Significant reform of England’s beleaguered adult social care sector could be ushered in by the next Labour government under plans that include boosting pay for care workers, expanding the scope of free support, and a £50 weekly contribution towards costs for those who need it.
A report by the Fabian Society thinktank, requested by the shadow health secretary, Wes Streeting, and commissioned by the trade union Unison, sets out a roadmap for a national care service (NCS) that is hoped would address the existing patchy, impersonal and inadequate state provision.
A 10-year government spending commitment would be required to fix the social care crisis, with a promise to increase real-terms funding for adult social care by a significant percentage each year, the report says.
However, it argues that simply pumping more money into the system will not be enough and that comprehensive change is required. Crucially, this should take place at the same time as making changes to the charging structure to avoid “an unnecessary hurdle” in changing the system.
It warns: “There is no quick fix for our social care emergency. Unless we take significant and sustained action over many years things will get worse for all of us.”
The report, which sources said had the support of many on the Labour frontbench although they are not expected to support all of the recommendations, stresses that the dismal state of the nation’s finances means changes will have to be staggered – with bigger spending commitments on hold until the economy recovers.
It does not give a figure for how much the new service for England would cost but says this should be informed by an independent assessment of cost pressures in adult social care at the time.
An early priority after the general election, expected next year, will be to draw up an emergency workforce package, with the tight labour market meaning the sector is struggling to fill 165,000 vacancies.
This could include a minimum wage and working conditions across the sector, initially on an opt-out basis; however, Labour has said it wants to legislate for binding sector-wide fair pay agreements.
The report also proposes care workers getting parity with equivalent skilled staff in the NHS on pay bands, pension entitlements and employment terms over time, starting with the lowest paid.
Labour could improve access to care in the months after the election, ending the situation where some local authorities unofficially ration support. Under the plan, support would be available to everyone regardless of their means, and at an earlier stage.
The proposed NCS would bring national government, local councils and contracted care providers under one umbrella, with independent providers fairly funded but expected to operate as part of a public service with new standards on workforce, care and financial conduct.
Longer term, in the run-up to the NHS’s 80th anniversary in 2028, the report suggests that if the Conservatives commit to finally bringing in the delayed plan for a £86,000 cap on how much individuals have to spend on personal care over their lifetime, then Labour should stick with the plans.
Labour should make all short-term support and care free, especially during the first six weeks after hospital discharge. Not all of this support is available under the existing system. In addition, it should uprate thresholds in existing means-testing rules every year.
However, the authors suggest that if the Dilnot reforms are not yet on track, despite them being scheduled for 2025-26, then a new Labour government should conduct a “short, sharp review” of reforms to the charging system.
This includes a proposal for a universal contribution to help fund the system so everybody who needs support can receive some financial help. Options could include a weekly cash contribution from the state of £25 to £50, a percentage contribution to the cost, or a weekly charge cap, which already exists in Wales.
Streeting 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.”
Andrew Harrop, the 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.”
A Labour spokesperson said: “This report is not Labour party policy and everything in our manifesto will be fully costed and fully funded.”
• This article was amended on 8 June 2023. An earlier version said incorrectly that people would be asked to contribute £50 a week towards costs.
