First proposed by Gordon Brown in the final months of the last Labour government, a National Care Service has been a key policy during the party’s time in opposition. With an election next year looking likely, and with the party currently ahead in the polls, Labour’s shadow health cabinet, led by the shadow health secretary Wes Streeting, has been looking to pad out what a National Care Service under Labour would actually look like. The Fabian Society published its road map for such a service in June this year.
In November, a group of health and social care experts took part in a round table, organised by New Statesman Spotlight and sponsored by the health insurance company, Bupa. They discussed how a National Care Service might work and what it should include. The round table was chaired by Sarah Dawood, senior associate editor at Spotlight, and was conducted under Chatham House rules, meaning comments were on the record but have not been attributed to individuals or organisations.
All attendees were clear that fixing the crisis in social care should be a priority for any incoming Labour government. It was highlighted by one parliamentarian attendee that social care is often “demonised” as causing the backlog in NHS waiting lists as there are not enough care placements to go around for all those who need them. They explained that Labour should look to use a new National Care Service to “work very hard on the image of social care” and to educate and explain what exactly services are used for and how they can support the community into good health.
Of course, the question of funding the service was addressed by attendees. One industry expert said that if a National Care Service is to be viewed as on-par with the NHS, “it should be funded in the same way”. Another said the ongoing overall focus on the NHS needs to be changed, so that funding is adequately and evenly distributed across all health services.
They described the funding system as “broken” and explained that the way in which funding is allocated needs to be improved to give confidence to long-term providers. They pointed to the current funding formula for local authorities, which has not been updated since 2013, leaving some areas receiving less than their fair share despite seeing significant population growth over the past decade.
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For example, research from the Institute for Fiscal Studies points out that since 2013, the population of Tower Hamlets has grown by 21 per cent, while the population of Blackpool has shrunk by 2 per cent. One industry expert said: “Providers who are in it for the long term will not be able to maintain or survive in certain parts of the UK unless that funding formula is changed.”
All attendees were clear that a National Care Service should not simply give social care more money. Rather it should ensure a more appropriate distribution of funding for care services across the country, which responds to need.
Another attendee working in local government made clear that any future National Care Service must ensure all sectors are collaborating effectively on the delivery of care. They pointed out that currently, the NHS, integrated care systems, local government and central government are all involved in the delivery of health and care services. Currently, services are not sufficiently joined up, which can lead to a difficult user experience, or see some patients slip through the gaps. The attendee explained that collaboration is essential to a National Care Service so that patients receive proper wrap-around care. “We can’t miss any part of that,” they said.
The question of workforce was another keen discussion point during the round table. In 2022-23 the percentage of vacancies in the social care sector dropped from 10.6 per cent to 9.9 per cent but have remained above pre-pandemic levels. Current data from the industry workforce group Skills for Care data shows there are 152,000 vacant posts. A future Labour government would have to assess ways of bringing on board and retaining essential carers, especially given the new immigration restrictions announced this week, which could impact the number of overseas carers who come to the UK to work. Social care staff accounted for 57 per cent of health and care visas in 2022-23.
So far, Labour has said that those working in the sector will be the first to receive access to the party’s new fair-pay agreements, developed by the party’s deputy leader, Angela Rayner. These deals will look to bring together unions and employers to agree a minimum wage rate, and other policies which benefit their staff. One industry attendee who was involved in the introduction of the Agenda for Change pay scales in the NHS said they would like to see the same policy for social care.
“It isn’t just about the pay progression,” they said. “When we did Agenda for Change, we created a training and progression strategy alongside that.” They pointed to examples of some local authorities attempting to do something similar for their care workforce but said it can be “quite limiting” when it’s just within a single council.
They explained a National Care Service should include Agenda for Change style grading and progression and training benefits. “What we’re missing is a real, ambitious sit down with employers, unions and councils to say, right, how do we make this work?” they said.
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