After years of piecemeal reform, adult social care in England is facing its biggest shake-up in a generation. Demand is soaring, costs are increasing, and providers are struggling to recruit and retain staff. Successive governments have promised reform, but the current Labour administration is pursuing its most ambitious plan yet: a National Care Service for England.
The idea isn’t new. Labour first floated it in 2009, but following the party’s 2024 general election victory, establishing an NCS is now official government policy. Delivery will take at least a decade, with the Casey Commission due to set out implementation plans in 2026 and 2028. Scotland and Wales have already experimented with NCS models – with very different results.
For public finance professionals, the key question is whether England can learn enough from these experiences to avoid costly mistakes.
Scotland: reform without clarity
The Scottish government introduced its National Care Service Bill in 2022, promising reform, accountability and improved performance management. But it lacked detail on what the NCS would look like, how much it would cost and who would ultimately pay for it.
Ministers suggested unanswered questions could be resolved later through co-production with people who use and deliver care. That failed to reassure local authorities, unions and finance officers. Fierce opposition forced amendments that stripped out major structural reforms.
The collapse of Scotland’s flagship policy highlights the dangers of moving ahead without financial clarity or adequate scrutiny of long-term costs.
Wales: a recipe for success?
Wales has moved further thanks to the legal framework provided by the Social Services and Well-being (Wales) Act 2014. The Act emphasises citizen voice, outcomes-based support and local authority leadership.
Implementation is being overseen by the new National Office for Care and Support, which published its first annual report this year. Progress includes the creation of a Social Care Good Practice Forum to share learning across Wales.
The challenge, however, remains funding. While political support and stakeholder engagement have been strong, decisions on how the NCS will be financed – and how resources will flow between national and local levels – are still pending.
For finance leaders, Wales shows the importance of building on solid legislation and political consensus, but also the risks of delaying tough fiscal choices.
Lessons for England
CIPFA and the Local Government Information Unit have begun publishing a three-part briefing series to inform the Casey Commission. The early message is clear: there is no single definition of an NCS, and each UK nation is pursuing its own path.
For England, the lessons are stark. Scotland shows the perils of overpromising without clarity on scope and cost. Wales demonstrates that progress depends on strong legislation, clear governance and steady political support, but also that financial sustainability cannot be an afterthought.
A financial challenge above all
For local government, the establishment of an NCS will not just be a policy experiment; it will reshape responsibilities, budgets and accountability. Without transparency on funding, the risk is that reform creates more uncertainty, rather than stability.
The adult social care sector is already in crisis. If England’s NCS is to succeed, financial realism must underpin every stage of design and delivery. The question is not whether reform is needed, but whether the government can afford to get it wrong.
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