A National Care Service is long overdue

Our part-public, part-private, part-charitable social care system is delivering an inefficient and unjust service. It’s time to finish Aneurin Bevan’s work, argues Helen Mary Jones


We often hear of the desperate stories of individuals from across Wales who are not receiving the social care that they need. For example, loved ones that have had to sell their homes to pay for their care later in life. 


The existing system is inefficient, unjust, and unsustainable.


That’s why over the past year, my shadow cabinet colleague Dr Dai Lloyd, Shadow Minister for Local Government, Care and Public Services, has led the seven strong Care Commission which was tasked into looking into the feasibility of establishing a national care service for Wales along the lines of our NHS. 


Today, it reports on its findings, and in short, it recommends all social care should be free at the point of need and funded from general taxation – just like the NHS.


Although at first, many instinctively reject this as unaffordable, our estimates suggest that in the early years, this would require an extra £247 million in spending, or to put that in context, 1.5% of the Welsh Government’s budget.


The Commission has also recommended that a major focus be on investing in services that prevent ill health and promote independent living and that there needs to be parity of pay between Health and Social Care and that workers in social care should be moved onto Welsh NHS pay scales – meaning a pay raise for many.


Clearly there will be funding challenges but I firmly believe that the people of Wales will be prepared to pay through taxation for social care, like healthcare, to be free at the point of need. 


Furthermore, the Commission found that the workforce needs to be fully bilingual to respond to patients’ needs. This should not be seen as a tick box exercise, but an essential part of providing a safe service to people who often lose the ability to speak a second language. 


However, changes in social care alone will not deal with the inbuilt unfairness in the system. If we keep a fully funded National Care Service separate from the NHS there will still be arguments about which budget pays for what. So we will need to go further.


That is why the Care Commission has recommended the creation of a single National Health and Care Service for Wales, planned and funded nationally and delivered locally. The implications of this recommendation are far reaching, and there is more work to do, but it makes no sense to perpetuate the artificial divide between health and social care that has led to so much inequity for so long.


Whilst many of the recommendations of the Commission carry financial implications, not implementing them will also carry huge financial costs. The current system is unsustainable, does not incentivise investment in the right areas, and will cost more over the long run as the under-resourcing Social Care leads to more pressure on the overstretched NHS. 


These recommendations will now be considered by Plaid Cymru as a policy for the May 2021 election and we are excited by the challenge to present a radical workable solution for social care for the people of Wales.


One of the reasons why I’m a fan of a Labour politician, Aneurin Bevan, is that he managed to create a coherent national health service with salaried nurses, doctors, physios, contracts, terms of employment, training, and all the rest when faced with the mishmash of health delivery in the 1930s.


At that point it was part-public, part-private, part-charitable provision, with nobody really in overall charge and people missing out on healthcare in droves. He overcame huge vested interests and brought the NHS into being as a coherent stand-alone service, despite opposition from doctors.


Fast forward over 70 years and when you look at the social care system, it’s like health was in the 1930s, the same part-public, part-private, part-charitable provision. We need to create a national care service in the same way that Aneurin Bevan faced down opponents who were saying, ‘It’s going to be too expensive, it’s going to be far too complicated, doctors don’t want to lose their private practice, local authorities losing their role.’


Huge political will brought about a truly national health service, free at the point of delivery, from general taxation, with all our health risks pooled together. We need to take Aneurin Bevan’s inspiration and vision and create a national care service in this twenty-first century.



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Helen Mary Jones is an Assembly Member for Mid and West Wales and is Plaid Cymru's Shadow Minister for Health

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