Launching a new Fabian Society report on the care sector, Labour's Shadow Minister for Mental Health and Social Care says the current system is 'manifestly unfair'.

It is now more than eight years since the publication of Building a National Care Service, the last Labour Government’s White Paper on long-term reform of social care.

Billed as the most ambitious change to the welfare state since the creation of the National Health Service, it represented the most comprehensive set of proposals for reform since the 1999 Royal Commission. However, Labour’s 2010 General Election defeat meant it was not implemented.

The White Paper retains many important features which will inform Labour’s new plans for a National Care Service. It set out what people could expect to receive on their journey through social care and how to embed quality in the system; I discuss this further in Take Good Care, a new Fabian Society report.

Personalised care, joined-up assessment, nationally consistent eligibility criteria, prevention and fair funding were all key principles and they remain part of our vision today. However, much else has changed since 2010.

The ever-increasing care needs of older and working age people have been met by austerity. Cuts of 40% or more to the budgets of councils responsible for delivering social care have led to our care system being hollowed out.

The care provider market, now almost wholly private, is faltering. Quality is worsening as underpaid and overworked care staff struggle to meet growing demand.

Levels of unmet need have risen, with 1.2 million older people managing with no care and 400,000 fewer people now receiving publicly-funded care. The unpaid back-pay bill for overnight shifts worked by staff caring for people with learning disabilities could see many providers having to reduce their services or close down altogether.  

The immediate priority of the next Labour Government must be easing the pressure on people in need of care and their families, while taking a staged approach to reforming the system.

Firstly, to ease the pressure and improve quality, we pledged to invest £8 billion across this Parliament, with £1 billion up front in the first year of government. This would enable offering the real living wage to care staff, as well as better working conditions as well as a package to reduce unmet need.

The second phase would be to put in place the building blocks of a new system, placing a maximum lifetime cap on costs lower than the £72,000 limit abandoned by the Government.

We can no longer ignore the manifest unfairness of the current system, which sees people with cancer receive free care on the NHS, while those with dementia and their families incur catastrophic care costs.

Our third step would be to introduce a fully-fledged National Care Service, which would enshrine in law clear national eligibility criteria to make care assessments consistent and portable across the country, ending the postcode lottery in social care.

We will also seek to take a totally new approach to how care is commissioned.

The system is fragmented between financially hamstrung councils who buy care, and providers seeking to make do with less, often putting pressure on staff. It means that in the current care landscape, commissioning often cannot achieve a wider purpose beyond finding whatever care is available, even if it is of poor quality.

So we will explore ways to ensure that councils purchase care from providers with certain workforce terms and conditions, training and development, as a minimum requirement.

Good quality care rests on long-term relationships. The evidence suggests that smaller care locations or different models of care, like Shared Lives and Homeshare can harness these relationships and provide outstanding care. We need to explore how the National Care Service can put these long-term relationships at the centre of our provision.

We know that reforming our care and support system has already proved to be one of the greatest political challenges of the last twenty years. 

But we must not pass up the opportunity to bring lasting, positive change to the way people receive care, to enable people of all ages with care needs to live independent lives.

The next Labour Government will take the historic, bold and far-reaching steps needed to bring social care back from the brink and establish a lasting settlement for the benefit of everyone in need of good quality care.

Barbara Keeley MP is Shadow Minister for Mental Health and Social Care.

This piece is from the Fabian Society’s new report, ‘Take Good Care’. You can read it here.

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