The future of the left since 1884

A National Care Service that works for everyone

A comprehensive plan for how to deliver on the Labour Party’s commitment to create a National Care Service in England.


Press release

A National Care Service was first proposed in the final months of the last Labour government and the party 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 should 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 adult social care system in crisis. Many people who need help are going without vital support. State provision is patchy, impersonal and inadequate. Unpaid carers are placed under an impossible burden and are unrecognised and unsupported. Workers are underpaid, undervalued, and under intense and unsustainable pressure. A system that was already inadequate in 2010 is now on the brink.   

Simply pumping in more money will not be enough to address these problems the report argues. 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 are: 

  1. For everyone: under the plan support will be available to everyone regardless of their means, and at a much earlier stage as their care 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 National Care Service constitution and people will have control and choice over the support they get. Disabled and older people will have new rights 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 contracted 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 conditions. People employed by 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. They should also consider other options like making support free for people with lifelong disabilities. 


Andrew Harrop, Report Co-author and General Secretary of the Fabian Society said:  

“This comprehensive plan for a National Care Service for England is an ambitious roadmap for solving one of the country’s most significant and enduring social challenges. The Fabian Society’s plan works for everyone who needs support or care now or who may do in the future. But vitally, it is also a blueprint that works for the under-valued care workforce and for our huge army of unpaid family carers.” 


Wes Streeting MP, Shadow Secretary of State for Health and Social Care said:   

“This report is an important contribution to the debate on our social care system. 

“Labour is committed to ensuring better terms and conditions, proper training, and fair pay for care workers, with national standards guaranteeing good quality care, as the first steps to building a National Care Service.” 


Christina McAnea, General Secretary of UNISON said:  

“Social care has been neglected for too long. The system is broken and the staff who work in it are either on their knees or leaving in droves.   

“Promises of reform have come to nothing and people needing care are being let down on a grand scale. Arranging care for a loved one is simply a minefield for families trying to navigate the system for the first time.  

“To make matters worse the sector is thousands of staff short. Raising pay is key to stopping the exodus of staff quitting for higher wages and less stressful, emotionally draining jobs elsewhere.  

“People who rely on care deserve much better. A national care service would boost wages, put quality above profit-making and ensure everyone receives the support they need.” 


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 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 
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 


Andrew Harrop is available for interview, comment or op-ed.  


– Ends – 



  1. Contact: Emma Burnell, Media Consultant, Fabian Society or 07851 941111.  
  2. The report is published at 
  3. Support guaranteed: the roadmap to a national care service by Ben Cooper and Andrew Harrop is published by the Fabian Society.   
  4. This is a report for UNISON and the Labour party. The project was generously supported by the UNISON Campaign Fund and was written at the request of Shadow Health and Social Care Secretary Wes Streeting MP. 
  5. The Fabian Society is Britain’s oldest political think tank. Founded in 1884, the society is at the forefront of developing political ideas and public policy on the left. The society is alone among think tanks in being a democratically-constituted membership organisation, with around 7,000 members. It is constitutionally affiliated to the Labour party.  


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