The prospect of an Andy Burnham-led government has accelerated discussion of a National Care Service (NCS) – an idea he’s repeatedly expressed strong support for.
Heady stuff for all of us social care nerds. But I don’t see many asking: “What problem does an NCS solve, which simply giving more money to local authorities doesn’t?”
I believe that question has an answer and it’s not about structures – or even about funding. It’s about purpose. We greatly need a shared purpose, and an NCS can be it.
Geography is destiny
Local non-profit or public-sector care providers are doing their best in a whirlwind of local government officialdom, regional NHS trusts, regulators and others.
Each of these forces could be broken down further into subsets of decision-makers all of whom I, the boss of a council-owned care firm, must heed. I am rarely short of advice.
But for the people using care services the current arrangements could be a good thing, or they could be a bad thing.
What makes the difference between good and bad? Where you live. That’s unacceptable, and that’s where an NCS could provide the transformative purpose we need.
We’re so close to the answer
Much of the current debate assumes the answer lies in designing new organisational structures, as has been done with the NHS on many occasions.
But that’s to put form over function. And to be blunt, it has a habit of not working at eye-watering expense.
Indeed, the danger in any major reform programme is assuming that everything existing is broken. It is not.
I strongly believe delivery models capable of advancing quality, choice and integration already exist and are operating right now.
The real challenge is the absence of a coherent national settlement – a golden thread – around which those models can trace their way to a better, more equal future.
The golden thread: a unified settlement
We need the answer to five fundamental questions:
1. What are people entitled to from the state?
2. What outcomes should social care deliver?
3. How should care be funded?
4. How should the workforce be valued?
5. What relationship should exist between health and care?
If it can answer those questions, the NCS becomes less an organisational model and more a culture-defining shared social contract.
It then falls to organisations like mine to deliver that contract.
The answer’s right here
And it is here the role of Local Authority Trading Companies (LATCos) – publicly owned but free to act commercially – become particularly interesting.
Some 82 local authorities use LATCos to deliver services.
A LATCo’s combination of public accountability, flexibility and reinvestment into the communities it serves is the ideal platform to deliver the promise of an NCS.
They are not the NCS in themselves, but they do express the best hope for national consistency of purpose, combined with local flexibility in delivery.
No big, horribly expensive redesign necessary.
The future National Care Service may therefore be less about constructing a new institution and more about creating a new relationship between national ambition and local delivery.
If we choose to see it, that relationship may already be taking shape.
Chris Best is the Managing Director at Care Dorset, which was established in October 2022 as a Local Authority Trading Company of Dorset Council. It employs over 800 colleagues offering care and support to around 900 people from 22 services plus home visits.
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