Local Government ExplainedA National Care Service: where does this leave local authorities?
Jon Gleek, Head of Research
A National Care Service has been promised, but what will it look like in practice, and what will local governments’ role be? This resource unpacks the uncertainties around delivery, national oversight and funding.
The phrase “Cinderella service” has often been used to describe the relative position of adult social care among public services. But in the past week Cinderella has finally been invited to the ball, with the Prime Minister making the commitment to developing a National Care Service a centrepiece of his party conference speech, and the Secretary of State for Health and Social Care following up with the promise of a new collective pension scheme for care workers.
The Prime Minister has made clear he wants adult social care delivered free at the point of use “along NHS lines”, and talked about the injustice of people with dementia shouldering the full costs of their care while those with cancer do not. But as yet there is very little flesh on the bones of the headline promise of a National Care Service – including around the key question of how truly national this service will be.
The Prime Minister has left it to Baroness Casey’s Independent Commission to define both how to deliver and to fund a National Care Service, so in theory everything is on the table.
Since her appointment, Baroness Casey has made clear that she is disturbed by the variation in the care and support available to people in different parts of the country, and she has criticised the fact that the system makes it impossible to offer people a clear, single source of information about their entitlements to care and support and how to access them. She has also spoken about the potential for savings through streamlining assessment processes and has been critical of what she sees as wasteful duplication of bureaucracy at local level. However, she has also been heavily critical of the NHS – describing it as a “National Hospital Service” – and has praised the effectiveness of local authorities in working with communities. In recent months, she has talked about her hopes for a renewed National Health and Care Service, but the details of how this will work, and what role local authorities will play in its delivery, remain to be worked out.
It’s important to note, however, that no serious commentator expects wholesale nationalisation of social care, even after the creation of a National Care Service. The 2010 White Paper, authored by Andy Burnham as Secretary of State for Health, described the National Care Service as “led by local authorities”. The report published by the Fabian Society prior to the 2024 election envisaged a significant delivery role for local authorities, operating within a national framework and national funding. And the 2024 manifesto promised national standards for services that were “delivered locally”.
So, where do the past few days’ developments leave local authorities?
The Prime Minister’s headline announcements and the Casey Commission’s work are focused on the long-term. The Prime Minister intends to put the most significant reforms to the public at the next election.
However, Baroness Casey has been clear that she wants to see ongoing work on reform in the meantime. She has already given the Department of Health and Social Care a to-do list, and is expected to do more of this. The increased Prime Ministerial interest in care is only likely to increase the impetus behind this.
Already, there are significant programmes of work underway which will have real impacts across social care, including the negotiations around a Fair Pay Agreement – which will kick off next year, the work to establish Neighbourhood Health (and Care) services, and new work on safeguarding, homecare commissioning, and more. Local authorities and their leadership bodies are already feeding into these.
Clearly, for many local authorities, funding pressures are the most front-of-mind concern, and leading voices in social care – including the architect of the Care Cap, Sir Andrew Dilnot – have continued to argue that a prerequisite for any National Care Service in future is stabilisation of the system now.
The government has been clear that there will be no funding without reform. But there may be a new window of opportunity for local authorities to make the case for funding – ahead of the next Spending Review – by plotting a line of sight between action now and longer-term ambition.
Cinderella may finally have her invitation to the ball, but local authorities will need to make sure they aren’t left sweeping up after midnight when the bill for the evening arrives.
Over the coming months, LGIU will be focusing on the implications for Rewiring the State on Adult Social Care. If you would be interested in getting involved, contact Jon, our Head of Research and Policy.
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