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The National Care Service (NCS) is a proposed publicly funded system of
social care Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social wo ...
in the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...
which was partially introduced by the Labour government of
Gordon Brown James Gordon Brown (born 20 February 1951) is a British politician who served as Prime Minister of the United Kingdom and Leader of the Labour Party (UK), Leader of the Labour Party from 2007 to 2010. Previously, he was Chancellor of the Ex ...
in 2010 but abandoned soon after when the
coalition government A coalition government, or coalition cabinet, is a government by political parties that enter into a power-sharing arrangement of the executive. Coalition governments usually occur when no single party has achieved an absolute majority after an ...
of
David Cameron David William Donald Cameron, Baron Cameron of Chipping Norton (born 9 October 1966) is a British politician who served as Prime Minister of the United Kingdom from 2010 to 2016. Until 2015, he led the first coalition government in the UK s ...
and
Nick Clegg Sir Nicholas William Peter Clegg (born 7 January 1967) is a British retired politician and media executive who served as Deputy Prime Minister of the United Kingdom from 2010 to 2015 and as Leader of the Liberal Democrats from 2007 to 2015. H ...
came to power in May 2010. Similar to the
National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...
, it would be free at the point of need and paid for through
taxation A tax is a mandatory financial charge or levy imposed on an individual or legal person, legal entity by a governmental organization to support government spending and public expenditures collectively or to Pigouvian tax, regulate and reduce nega ...
. The Labour Party has continued to propose the creation of an NCS while in
opposition Opposition may refer to: Arts and media * ''Opposition'' (Altars EP), 2011 EP by Christian metalcore band Altars * The Opposition (band), a London post-punk band * ''The Opposition with Jordan Klepper'', a late-night television series on Comedy ...
, and has done so under each consecutive leader since
Ed Miliband Edward Samuel Miliband (born 24 December 1969) is a British politician who has served as Secretary of State for Energy Security and Net Zero since July 2024. He has been Member of Parliament (United Kingdom), Member of Parliament (MP) for D ...
's leadership in 2010. Since 2021, the proposal has been adopted by the
devolved Devolution is the statutory delegation of powers from the central government of a sovereign state to govern at a subnational level, such as a regional or local level. It is a form of administrative decentralization. Devolved territories ...
governments of
Scotland Scotland is a Countries of the United Kingdom, country that is part of the United Kingdom. It contains nearly one-third of the United Kingdom's land area, consisting of the northern part of the island of Great Britain and more than 790 adjac ...
and
Wales Wales ( ) is a Countries of the United Kingdom, country that is part of the United Kingdom. It is bordered by the Irish Sea to the north and west, England to the England–Wales border, east, the Bristol Channel to the south, and the Celtic ...
. In Scotland, it is planned for the service to be fully operational by 2028 or 2029. In Wales, the government has begun gradually implementing the service from 2022 for what is expected to be a ten-year period.


Background

The Labour government of
Clement Attlee Clement Richard Attlee, 1st Earl Attlee (3 January 18838 October 1967) was a British statesman who was Prime Minister of the United Kingdom from 1945 to 1951 and Leader of the Labour Party (UK), Leader of the Labour Party from 1935 to 1955. At ...
introduced a publicly funded system of
health care Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...
with the establishment of the
National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...
(NHS) in 1948. The NHS covered social care until 1976, when most social care services were transferred to
local authorities Local government is a generic term for the lowest tiers of governance or public administration within a particular sovereign state. Local governments typically constitute a subdivision of a higher-level political or administrative unit, such a ...
. Since then, most people have had to pay for social care, with publicly funded social care still available to those who pass a
means test A means test is a determination of whether an individual or family is eligible for government benefits, assistance or welfare, based upon whether the individual or family possesses the means to do with less or none of that help. Means testing is ...
in which examinees must prove a lack of wealth and a high need for care. Publicly funded social care is also offered to some adults with "long-term complex health needs" through the NHS
continuing healthcare The English national framework for NHS continuing healthcare came into force on 1 October 2007 as a development in the light of the case of Coughlan which established that where a person's need is primarily for health care then the health service ...
scheme.


History


England and Wales

A "National Care Service" was first proposed in the later stages of Prime Minister
Gordon Brown James Gordon Brown (born 20 February 1951) is a British politician who served as Prime Minister of the United Kingdom and Leader of the Labour Party (UK), Leader of the Labour Party from 2007 to 2010. Previously, he was Chancellor of the Ex ...
's Labour government. The
Department of Health A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their o ...
under
Andy Burnham Andrew Murray Burnham (born 7 January 1970) is a British politician who has served as Mayor of Greater Manchester since 2017 Greater Manchester mayoral election, 2017. He served in Gordon Brown's Brown ministry, Cabinet as Chief Secretary to th ...
released its
green paper In the United Kingdom, the Commonwealth countries, Hong Kong, the United States and the European Union, a green paper is a tentative government report and consultation document of policy proposals for debate and discussion. A green paper represen ...
''Shaping the Future of Care Together'' in July 2009, which proposed a new National Care Service "on par with the NHS". This was followed by a public consultation in September called the "Big Care Debate", which was promoted by Brown as a "crucial national debate". The consultation found a public desire for social care reform and explored different ways to introduce the NCS. The government decided to introduce the NCS gradually and in different stages, with the first stage beginning with the Personal Care at Home Act 2010. This Act legally extended to
England and Wales England and Wales () is one of the Law of the United Kingdom#Legal jurisdictions, three legal jurisdictions of the United Kingdom. It covers the constituent countries England and Wales and was formed by the Laws in Wales Acts 1535 and 1542. Th ...
. The Act was passed by
parliament In modern politics and history, a parliament is a legislative body of government. Generally, a modern parliament has three functions: Representation (politics), representing the Election#Suffrage, electorate, making laws, and overseeing ...
in April 2010, with the NCS being launched a month earlier by Health Secretary Andy Burnham, giving all
elderly Old age is the range of ages for people nearing and surpassing life expectancy. People who are of old age are also referred to as: old people, elderly, elders, senior citizens, seniors or older adults. Old age is not a definite biological sta ...
and
disabled people Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...
free social care. The second stage was planned to begin from 2014 and would extend free social care to people who were in
residential care Residential care refers to long-term care given to adults or children who stay in a residential setting rather than in their own home or family home. There are various residential care options available, depending on the needs of the individual. ...
for more than two years. A third and final stage would fully introduce the NCS, giving all adults free social care after 2015. However, the Labour government lost the May 2010 general election and the Conservative–Liberal Democrat coalition came to power. The coalition abandoned the NCS and the Personal Care at Home Act 2010 was later repealed. In
opposition Opposition may refer to: Arts and media * ''Opposition'' (Altars EP), 2011 EP by Christian metalcore band Altars * The Opposition (band), a London post-punk band * ''The Opposition with Jordan Klepper'', a late-night television series on Comedy ...
, the Labour Party under the leadership of
Ed Miliband Edward Samuel Miliband (born 24 December 1969) is a British politician who has served as Secretary of State for Energy Security and Net Zero since July 2024. He has been Member of Parliament (United Kingdom), Member of Parliament (MP) for D ...
(2010–2015) continued calling for the introduction of an NCS that would give elderly and disabled people free social care. Under
Jeremy Corbyn Jeremy Bernard Corbyn (; born 26 May 1949) is a British politician who has been Member of Parliament (United Kingdom), Member of Parliament (MP) for Islington North (UK Parliament constituency), Islington North since 1983. Now an Independent ...
's leadership (2015–2020), the party promised to introduce the NCS in its
manifestos A manifesto is a written declaration of the intentions, motives, or views of the issuer, be it an individual, group, political party, or government. A manifesto can accept a previously published opinion or public consensus, but many prominent ...
for the
2017 2017 was designated as the International Year of Sustainable Tourism for Development by the United Nations General Assembly. Events January * January 1 – Istanbul nightclub shooting: A gunman dressed as Santa Claus opens fire at the ...
and 2019 general elections, once again proposing free social care for all adults and also free
personal care Personal care products are consumer products which are applied on various external parts of the body such as skin, hair, nails, lips, external genital and anal areas, as well as teeth and mucous membrane of the oral cavity, in order to make ...
for the elderly. It is also supported by leader
Keir Starmer Sir Keir Rodney Starmer (born 2 September 1962) is a British politician and lawyer who has served as Prime Minister of the United Kingdom since 2024 and as Leader of the Labour Party (UK), Leader of the Labour Party since 2020. He previously ...
(2020–present), who is planning to introduce it as a needs-based, locally delivered system should Labour enter government. His
Shadow Health Secretary A shadow is a dark area on a surface where light from a light source is blocked by an object. In contrast, shade occupies the three-dimensional volume behind an object with light in front of it. The cross-section of a shadow is a two-dimensional ...
Wes Streeting Wesley Paul William Streeting (; born 21 January 1983) is a British politician who has served as Secretary of State for Health and Social Care since July 2024. A member of the Labour Party, he has been the Member of Parliament (MP) for Ilford ...
launched a review by the
Fabian Society The Fabian Society () is a History of the socialist movement in the United Kingdom, British socialist organisation whose purpose is to advance the principles of social democracy and democratic socialism via gradualist and reformist effort in ...
to see how it would operate and be funded, and aims to gradually introduce it over two or three terms of a Labour government, with a long-term aspiration of introducing the service on par with the NHS. The Fabian Society's report was released in June 2023. Its proposals only apply to England and include the recommendations that short-term care and support should be free and that support should be made available for everyone regardless of their
means Means may refer to: * Means LLC, an anti-capitalist media worker cooperative * Means (band), a Christian hardcore band from Regina, Saskatchewan * Means, Kentucky, a town in the US * Means (surname) * Means Johnston Jr. (1916–1989), US Navy ...
. The NCS was included in a draft Labour manifesto for the
2024 general election This is a list of elections that were held in 2024. The National Democratic Institute also maintains a calendar of elections around the world. * 2024 United Nations Security Council election * 2024 national electoral calendar * 2024 local electo ...
from May 2023 and was acknowledged as Labour Party policy by Streeting in October 2023. It was included in the Labour Party's published general election manifesto, ''
Change Change, Changed or Changing may refer to the below. Other forms are listed at Alteration * Impermanence, a difference in a state of affairs at different points in time * Menopause, also referred to as "the change", the permanent cessation of t ...
''.


Wales

The
devolved Devolution is the statutory delegation of powers from the central government of a sovereign state to govern at a subnational level, such as a regional or local level. It is a form of administrative decentralization. Devolved territories ...
Labour-led government of
Wales Wales ( ) is a Countries of the United Kingdom, country that is part of the United Kingdom. It is bordered by the Irish Sea to the north and west, England to the England–Wales border, east, the Bristol Channel to the south, and the Celtic ...
explored options for a Welsh NCS as part of its 2021 cooperation agreement with
Plaid Cymru Plaid Cymru ( ; , ; officially Plaid Cymru – the Party of Wales, and often referred to simply as Plaid) is a centre-left, Welsh nationalist list of political parties in Wales, political party in Wales, committed to Welsh independence from th ...
, with a plan for its implementation expected by the end of 2023. The Welsh branch of Labour had supported the NCS since the
2021 Senedd election The 2021 Senedd election took place on Thursday 6 May 2021 to elect 60 members to the Senedd (Welsh Parliament; ). It was the sixth Devolution in the United Kingdom, devolved general election since the Senedd (formerly the National Assembly for ...
. Since 2022, the Welsh government has gradually introduced the service over what is expected to be a ten-year period.


Scotland

Scottish Labour Scottish Labour (), is the part of the UK Labour Party (UK), Labour Party active in Scotland. Ideologically social democratic and Unionism in the United Kingdom, unionist, it holds 23 of 129 seats in the Scottish Parliament and 37 of 57 Sco ...
has been calling for the implementation of a Scottish NCS since 2011, with then party leader
Iain Gray Iain Cumming Gray (born 7 June 1957) is a Scottish politician who served as Leader of the Scottish Labour Party from 2008 to 2011. He was the Member of the Scottish Parliament (MSP) for the East Lothian constituency from 2007 to 2021, having p ...
(2008–2011) negotiating the proposal with civil servants in 2010. The
Scottish Conservatives The Scottish Conservative and Unionist Party (), known as Scottish Tories, is part of the UK Conservative Party (UK), Conservative Party active in Scotland. It currently holds 5 of the 57 Scottish seats in the House of Commons of the United Ki ...
supported the proposal, as did the
Scottish National Party The Scottish National Party (SNP; ) is a Scottish nationalist and social democratic party. The party holds 61 of the 129 seats in the Scottish Parliament, and holds 9 out of the 57 Scottish seats in the House of Commons of the United Kingdom, ...
(SNP) government's then- Health Secretary
Nicola Sturgeon Nicola Ferguson Sturgeon (born 19 July 1970) is a Scottish politician who served as First Minister of Scotland and Leader of the Scottish National Party (SNP) from 2014 to 2023. She has served as a member of the Scottish Parliament (MSP) sin ...
, however Sturgeon and the SNP government ultimately rejected the proposal. An independent review into Scottish adult social care was commissioned by
First Minister A first minister is any of a variety of leaders of government cabinets. The term literally has the same meaning as "prime minister" but is typically chosen to distinguish the office-holder from a superior prime minister. Currently the title of ' ...
Nicola Sturgeon in 2020, as a response to the damage to
care home Care may refer to: Organizations and projects * CARE (New Zealand), Citizens Association for Racial Equality, a former New Zealand organisation * CARE (England) West Midlands, Central Accident Resuscitation Emergency team, a team of doctors & ...
s caused by the
COVID-19 pandemic in Scotland The COVID-19 pandemic in Scotland is part of the COVID-19 pandemic of COVID-19, coronavirus disease-2019, caused by the virus Severe acute respiratory syndrome coronavirus 2, SARS-CoV-2. The first case of COVID-19 was confirmed in Scotland on 1 M ...
. This review was dubbed "The Feeley Review" after its author and chair Derek Feeley, the former chief executive of
NHS Scotland NHS Scotland, sometimes styled NHSScotland, is the publicly–funded healthcare system in Scotland and one of the four systems that make up the National Health Service in the United Kingdom. It operates 14 territorial NHS boards across Scotland ...
, and was published in February 2021. The review recommended the establishment of a Scottish NCS on an equal footing with NHS Scotland, receiving centralised funding from the Scottish government. Health Secretary
Jeane Freeman Jeane Tennent Freeman (born 28 September 1953) is a Scottish people, Scottish retired businesswoman and politician who served as Cabinet Secretary for Health and Sport from 2018 to 2021. A member of the Scottish National Party (SNP), she was t ...
accepted the recommendation and the SNP promised to introduce the NCS as a "top priority" in government in its manifesto for the
2021 Scottish Parliament election The 2021 Scottish Parliament election took place on 6 May 2021 under the provisions of the Scotland Act 1998. It was the sixth Scottish Parliament election since the parliament was re-established in 1999. 129 Member of the Scottish Parliament, ...
, alongside the introduction of a national wage for care staff. It is planned that the new service will be fully operational in Scotland by 2026. Nationalising care homes is not part of the proposal, but it will mean ministers will get more power over social care. There is a pledge to make social care free at the point of use, although this will not include accommodation costs. The
Scottish Socialist Party The Scottish Socialist Party (SSP) is a Left-wing politics, left-wing political party campaigning for the establishment of an Scottish independence, independent Socialism, socialist Scottish Scottish republicanism, republic. The party was fou ...
supports a publicly owned and publicly funded National Care Service that would be free at the point of use (like the
NHS The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...
).


National Care Service (Scotland) Bill

The National Care Service (Scotland) Bill was introduced to the
Scottish Parliament The Scottish Parliament ( ; ) is the Devolution in the United Kingdom, devolved, unicameral legislature of Scotland. It is located in the Holyrood, Edinburgh, Holyrood area of Edinburgh, and is frequently referred to by the metonym 'Holyrood'. ...
on 20 June 2022. If passed, the Bill will establish the NCS in Scotland and give Scottish ministers the ability to transfer social care services, which in Scotland are currently maintained by
local authorities Local government is a generic term for the lowest tiers of governance or public administration within a particular sovereign state. Local governments typically constitute a subdivision of a higher-level political or administrative unit, such a ...
, to the new care service. In the case of children's services, ministers would have to hold a public consultation to be able to transfer them to the NCS. Some health services which are currently maintained by NHS Scotland and its
Health Boards NHS Scotland, sometimes styled NHSScotland, is the publicly–funded healthcare system in Scotland and one of the four systems that make up the National Health Service in the United Kingdom. It operates 14 territorial NHS boards across Scotland ...
could also be transferred should the Bill pass. NCS Care Boards would deliver care on a local level, although transferred services could also be delivered nationally. The NCS and NHS Scotland would also share information, carers would have a right to take breaks and the proposed "Anne's Law", a law which would entitle care home residents to meeting people important to them, would also be enacted in the Bill. The Bill has been met with controversy. Scottish Labour called the SNP's plans to introduce the NCS "the biggest power grab in the history of Holyrood", with deputy leader
Jackie Baillie Dame Jacqueline Marie Baillie (' Barnes; born 15 January 1964) is a Scottish politician who has served as Deputy Leader of the Scottish Labour Party since 2020 Scottish Labour deputy leadership election, 2020. She has been Member of the Scottis ...
claiming that it would endanger local authorities, adding that it was "not a National Care Service" but a "national commissioning service which can be used as a
fig leaf thumb In culture, a "fig leaf" or "fig-leaf" is a literal or figurative method of obscuring an act or object considered embarrassing or distasteful with something of innocuous appearance. The use of an actual fig leaf for the purpose originates i ...
for centralising power". Other opposition parties have raised concerns about the cost of the service, which is believed to have the possibility of redirecting nearly £1.3 billion of public money from frontline services to the NCS (£495 million for the overall service and another £726 million for its Care Boards). Trade unions GMB,
Unison Unison (stylised as UNISON) is a Great Britain, British trade union. Along with Unite the Union, Unite, Unison is one of the two largest trade unions in the United Kingdom, with over 1.2 million members who work predominantly in public servic ...
and
Unite Unite may refer to: Arts, entertainment, and media Music Albums * ''Unite'' (1GN album), 2016 * ''Unite'' (A Friend in London album), 2013 * ''Unite'' (Kool & the Gang album), 1992 * ''Unite'' (The O.C. Supertones album), 2005 Songs *"Unite!" ...
are also concerned about the centralisation of power away from local authorities that would be caused by the service, while the
Convention of Scottish Local Authorities The Convention of Scottish Local Authorities (COSLA) is the national association of Scottish councils and acts as an employers' association for its 32 member authorities. History Formed in 1975, COSLA exists to promote and protect the int ...
(COSLA) is currently taking "the time and consideration that is rightfully needed with legislation of this magnitude, to understand the breadth of the impact it will have on communities the length and breadth of Scotland".


Notes


References

{{Gordon Brown Social care in the United Kingdom 2022 establishments in Wales 2021 establishments in Scotland Gordon Brown New Labour Ed Miliband Jeremy Corbyn Premiership of Keir Starmer