Time to Nationalise Social Care

By Robert Page

The Labour government of 1945 set about tackling the five giant evils identified by Beveridge (want, ignorance, idleness, squalor and disease) through an ambitious programme of social reform.  While it proved difficult from the onset to provide the nationwide, uniform, high quality services that had been envisaged (not least because of historic levels of underfunding and the austere post-war economic climate), there was at least the promise of improved social protection for all.  

While Labour made significant progress in social security provision and created the National Health Service, it failed to develop a clear strategy in what has come to be known as social care.  Citizens who required `non-medical’ support of various kinds, such as help with washing and  dressing,  were forced to rely on the assistance of family members, voluntary agencies and rudimentary , `Poor Law’ style  local authority services. In the intervening years, social care has been unable to shed its `Cinderella’ status within the welfare state.  As a consequence, it remains largely a matter of chance whether citizens who lack the means to pay for, say, high quality residential care at an institution such as West Hill (a not for profit home run by the Anchor Trust in West Byfleet, Surrey)¹, will receive the  basic care they need.

The peripheral status of the social care sector was reinforced by the National Health Service and Community Care Act of 1990, which removed the provider role of Local Authorities with a view to driving down costs through greater reliance on competitive non-state provision.  Over time, this has resulted in cash strapped local authorities commissioning low grade services and resorting to ever more stringent eligibility criteria as a way of stemming demand. 

Given that the care system is now recognised by many leading authorities (e.g. the Kings Fund) as being at breaking point, it is time to consider more radical policy alternatives.  It seems appropriate to consider nationalising social care given that local authorities have neither the resources nor the capacity to provide high quality services to vulnerable citizens.  By incorporating social care within the National Health Service, the counter-productive divide between these two services can finally be ended.   A new National Health and Care Service (NHCS) will be able to ensure that all citizens receive the most appropriate form of support to meet their needs whether this be in the form of a hospital stay, a short-term rehabilitative placement, support within the home or help accessing a range of other community services.  Considerable work will be needed to ensure that the design of the new service is fit for purpose.  The emerging evidence from experimental work in Greater Manchester and elsewhere will be invaluable in this regard.  One vital component of the new service will be the appointment of  designated personal Health and Social Care advisors, who will be responsible for co-ordinating the various kinds of support that those in need require.   A workforce plan will also need to be developed to ensure that all NHCS staff are well paid, properly trained and have appropriate career paths similar to those that have already been developed within the NHS. 

The new NHCS will require significant levels of investment in new care and rehabilitation centres as well as in adapting the homes of needy citizens.  This enhanced investment should be funded through general taxation so that social care comes to be seen as a collective rather than individual responsibility.  New funding sources for this service could include a community wealth tax and the hypothecation of corporation tax.  This latter initiative could prove particularly beneficial as it would reinforce the obligation of corporations to pay fair taxes rather than seeking ever more ingenious ways of avoiding them.

While there will be a number of siren voices suggesting that major organisational change of this kind is neither desirable nor affordable, the time for tinkering has long passed. The 1945-51 Labour government created the welfare state despite much more inauspicious economic circumstances than are currently being experienced.  There are no significant impediments to the introduction of a bold and imaginative `New Deal’ for social care except the lack of the necessary political will.

¹West Hill, a residential care home for the over 65s, is currently rated as outstanding by the Care Quality Commission.  All of its residents are privately funded. There is one care worker for every four residents.  See The Observer (11 December 2016).

Robert M Page is Reader in Democratic Socialism and Social Policy