The future of the left since 1884

NEW PROJECT: Roadmap to a national care service

The Fabian Society is working with Unison to develop a roadmap to a national care service




The Fabian Society is delighted to announce a new inquiry that will develop a roadmap towards 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.

Fabian Society General Secretary Andrew Harrop said:

“The Fabian Society, the trade unions and the Labour party have been working together to build Britain’s public services for over 100 years. The Fabians first called for a national healthcare service in 1911 and then played an instrumental role in the development of the NHS.

“We are delighted to now be working on plans to develop a national care service for England based on the spirit of those past reforms. We will present practical, workable proposals to gradually develop national entitlements, standards and funding models that will support the integration of social care with healthcare and are designed around local accountability and individual preferences and needs.”


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 the eventual structure. The endpoint may be national standards and values rather than a single national organisation.

The inquiry

The research will review the latest evidence and policy proposals on adult social care in England, take evidence from key experts and undertake quantitative analysis to develop up-to-date estimates of costs and benefits.

At the outset of the project we envisage the report covering five key topics:

  1. Context and issues to consider
  2. Essential features for a national care service
  3. Design options and alternative models
  4. Costs and benefits
  5. The roadmap to reform and sequencing of measures

For further information please email

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