National Care Service
{{Short description|Proposed publicly-funded social care system in the United Kingdom}}
{{Use dmy dates|date=April 2022}}{{Use British English|date=June 2022}}
{{Gordon Brown sidebar}}
The National Care Service (NCS) is a proposed publicly funded system of social care in the United Kingdom which was partially introduced by the Labour government of Gordon Brown in 2010 but abandoned soon after when the coalition government of David Cameron and Nick Clegg came to power in May 2010. Similar to the National Health Service, it would be free at the point of need and paid for through taxation.{{Cite web |last=Whittome |first=Nadia |author-link=Nadia Whittome |date=2022-06-15 |title=We desperately need an alternative to the orthodox economic consensus |url=https://labourlist.org/2022/06/we-desperately-need-an-alternative-to-the-orthodox-economic-consensus/ |access-date=2022-06-15 |website=LabourList |language=en-GB}}{{Cite web |last=Buchan |first=Lizzy |date=2019-09-22 |title=Labour promises free personal care for older people in bid to end 'national scandal' |url=https://www.independent.co.uk/news/uk/politics/labour-free-care-older-generation-mcdonnell-jeremy-corbyn-conference-2019-a9115886.html |access-date=2022-06-15 |website=The Independent |language=en}} The Labour Party has continued to propose the creation of an NCS while in opposition, and has done so under each consecutive leader since Ed Miliband's leadership in 2010.
Since 2021, the proposal has been adopted by the devolved governments of Scotland and Wales.{{cite news |date=20 April 2021 |title=Nicola Sturgeon pledges National Care Service is a 'top priority' if SNP wins election |publisher=Daily Record |url=https://www.dailyrecord.co.uk/news/politics/nicola-sturgeon-pledges-national-care-23945839 |access-date=28 July 2021}}{{Cite web |last=Pamben |first=Deven |date=2021-11-23 |title=Wales to examine creation of a National Care Service |url=https://www.laingbuissonnews.com/care-markets-content/news/wales-to-examine-creation-of-a-national-care-service/ |access-date=2022-06-15 |website=LaingBuisson News |language=en-GB}} In Scotland, it is planned for the service to be fully operational by 2028 or 2029.{{Cite web |last=Pringle |first=Esmé |date=2022-01-27 |title=Watchdogs: Care can't wait five years for action |url=https://healthandcare.scot/default.asp?page=story&story=2993#:~:text=The%20Scottish%20government%20has%20committed,fully%20operational%20by%20May%202026. |access-date=2022-06-15 |website=Healthandcare.scot}}{{Cite news |date=14 December 2023 |title=Scotland's National Care Service delayed by three years |url=https://www.bbc.co.uk/news/uk-scotland-67714086 |access-date=5 January 2023 |work=BBC News}} In Wales, the government has begun gradually implementing the service from 2022 for what is expected to be a ten-year period.{{OGL-attribution|{{Cite web |title=First step to National Care Service as expert panel announced |url=https://gov.wales/first-step-national-care-service-expert-panel-announced |access-date=2022-06-15 |website=Welsh Government|date=21 February 2022 |language=en}}}}{{Cite web |date=2023-12-14 |title=Written Statement: National Care Service – Initial Implementation Plan Publication (14 December 2023) |url=https://www.gov.wales/written-statement-national-care-service-initial-implementation-plan-publication |access-date=5 January 2024 |website=GOV.WALES}}
Background
The Labour government of Clement Attlee introduced a publicly funded system of health care with the establishment of the National Health Service (NHS) in 1948.{{Cite web |last1=Mandhai |first1=Shafik |last2=Chughtai |first2=Alia |date=2017-06-07 |title=NHS England at a glance |url=https://www.aljazeera.com/news/2017/6/7/nhs-england-at-a-glance |access-date=2022-06-16 |website=Al Jazeera |language=en}} The NHS covered social care until 1976,{{Efn|The NHS in Northern Ireland did not cover social care until 1973, when it merged with Northern Ireland's social care system to form Health and Social Care, which still provides free health and social care to this day.{{Cite web |url=https://www.instituteforgovernment.org.uk/explainers/devolution-nhs |title=Devolution and the NHS |date=2020-08-18 |access-date=2022-06-16 |website=Institute for Government |last1=Nicholson |first1=Elspeth |last2=Shuttleworth |first2=Kelly}}|group=lower-alpha}} when most social care services were transferred to local authorities.{{Cite web |date=2005-04-12 |title=Separation of health and social care |url=https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/399/39906.htm |access-date=2022-06-16 |website=parliament.uk}} Since then, most people have had to pay for social care, with publicly funded social care still available to those who pass a means test in which examinees must prove a lack of wealth and a high need for care.{{Cite web |last=Bottery |first=Simon |date=2021-09-07 |title=What will the government's proposals mean for the social care system? |url=https://www.kingsfund.org.uk/publications/government-proposals-social-care-system |access-date=2022-06-16 |website=The King's Fund |language=en}} Publicly funded social care is also offered to some adults with "long-term complex health needs" through the NHS continuing healthcare scheme.{{Cite web |date=2018-08-03 |title=NHS continuing healthcare |url=https://www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/nhs-continuing-healthcare/ |access-date=2022-06-16 |website=NHS.uk |language=en}}
History
= England and Wales =
A "National Care Service" was first proposed in the later stages of Prime Minister Gordon Brown's Labour government.{{Cite news |date=3 January 2024 |title=What would a National Care Service look like? |url=https://www.newstatesman.com/spotlight/healthcare/social-care/2024/01/national-care-service-social-sector-bupa |access-date=5 January 2024 |work=New Statesman}} The Department of Health under Andy Burnham released its green paper Shaping the Future of Care Together in July 2009, which proposed a new National Care Service "on par with the NHS".{{Cite web |last=Burke |first=Stephen |date=2009-10-02 |title=National care service – what's the big idea? |url=http://www.theguardian.com/society/2009/oct/02/national-social-care-service-general-election |access-date=2022-06-15 |website=The Guardian |language=en}} This was followed by a public consultation in September called the "Big Care Debate", which was promoted by Brown as a "crucial national debate".{{Cite web |last= |first= |date=2009-09-08 |title=Big Care Debate: How to get involved |url=http://www.theguardian.com/careandsupportreform/big-care-debate |access-date=2022-06-15 |website=The Guardian |language=en}} The consultation found a public desire for social care reform and explored different ways to introduce the NCS. The government decided to introduce the NCS gradually and in different stages, with the first stage beginning with the Personal Care at Home Act 2010.{{Cite book |url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/238441/7854.pdf |title=Building the National Care Service |date=2010-03-30 |publisher=HM Stationery Office |isbn=9780101785426 |location=London |pages=4, 7–8 |department=Department of Health}} This Act legally extended to England and Wales.{{Cite web |title=Personal Care at Home Act 2010 Content: Provision 3 |url=https://www.legislation.gov.uk/ukpga/2010/18/section/2/enacted |access-date=2022-06-15 |website=legislation.gov.uk}}
The Act was passed by parliament in April 2010,{{Cite web |date=2010-08-17 |title=Personal Care at Home Act 2010 |url=https://bills.parliament.uk/bills/542 |access-date=2022-06-15 |website=UK Parliament}} with the NCS being launched a month earlier by Health Secretary Andy Burnham, giving all elderly and disabled people free social care. The second stage was planned to begin from 2014 and would extend free social care to people who were in residential care for more than two years. A third and final stage would fully introduce the NCS, giving all adults free social care after 2015.{{Cite web |date=2010-03-30 |title=National Care Service launched |url=http://careandsupport.direct.gov.uk/news/2010/03/national-care-service-launched/ |archive-url=https://webarchive.nationalarchives.gov.uk/ukgwa/20100609064203/http://careandsupport.direct.gov.uk/news/2010/03/national-care-service-launched/ |archive-date=2010-06-09 |access-date=2022-06-15 |website=GOV.UK}}{{Cite book |url=https://publications.parliament.uk/pa/ld201719/ldselect/ldeconaf/392/392.pdf |title=Social Care Funding: Time to End a National Scandal |date=2019-07-04 |publisher=Dandy Booksellers Limited |isbn=9781787764316 |page=11 |department=House of Lords Select Committee on Economic Affairs}} However, the Labour government lost the May 2010 general election and the Conservative–Liberal Democrat coalition came to power. The coalition abandoned the NCS{{Cite book |last=Jarrett |first=Tim |title=Social care: Government reviews and policy proposals for paying for care since 1997 (England) |date=2017-09-23 |publisher=House of Commons Library |page=11}} and the Personal Care at Home Act 2010 was later repealed.{{Cite web |title=Personal Care at Home Act 2010 (repealed) |url=https://www.legislation.gov.uk/ukpga/2010/18/resources |access-date=2022-06-15 |website=legislation.gov.uk}}
In opposition, the Labour Party under the leadership of Ed Miliband (2010–2015) continued calling for the introduction of an NCS that would give elderly and disabled people free social care.{{Cite web |last=Samuel |first=Mithran |date=2010-09-27 |title=Labour leader Ed Miliband backs national care service |url=https://www.communitycare.co.uk/2010/09/27/labour-leader-ed-miliband-backs-national-care-service/ |access-date=2022-06-15 |website=Community Care |language=en-GB}} Under Jeremy Corbyn's leadership (2015–2020), the party promised to introduce the NCS in its manifestos for the 2017 and 2019 general elections,{{Cite web |date=2017-06-22 |title=Social care: What's happened to the 'dementia tax'? |url=https://www.theweek.co.uk/85934/social-care-whats-happened-to-the-dementia-tax |access-date=2022-06-15 |website=The Week UK |language=en}}{{Cite news |last=Clarke |first=Sarah |date=2019-11-21 |title=Labour confirms plans for free personal care in 'radical' manifesto |url=https://www.homecareinsight.co.uk/labour-confirms-plans-for-free-personal-care-in-radical-manifesto/ |access-date=2022-06-15 |newspaper=Home Care Insight}} once again proposing free social care for all adults{{Cite web |date=2019-09-22 |title=Labour pledges to spend £6bn to make social care free |url=https://inews.co.uk/news/politics/labour-6-billion-social-care-free-everyone-341844 |access-date=2022-06-15 |website=i |language=en}} and also free personal care for the elderly. It is also supported by leader Keir Starmer (2020–present), who is planning to introduce it as a needs-based, locally delivered system should Labour enter government.{{Cite web |last=Starmer |first=Keir |author-link=Keir Starmer |date=2022-06-19 |title="Councils will be at the top table" – Keir Starmer's LGA Labour conference speech |url=https://labourlist.org/2022/06/councils-will-be-at-the-top-table-keir-starmers-lga-labour-conference-speech/ |access-date=2022-06-21 |website=LabourList |language=en-GB}} His Shadow Health Secretary Wes Streeting launched a review by the Fabian Society to see how it would operate and be funded, and aims to gradually introduce it over two or three terms of a Labour government, with a long-term aspiration of introducing the service on par with the NHS.{{Cite web |last=Mason |first=Rowena |date=2022-07-03 |title=Labour to aim to launch national care service inspired by creation of NHS |url=https://www.theguardian.com/politics/2022/jul/03/labours-wes-streeting-launches-review-to-plan-for-national-care-service |access-date=2022-07-04 |website=The Guardian |language=en}} The Fabian Society's report was released in June 2023. Its proposals only apply to England and include the recommendations that short-term care and support should be free and that support should be made available for everyone regardless of their means.{{Cite news |last=Watson |first=Iain |date=8 June 2023 |title=Social care: Labour urged to commit to care worker pay increases |language=en-GB |work=BBC News |url=https://www.bbc.co.uk/news/uk-politics-65839730 |access-date=13 June 2023}}{{Cite news |last=Crerar |first=Pippa |date=2023-06-08 |title=Labour aims to reform England's adult social care sector if it wins election |language=en-GB |work=The Guardian |url=https://www.theguardian.com/society/2023/jun/08/labour-unveils-plan-to-fix-social-care-better-pay-and-free-short-term-support |access-date=13 June 2023 |issn=0261-3077}} The NCS was included in a draft Labour manifesto for the 2024 general election from May 2023{{Cite web |last=Neame |first=Tom Belger, Morgan Jones, Katie |date=2023-05-11 |title=Revealed: Full draft policy platform that could form 2024 Labour manifesto |url=https://labourlist.org/2023/05/labour-manifesto-2024-election-what-policies-npf-party/ |access-date=2023-06-13 |website=LabourList |language=en-GB}} and was acknowledged as Labour Party policy by Streeting in October 2023.{{Cite web |last=Weakley |first=Kirsty |date=2023-10-09 |title=National care service to be built with local government, Labour says |url=https://www.lgcplus.com/services/national-care-service-to-be-built-with-local-government-labour-says-09-10-2023/ |access-date=2023-10-28 |website=Local Government Chronicle (LGC) |language=en}} It was included in the Labour Party's published general election manifesto, Change.{{Cite news |date=5 July 2024 |title=Labour manifesto: What they plan to do in government |url=https://www.bbc.co.uk/news/articles/cml2en8xlxko |access-date=8 July 2024 |work=BBC News}}
== Wales ==
The devolved Labour-led government of Wales explored options for a Welsh NCS as part of its 2021 cooperation agreement with Plaid Cymru, with a plan for its implementation expected by the end of 2023. The Welsh branch of Labour had supported the NCS since the 2021 Senedd election.{{Cite web |last=Owen |first=Twm |date=2021-09-14 |title=Welsh Government putting £48m towards social care |url=https://www.thenational.wales/news/19577961.welsh-government-putting-48m-towards-social-care/ |access-date=2022-06-16 |website=The National |language=en}} Since 2022, the Welsh government has gradually introduced the service over what is expected to be a ten-year period.{{Cite web |date=14 December 2023 |title=Welsh national care service |url=https://www.hfma.org.uk/news-alerts/welsh-national-care-service |access-date=5 January 2024 |website=Healthcare Financial Management Association}}
= Scotland =
Scottish Labour has been calling for the implementation of a Scottish NCS since 2011,{{Cite web |title=National Care Service is the only way forward for adult care |url=https://www.eastlothianlabourparty.co.uk/news/2021/02/03/national-care-service-is-the-only-way-forward-for-adult-care/ |access-date=2022-06-17 |website=East Lothian Labour |language=en-GB}} with then party leader Iain Gray (2008–2011) negotiating the proposal with civil servants in 2010.{{Cite web |date=2010-11-01 |title=Iain Gray in civil service talks about return to power |url=https://www.scotsman.com/news/iain-gray-civil-service-talks-about-return-power-1698045 |access-date=2022-06-17 |website=The Scotsman |language=en}} The Scottish Conservatives supported the proposal, as did the Scottish National Party (SNP) government's then-Health Secretary Nicola Sturgeon,{{Cite web |last=Torrance |first=David |date=2011-08-10 |title=Scotland speeds plans to pool health and social care |url=http://www.theguardian.com/healthcare-network/2011/aug/10/scotland-plans-pool-health-social-care |access-date=2022-06-17 |website=The Guardian |language=en}} however Sturgeon and the SNP government ultimately rejected the proposal.{{Cite book |url=https://scottishlabour.org.uk/wp-content/uploads/2021/04/SCOTTISH-LABOURS-NHS-RECOVERY-PLAN.pdf |title=Scottish Labour: Scotland's NHS Recovery Plan |publisher=Scottish Labour |year=2021 |page=11}}
An independent review into Scottish adult social care was commissioned by First Minister Nicola Sturgeon in 2020, as a response to the damage to care homes caused by the COVID-19 pandemic in Scotland. This review was dubbed "The Feeley Review" after its author and chair Derek Feeley,{{Cite web |date=2022-06-20 |title=National Care Service (Scotland) Bill: Overview |url=https://www.parliament.scot/bills-and-laws/bills/national-care-service-scotland-bill/overview |access-date=2022-06-21 |website=Scottish Parliament |language=en}} the former chief executive of NHS Scotland, and was published in February 2021.{{Cite web |last=Wilson |first=Caroline |date=2021-02-03 |title=Review backs National Care Service to 'raise standards' in care homes |url=https://www.heraldscotland.com/news/19061223.national-care-service-recommended-derek-feeley-review-raise-standards-care-homes/ |access-date=2022-06-17 |website=The Herald |language=en}}{{OGL-attribution|{{Cite web |title=Independent Review of Adult Social Care |url=https://www.gov.scot/groups/independent-review-of-adult-social-care/ |access-date=2022-06-17 |website=Scottish Government |language=en}}}} The review recommended the establishment of a Scottish NCS on an equal footing with NHS Scotland, receiving centralised funding from the Scottish government.{{Cite news |last=Fraser |first=Douglas |date=2021-05-03 |title=How much do we care about those who need care? |language=en-GB |work=BBC News |url=https://www.bbc.com/news/uk-scotland-scotland-business-56965335 |access-date=2022-06-17}}{{cite news |date=2 June 2021 |title=Nicola Sturgeon to consult on National Care Service in first 100 hundred days |publisher=Home Care Insight |url=https://www.homecareinsight.co.uk/nicola-sturgeon-to-consult-on-national-care-service-in-first-100-hundred-days/ |access-date=28 July 2021}} Health Secretary Jeane Freeman accepted the recommendation{{Cite web |date=2021-02-16 |title=Backing for Feeley Review recommendations |url=http://www.gov.scot/news/backing-for-feeley-review-recommendations/ |access-date=2022-06-17 |website=Scottish Government |language=en}} and the SNP promised to introduce the NCS as a "top priority" in government in its manifesto for the 2021 Scottish Parliament election, alongside the introduction of a national wage for care staff.{{Cite web |last=Albert |first=Angeline |date=2021-04-15 |title=Nicola Sturgeon promises National Care Service and national wage for care workers |url=https://www.carehome.co.uk/news/article.cfm/id/1647200/Nicola-sturgeon-promises-ncs-but-says-government-wont-run-scotlands-care-homes |access-date=2022-06-17 |website=Carehome.co.uk}} It is planned that the new service will be fully operational in Scotland by 2026. Nationalising care homes is not part of the proposal, but it will mean ministers will get more power over social care. There is a pledge to make social care free at the point of use, although this will not include accommodation costs.{{cite news |date=9 June 2021 |title=Letter from Scotland: A more generous social care system |publisher=Health Service Journal |url=https://www.hsj.co.uk/policy-and-regulation/letter-from-scotland-a-more-generous-social-care-system/7030242.article |access-date=28 July 2021}}
The Scottish Socialist Party supports a publicly owned and publicly funded National Care Service that would be free at the point of use (like the NHS).{{cite news |date= 15 December 2020 |title= Scandal of underpaid care home workers predates coronavirus |url= https://www.thenational.scot/news/18944026.scandal-underpaid-care-home-workers-predates-coronavirus/ |work= The National |access-date= 20 January 2021}}{{cite news |date= 23 July 2020 |title= Elderly care for profit is a scandal that should be ended |url= https://www.thenational.scot/news/18600513.elderly-care-profit-scandal-ended/ |work= The National |access-date= 20 January 2021}}{{cite news |last= Fox |first= Colin |date= 25 May 2020 |title= Colin Fox: Why Scotland needs to have a National Care Service |url= https://www.thenational.scot/news/18472750.colin-fox-scotland-needs-national-care-service/ |work= The National |access-date= 20 January 2021}}
== National Care Service (Scotland) Bill ==
The National Care Service (Scotland) Bill was introduced to the Scottish Parliament on 20 June 2022.{{Cite web |date=2022-06-20 |title=National Care Service (Scotland) Bill |url=https://www.parliament.scot/bills-and-laws/bills/National-Care-Service-Scotland-Bill |access-date=2022-06-21 |website=Scottish Parliament |language=en}} If passed, the Bill will establish the NCS in Scotland and give Scottish ministers the ability to transfer social care services, which in Scotland are currently maintained by local authorities, to the new care service. In the case of children's services, ministers would have to hold a public consultation to be able to transfer them to the NCS. Some health services which are currently maintained by NHS Scotland and its Health Boards could also be transferred should the Bill pass. NCS Care Boards would deliver care on a local level, although transferred services could also be delivered nationally. The NCS and NHS Scotland would also share information, carers would have a right to take breaks and the proposed "Anne's Law", a law which would entitle care home residents to meeting people important to them, would also be enacted in the Bill.
The Bill has been met with controversy. Scottish Labour called the SNP's plans to introduce the NCS "the biggest power grab in the history of Holyrood",{{Cite news |last=Summers |first=Lisa |date=2022-06-21 |title=National Care Service for Scotland will 'end postcode lottery' |language=en-GB |work=BBC News |url=https://www.bbc.com/news/uk-scotland-61879823 |access-date=2022-06-21}} with deputy leader Jackie Baillie claiming that it would endanger local authorities, adding that it was "not a National Care Service" but a "national commissioning service which can be used as a fig leaf for centralising power".{{Cite web |last=Grant |first=Alistair |date=2022-06-21 |title=National Care Service plans branded 'biggest power grab in history of Holyrood' |url=https://www.scotsman.com/news/politics/national-care-service-plans-branded-biggest-power-grab-in-history-of-holyrood-3739175 |access-date=2022-06-21 |website=The Scotsman |language=en}} Other opposition parties have raised concerns about the cost of the service, which is believed to have the possibility of redirecting nearly £1.3 billion of public money from frontline services to the NCS (£495 million for the overall service and another £726 million for its Care Boards). Trade unions GMB,{{Cite web |last=Green |first=Chris |date=2022-06-21 |title=Scotland's plan for National Care Service sparks backlash from unions |url=https://inews.co.uk/news/scotland/scotland-plan-national-care-service-backlash-unions-1698782 |access-date=2022-06-21 |website=i |language=en}} Unison and Unite are also concerned about the centralisation of power away from local authorities that would be caused by the service, while the Convention of Scottish Local Authorities (COSLA) is currently taking "the time and consideration that is rightfully needed with legislation of this magnitude, to understand the breadth of the impact it will have on communities the length and breadth of Scotland".{{Cite web |last=Bol |first=David |title=Warning SNP ministers risk diverting £1.3bn to set up National Care Service |url=https://www.heraldscotland.com/politics/20226112.snp-ministers-warned-1-3bn-diverted-set-national-care-service/ |access-date=2022-06-21 |website=The Herald |date=21 June 2022 |language=en}}
Notes
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