Why we don’t know how much a ‘National Care Service’ could cost UK
Health secretary Wes Streeting has unveiled the government’s latest move towards reform of the UK’s social care system.
Taking the form of an independent commission into the issue, led by Baroness Louise Casey, the review – reporting in 2026 and 2028 – will aim to build “cross-party consensus” for the creation of a new National Care Service.
Streeting’s – and Labour’s – long-term aim, they say, is to create a “national consensus” around such a service which would look after the UK’s elderly and disabled in the 21st century and for it to “survive governments of different shades”, as the NHS has done.
What’s the reaction been?
Charities and opposition parties were swift to criticise the government for the lengthy review time frame.
Professor Martin Green, Care England chief executive, stressed: “This commission will simply confirm what we already know – how many more reports must we endure before action is taken?”
While Liberal Democrat leader Sir Ed Davey branded it “another excuse to kick the can down the road” – and said the review should be “done and dusted within a year at most”.
Shadow health secretary Edward Argar stated: “After 14 years in opposition it is deeply disappointing that Labour doesn’t have a plan for social care.”
How much could a National Care Service cost?
At this stage, it’s effectively impossible to say. The government is yet to formally publish the terms of reference for the commission – and what the commission might recommend, could be anyone’s guess.
In Scotland, where plans for a Scottish National Care Service (NCS) are underway but have been delayed, the government wants to transfer responsibility for social care from councils to a new national body.
A Scotgov factsheet states that in the “most recent financial year [2022-2023] that we have full figures for spending on social care in Scotland,… £5.75bn was spent on social care”.
The government also expects costs of around £345m over the next decade to “make the NCS a reality”, including setting up a National Board, National Social Work Agency and the NCS Local Boards.
Scotland’s population is around 5.5m – with the population of England and Wales much higher at almost 61m.
And speaking to CityAM, outgoing Institute for Fiscal Studies (IFS) director Paul Johnson stressed the scale of the challenge for the government.
“What people ignore is social care is now delivered by 153 local authorities,” he said. “Will they really take all that responsibility away and make it a national service – or will they aim to make it more consistent across the country?
“[The commission] has got an awful lot of things to look at – from the workforce low pay, to our aging population, the quality of care, the fact those who pay for their own care are subsidising those who are funded by councils.”
How could it be funded?
Again, at this stage, we don’t know the government’s plans for funding an NCS – but questions are certain to arise.
As Dr Clarissa Giebel, Senior Research Fellow in the Institute of Population Health, wrote last year: “Would it mean a tax for everyone, similar to National Insurance?
“Would it be an additionally embedded fee within our council tax, even though some of us already pay a social care fee within our council tax?”
Under the previous government, in September 2021, a cap on social care costs of some £86,000 was announced, which would be the max each individual would have to pay.
This – alongside an announced £3.6bn to pay for reforms – was later delayed until 2024 and then scrapped by Chancellor Rachel Reeves in her October Budget.
But could these sums factor into a commission’s findings – and plans for the NCS?
However, when it comes to paying the bill, the government will be on the hook for that one and any political or economic fallout from such a decision.
This is because, as Johnson noted, the commission itself would be unlikely to have any say over the funding of any NCS – or where the money for it might come from.
“Usually these commissions are instructed by the Treasury not to look at where the money might come from, as the Treasury sees it as their role,” he explained.
“The last thing the Treasury would be willing to countenance is the review recommending, for example, increasing income tax.”