“Universal public services are funded collectively because the risks they protect us from are shared by everyone. The NHS has always embodied that principle. Social care should too.”
By Rebecca Long-Bailey MP
You expect the emotional challenge of seeing a parent face serious illness. Still, nothing prepared me for the moment it became clear that my brave, strong mum needed to rely on care. As she struggled with her health, battling each day for some semblance of dignity and normality, I found myself navigating a brutal care system for her that is confusing, fragmented and under enormous strain.
So many families like mine coping with illness, disability or old age should not have to battle bureaucracy, uncertainty and the fear that essential support either won’t turn up or could disappear completely. Yet that is the reality for millions of people across the country every day.
It has been a stark reminder that for all our pride in the creation of the NHS, social care remains the Labour Party’s unfinished business.
We often like to tell ourselves that the creation of the National Health Service in 1948 marked the completion of a moral and political revolution. Healthcare, it was decided, would be provided according to need, not ability to pay. It was a bold statement about the kind of society Britain wanted to become: one where illness was not a personal failure and where people were not left to face life’s greatest challenges alone.
It delivered a historic transformation, but it was only half completed. Social care was never fully brought into that same settlement and now care in old age, disability and chronic illness remains fragmented, means-tested and heavily dependent on a precarious mixture of local authority budgets and private provision. The result is a system where dignity is conditional, independence is fragile and support is too often determined by postcode, bureaucracy and personal wealth.
Older people are forced to spend down life savings or sell family homes to pay for essential care and disabled people face exhausting battles to secure the support they need to live independently. Millions of unpaid carers shoulder responsibilities that should be shared collectively, sacrificing incomes, careers and their own health in the process; meanwhile, care workers, whose labour is among the most socially important in our economy, remain some of the worst-paid and least protected workers in Britain.
In fact, England’s social care model has become a textbook example of market failure.
We see local authorities increasingly acting as commissioners rather than providers, purchasing care from thousands of private companies operating under different standards, employment conditions and financial pressures. Competitive tendering has encouraged providers to cut costs in order to win contracts, while councils facing years of financial constraint have too often had little choice but to seek the cheapest option available.
The consequences have been entirely predictable. High staff turnover, insecure employment and chronic workforce shortages which undermine the quality and continuity of care. Providers are also collapsing on a regular basis, leaving families and residents facing uncertainty through no fault of their own and, too often, public money disappears into debt repayments, rent extraction and shareholder returns instead of improving frontline services.
Nor does the damage stop with social care itself. The harrowing scenes of hospital corridor care and delayed hospital discharges can trace their root causes to a lack of suitable care provision which is placing additional pressure on the NHS.
The answer is not another sticking plaster. It is to build something fundamentally different: a National Care, (Support and Independent Living) Service based on exactly the same principle that created the NHS: that essential support should be available according to need, not according to the ability to pay.
At the heart of that vision is a simple but transformative idea. Disabled people and older people should have a real, enforceable right to live independently, with genuine choice and control over their own lives. That changes the entire starting point. Care is no longer something people have to fight for after navigating endless assessments and eligibility tests. It becomes an entitlement.
And if care is an entitlement, it cannot depend on the size of someone’s bank account.
We already accept that if someone develops cancer or suffers a heart attack, they should never receive a bill afterwards, yet if someone becomes disabled or needs support in later life, often due to illness, we often expect them to pay, sometimes sacrificing everything they have worked for over a lifetime.
The goal must therefore be to move steadily and rapidly towards publicly run and accountable provision, where care is organised as a public good rather than a commercial transaction.
That transition does not have to happen overnight, but it must be rapid, and the direction of travel must be unmistakable. New publicly run services can be established locally, and existing contracts can move into public provision as they expire (not unlike the railways). And where providers fail, services should not collapse and leave vulnerable people abandoned; they should be brought into public hands to protect continuity of care.
Not-for-profit organisations and co-operatives can continue to play an important role too, but within a system where accountability and quality, not profit, come first.
This is also not simply about public ownership. It is about power.
One of the defining principles behind a National Care (Support and Independent Living) Service should be co-production. Services should not be designed in Whitehall and imposed from above. Disabled people, older people, unpaid carers and frontline workers must have a genuine role in shaping how care is delivered because they are the experts in their own lives.
The same principle applies to the workforce. Care work in Britain is still too often treated as low-skilled, low-status employment, but anyone who has cared for someone they love, or relied upon care themselves, knows nothing could be further from the truth. Care demands judgement, patience, skill, professionalism and enormous compassion.
So, if we want a system that works, we must finally value the people who make it work. That means better pay, proper career pathways, national collective bargaining, funded training, sick pay, pensions and genuine professional recognition. Care should be treated as the essential public service it is, not as an afterthought at the bottom of the labour market.
There must also be lasting democratic oversight. A permanent Independent Living Taskforce, led by those who need care support themselves, would help ensure reform is not reduced to another short-lived political announcement. The people who rely on the system must have a permanent voice in shaping it.
The million-dollar question that inevitably follows then is, of course, how do we pay for it?
The best estimates suggest that a fully universal, properly funded system could require around £15–20 billion of additional spending each year by the early 2030s. That is a substantial investment, but it needs to be seen in context. Britain already spends more than £190 billion each year on the NHS and over £140 billion on pensions. Total tax revenues exceed £1 trillion.
Innovative funding streams could come through a combination of fairer taxation measures. For example, reforming Capital Gains Tax so that income from wealth is treated more fairly alongside income from work could raise significant revenue. Changes to dividend taxation could ensure those with substantial investment income make a more proportionate contribution. National Insurance could also be modernised so that wealth generated through investments contributes more fairly to the services that underpin our society.
There is also a compelling case for property tax reform. Council Tax is an outdated system that often places unfair burdens on households while failing to reflect the distribution of property wealth. A proportional property tax could provide a fairer and more sustainable funding base. Alongside that, a modest levy on the very largest fortunes could ensure those with the broadest shoulders contribute more towards maintaining the social infrastructure from which we all benefit.
Universal public services are funded collectively because the risks they protect us from are shared by everyone. The NHS has always embodied that principle. Social care should too.
In 1948, Britain decided that healthcare should be a universal right. So nearly eighty years later, the unfinished question is whether we are finally prepared to extend that same principle to care—and complete the welfare state.
Thankfully, we seem to have a Prime Minister in Andy Burnham who finally gets it and wants to finish the job, so collectively we must now focus on truly driving this change forward with the urgency, courage and moral clarity it demands.
- Rebecca Long-Bailey is the MP for Salford and a regular contributor for Labour Outlook. You can follow her on Facebook, Instagram, Twitter/X and Bluesky.
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