Social care is a policy area that has claimed more than its fair share of political scalps. It has become the issue nobody has wanted to grasp. And while it stayed in the too difficult box, the number of victims of that inertia grew.

This understated crisis is playing out against a demographic reality we can all see coming. More of us will need more care, for longer, than any generation before us. that 2 million older people in England already have some level of unmet need for social care and without change, spending on adult social care (ASC) in England is projected to rise by around £9 billion in real terms by 2036, driven purely by increased demand.

The costs of inaction are simply too high.

Andy Burnham has now put social care back at the heart of the agenda, and Baroness Casey is expected to deliver her final report by summer 2027. That gives us a window. We should use it well. At the Women’s Budget Group, we think the conversation about adult social care too often opens and closes with how it might be funded. We prefer to start with a different question: what do we need as a nation? 

READ MORE: Time to care

Our contribution to this urgent debate is ‘ – an innovative model for a National Care Service. Our aim is to move the debate beyond tax and spend and ask instead what it would take for us, as a country, to come together and share both the risks and the costs of social care across the whole population.

We have set out a 10-year vision for a National Care Service backed by a social insurance model. At the centre of the model is a dedicated national pooled fund, ‘CarePool’ that would create a stable, long-term funding settlement protected from short-term political cycles.

Fortunately, relatively few of us will ever need intensive or residential care. For those who do however, the costs can be life-changing – for them and for their families. This is the very principle on which risk pooling was founded; we shoulder the costs as a nation to help the few when they need it.

Our modelling shows that a National Care Service built on such risk and cost sharing principles could meet around 83 percent of people’s care needs at a relatively affordable rate to tax payers. It would be funded by a levy on income of between 1.5 percent and 2.5 percent, phased in over five years, alongside other revenue streams: inheritance tax receipts, a cap on the profits of private equity care providers, and an offset from existing local authority spending.

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The result would mean everyone would have guaranteed access to some care at the point when they need it, wherever they live, regardless of what they own. The care you receive would depend on your independently assessed needs, and your local authority’s budget would never be the deciding factor.

It would also give care a stable funding settlement reviewed on a periodic basis, lifted above the annual scramble over what is left in the kitty. Care would become a settled part of how the UK budgets, because we recognise it is something we can no longer afford to stop spending on.

The current situation

The current provision of care is increasingly unworkable. 

People who need care are more likely to live in poorer areas, and those areas are the least able to pay for it. Under the Care Act 2014 settlement, local authorities are hamstrung by rising costs, and the people with the greatest need are those least able to meet the bill. Anyone with assets above £23,250 must fund their own long-term care and there are very few products you can buy to help you out if and when you might need residential care.

Into that gap private equity has stepped, extracting profit from some of the most vulnerable people and cash strapped areas in our society. Much of that profit leaves the system entirely and never finds its way back to the Treasury’s coffers.

The NHS feels the strain too. When people cannot access timely, well-planned care, they stay in hospital longer than they need to, and the whole system slows.

Underpinning all of this is unpaid care. Mostly women, mostly family, giving everything they can, often towards the end of a loved one’s life when needs are at their most acute and complex. They do it with extraordinary love, and at great cost to their own health, earnings and pensions.

That is why it is so welcome to see a Prime Minister willing to spend political capital in this space.

Choices worth making

Choices do need to be made. Those choices should be about building something that lasts, regardless of who is in government. It is time for families, and the women who carry most of the load, to stop paying the price for political inaction.

So let us ask better questions. If there is to be a market in social care, what would a functional market look like? How do we protect people at the moment they need it most? How do we ensure that those who provide our social care are recognised, well paid and bound by ethical obligations? Perhaps most importantly, how can we make sure the shoulders of the nation are broad enough, while keeping the burden on younger generations fair and sustainable?

The answer, we believe, is a social contract: a shared expectation of stability and regularity in care, whoever you are and wherever you live, in keeping with the long and proud tradition of the NHS.

This is everybody’s issue. A National Care Service on a fundable, sustainable footing will help all of us, whatever our own circumstances.

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