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Moving towards a National Care Service

Radical plans for a new national care service under which health and social care would be delivered by the same organisation are being actively considered by the government for inclusion in a white paper due to be published next month.

The idea of local authorities and the NHS taking joint responsibility for social care, perhaps working from a single combined budget for the first time, would amount to one of the most far-reaching reforms since the NHS was founded in 1948.

Current situation

At present, local authorities have responsibility for running social care services in their own areas. Critics say there is, as a result, insufficient incentive for cash-strapped councils to develop better care for people in their homes or in the community, as it is cheaper for them if those in need go into hospital where the cost is met from the separate NHS budget.

The result is that many people who could be cared for at home or in the community end up occupying much-needed hospital beds.

Similar systems operate in Wales and Northern Ireland, although there are variations in how much care is paid for by the state. The Scottish government is holding a consultation, due to end next month, on proposals for a National Care Service.

A new integrated service

It is believed that health secretary Sajid Javid is examining how a new integrated service that would deliver better care and free up NHS beds across England could be delivered. It is understood there would be national standards for care, and conditions for carers.

It is known that Boris Johnson was keen to announce plans to integrate health and social care services last month when he revealed that National Insurance contributions would rise by 1.25 percentage points from next April, to raise £12bn a year for the NHS and social care. But at that time Downing Street remained unclear about how an integrated system could best work, so an announcement was put back.

Radical option

Under the most radical option of all, local authorities would be stripped of any involvement for social care, which would come entirely under the NHS. Sources say, however, that this would involve too great an upheaval and prove hugely unpopular with councils, many of which are Tory controlled. Councils have already lost much of their responsibility over education.


Tory MP and former health under-secretary Dr Dan Poulter, who works part time as an NHS psychiatrist, said: “There is a growing expectation that a substantive health and social care white paper will emerge in the next few weeks aiming to establish a national care service.

“If integration is to be a success, it is essential that reform does not just deliver parallel commissioning of health and care services but also services commissioned through a single pooled budget. Unified health and social care budgets are the only way to deliver both a more efficient health and social care system as well as properly joining up for the benefit of patients what is currently a badly fragmented system.”


At last, the drive to improve social care and give the service the recognition it deserves is gathering pace. The concept of a National Care Service is alive in England and Scotland. This has come about because the balance between national and local has shifted too far to the local in recent years. Not least because councils in more deprived areas have less capacity to raise money to spend on services, exacerbating postcode lotteries in access to services.

I agree with Simon Bottery a senior fellow in social care at the King’s Fund who suggests that some aspects of adult social care should be run nationally but this should not be the default. Instead, the principle of subsidiarity should apply, with decisions about different aspects of the system taken at the most appropriate level. This may be a more complex framework than some might expect of a national care service, but it will deliver better social care.

In any event I am sure we would all welcome clearly defined national standards for care, and conditions for carers.

Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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