News / National care service in England would require 10 years of investment

The report from left-leaning think tank the Fabian Society - Support guaranteed: the roadmap to a national care service – was requested by shadow health secretary Wes Streeting and commissioned by trade union Unison. It said that care and support in England had gone downhill fast since 2010, when the then outgoing Labour government first proposed a national care service. Spending had ‘fallen hugely’ compared to levels of need, with poorer communities bearing the brunt.

Funding cuts also meant that councils were often not paying enough to secure safe and sustainable care and there was limited investment in new facilities. And poor pay and conditions for staff had contributed to a recruitment and retention crisis. The report said that without action, things would get even worse as the number of people in late old age and with complex lifelong disabilities increases.

With projections suggesting the care workforce will need to increase by more than half and the number of care home places by a quarter, ‘billions of pounds of extra money will be needed just to replicate today’s level of provision’, the report said. It identified 10 core building blocks on which to establish a new national care service, ranging from improving working conditions for staff, expanding access and providing sufficient long-term funding.

Money will be key to the changes, with ‘year one stabilisation spending’ needed to start to tackle the current workforce crisis and ensure service continuity. But this would need to be accompanied by a 10-year spending commitment to significantly raise expenditure in real terms every year.

The society stopped short of quantifying the funds needed, but said that independent advice should be commissioned. And it added that the amount would need to be sufficient to respond to rising demand, provide more consistent access to care, and achieve sustainable workforce pay and provider viability. It should also cover any new policies adopted as part of reforms, including charging changes and cost caps, and the alignment of pay and conditions across social care and the NHS.

Natasha Curry (pictured), deputy director of policy at the Nuffield Trust, said the proposals were a ‘welcome nod towards phased and realistic comprehensive reform’, rather than the short-term tinkering the sector usually experienced. But she called for realism over the funding needed for real reform.

‘Funding and workforce are pressing priorities within this blueprint, which if adopted by Labour would require a serious plan for how these needed changes are funded,’ she said. ‘While the report suggests moving away from a reliance on local taxes, it does little to set out a firm alternative.’

She added that proposals to address pay and conditions ‘present a potential starting point to help keep valuable care professionals’, but stressed that realism about the difficulties and complexities in implementing and enforcing them was needed.

Chris Tallack, director of data analytics at the Health Foundation, also warned that reform would not be cheap and would require real political will. ‘No amount of reform will avoid the need for additional investment in social care to recover services and expand the system,’ he said. ‘In 2021, we estimated that the social care system would need at least an additional £6bn per year by 2030/31 to keep pace with the growing demand for care – with cost pressures likely to have grown. If it chooses to, the next government can afford to provide fairer and more generous care and support for vulnerable people in society.'