Care Guaranteed: A National Care Service

Austerity, privatisation and fragmentation within the NHS and care sectors have exposed the UK to one of the worst Covid death rates in the world. If we aspire to ensure good health and care for all we need a reset programme to rebuild our NHS as a publicly-owned universal and comprehensive health service, alongside the founding of a National Care and Support Service.


Over the last decade the NHS was subjected to the longest funding squeeze in its 72 year history. When the coronavirus crisis began, the NHS had over 100,000 staff vacancies, including 40,000 nurse vacancies caused by the removal of the nurse student bursary exacerbated by the ‘hostile environment’ policies and pay falling by 8% in real terms.

Before the pandemic NHS hospitals had recorded the highest number of A&E ‘trolley waits’ on record, NHS targets had not been met since at least 2016, and some not since 2015, including the waiting time for cancer treatment.

The 2012 Health & Social Care Act opened the door to large scale outsourcing and privatisation, whilst the number of NHS hospital beds fell by 5% between 2012 and 2019, leaving the government needing to rent private hospital beds for coronavirus patients at huge expense. Chronic underfunding resulted in NHS Trusts entering the Covid-19 crisis with £13.4 billion of debt.

If the NHS was under pressure, then social care was in crisis. There were 120,000 vacancies across the care sector, where low pay for care workers was endemic. Due to £8 billion being cut from the social care sector since 2010, Age UK estimated that 1.5 million older people were not receiving care even though they needed it.

Despite rising need, the number of disabled people receiving social care support has also fallen dramatically. Between 2009 and 2019, the number of people receiving adult social care in England fell by 50 per cent from 1.8 million to 0.9 million.

Even before the pandemic hit the UK, life expectancy improvements had slowed dramatically, and even begun to fall for some groups, and health inequalities were widening. According to the King’s Fund, “in 2015–17, people in the least deprived areas could expect to live roughly 19 more years in good health than those in the most deprived areas.”

From the identification of the first case of Covid 19, the Government’s response to the pandemic has ranged from the complacent to the incompetent and at times downright dangerous.

An initial adoption of a dangerous strategy of herd immunity has been followed by the failures in the supply of PPE and testing and tracing on anywhere near the scale and speed required. Lockdown policies have been late in implementation, then confused and undermined by being disregarded with impunity by senior government ministers and advisers.

So far the failure to effectively implement the World Health Organisation test, trace and isolate strategy has contributed to a death toll of 45.000 and predicted to reach 60,000. Two thirds of the deaths were disabled people. 600 of our health and social care workers have also already died.

A Reset Programme for the NHS and Care Services

We need an NHS and Social Care reset programme on the scale of a ‘new Beveridge settlement’ to rebuild our NHS and to create a National Care and Support Service.

The first priority for the NHS is to secure the long term funding it needs: to meet the needs of an ageing society, to recruit the staff to fill gaps, to give especially lower paid staff a decent pay rise, and to address the backlog of delayed operations and treatments. This will require substantial and sustained investment, well in excess of existing commitments.

The NHS already had record waiting times, which are being exacerbated by the coronavirus. The NHS will need considerable investment in reopening beds and increasing capacity to cope with the accumulated backlog.


Increasing NHS workers’ pay is essential to retaining existing workers and those who have recently returned, as well as attracting new recruits and trainees. The nurse bursary is set to be restored in 2020 (at a lower level), but the Government should go further and abolish all fees for all health professionals’ training. The NHS has been operating below safe staffing levels, and the Government should legislate to require safe staffing on wards.

The Government should also end the ‘hostile environment’ so that all UK residents can access NHS services. We are all at greater risk if some are excluded from care. There should be no checks on immigration status at NHS or primary care settings.

Outdated institutions must be replaced with forms of support capable of upholding the dignity of all disabled people regardless of impairment or support need.

It is also clear that there will need to be extra investment in mental health, as cases emerge of Covid-19 survivors, as well as NHS and care staff, suffering from PTSD, and to deliver the commitment to put mental health on a par with physical health.

NHS privatisation must end and services be brought back in-house to meet public need not private greed. Repealing the Health & Social Care Act is the key to rebuilding a comprehensive and universal healthcare system that ends the requirement on health authorities to put services out to competitive tender, and ensure services are delivered in-house. It is also vital that the NHS, social care and all vital public services are kept out of future post-Brexit trade deals.

To reduce NHS procurement costs and aid future pandemic preparedness, the UK Government should establish a generic drug company whilst incentivising all pharmaceutical companies to prioritise research on what is most medically urgent, not on what is most profitable.

A National Care and Support Service is needed with the status, respect and commensurate resources of the NHS to meet the needs of an ageing population and to ensure independent living for people with disabilities. It should be funded from progressive taxation, free at point of use, and have universal coverage, and staffed on terms aligned to the NHS.

This service must deliver the right to independent living, as outlined in Article 19 of the United Nations Convention on the Rights of Persons with Disabilities: “All Disabled people to have equal rights to live in the community, with choices equal to others, and be fully included and able to participate in the community.”

It must be grounded in an understanding of the particular forms of oppression that disabled people face and be consistent with the disabled people’s movement’s independent living philosophy. This is not about disabled people doing everything for themselves but having the same chance to live and participate in the community as non-disabled people with choice and control over the support they receive.

Support for disabled people and the social care support workforce should not be seen as a burden on the economy but understood as a social and economic investment that benefits us all.

To fundamentally refocus our social and economic decision-making, the Government should consider adopting the Welsh Government’s Future Generations Wellbeing Act 2015, to ensure that health and wellbeing of the nation is prioritised in all policy-making.