The Week

The Week 9 June 2023

Sebastian Rees
Senior Researcher

In 2009, the Labour party first floated the idea of a National Care Service (NCS) on “par with the NHS” and it has reared its head periodically ever since. In 2022, the Shadow Health Secretary committed Labour to launching an NCS and requested a report to set out in detail what a Service should look like and how it could be implemented. After a year long consultation, the Fabians (Labour’s commissioned author) set out their proposals this week. The report therefore gives us a critical insight into where Labour might take the NCS idea if they form the next government.

Reform’s judgement? We’re not convinced. It’s not that this report is devoid of good ideas. Though we’re strong believers in the idea that social care should be designed and delivered locally, some of the (centralising) proposals here mark moves in the right direction. Improving and systematising data collection, developing a comprehensive approach to pay through a sector minimum wage and enhancing training and continuing professional development opportunities for care workers are sensible reforms.

And thankfully, the report stops short of recommending a single national care provider (on NHS lines), noting that “a successful NCS is likely to be a network of thousands of different providers” and recognising that “diversity, experimentation, and personal control” must be at the core of care provision.

The big problem for this report is not its content, but what it misses. It’s great that the social care debate has begun to focus more on the delivery of excellent care rather than just on how to financially rescue a (broken) system. But we can’t lose sight of the money problem altogether. Social care does need more money and the report argues for a “10-year spending commitment to significantly raise expenditure in real terms every year”. But a genuine plan for reform can’t dodge the question of how “significant” the spending commitment needs to be. Omissions of any detail on costings look all the more glaring given the report’s desire to reduce reliance on local taxation for social care and move to a far more national funding model.

The second problem that this report ducks is the question of entitlement. According to the Fabians, reform should centre on a national guarantee to provide accessible, consistent care “for everyone with support needs, regardless of their means, and affordable to all”. That, of course, raises tricky financial questions on where the state’s and individuals’ responsibilities start and end — are there certain forms of care that the state should fund entirely, should care costs be capped, should the assets means test to access care be reformed? The report recommends that a future government should “take immediate steps on charging reform” but gives no indication of what these might be (just a list of potential options). A failure to seriously grapple with ‘who gets what’ questions undermines any notion of a national care guarantee.

There is a lot more detail in this report and its proposals merit serious consideration. But without an answer to the two issues that have long undermined reform efforts — how much will it cost and how should it be paid for — these proposals can’t stand alone as a roadmap for transformation.

On to our read of the week…

This week the Public Accounts Committee released its annual report — recapping consistent challenges identified by the Committee in its first full year since the end of the pandemic. Many will be familiar to regular readers of The Week, including the disconnect between policymakers and commissioners, and those who deliver services; specific skills deficits in Whitehall in areas like digital and project management; and a failure to effectively manage risk (from procurement blunders, to more high-profile incidents of fraud).

The report goes on to raise the alarm bell about four specific departments: the Ministry of Defence, the Department of Health and Social Care, Department for Levelling Up, Housing and Communities, and the former Department for Business, Energy and Industrial Strategy. Each of these needs to get its house in order — of particular interest to us is the DHSC, where we’re told a “perfect storm” has been brewing over its management of public money. But to really secure greater accountability and effectiveness in public spending will require a genuine cross-departmental effort. Watch this space for Reform work in this area.