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National Care Service

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The National Care Service (NCS) is a proposed publicly funded system of social care in the United Kingdom which was partially introduced by the Labour government of Gordon Brown in 2010 but abandoned soon after when the coalition government of David Cameron and Nick Clegg came to power in May 2010. Similar to the National Health Service, it would be free at the point of need and paid for through taxation.[1][2] The Labour Party has continued to propose the creation of an NCS while in opposition, and has done so under each consecutive leader since Ed Miliband's leadership in 2010.

Since 2021, the proposal has been adopted by the devolved governments of Scotland and Wales.[3][4] In Scotland, it is planned for the service to be fully operational by 2028 or 2029.[5][6] In Wales, the government has begun gradually implementing the service from 2022 for what is expected to be a ten-year period.[7][8]

Background

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The Labour government of Clement Attlee introduced a publicly funded system of health care with the establishment of the National Health Service (NHS) in 1948.[9] The NHS covered social care until 1976,[a] when most social care services were transferred to local authorities.[11] Since then, most people have had to pay for social care, with publicly funded social care still available to those who pass a means test in which examinees must prove a lack of wealth and a high need for care.[12] Publicly funded social care is also offered to some adults with "long-term complex health needs" through the NHS continuing healthcare scheme.[13]

History

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England and Wales

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A "National Care Service" was first proposed in the later stages of Prime Minister Gordon Brown's Labour government.[14] The Department of Health under Andy Burnham released its green paper Shaping the Future of Care Together in July 2009, which proposed a new National Care Service "on par with the NHS".[15] This was followed by a public consultation in September called the "Big Care Debate", which was promoted by Brown as a "crucial national debate".[16] The consultation found a public desire for social care reform and explored different ways to introduce the NCS. The government decided to introduce the NCS gradually and in different stages, with the first stage beginning with the Personal Care at Home Act 2010.[17] This Act legally extended to England and Wales.[18]

The Act was passed by parliament in April 2010,[19] with the NCS being launched a month earlier by Health Secretary Andy Burnham, giving all elderly and disabled people free social care. The second stage was planned to begin from 2014 and would extend free social care to people who were in residential care for more than two years. A third and final stage would fully introduce the NCS, giving all adults free social care after 2015.[20][21] However, the Labour government lost the May 2010 general election and the Conservative–Liberal Democrat coalition came to power. The coalition abandoned the NCS[22] and the Personal Care at Home Act 2010 was later repealed.[23]

In opposition, the Labour Party under the leadership of Ed Miliband (2010–2015) continued calling for the introduction of an NCS that would give elderly and disabled people free social care.[24] Under Jeremy Corbyn's leadership (2015–2020), the party promised to introduce the NCS in its manifestos for the 2017 and 2019 general elections,[25][26] once again proposing free social care for all adults[27] and also free personal care for the elderly.[2] It is also supported by leader Keir Starmer (2020–present), who is planning to introduce it as a needs-based, locally delivered system should Labour enter government.[28] His Shadow Health Secretary Wes Streeting launched a review by the Fabian Society to see how it would operate and be funded, and aims to gradually introduce it over two or three terms of a Labour government, with a long-term aspiration of introducing the service on par with the NHS.[29] The Fabian Society's report was released in June 2023. Its proposals only apply to England and include the recommendations that short-term care and support should be free and that support should be made available for everyone regardless of their means.[30][31] The NCS was included in a draft Labour manifesto for the 2024 general election from May 2023[32] and was acknowledged as Labour Party policy by Streeting in October 2023.[33] It was included in the Labour Party's published general election manifesto, Change.[34]

Wales

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The devolved Labour-led government of Wales explored options for a Welsh NCS as part of its 2021 cooperation agreement with Plaid Cymru,[4] with a plan for its implementation expected by the end of 2023.[7] The Welsh branch of Labour had supported the NCS since the 2021 Senedd election.[35] Since 2022, the Welsh government has gradually introduced the service over what is expected to be a ten-year period.[8][36]

Scotland

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Scottish Labour has been calling for the implementation of a Scottish NCS since 2011,[37] with then party leader Iain Gray (2008–2011) negotiating the proposal with civil servants in 2010.[38] The Scottish Conservatives supported the proposal, as did the Scottish National Party (SNP) government's then-Health Secretary Nicola Sturgeon,[39] however Sturgeon and the SNP government ultimately rejected the proposal.[40]

An independent review into Scottish adult social care was commissioned by First Minister Nicola Sturgeon in 2020, as a response to the damage to care homes caused by the COVID-19 pandemic in Scotland. This review was dubbed "The Feeley Review" after its author and chair Derek Feeley,[41] the former chief executive of NHS Scotland, and was published in February 2021.[42][43] The review recommended the establishment of a Scottish NCS on an equal footing with NHS Scotland, receiving centralised funding from the Scottish government.[44][45] Health Secretary Jeane Freeman accepted the recommendation[46] and the SNP promised to introduce the NCS as a "top priority" in government in its manifesto for the 2021 Scottish Parliament election, alongside the introduction of a national wage for care staff.[47][3] It is planned that the new service will be fully operational in Scotland by 2026.[5] Nationalising care homes is not part of the proposal, but it will mean ministers will get more power over social care. There is a pledge to make social care free at the point of use, although this will not include accommodation costs.[48]

The Scottish Socialist Party supports a publicly owned and publicly funded National Care Service that would be free at the point of use (like the NHS).[49][50][51]

National Care Service (Scotland) Bill

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The National Care Service (Scotland) Bill was introduced to the Scottish Parliament on 20 June 2022.[52] If passed, the Bill will establish the NCS in Scotland and give Scottish ministers the ability to transfer social care services, which in Scotland are currently maintained by local authorities, to the new care service. In the case of children's services, ministers would have to hold a public consultation to be able to transfer them to the NCS. Some health services which are currently maintained by NHS Scotland and its Health Boards could also be transferred should the Bill pass. NCS Care Boards would deliver care on a local level, although transferred services could also be delivered nationally. The NCS and NHS Scotland would also share information, carers would have a right to take breaks and the proposed "Anne's Law", a law which would entitle care home residents to meeting people important to them, would also be enacted in the Bill.[41]

The Bill has been met with controversy. Scottish Labour called the SNP's plans to introduce the NCS "the biggest power grab in the history of Holyrood",[53] with deputy leader Jackie Baillie claiming that it would endanger local authorities, adding that it was "not a National Care Service" but a "national commissioning service which can be used as a fig leaf for centralising power".[54] Other opposition parties have raised concerns about the cost of the service, which is believed to have the possibility of redirecting nearly £1.3 billion of public money from frontline services to the NCS (£495 million for the overall service and another £726 million for its Care Boards). Trade unions GMB,[55] Unison and Unite are also concerned about the centralisation of power away from local authorities that would be caused by the service, while the Convention of Scottish Local Authorities (COSLA) is currently taking "the time and consideration that is rightfully needed with legislation of this magnitude, to understand the breadth of the impact it will have on communities the length and breadth of Scotland".[56]

Notes

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  1. ^ The NHS in Northern Ireland did not cover social care until 1973, when it merged with Northern Ireland's social care system to form Health and Social Care, which still provides free health and social care to this day.[10]

References

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  1. ^ Whittome, Nadia (15 June 2022). "We desperately need an alternative to the orthodox economic consensus". LabourList. Retrieved 15 June 2022.
  2. ^ a b Buchan, Lizzy (22 September 2019). "Labour promises free personal care for older people in bid to end 'national scandal'". The Independent. Retrieved 15 June 2022.
  3. ^ a b "Nicola Sturgeon pledges National Care Service is a 'top priority' if SNP wins election". Daily Record. 20 April 2021. Retrieved 28 July 2021.
  4. ^ a b Pamben, Deven (23 November 2021). "Wales to examine creation of a National Care Service". LaingBuisson News. Retrieved 15 June 2022.
  5. ^ a b Pringle, Esmé (27 January 2022). "Watchdogs: Care can't wait five years for action". Healthandcare.scot. Retrieved 15 June 2022.
  6. ^ "Scotland's National Care Service delayed by three years". BBC News. 14 December 2023. Retrieved 5 January 2023.
  7. ^ a b This article contains OGL licensed text This article incorporates text published under the British Open Government Licence: "First step to National Care Service as expert panel announced". Welsh Government. 21 February 2022. Retrieved 15 June 2022.
  8. ^ a b "Written Statement: National Care Service – Initial Implementation Plan Publication (14 December 2023)". GOV.WALES. 14 December 2023. Retrieved 5 January 2024.
  9. ^ Mandhai, Shafik; Chughtai, Alia (7 June 2017). "NHS England at a glance". Al Jazeera. Retrieved 16 June 2022.
  10. ^ Nicholson, Elspeth; Shuttleworth, Kelly (18 August 2020). "Devolution and the NHS". Institute for Government. Retrieved 16 June 2022.
  11. ^ "Separation of health and social care". parliament.uk. 12 April 2005. Retrieved 16 June 2022.
  12. ^ Bottery, Simon (7 September 2021). "What will the government's proposals mean for the social care system?". The King's Fund. Retrieved 16 June 2022.
  13. ^ "NHS continuing healthcare". NHS.uk. 3 August 2018. Retrieved 16 June 2022.
  14. ^ "What would a National Care Service look like?". New Statesman. 3 January 2024. Retrieved 5 January 2024.
  15. ^ Burke, Stephen (2 October 2009). "National care service – what's the big idea?". The Guardian. Retrieved 15 June 2022.
  16. ^ "Big Care Debate: How to get involved". The Guardian. 8 September 2009. Retrieved 15 June 2022.
  17. ^ Building the National Care Service (PDF). Department of Health. London: HM Stationery Office. 30 March 2010. pp. 4, 7–8. ISBN 9780101785426.
  18. ^ "Personal Care at Home Act 2010 Content: Provision 3". legislation.gov.uk. Retrieved 15 June 2022.
  19. ^ "Personal Care at Home Act 2010". UK Parliament. 17 August 2010. Retrieved 15 June 2022.
  20. ^ "National Care Service launched". GOV.UK. 30 March 2010. Archived from the original on 9 June 2010. Retrieved 15 June 2022.
  21. ^ Social Care Funding: Time to End a National Scandal (PDF). House of Lords Select Committee on Economic Affairs. Dandy Booksellers Limited. 4 July 2019. p. 11. ISBN 9781787764316.
  22. ^ Jarrett, Tim (23 September 2017). Social care: Government reviews and policy proposals for paying for care since 1997 (England). House of Commons Library. p. 11.
  23. ^ "Personal Care at Home Act 2010 (repealed)". legislation.gov.uk. Retrieved 15 June 2022.
  24. ^ Samuel, Mithran (27 September 2010). "Labour leader Ed Miliband backs national care service". Community Care. Retrieved 15 June 2022.
  25. ^ "Social care: What's happened to the 'dementia tax'?". The Week UK. 22 June 2017. Retrieved 15 June 2022.
  26. ^ Clarke, Sarah (21 November 2019). "Labour confirms plans for free personal care in 'radical' manifesto". Home Care Insight. Retrieved 15 June 2022.
  27. ^ "Labour pledges to spend £6bn to make social care free". i. 22 September 2019. Retrieved 15 June 2022.
  28. ^ Starmer, Keir (19 June 2022). ""Councils will be at the top table" – Keir Starmer's LGA Labour conference speech". LabourList. Retrieved 21 June 2022.
  29. ^ Mason, Rowena (3 July 2022). "Labour to aim to launch national care service inspired by creation of NHS". The Guardian. Retrieved 4 July 2022.
  30. ^ Watson, Iain (8 June 2023). "Social care: Labour urged to commit to care worker pay increases". BBC News. Retrieved 13 June 2023.
  31. ^ Crerar, Pippa (8 June 2023). "Labour aims to reform England's adult social care sector if it wins election". The Guardian. ISSN 0261-3077. Retrieved 13 June 2023.
  32. ^ Neame, Tom Belger, Morgan Jones, Katie (11 May 2023). "Revealed: Full draft policy platform that could form 2024 Labour manifesto". LabourList. Retrieved 13 June 2023.{{cite web}}: CS1 maint: multiple names: authors list (link)
  33. ^ Weakley, Kirsty (9 October 2023). "National care service to be built with local government, Labour says". Local Government Chronicle (LGC). Retrieved 28 October 2023.
  34. ^ "Labour manifesto: What they plan to do in government". BBC News. 5 July 2024. Retrieved 8 July 2024.
  35. ^ Owen, Twm (14 September 2021). "Welsh Government putting £48m towards social care". The National. Retrieved 16 June 2022.
  36. ^ "Welsh national care service". Healthcare Financial Management Association. 14 December 2023. Retrieved 5 January 2024.
  37. ^ "National Care Service is the only way forward for adult care". East Lothian Labour. Retrieved 17 June 2022.
  38. ^ "Iain Gray in civil service talks about return to power". The Scotsman. 1 November 2010. Retrieved 17 June 2022.
  39. ^ Torrance, David (10 August 2011). "Scotland speeds plans to pool health and social care". The Guardian. Retrieved 17 June 2022.
  40. ^ Scottish Labour: Scotland's NHS Recovery Plan (PDF). Scottish Labour. 2021. p. 11.
  41. ^ a b "National Care Service (Scotland) Bill: Overview". Scottish Parliament. 20 June 2022. Retrieved 21 June 2022.
  42. ^ Wilson, Caroline (3 February 2021). "Review backs National Care Service to 'raise standards' in care homes". The Herald. Retrieved 17 June 2022.
  43. ^ This article contains OGL licensed text This article incorporates text published under the British Open Government Licence: "Independent Review of Adult Social Care". Scottish Government. Retrieved 17 June 2022.
  44. ^ Fraser, Douglas (3 May 2021). "How much do we care about those who need care?". BBC News. Retrieved 17 June 2022.
  45. ^ "Nicola Sturgeon to consult on National Care Service in first 100 hundred days". Home Care Insight. 2 June 2021. Retrieved 28 July 2021.
  46. ^ "Backing for Feeley Review recommendations". Scottish Government. 16 February 2021. Retrieved 17 June 2022.
  47. ^ Albert, Angeline (15 April 2021). "Nicola Sturgeon promises National Care Service and national wage for care workers". Carehome.co.uk. Retrieved 17 June 2022.
  48. ^ "Letter from Scotland: A more generous social care system". Health Service Journal. 9 June 2021. Retrieved 28 July 2021.
  49. ^ "Scandal of underpaid care home workers predates coronavirus". The National. 15 December 2020. Retrieved 20 January 2021.
  50. ^ "Elderly care for profit is a scandal that should be ended". The National. 23 July 2020. Retrieved 20 January 2021.
  51. ^ Fox, Colin (25 May 2020). "Colin Fox: Why Scotland needs to have a National Care Service". The National. Retrieved 20 January 2021.
  52. ^ "National Care Service (Scotland) Bill". Scottish Parliament. 20 June 2022. Retrieved 21 June 2022.
  53. ^ Summers, Lisa (21 June 2022). "National Care Service for Scotland will 'end postcode lottery'". BBC News. Retrieved 21 June 2022.
  54. ^ Grant, Alistair (21 June 2022). "National Care Service plans branded 'biggest power grab in history of Holyrood'". The Scotsman. Retrieved 21 June 2022.
  55. ^ Green, Chris (21 June 2022). "Scotland's plan for National Care Service sparks backlash from unions". i. Retrieved 21 June 2022.
  56. ^ Bol, David (21 June 2022). "Warning SNP ministers risk diverting £1.3bn to set up National Care Service". The Herald. Retrieved 21 June 2022.
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