The future of the left since 1884

A National Care Service for all



Today the Fabian Society publishes a comprehensive plan for how to deliver on the Labour party’s ambition to create a National Care Service in England.

A National Care Service was first proposed in the final months of the last Labour government and Labour has recently recommitted to the idea. But this is the first time an independent blueprint has been created setting out what the National Care Service could look like and how it should be implemented.

Support Guaranteed: the roadmap to a national care service is a report for Shadow Health and Social Care Secretary Wes Streeting MP and UNISON. It sets out in detail how a care service would work for everyone. The report is independent advice not a statement of Labour policy.

The backdrop for the project is an adult social care system in crisis. This winter’s hospital discharge crisis was only a symptom of much wider problems. Since 2010, spending has fallen hugely relative to levels of need. Access to care has been unfairly rationed and many people who need help are going without vital support. Publicly funded provision is often patchy, impersonal and inadequate. Poor pay and conditions have helped trigger a staffing crisis in the sector, with 165,000 vacancies. Unpaid family carers are bearing the brunt of the system’s failures, and people receiving support are paying charges they often find punishing.

But simply pumping in more money will not be enough to address these problems. Adult social care needs comprehensive reform not just extra spending. The report makes 48 recommendations that would result in a transformation in adult care in England. The key elements of the proposals include:

  1. For everyone: under the plan, support will be available to everyone, regardless of their means, and at an earlier stage as their care and support needs develop. Disabled people and unpaid carers will be automatically referred to the service. Everyone will have peace of mind about help being there for them in the future.
  2. Stronger rights: citizen rights will be spelled out in a co-produced National Care Service constitution and people will have control and choice over the support they get. Disabled and older people will have a new right to choose where they live and to take part in society. Unpaid carers will be asked how much they wish to care and will have a new right to short breaks. A formal appeal process will be introduced.
  3. A new public service: the National Care Service will offer end-to-end support under a shared brand delivered together by national government, local councils and licensed care providers. Independent providers will be fairly funded but expected to operate as part of a public service with new standards on care quality, workforce and financial conduct. National leadership and consistency will replace postcode lotteries.
  4. A fair workforce settlement: a sector-wide Fair Pay Agreement will be negotiated including a sector minimum wage and minimum employment conditions. People employed by contracted National Care Service providers will have national pay-bands and employment terms designed to achieve parity over time with similar roles in the NHS.
  5. More affordable charges: reforms to care funding should run in parallel to other changes, so that support becomes more affordable over time as services start to improve. Incoming ministers should match any government funding reforms announced before the next election. As they develop the new service, they should also consider other options, like making support free for people with lifelong disabilities.

You can hear more about the proposals on the new Fabian Thinking podcast.

Summary of the proposals
The position now A National Care Service
Local authorities supposedly in charge but without the money or powers they need National ministerial responsibility and leadership working in partnership with strong councils
Unclear entitlements that are often not realised in practice Clear rights and entitlements and the ability to enforce them
Inconsistency in access to support and quality of care Nationwide entitlements and geographic consistency
A fragile, fragmented and sometimes extractive ‘market’ of care providers Commissioners and licensed partners working together as part of a public service
Support only for people with limited means Support and peace of mind for everyone
Inadequate funding and emergency cash injections Long-term and sustainable approach to finance, including a new national funding formula
Insufficient development of specialist housing and modern care homes Long-term certainty and funding to build new facilities
Inadequately rewarded staff and a recruitment and retention crisis National terms and conditions working towards parity with the NHS
Unaffordable fees and inability to pool risks Improvements to affordability by reducing the scope of charging over time

Support guaranteed: the roadmap to a national care service by Ben Cooper and Andrew Harrop is published by the Fabian Society on 8 June 2023. The research was funded by the UNISON campaign fund.


Andrew Harrop

Andrew Harrop is general secretary of the Fabian Society.


Ben Cooper

Ben is a senior researcher at the Fabian Society.


Fabian membership

Join the Fabian Society today and help shape the future of the left

You’ll receive the quarterly Fabian Review and at least four reports or pamphlets each year sent to your door

Be a part of the debate at Fabian conferences and events and join one of our network of local Fabian societies

Join the Fabian Society
Fabian Society

By continuing to use the site, you agree to the use of cookies. more information

The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this.