Burnham’s UK National Care Service must learn lessons from Scotland

Prime Minister Andy Burnham’s keystone announcement at the Labour Conference at the weekend was that the plans for an “NHS-style” UK National Care Service are still underway. To do it properly though, he will need to learn lessons from Scotland’s failed attempt to create an NCS to avoid replicating the same errors. The early signs are that at least some of them might have been avoided, but it is very early in the process to be confident..

The rub in the announcement is that a UK NCS won’t be created in this Parliamentary session. The plan will be built over the course of the next few years and then put to the public at the next UK General Election – currently scheduled for 2029. Even though Burnham has the manifesto mandate to create one (it appeared as a promise in Keir Starmer’s 2024 manifesto which Burnham is still somewhat bound to follow) and even though he has the Parliamentary majority to push one though regardless, taking a bit of time now is probably a good thing. The first and most important lesson to learn from Scotland is that legislating for an NCS first and then trying to build one on the fly while under a self-imposed deadline is a very bad idea.

Second is that he has promised that the care service will be free at the point of care and he has hinted that significant support will come from public funding. This is also a good thing. The upfront cost of care is a major problem for many people in the UK. Worse though, the current system of funding essentially means playing a wealth tax lottery where if you have a house and you need more than a small amount of care, you’ll effectively lose everything and the state will still need to pay for those who don’t have the assets to fund their own care.

The Scottish lesson of socialising the costs across all taxpayers (and other sources of tax beyond Income Tax and National Insurance) leads to fairer outcomes for all. This will be true even if some of the taxes Burnham is thinking about raising happen to include wealth taxes such as Council Tax reform and inheritance taxes.

Simply being free at the point of use is not sufficient though. A third lesson from Scotland is that having private companies remain within a National Care Service will inevitably mean vast amounts of public money gets sucked out of the system either as private profits or via more complex financial chicanery that can extract profits even from a ‘not-for-profit’ system and even where making a profit from care services is supposed to be outright illegal. The UK National Care Service must be fully publicly owned to avoid this.

Finally, the care system must be locally delivered even if, as the Labour manifesto promised, there are UK-wide national standards. An egregious error made in the planning for the Scottish National Care Service was the first stage legislation that would have centralised all care in Scotland (including that currently run by Local Authorities) under the remit of Scottish Ministers. Not only was this a democratic outrage and a logistical nightmare, it simply wouldn’t have worked in Scotland and it’ll work even less well if Burnham tries to do it across the whole of the UK.

Care is one of the most locally delivered public services. When best done, it is founded upon one-to-one relationships between the carer and the cared for. Common Weal’s own blueprint for a National Care Service recognised this through our network of Community Hubs that would have meant that carers would have direct control over the care they deliver on a day-to-day basis. Care that meets the needs of the person being cared for, not the needs of a Minister who wants a form filled in and to see a line on a graph going up or down.

Common Weal has submitted a package of evidence of our experiences during the last half decade of working on care to both the UK Government and to the Casey Commission that is building out recommendations for care reform for Burnham. We hope that we can use both the negative and the positive lessons we have learned in that process to ensure that when the UK is finally ready to create a National Care Service that is as worthy of that name as the National Health Service is, then the plan to create that service will be in place.

Care is one of the most important political subjects imaginable. Almost all of us will, at some point in our lives, either need care, will provide care or both. We owe it to All of Us to get it right.