The prospect of a National Care Service in England could spark the beginning of a major overhaul of adult social care and a necessary step towards addressing the longstanding issues within the sector. However, the recent failure of the SNP’s attempt to implement a more ambitious scheme in Scotland provides a cautionary tale for Labour. If it is to succeed, Labour must take lessons from the SNP’s failure seriously. 

Poor delivery and execution

Initially proposed in 2021 under Nicola Sturgeon’s leadership, the vision was to create a centralised care system under ministerial control, eliminating inconsistencies in care quality across the country.

One of the criticisms from the start that hounded the policy was the lack of precise planning and financial sustainability. Whilst originally estimated to cost between £644 million and £1.26 billion over five years, the projected costs soon ballooned to £2 billion. The Nuffield Trust highlighted that centralisation did not necessarily lead to better service quality or consistency, referencing ongoing disparities within Scotland’s NHS, which operates under a similar model.

Meanwhile, the Institute for Fiscal Studies also warned that shifting funding from local to national control would require significant financial restructuring and could remove local flexibility in allocating resources.

Another key failure, however, was the excessive centralisation of services. The SNP’s plan sought to remove social care responsibilities from local councils and place them under regional care boards, ultimately accountable to the Scottish government. This alienated local authorities, who argued that centralisation would strip away local decision-making, leading to a bureaucratic system disconnected from the specific needs of different communities.

Social care, far more so than healthcare, exists in a web of relationships that operate at the neighbourhood level. Ripping local stakeholders out of the process does little to ensure care delivery is tailored to each community.

A critical issue that finally killed the initiative was the SNP’s failure to gain widespread support. The Scottish Greens, initially supportive, withdrew their backing, leading to the policy’s collapse. COSLA, representing local councils, and significant trade unions also withdrew their support, citing concerns over a "restrictive centralised model" and a lack of focus on workforce conditions. 

Despite multiple revisions to the plan, including a shift towards a “shared accountability” model between the Scottish government, NHS, and local councils, support for the bill eroded further until the SNP ultimately scrapped the structural overhaul.

Labour must learn 

Labour’s manifesto pledges to establish a National Care Service underpinned by national standards. However, details on funding were (and still remain) vague. The party’s 2022 proposal suggested a radical overhaul akin to creating the NHS, yet the 2024 manifesto offered a far less substantive reform. Labour must be transparent about what exactly the goals of the initiative are and how it will be funded.

Furthermore, there must be a collaborative approach from the outset, ensuring that key stakeholders, especially councils, care workers, and those in need of care, are integral to shaping the policy.

It is hardly original to note that perhaps one of the biggest crises in social care is staffing. Low pay and high turnover rates have plagued the sector for years. Whilst Labour has promised a Fair Pay Agreement for the sector, it is unclear what a National Care Service will do to underpin improved outcomes for those working in care.

The challenge in social care is immense, as it has been for years. However, it seems political pressure is finally beginning to build, and attention is turning to the dire need for action in reforming and overhauling the status quo. Labour must approach this with the ambition to improve delivery of care but also pragmatism. It must be willing to reflect on past mistakes to achieve its vision. Otherwise, we may have to witness another National Care Service crumbling away in its infancy.