Austerity-hit councils already face sweeping changes in the form of devolution, reorganisation and ambitious new housing targets. But with the announcement on 3 January of a new independent commission to look at social care in England, another major transformation is on the horizon – potentially the most consequential change to how local services will be delivered in decades.
The commission, led by Baroness Louise Casey, aims to build consensus around a National Care Service for England – a declared aim of the Labour Government – that meets the needs of older and disabled people in the 21st century. It will report back to ministers with full recommendations by 2028. Casey will work with those who need care, their families, the workforce, providers and politicians to recommend how to rebuild an adult care system plagued by chronic underfunding, substandard services and a staffing crisis fuelled by low pay.
Unison has long argued for a National Care Service for England to raise standards for those in need of support and to improve conditions for care staff. Indeed, it was a Unison-commissioned Fabian Society report that encouraged health and social care secretary Wes Streeting to back the idea.
That 2023 report set out what a National Care Service should look like and how it could be achieved. It also reinforced the crucial role local Government would play in managing and delivering it.
Given the Government's commitment to deliver a National Care Service, councils might wonder what this would look like in practice. The final decision will rest with ministers, informed by the commission's advice. However, there are several elements that should form the basis of any national system. The care service shouldn't be a single, centralised institution. Instead, it should set national standards for all forms of adult social care, which councils and providers must meet. These should apply to all local services such as domiciliary care, residential homes, supported living and personal assistants.
Crucially, local authorities would remain responsible for commissioning social care and have greater freedom to provide services in-house. Councils are best placed to understand the care needs of their residents, so locally managed services, overseen by national Government, should be a key part of the new system. Under this model, ministers or a social care watchdog would only intervene if services failed to meet agreed standards, such as when unscrupulous providers offer inadequate services or mistreat staff.
Another crucial element of a National Care Service is the introduction of minimum standards across the workforce. These would cover pay and conditions for adult care staff, as well as training requirements. These are key to making social care an attractive career, with well-trained, well-paid staff, addressing the low wages and insecurity that have caused the recruitment crisis and a reliance on migrant workers, exploited by unscrupulous employers.
One vital step on the way is to establish a Fair Pay Agreement for social care, which the Government is already pursuing. The creation of a negotiating body to bring this about was included in the Employment Rights Bill in November. The new body will set pay and conditions in the sector and should raise standards by attracting and retaining high-quality staff. Once that's achieved, the Government should require minimum care standards across all providers, whether they're in-house, private contractors or charities working with local authorities.
With 18,500 adult care organisations currently in England, it's a huge challenge to monitor them all effectively − meaning some poor-quality services go unchecked. The question is whether this level of fragmentation helps drive up overall service quality in social care or drags it down. It will be interesting to see how the sector is affected following the Cabinet Office's imminent announcement of the biggest in-sourcing drive across public services in a generation. Given the long-term contracts held by many private and third-sector providers, widespread in-sourcing is unlikely to happen overnight. But a National Care Service allowing councils to choose the provision that works best for them, as long as it's affordable and meets future national standards, is an important initial step. Having an identifiable, widely recognised system branded as the National Care Service is central to this vision. The brand would not only hold political weight but embody shared values people can relate to, much like the NHS.
The major challenge for these ambitions is funding. Local government and the care sector face severe financial constraints. But if the Government's committed to solving the adult care crisis, resources must be unlocked to improve care for all − and ensure councils remain central to the system.
