“In 1948, Britain decided that healthcare should be a universal right. The unfinished question is whether we are prepared to extend that principle to care and finally complete the welfare state.”
Rebecca Long-Bailey wrote a piece for the Socialist Campaign Group’s 2026 pamphlet ‘The Socialist Policies We Need’. You can read the pamphlet in full below.
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.
But if this was a Netflix box set of Labour’s great achievements in government, we only got to the end of season one. The finale delivered a historic transformation, but it left us with a cliffhanger: social care was never fully brought into that same settlement, and we have been waiting decades for season two.
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. 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 the economy, remain some of the worst-paid and least protected workers in Britain.
England’s social care model has become a textbook example of market failure. Local authorities increasingly act 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 to win contracts, while councils facing years of financial constraint have often had little choice but to seek the cheapest option available.
The consequences have been predictable. High staff turnover, insecure employment and chronic shortages undermine the quality and continuity of care. Providers collapse, leaving families and residents facing uncertainty through no fault of their own. Too often, public money is absorbed by debt repayments, rent extraction and shareholder returns rather than improving frontline services.
And the damage does not stop at the care system itself. Every delayed hospital discharge caused by a lack of suitable support places additional pressure on the NHS. Every unpaid carer forced to reduce working hours represents lost income, lost economic potential and a hidden subsidy that keeps a failing system afloat. Every council struggling to meet rising demand is forced into impossible choices about which essential services to protect.
The answer is not another sticking plaster. It is to build something fundamentally different: a National Care, Support and Independent Living Service based on the same principle that created the NHS. That essential support should be available according to need, not the ability to pay
At the heart of this vision is a simple idea: disabled people and older people should have a real, enforceable right to live independently, with choice and control over their own lives. This changes the entire starting point. Care is no longer something people have to fight for, something granted only 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 not receive a bill afterwards. Yet if someone becomes disabled or needs support in later life, we often expect them to pay, sometimes sacrificing everything they have accumulated over a lifetime.
The goal must therefore be to move towards publicly accountable provision, where care is organised as a public good rather than a commercial transaction.
Transition does not need to happen overnight, but the direction of travel must be clear. New publicly run services can be established locally and existing contracts can move into public provision as they expire. 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 and cooperative providers can still contribute, but within a system where accountability and quality, not profit, come first.
However, this is not just about ownership. It is also about who has power within the system.
One of the strongest principles behind a National Care, Support and Independent Living Service is co-production: the idea that services should not simply be designed in government offices and imposed from above. Disabled people, older people, unpaid carers and frontline workers must have a genuine role in shaping how care works. They should be recognised as 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 provided care, or relied upon it, knows that is simply wrong. Care requires skill, judgement, patience and compassion.
So if we want a system that works, we need to value the people who deliver it. That means better pay, proper career pathways, national collective bargaining, funded training, sick pay, pensions and 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 is also a need for lasting democratic oversight. A permanent Independent Living Taskforce, led by disabled people themselves, would help ensure that reform does not become another short-lived political announcement. People who use the system must have a permanent voice in shaping it.
Of course, the million-dollar question that always follows is: how much would this cost and how would we pay for it?
The best estimates suggest that a fully universal and properly funded system could require around £15–20 billion of additional spending each year by the early 2030s. That is significant, but it must be placed in context. Britain already spends more than £190 billion annually on the NHS and over £140 billion on pensions. Total tax revenues exceed £1 trillion.
Funding could come through a combination of fairer taxation measures. 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 society.
There is also a strong 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. Also, a modest levy on very large fortunes could ensure that those with the greatest resources contribute more towards maintaining the social infrastructure from which everyone benefits.
Ultimately, universal services are funded collectively because the risks they protect against affect us all. The NHS has always demonstrated that principle. Social care should be no different.
In 1948, Britain decided that healthcare should be a universal right. The unfinished question is whether we are prepared to extend that principle to care and finally complete the welfare state.
- Rebecca Long-Bailey is the MP for Salford. You can follow her on Facebook, Instagram, Twitter/X and Bluesky.
- You can read the SCG pamphlet ‘The Socialist Policies We Need’ in full here. The foreword says that “We hope this contributes to a debate across the Labour Party, trade unions and the wider movement about the political programme needed to deliver the change people voted for, to build a better future for our communities and to prevent the rise of a Trump-style government here in Britain.“
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