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CALL FOR EVIDENCE: Roadmap to a national care service

The Fabian Society is undertaking research supported by Unison to develop a roadmap to a national care service for England. We are seeking evidence and proposals for reform



The Fabian Society is undertaking an inquiry to develop a roadmap to a national care service for England. The study will make recommendations to the Labour party policy review and to shadow health and social care secretary Wes Streeting MP. The research is kindly funded by Unison and is led by Fabian Society general secretary Andrew Harrop.

The project is an independent study and its proposals will not necessarily reflect the views of either the Labour party or Unison. It aims to present practical, workable proposals to gradually develop national entitlements, standards and funding models that will support the integration of social care with other public services and are designed around local accountability and individual preferences and needs.

This call for evidence seeks evidence and proposals for reform from individuals and organisations with an interest in adult social care.


  1. What should care and support for adults in England look like in 10 to 15 years’ time? What should it achieve? What values should inform it? How should it be run?
  2. What level of demand will there be for care and support in England over the coming years? What will be the costs and benefits of adequately meeting this need? What will happen if it isn’t met? What are the implications for equality, diversity and inclusion?
  3. What reforms to care and support in England should be initiated in the first year of a new government elected in 2024?
  4. What further reforms should be initiated or planned over the course of one parliament?
  5. Specifically, what changes should an incoming government consider with respect to:
    • Rights, control and personalisation for service users, carers and families
    • Workforce reform
    • Financial allocations and funding mechanisms
    • Organisational structures for commissioning and delivery
    • National and local leadership and accountability
    • Boundaries, interactions and integration with other parts of government, and with the rest of society

How to respond

The Fabian Society is very grateful to individuals and organisations interested in feeding into the project and we want to make it as easy as possible for you to engage. You can (1) submit a written response to our questions, (2) send us previous published work relevant to the project, or (3) make a sound recording summarising your views on the issues.

Please send an email to including links and/or attachments if applicable. The deadline for the call for evidence is Monday 12 September 2022.


The idea of a ‘national care service’ was first developed in the final year of the last Labour government. In a 2009 green paper Labour proposed a service that would deliver: prevention services; national assessment; a joined-up service; information and advice; personalised care and support; and fair funding. The service was to be universal, fair and affordable, helping everyone who needed care and support.

At each election since then, the Labour party has promised to introduce a national care service. But in more than a decade little work has been done to flesh out what this should mean in practice. Over those years the state of adult social care has gone from bad to worse, with an acute funding crisis that makes a mockery of the statutory rights the system is supposed to deliver to older and disabled people. Frontline workers have borne the brunt of the funding pressures, through low pay and unfair, insecure working conditions. And policy debate has been badly skewed by ministers’ narrow focus on how to reform the funding of older people’s care, at the expense of other more fundamental challenges facing social care for adults of all ages.

Against this backdrop, the transformation of adult social care is likely to need to be achieved gradually over time. A ‘big bang’ reform would be destabilising for staff and service users, and would not be affordable in the short term. There are also a number of models to consider, especially taking into account current moves to integrate health and care and decentralise public services. 13 years after a ‘national care service’ was first proposed the principles behind the concept are what matters not any particular structure. The endpoint may be national standards and values rather than a single national organisation.

The inquiry

The research is reviewing the latest evidence and policy proposals on adult social care in England, seeking evidence and reform proposals from interested parties, and undertaking quantitative analysis to develop up-to-date estimates of costs and benefits.

We envisage the report covering five key topics:

  • Context and issues to consider
  • Essential features for a national care service
  • Design options and alternative models
  • Costs and benefits
  • The roadmap to reform and sequencing of measures

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