Contributed by End Social Care Disgrace: Campaign for a National Care, Support and Independent Living Service
Introduction: Navigating a Systemic Crisis
Adult social care in England is in a deep and longstanding crisis. Years of underfunding, including a £7 billion reduction in local authority budgets since 2010, have left the sector fragmented and failing. More than two million people seek support each year, yet over half are turned away. Around 10,000 patients remain in hospital because of inadequate community services, undermining the NHS and increasing the risk of lost independence and hospital-acquired infections.
Rationing is often disguised through repeated assessments requiring people to prove what they cannot do, while rising care charges deepen poverty and exclusion. Even where needs are officially met, many experience lives with limited choice, control and dignity.
With over 80% of provision in private hands and 18,000 providers, the system is unstable and fragmented. Local authorities lack the capacity to step in when services fail. At the same time, chronic undervaluing of care work has fuelled workforce shortages and high staff turnover.
Abuse and neglect of disabled people, particularly those with learning disabilities and autism, continue to expose systemic failures repeatedly highlighted in inquiries and safeguarding reviews.
Despite decades of evidence and more than 20 reviews, successive governments have failed to deliver fundamental reform. The time for incremental change has passed. A National Care, Support and Independent Living Service (NaCSILS), based on human rights and social justice, would create a sustainable alternative, removing the profit motive from care while supporting not-for-profit and cooperative provision.
A Blueprint for Radical Reform
Fixing this broken system requires embracing a liberating “social model” of disability. This paradigm shift treats individuals as equal citizens with inherent rights, rather than mere bundles of physical needs to be managed. To achieve this, seven interconnected legislative and structural changes must be enacted:
- State Responsibility and UN Rights: The state must assume a statutory duty to provide a NaCSILS, fully adopting the UN Convention on the Rights of Disabled People into English law to guarantee choice, dignity, and personal control.
- Fully Funded and Free: Mirroring the founding principles of our healthcare system, the service must be funded via progressive taxation and remain entirely free at the point of need for everyone living in the country.
- Publicly Provided and Accountable: To dismantle the commodification of care, the service must be publicly provided and strictly not-for-profit, prioritising a clear strategy for de-institutionalisation and community-based living.
- Nationally Mandated, Locally Delivered: While quality standards must be mandated nationally, service design and execution must happen locally through partnerships led by service users, carers, and local authorities.
- Support for Informal Carers: The system must structurally acknowledge and support family and friends who provide unpaid care, giving them the choice and flexibility to live their own lives fully.
- A Fit-for-Purpose Workforce Strategy: Care staff and personal assistants must be granted pay, working conditions, and career pathways that reflect the true value of their skills, permanently ending the era of rock-bottom wages.
- Independent Living Taskforce: A user-led taskforce must be given meaningful legislative influence, ensuring that ongoing reform is guided by those with the greatest expertise: the users themselves.
Crucially, this new service must remain institutionally independent from the NHS. This clear separation is vital to prevent social care and independent living priorities from being swallowed by the medical agendas of Integrated Care Boards.
To break the current impasse, vision alone is not enough. We must challenge the myth that such a model of free, fair Social Care is unaffordable.
An analysis of the economic cost of inaction reveals that the status quo is itself wildly unsustainable, draining at least £26 billion from the nation annually. This hidden deficit comprises £20 billion in lost economic potential due to delayed NHS discharges, £5 billion in costs to the Treasury from family carers being forced to abandon the workforce, and the £1.5 billion leaked out of public funds as private profit by major care-home chains. Conversely, the adult social care sector is not an economic drain; it already contributes £50.3 billion annually to the English economy—more than double its current cost of provision. Economic modelling demonstrates that for every further £1 invested in social care; £1.75 of wider economic activity is generated, providing a powerful stimulus to local communities. Raising care worker wages to at least £15 per hour would inject an estimated £7.7 billion back into the economy. Freeing up carers who want to return or stay in paid employment by providing formal, reliable support for their loved ones would also boost consumer spending and income from taxes and wipe out the £5 billion productivity loss caused by family carers leaving the Labour market. The overall costs of setting up a robust National Care, Support and independent Living Service would be approximately £41.2 billion.
To fund this transition equitably, progressive mechanisms must be deployed including implementing targeted wealth taxes, aligning capital gains tax with earned income rates, and closing aggressive corporate tax avoidance loopholes.
To win support for a radical transformation of care and support, we also need to challenge the narrative that Social Care is about ‘them’ not us, that it isn’t a universal service like the NHS. The reality is that the lives of at least half the population and rising will encounter Social Care or the lack of it, either personally or within our families at some stage or stages of our lives. When this happens many people are shocked to find that there is no financial help for anyone whose assets are greater than £23,250 and this figure hasn’t changed for 16 years!
Some countries like Australia have had significant success in rebranding Care as a vital universal service. However, this needs to be more than a marketing exercise. By breaking out of silos and bringing everyone involved in cross-sector campaigns like the End Social Care Disgrace Campaign together, it rapidly becomes obvious that what works for disabled people of all ages also works for families, unpaid carers, care workers and local communities. We really are all in it together. Trade Unions are in an excellent position to straddle divides but need to look well beyond the familiar home turf of improved pay and conditions for care and support workers and “nationalisation”, learn from disabled people’s movements and accommodate radical and creative solutions.
Conclusion: A 1948 Moment for Social Care
We stand at a historical juncture analogous to the years immediately preceding 1948, an era when doctor visits required cash and hospitals operated as a fragmented patchwork of charity and private provision. The demand for a NaCSILS is a call for a new social settlement, one intended to be just as transformative, enduring, and universally valued as the National Health Service, an investment in our collective wellbeing and economic future.
It will require bold, determined action from national politicians, but local Councils also have an important role to play. They can start now by developing structures for co-production, piloting and nurturing green shoots of change, dropping care charges for in-home support, supporting Cooperatives, micro enterprises and peer support initiatives as well as building inclusive communities. This not only helps to create the groundwork for doing things differently; it also builds hope, pulls feet out of the mud in which Social Care is sinking and encourages people to think about what a human-shaped not profit-shaped society might look like!