PM: Not possible to build an NHS for the future without fixing social care

Fixing social care must be part of any plan to build an NHS for the future, the Prime Minister has said, but he declined to give further detail on the Government’s plans for the sector.

Sir Keir Starmer’s comments came as a major review of the health service branded the state of social care as “dire” and noted the “profound human cost and economic consequences” of a long under-resourced area of healthcare.

The report by independent peer Lord Darzi, published this week, is focused on the NHS but said a growing gap between people’s needs and those getting publicly funded social care in England is placing “an increasingly large burden on families and on the NHS”.

Sir Keir (pictured) was twice asked by reporters about timings for major reform of social care but declined to give detail other than repeating Labour’s “ambition” to have a National Care Service.

He said he wants such a service to be created “as consensually as possible” and with cross-party involvement.

Addressing a conference hosted by The King’s Fund, the Prime Minister said: “We want that national service. We will start with the staff and build up from there with a vehicle for the consensus that we need.

“But the challenge is absolutely right. We have to fix social care because I don’t think it’s possible to build an NHS for the future if we don’t fix social care as we do it. And that makes the challenge greater.

“But the point of this report and the 10-year plan really is to look beyond just the NHS itself and broaden it out, and social care is obviously part of that 10-year plan.”

He indicated that a reference to capping care costs will be included in the 10-year plan, but cautioned that such a measure must be “deliverable”.

In July, Chancellor Rachel Reeves used a wider speech on public finances to state that previously delayed adult social care charging reforms will not be taken forward.

The decision not to proceed in October 2025 with the charging reforms, including an £86,000 cap on the amount anyone in England has to spend on their personal care over their lifetime, will save a projected £1 billion by the end of that year, the Government has said.

On capping care costs, Sir Keir said on Thursday: “Promises were again made by the last government.

“They were delayed because they were undeliverable. We’ve looked at them. We don’t think they are deliverable in the time frame the last government said.

“That’s why we’ve taken them down and will review it.

“It is an issue we are going to have to look at, I readily accept that. We will have it within the 10-year plan, but again it’s got to be done properly, it’s got to be deliverable.”

Organisations representing both care providers and those cared for within the sector, welcomed Lord Darzi’s acknowledgement that social care “has not been valued or resourced sufficiently, which has both a profound human cost and economic consequences”.

While stating that social care was outside the scope of his investigation, Lord Darzi said it is “impossible” to understand the situation in the NHS without understanding how things are in social care.

He said the “dire state of social care” means 13% of NHS beds are occupied by people waiting for social care support or care in “more appropriate” settings.

Voices within the sector – which cares for older people and children and working age adults with disabilities – have repeated calls for urgent detail on reform, saying the sector cannot afford to wait much longer.

Melanie Williams, president of the Association of Directors of Adult Social Services (Adass), said: “We support Lord Darzi’s recommendation to shift focus and funding from hospitals towards community and mental health services.

“But social care must be at the heart of any plans to create a ‘neighbourhood NHS’, otherwise we’re at risk of failing to deliver this once-in-a-generation opportunity to transform health and social care.”

Nadra Ahmed, executive co-chair of the National Care Association, said: “We cannot continue to allow social care to be undervalued, as this has dire human and economic consequences.

“It is imperative that social care is resourced and restructured as an integral part of the health service, particularly as our aging population grows and the prevalence of long-term conditions increases.”

Caroline Abrahams, charity director at Age UK, said: “Social care and the NHS are really two sides of the same coin, especially for our older population.

“It is unusual for an older person who has health needs, for example long-term conditions like heart disease, cancer or diabetes, not to have social care needs too.

“For this reason, it is essential that the 10-year NHS plan, for which the Darzi report establishes the baseline, sets out how we can ensure social care plays a full part in the joined-up care at home or a care home that many older people need.”

The Independent Care Group, representing adult social care providers in York and North Yorkshire, said it was “dismayed” the review’s scope did not include a detailed review of the sector.

Chairman Mike Padgham said: “That is a serious omission and makes something of a nonsense of the whole process.

“You can’t fix the NHS unless you fix social care.”

Nuffield Trust chief executive Thea Stein said it is right that the report “repeatedly references the inter-related, compounding pressures of the desperate state of social care and cuts to public health provision”.

Kathryn Smith, chief executive of the Social Care Institute for Excellence, said: “Waiting for Government action and investment on social care may prove to be a false economy.

“Social care must be treated as an equal partner to the NHS, and we must leverage opportunities now for upstream prevention, new models of community care and digital innovation.

“The NHS 10-year plan has an important role to play in reimagining both our future national health system and social care.

“This is a vital moment for the future of care in the UK – one we cannot afford to miss.

“We look forward to working closely with Government, health and care partners as future plans for the NHS and a National Care System take shape.”

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