Local Government ExplainedA National Care Service: Briefing 2 – lessons from Scotland and Wales
Executive summary
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- This is the second of three briefings produced by CIPFA and the Local Government Information Unit (LGIU) examining progress towards National Care Services (NCSs) in England, Scotland and Wales. The first briefing of the series can be accessed on the CIPFA and LGIU websites and covers the ‘story so far’ in each country, from the inception of NCS policy to the current state of affairs.
- There are lessons to be learned from Scotland and Wales’ NCS experiences that can be taken up by the Casey Commission in its work to propose a route to establishing an NCS in England.
- Scotland’s structural reform-led approach failed due to a lack of clarity, unconvincing operational capacity and financial cases, and insufficient collaboration.
- Wales’ incremental, collaborative approach has maintained momentum, but there are still many important policy decisions to be resolved.
- Given that local authorities are responsible for social care and that social care comprises the majority of local authority discretionary expenditure, any effort to reform social care has to be viewed as a form of local government reform.
- Adult social care reform must take a whole system, place-based approach.
- Alignment, shared purpose and consistent engagement with stakeholders are essential to progress.
- Iterative, co-designed, flexible approaches to reform appear to be more resilient than top-down ‘big bang’ restructuring based on the examples of Scotland and Wales.
Key messages from the Scottish and Welsh NCS experiences
Scotland
Structural reform
1. The Scottish Government underestimated the complexity of structural reform.
2. There was a lack of clarity on how outcomes would be improved through structural reform.
3. There was a failure to take a whole-system, place-based approach.
Stakeholder engagement
4. There was a failure to build and maintain a broad coalition of support for establishing an NCS.
5. Co-production came after the legislation was introduced, making proper scrutiny impossible.
6. Reform was perceived as top-down and local government felt marginalised.
The financial case
7. Existing pressures and a lack of evidence around benefits and improved outcomes meant that the financial case for structural reform was untenable.
8. The financial memorandum that accompanied the National Care Service (Scotland) Bill lacked detail and credibility and was unclear on overall cost implications.
9. Structural reform risked diverting resources from frontline services during a time of acute pressure.
Workforce and delivery capacity
10. The evaluation of capacity within the system to deliver large-scale reform was unrealistic.
11. The process of establishing an NCS added stress to an already fragile workforce.
12. The uncertainty around employment conditions created anxiety for care workers.
Politics and partnership
13. The NCS process damaged relationships between local and central government and other key stakeholders.
14. Local government reform was not acknowledged as central to the process.
Wales
Policy foundations
1. Wales implemented legislation in the form of the Social Services and Well-being (Wales) Act 2014, which has provided the framework for continued progress on the NCS.
2. Further policy developments through the Rebalancing Care and Support Programme have allowed for continual development of health and social care policy.
3. Further legislative changes that may be required are built into the implementation plan, meaning it is possible legislative changes will be a barrier later in the process.
Consensus through expertise
4. An expert group was selected by ministers to represent the weight of opinion on developing an NCS and provided an authoritative report in 2022 that outlined the route to an NCS.
5. However, the expert group was not representative of all stakeholders; there was a lack of representation from current local government and health sector professionals.
6. Despite these criticisms, it was noted that the expert group strengthened the consensus around the key aims of the NCS policy.
Structure for implementation
7. The creation of the implementation timeline and the National Office for Care and Support have set up an accountability structure for progress towards an NCS.
8. However, the plan and office were criticised by stakeholders, who said that although they gave the appearance of progress, they have not translated into tangible outcomes.
9. Since it was established in 2024, the National Office for Care and Support has become the key body with responsibility for ensuring the development and delivery of the NCS programme, as well as reporting on progress.
10. Stakeholders in our roundtable suggested that the visibility of the office and its work remain limited.
The financial case
11. The central unresolved challenge of establishing an NCS in Wales is how it will be funded.
12. As per recommendations by the expert group, the National Office for Care and Support has “started to co-ordinate research activity into how best [it] can move towards a charging regime where most non-residential care is delivered, free at the point of need” (annual report, 2024/25).
13. However, there is currently no clarity regarding the changes to funding that will allow for the additional costs associated with moving to this model.
Introduction
In this briefing, CIPFA and the LGIU explore the lessons to be learned from the experiences of attempting to establish an NCS in Scotland and Wales and how these lessons should be taken on in the work of the Casey Commission, whose remit it is to set out the plan for how to implement an NCS in England.
To inform this briefing, CIPFA and the LGIU held three roundtables in October 2025, which focused on lessons from Scotland and Wales and aspirations for England at this early stage in their NCS journey.
The roundtables comprised key stakeholders from the NCS journey in each country, including local and central government leaders, directors of finance, directors of adult social care, and members of third sector and representative bodies. Delegates were asked to consider key points of success and failure in the respective journeys and the financial, structural and implementation aspects of reform. CIPFA and the LGIU would like to thank everyone who attended the roundtables for their insights that have informed this briefing.
A note on terminology
It is important to recognise that ‘National Care Service’ has meant different things in each nation. Scotland pursued a structural transfer of responsibilities, Wales has developed a national framework within an existing legislative base, and England’s model remains undefined. This variation underpins many of the lessons described.
Lessons from Scotland’s NCS journey
As CIPFA and the LGIU set out in the first briefing of this series, the journey to establishing an NCS in Scotland was beset by challenges over three years, resulting in the Scottish Government removing structural reform from its NCS ambitions in early 2025 and rebranding the National Care Service (Scotland) Bill as the Care Reform (Scotland) Bill.
While the Scottish Government maintains its commitment to the ambitions of an NCS, it has acknowledged that structural reform was not possible through the Bill as proposed.
In the Scotland roundtable, delegates were asked to reflect on key moments in the process that led to the failure of the policy of establishing an NCS in Scotland.
In this section, we summarise what were viewed as the key points of failure and then expand on these points in the narrative that follows. We then provide practical lessons based on these reflections that should be taken on by government when undertaking large-scale social care reform.
Structural reform
Key messages
1. The Scottish Government underestimated the complexity of structural reform.
2. There was a lack of clarity on how outcomes would be improved through structural reform.
3. There was a failure to take a whole-system, place-based approach.
Reflections from the roundtable
There was the impression in Scotland that structural reform was ‘the only game in town’ and that the case had not been effectively made that structural reform would lead to better outcomes for people who draw on care and support.
The complexity of unpicking the existing system of health and social care integration was underestimated, including removing responsibility for social care from local authorities and integration authorities. It was also noted that in order to achieve the policy objective of improved health and social care in Scotland, NHS reform would be required, but that this was not on the table. This represented a failure to take a whole-system approach to reform and risked reinforcing existing organisational and cultural divides rather than breaking down those barriers.
Stakeholder engagement
Key messages
4. There was a failure to build and maintain a broad coalition of support for establishing an NCS.
5. Co-production came after the legislation was introduced, making proper scrutiny impossible.
6. Reform was perceived as top-down and local government felt marginalised.
Reflections from the roundtable
While there was initial support for establishing an NCS in Scotland following the Feeley Review (2021), as evidenced by an independent analysis of the first NCS public consultation, the Scottish Government failed to capitalise on this to build and maintain a broad coalition of support for an NCS. Instead, the process became adversarial, with local government and other stakeholders feeling marginalised.
The use of framework legislation meant that many of the fundamental questions of reform remained unanswered. As we explored in the first briefing of this series, details were to be worked through after the framework legislation passed. However, this hindered adequate scrutiny. It was the Scottish Government’s position that these issues would be resolved following co-design with people with lived experience of care and support, but it was noted that co-production should have come before the legislation was presented to Parliament, not after.
Furthermore, the process created uncertainty about future working relationships between local authorities, integration authorities and service providers, which affected collaboration and service development. This uncertainty continued as the plans changed throughout the process, including the relative responsibilities of different stakeholders.
The financial case
Key messages
7. Existing pressures and a lack of evidence around benefits and improved outcomes meant that the financial case for structural reform was untenable.
8. The financial memorandum that accompanied the National Care Service (Scotland) Bill lacked detail and credibility and was unclear on overall cost implications.
9. Structural reform risked diverting resources from frontline services during a time of acute pressure.
Reflections from the roundtable
It was questioned whether embarking on large-scale structural reform at a time of acute financial pressure for local authorities and integration joint boards (IJBs) was an appropriate use of time and resources. There was also the question of whether the investment required to carry out large-scale structural reform would have been better spent on improving existing services.
The lack of clarity around pensions, staffing transfers and long-term costs further eroded confidence in the financial sustainability of the reform. Uncertainty hindered long-term decision making. The uncertainty of structural reform also introduced strategic planning challenges, with some public bodies hesitant to make long-term decisions and investments.
CIPFA broke down the key failures of the NCS financial memorandum (FM) in our consultation response, which underpinned a number of recommendations made by the Finance and Public Administration Committee.
CIPFA’s response underlined the lack of detail and evidence in the FM, lack of opportunities for effective scrutiny, the risk to local accountability and challenging timescales for implementation. While it can be argued that there will never be a ‘perfect time’ financially to undertake large-scale reform considering current pressures, it was agreed that the wake of the pandemic, with its resultant effects on health and social care, made large-scale reform particularly challenging.
Workforce and delivery capacity
Key messages
10. The evaluation of capacity within the system to deliver large-scale reform was unrealistic.
11. The process of establishing an NCS added stress to an already fragile workforce.
12. The uncertainty around employment conditions created anxiety for care workers.
Reflections from the roundtable
Delegates argued that there was no realistic assessment of delivery capacity within the system. The process of establishing an NCS was described as “traumatic” for the already fragile social care workforce, particularly as the system was still reeling from the impact of the pandemic. The lack of clarity around terms and conditions, job security and pensions created significant anxiety among staff and exacerbated existing workforce recruitment and retention challenges, including in social work and managerial roles.
Politics and partnership
Key messages
13. The NCS process damaged relationships between local and central government and other key stakeholders.
14. Local government reform was not acknowledged as central to the process.
Reflections from the roundtable
It was clear during the roundtable that relationships between local and central government were damaged by the NCS process. Related to the previous point around building a coalition of support rather than strong, collaborative joint working, the NCS process was at times adversarial.
It was the experience of local government and other stakeholders that reform was being imposed on them rather than being worked through in collaboration. Importantly, given that local authorities are responsible for social care, and that social care comprises the majority of local authority discretionary expenditure, any effort to reform social care must be viewed as a form of local government reform. The delegates expressed the view that the Scottish Government overlooked this key distinction.
What the Scottish NCS experience has taught us
- Clearly define the improvements to the outcomes of people who draw on care and support.
- Take a whole-system, place-based approach to reform.
- Build and maintain a broad coalition of support.
- Ensure this broad coalition is resilient to inevitable political changes.
- Do not lose sight of the fact that social care reform is local government reform.
- Ensure financial credibility.
- Assess delivery capacity realistically.
- Use co-design in a way that does not hinder scrutiny.
Lessons from Wales’ NCS journey
Given the Welsh Government has established the National Office for Care and Support with responsibility for implementing an ongoing plan towards an NCS, it can be argued that Wales is closer to fulfilling this achievement than Scotland and England.
Though tangible outcomes remain limited, this relative progress has been driven by collective buy-in grounded in national policy frameworks. In combination, these have helped reform to develop incrementally through a shared exploration of how things should work across the sector rather than by an initial implementation of a single blueprint.
However, there remains ambiguity about the eventual policy aims for a national care and support service in Wales, which draws into question the extent of progress so far, with several key elements of the eventual NCS not yet determined. The Welsh experience offers valuable lessons in how collaboration and gradual evolution alongside the existence of formal foundations can help to act as enabling factors to reform.
At the same time, the Welsh experience reveals ongoing challenges around determining the eventual goals of the NCS policy and how it can be implemented, particularly given the complex funding and capacity challenges facing the sector. Constructive ambiguity can allow for movement, but it does not necessarily guarantee progress towards a final goal that will succeed in tackling the challenges facing the adult social care sector.
Policy foundations
Key messages
1. Wales implemented legislation in the form of the Social Services and Well-being (Wales) Act 2014, which has provided the framework for continued progress on the NCS.
2. Further policy developments through the Rebalancing Care and Support Programme have allowed for continual development of health and social care policy.
3. Further legislative changes that may be required are built into the implementation plan, meaning it is possible legislative changes will be a barrier later in the process.
Reflections from the roundtable
Together these policy foundations have provided a way to implement the NCS. The existing legislation places the reform in Wales’ wider vision of wellbeing, prevention and cooperation. The expert group reflected in 2022:
To some extent, Wales already has a care service which should be available nationally and consistently, due to the implementation of the Social Services and Well-Being (Wales) Act 2014.
Source: Towards a National Care and Support Service for Wales (Welsh Government, 2022).
However, it is not the case that this legislation guarantees the movement towards care provision that could be described as a “national care service,” and the implementation plan implies further legislative changes may be required. This may mean the NCS in Wales could face the same challenges as in Scotland, depending on the scale of legislative changes.
Consensus through expertise
Key messages
4. An expert group was selected by ministers to represent the weight of opinion on developing an NSC and provided an authoritative report in 2022 that outlined the route to an NCS.
5. However, the expert group was not representative of all stakeholders, including a lack of representation from current local government and health sector professionals.
6. Despite these criticisms, it was noted that the expert group strengthened the consensus around the key aims of the NCS policy.
Reflections from the roundtable
The expert group offered a formal space to progress towards consensus based on ministerial selection and with significant although imperfect representation of stakeholder groups. The group established a shared point of understanding and built legitimacy around the NCS. The document produced by the expert group outlined the key principles that the NCS should work towards, including outlining decisions that would be made later in the process, such as on a national funding model. This has been used throughout the process to legitimise and add structure to the implementation plan.
Structure for implementation
Key messages
7. The creation of the implementation timeline and the National Office for Care and Support have set up an accountability structure for progress towards an NCS.
8. However, the plan and office were criticised by stakeholders, who said that although they gave the appearance of progress, they have not translated into tangible outcomes.
9. Since it was established in 2024, the National Office for Care and Support has become the key body with responsibility for ensuring the development and delivery of the National Care Service programme, as well as reporting on progress.
10. Stakeholders in our roundtable suggested that the visibility of the office and its work remain limited.
Reflections from the roundtable
The idea of an implementation plan and an office dedicated to working through delivery of the NCS are important steps for ensuring accountability, and a series of stages provides structure to the progress towards reform. However, stakeholders in the roundtable drew attention to the limited tangible progress that has been made.
The financial case
Key messages
11. The central unresolved challenge of establishing an NCS in Wales is how it will be funded.
12. As per recommendations by the expert group, The National Office for Care and Support has “started to co-ordinate research activity into how best [it] can move towards a charging regime where most non-residential care is delivered, free at the point of need.”
13. However, there is currently no clarity regarding the changes to funding that will allow for the additional costs associated with moving to this model.
Reflections from the roundtable
Funding remains the central unresolved challenge. Whatever the direction of travel reform takes, it must be adequately funded if it is to succeed.
In context, Welsh local authorities already face severe financial pressures, making it hard to plan strategically for ‘free at the point of use’ social care, when day-to-day services and increasing demand are already stretching resources. Participants across the roundtables were also keen to point out the significant burden social care places on local taxpayers under the current funding models.
What the Welsh NCS experience has taught us
- Working towards shared goals in collaboration between central government and key stakeholders from the start can help to maintain a coalition of support, even where there is ambiguity in the end goal.
- However, there is a risk that iterative progress can mean the most difficult questions are left unanswered, meaning that tangible results are realised very slowly, if at all.
- Expertise across stakeholder groups should be utilised at the start of the NCS journey to ensure collective buy-in and a well-received foundation on which to base future decisions.
- A staged plan and a body with responsibility for implementing it are useful tools for ensuring accountability but do not guarantee progress, and stakeholders need to be kept up to date with developments and the work of the responsible body must be visible.
- The legislative basis for reform, based on the 2014 Act, has been useful for facilitating changes but does not guarantee future legislative reforms, if necessary, will be straightforward.
England: the beginning stages of the NCS journey
Although England is at an earlier stage of its journey towards an NCS, there are several lessons that the participants in our roundtable emphasised.
- Social care reform cannot take place in isolation but should consider all other areas that interact with social care, including health, housing, welfare, transport, etc. Social care reform should take a whole-system, place-based approach.
- The idea of an NCS has political appeal as a ‘brand’ but hides the many different types of structure that the name could imply, from a national care standards framework to a national body responsible for care delivery like the NHS but for care.
- Care reform depends on a balancing act between national accountability and local autonomy.
- Reform should be defined through collaboration with those who draw on care and support, carers and all other stakeholders involved in the delivery and receipt of social care.
Participants at the roundtable consistently emphasised the importance of collaboration and the confusion over differing definitions of an NCS – points that have already been exemplified in the experiences of Wales and Scotland. Many of the lessons from Wales and Scotland will become relevant in England as progress is made through the work of the Casey Commission.
Where the Scottish and Welsh roundtables were reflective – looking back on two distinct processes with clear points of success and failure – the English roundtable was forward-looking and characterised by stakeholders’ ambitions for what an NCS could be in England. Therefore, many of the insights that were shared during the English roundtable will feature in the third briefing of this series, which will focus on the future direction of adult social care reform across all three nations.
Bringing together the lessons
Uncovering lessons for how an NCS should be set up is complicated by the fact that there is no shared definition of what an NCS is or should be. It has meant different things in the three UK nations that have adopted the policy, which can be explained by the fact that health and social care are responsibilities that have diverged since devolution.
No government in the UK has implemented the policy so far, and there are differences of opinion among stakeholders over how an NCS should be structured, funded and implemented. At present, the NCS is more a conceptual embodiment of improvement within struggling adult social care systems than a clearly defined goal.
However, from the reflections of those involved in the processes in Scotland and Wales, and the early thoughts of those in England, there are clear differences between the methods that have definitively harmed progress and those that have allowed the journey towards an NCS to continue.
The following points of failure were identified by participants reflecting on the NCS processes in Scotland and Wales:
- Overly centralised decision making.
- Lack of clarity about proposals at the points where clarity was necessary, such as during the drafting of legislation.
- Stakeholder engagement did not always include key stakeholders.
- Viewing social care in isolation rather than as part of a complex system of public services, including local government and health.
- Plans that were not financially credible.
Each of these contributed to the eventual failure of the NCS process in Scotland and some – for instance, financial credibility and detailed proposals – remain risks for Wales.
On the other hand, points of success include:
- Cross-stakeholder expertise and strong collaboration to build and maintain consensus.
- Enshrining key principles from the start and working towards goals with flexibility rather than imposing direction top-down.
- A well-defined, co-designed implementation plan can help to keep the process moving forward and provide an accountability framework for driving changes.
- An iterative approach to reform rather than a ‘big bang.’
Conclusion
In this briefing, CIPFA and the LGIU have shared insights gained from roundtables focused on the lessons to be learned from the experiences of establishing NCSs in Scotland and Wales. It is important that we understand key points of success and failure from what has taken place so far, so that future attempts at adult social care reform can avoid previous errors while capitalising on what has worked well.
In the next and final briefing of this series, we will look forward and examine the future directions of adult social care reform in England, Scotland and Wales.
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