Fabian Society sets out roadmap for creation of a National Care Service to help transform care and support in England

New report also sets out proposals for charging reforms, including changes to the means test and a lifetime cap on care costs, as part of a new ‘national care guarantee’

A roadmap for the creation of a National Care Service to help transform care and support in England has been set out today in a new report from the Fabian Society.

In Support guaranteed: the roadmap to a National Care Service – commissioned for UNISON and the Labour party – the Fabian Society says –

'Plans for a National Care Service were first presented 13 years ago in the dying days of the last Labour government. Since then no detailed work has taken place to flesh out what the service might look like or how it should be implemented. That is the purpose of this report.

Since 2010 adult social care has gone downhill fast: spending has fallen hugely when compared to levels of need and access to care has been unfairly rationed, with people not receiving the services they are entitled to.

But extra spending is not enough to solve these problems. Money must come with reform. This report sets out the principles which should underpin the National Care Service and the building blocks which should be used to bring it to life.'

Centred on a new 'national care guarantee', the report says that a series of building blocks would bring the guarantee to life – including in relation to the structure and identity of the new service, workforce issues, the involvement of those with lived experience, the needs of unpaid carers, and how the new system might be funded – some of which will require legislation to revise and expand on the Care Act 2014 (with consultation with devolved governments on aspects that could best be delivered on a four nations basis).

In addition, the report suggests the need for immediate action on charging reform – for example by making short-term care free, uprating means-testing thresholds, and changes to the disabled facilities grant means-test – with further reforms to coincide with the National Care Service launch date as part of the new national care guarantee, including –

  • expanding the scope of free support, for example for people who have disabilities acquired at birth or early in life;
  • a lifetime cap on care costs, with payments towards the cap including both local authority and personal contributions as provided for in the Care Act – ie the version of the policy cancelled in 2015, as opposed to the government’s 2022 version of the reform where only private payments were to count which meant that people with assets just over the cap could eventually pay almost their entire wealth in care fees;
  • reform of the assets means test (also delayed since 2015) with support available to people with assets of up to £100,000, excluding the value of their home when they or their partner live there;
  • reform of the income means test, for example by exempting disability benefits from home care charges (replacing complex rules exempting ‘disability-related costs’), and increasing the ‘minimum income guarantee’ (especially for people aged under 65) and the ‘personal expenses allowance’;
  • providing a modest universal contribution to everyone’s care costs – of £25 to £50  a week, a percentage contribution to the cost, or a weekly charge cap as with home care in Wales – which would bind former self-funders into the new public system and create a financial incentive that would induce take-up among people currently not receiving any support; and
  • free support for people with very significant support and clinical needs by in effect relaxing the conditions for NHS continuing care.

NB – the report says however that it does not support the introduction of free ‘personal care’ –

'Making a distinction between meeting ‘personal care’ needs and needs relating to wellbeing and social inclusion contradicts the direction of adult social care policy for well over a decade including the Care Act 2014. In fact, experience in Scottish care homes suggests that ‘free personal care’ ends up being an arbitrary financial contribution that may well be insufficient to meet even personal care needs. We think it would be more straightforward to offer a defined government contribution towards meeting any care and support need in order to maximise people’s control and choice.'

In response to the report – that makes clear that it does not reflect the policy views of either Unison or the Labour party – Shadow Secretary of State for Health and Social Care Wes Streeting said today

'This is an important contribution to the debate about the future of social care. We will look carefully at the recommendations as part of our policy-making process but we will only make commitments in our manifesto that are fully costed and fully funded.'

For more information, see A National Care Service for all from the Fabian Society website.