The Casey Commission has been tasked with setting out the plan to establish a National Care Service in England, with plans due in 2026 and 2028. Scotland and Wales have already begun the process of establishing an NCS with mixed results. CIPFA and the Local Government Information Unit are publishing a series of briefings to inform the Commission and provide a blueprint to guide the journey ahead.
The first briefing outlined the experiences of Scotland and Wales on the road to establishing an NCS and in this second briefing the question remains: what can England learn from their experiences? To answer this question, CIPFA and LGIU held a series of roundtables earlier this year attended by key stakeholders involved with the NCS processes of Scotland and Wales.
Scotland: what went wrong?
The Scottish Government promised that an NCS would bring reform, accountability and improved performance management. But ultimately, the Scottish government dropped its policy of structural reform, in what was viewed as a legislative failure.
One issue highlighted at the roundtables was that Scotland underestimated the true complexity of structural change. It was also not clear how the proposed reforms would actually improve outcomes for those drawing on care.
To achieve the ambition of improved health and care, reform of the NHS would be necessary – but this was not on the table. For reform to be effective, a whole-system approach would be needed, otherwise existing organisational and cultural divides will be reinforced, rather than broken down.
Public and professional confidence was eroded. There was a lack of detail around the financial plan, and questions were raised around whether trying to carry out structural reform in the wake of the pandemic was an effective use of stretched resources.
Good financial management is key
The Welsh Government set up a National Office for Care and Support, responsible for implementing the ongoing plan for an NCS. While Wales has had some success, such as collective support for the project grounded in national policy frameworks, there are things that could have been better.
The major question is where the funding for a new model of care will come from. As in England, the Welsh social care sector is facing myriad challenges: demand is soaring and resources are scarce. The current funding model for social care already places a significant burden on local taxpayers, so introducing an NCS under these circumstances will be difficult.
Wales is in the early stages of developing a new funding system, but there is no clarity on what the changes to funding will be and how they will allow for additional costs. The message from roundtables was clear: reform must be properly funded to succeed.
The financial case in England
The second briefing paper emphasised the need for collaboration between policymakers, providers delivering care and the people who draw on care and support. This would ensure collective buy-in for any proposed reforms.
If an NCS in England is to work, however it is defined, social care must be viewed alongside the other components that feed into it, such as health, welfare, housing and transport. Social care reform cannot happen in a vacuum and will require cross-sector collaboration.
Above all, a clearly defined and well-thought-out financial plan will be vital for an NCS in England to succeed. The social care system is crying out for reform, and for public finance professionals this will require robust financial management and confident, evidence-based decision making.