On Thursday 8 June 2023, the Fabian Society released its roadmap to a National Care Service (NCS).
The report was commissioned by UNISON following a request by the Shadow Health and Social Care Secretary, Wes Streeting MP, asking the Fabian Society to look at how to establish and develop a NCS over the course of a decade.
The proposal they came up with is guided by 10 principles:
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Choice and Control for individuals and their families
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Local and place-based
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Nationally consistent
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Accessible
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For everyone
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Preventative
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Relationship-based
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Rights-based
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High quality and diverse
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Connected.
There would be a national care guarantee, codified in a new National Care Service ‘constitution’, backed by legislation; greater ministerial responsibility over social care; a national service that commissions providers to deliver against a framework; and greater structure around the care workforce (mirroring although not identical to structures in the NHS).
The ten ‘building blocks’ of the proposed NCS are below, of particular interest to members will be the proposals for providers and on affordability:
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Structure and Identity – clearly established nationally, regionally and locally.
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Workforce – properly funded, with career development and professional registration for the adult social care workforce
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Co-production – nationally and locally embedded, with a new co-production duty for ministers and an independent scrutiny, evidence and engagement body led by people who require support and carers
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Rights – protected in the National Care Service ‘constitution’ and potentially codified in law
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Unpaid carers - a National Care Service carers strategy would promote carers’ existing rights, introduce a right to short breaks and require local authorities to discuss carers’ wishes when a family member’s support and care is being planned
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Access – improve early access, prevention and integrated arrangements between the NHS and local authorities on hospital discharges.
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Models of support – including greater take-up and use of direct payments by increasing flexibility in using budgets and providing peer-led support, introducing a new planning use class of ‘housing with care’ and requiring adult care and improving use of data and technology.
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Providers – a stronger public service relationship with ‘licensed’ independent providers with stable contracts, national employment conditions and joint branding. Promotion of public sector and non-profit providers giving local authorities greater flexibility to choose the right mix of providers for their areas. Stronger collaboration between providers and councils on service planning, quality, costs and workforce. Implementation of the standardised pricing of services, building on the current government’s Fair Cost of Care initiative; and strengthening the financial supervision of providers with expanded national regulation for large providers and light-touch local authority oversight for small providers.
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Affordability – The report does not make any concrete funding proposals but offers a number of options focused on charging reforms. These include making short-term care free or uprating means-testing thresholds; implementing the delayed 2022 charging reforms if they have been confirmed by the existing government; free support for people disabled before adulthood; a reformed means-test; a universal contribution or the ‘Dilnot’ cap on lifetime costs.
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Money - Prioritise ‘year one’ stabilisation spending with the aim of tackling the workforce crisis alongside a commitment to a 10-year spending plan and national funding formula.
VODG Commentary
There is much in the report to welcome - particularly greater promotion of people’s right to choose where they live, work with DPOs, greater focus on direct payment, protections for carers and recognition of the workforce – but we would urge any future government considering their social care plans to be even more ambitious.
There are huge opportunities for co-creation, co-production and co-commissioning of services with the people who use them, their families and with the voluntary sector, that would revolutionise the system into one that was person, rather than government or systems led.
The proposals largely reinforce current system arrangements and feel very local government led. This could potentially bring further tension to an already challenged market, especially if councils deliver more services, as well as commission them, as is inferred. It also misses an opportunity to fully embrace co-design and delivery.
There are some suggestions of ways proposals might be funded, but the report intentionally lacks a fully costed plan, leaving that instead to politicians.
As the Fabian Society were keen to emphasise, the report makes proposals, it is not formally Labour Party Policy, but it gives further insight into how social care commissioning and delivery may change if there were a change of government.