Andy Burnham should establish the National Care Service this parliament

Burnham’s vision is ambitious but vague

In his speech, Burnham outlined his goal to establish a ‘National Care Service’ (NCS). This is not new: he was recommitting, if passionately, to a promise set out in Labour’s 2024 manifesto and, even further back, Gordon Brown’s 2010 manifesto. ¹³ https://manifesto.deryn.co.uk/wp-content/uploads/2021/04/TheLabourPartyManifesto-2010.pdf  

Details were slim in both documents, however. To flesh out that offering Wes Streeting, when health secretary, commissioned Louise Casey to run a commission on what form the NCS could take. (That was an odd decision, given that he’d commissioned the Fabians to undertake a similar exercise while in opposition.)

The prime minister’s sense of urgency was palpable, but also not new: the government has already asked Casey to report sooner than planned, and begun outlining some workforce reforms – including that pay be more closely matched to NHS staff, and better opportunities for progression, among others.

The speech and subsequent press release from No.10 provided slightly more detail about what the NCS will eventually entail. The government intends to provide older adults with free personal care – support to carry out daily tasks like dressing, washing and eating – funded through “adjustments” the triple lock on pensions. 

This sounds expansive but still leaves a lot of questions. Free personal care is specifically for older adults, but the government has said nothing about working age adults, who account for a little over 40% of people receiving publicly funded long-term care. The press release rules out free “bed and board” in residential care, meaning that some people may still face enormous costs for care. ¹⁴ https://www.gov.uk/government/news/prime-minister-andy-burnham-sets-out-plans-for-a-new-national-care-service  In his speech, Burnham said that no one will pay care charges out of their “basic state pension” but does not rule out some kind of co-payment out of other income. Further permutations and options are too numerous to list.

Crucially, though, Burnham said he will not establish the NCS until after the next general election. That means none of this could start until as late as 2029. That is a mistake.

The government should establish the NCS in this parliament and build it further in the next

Waiting until after the next election is the wrong decision. It leaves the sector in limbo for another three years, struggling to deal with years of underfunding and decades of neglect by consecutive governments. It will break a manifesto promise (despite others being treated as sacrosanct). Most obviously it means there is no guarantee of an NCS ever being established, as it relies on Labour winning the next election, a far from certain outcome.

Instead, Burnham should have the courage of his own convictions establish the NCS in this parliament – and build then on it from there. Form should follow function when it comes to new structures in public services: but once Casey provides her final report next year, Burnham should then have no excuse for not having a clear vision for the NCS.

The newly established NCS need not be the finished article. But the government should give it responsibility for some initial functions that it wants to be in any final version. Those could include things such as: 

• Workforce planning, data gathering, and some training, responsibility for which currently sits mostly with two charities (Skills for Care and the Social Care Institute for Excellence, SCIE) and some with the DHSC
• Involvement in the Fair Pay Agreement negotiations, the process that the government is establishing to agree pay and conditions for care workers ¹⁵ https://www.gov.uk/government/consultations/fair-pay-agreement-process-in-adult-social-care/outcome/fair-pay-agreement-process-in-adult-social-care-g…
• Standardising the assessment process for adult social care across the country
• Commissioning of specialist services, where there is limited national demand and therefore provision in local areas
• Supporting improvement across the sector by identifying and spreading best practice, responsibility for which currently sits with SCIE

Establishing the NCS along these lines would not undermine the government’s ability to expand the organisation’s role later. The government has already said it intends to introduce the NCS “in phases”, ¹⁶ https://www.gov.uk/government/news/prime-minister-andy-burnham-sets-out-plans-for-a-new-national-care-service  though is waiting until after the election so that it can secure a mandate for adjusting the triple lock. But the proposals laid out above could be relatively cheap and still allow expansion after the 2029 election.

It would also address real issues in the sector and support the government’s planned workforce reforms. For example, stewardship of the workforce is currently too fragmented and reliant on a charity (Skills for Care) for what is a vital function. 

There is also a potential political benefit. It would allow Labour to claim, correctly, that it has fulfilled a 2024 manifesto commitment and would give Burnham a strong story to tell at the next election, showing progress on what has become a totemic issue for him. It would also safeguard the NCS. If Labour lose the next election, it would be more harder for an incoming government to scrap it, even in nascent form, than to cancel ‘plans’ still little more than a glint in a former prime minister’s eye. 

There is no reason for delay. Burnham has a huge majority and a mandate to establish the NCS from the 2024 manifesto. Rather than waste this parliament – and risk wasting the next one if he loses the election – he should get on and establish the NCS.