to achieve parity over time with similar roles in the NHS.
5. Support should become more affordable over time as services start to improve. Incoming ministers should match any government funding reforms announced before the next election. As they develop the new service, they should also consider other options, like making support free for people with lifelong disabilities.

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