Proposal 07

National Care Service

Could Britain create a sustainable social-care safety net for people who cannot afford essential care — without simply building another NHS?

Britain needs a more secure way to protect people from unaffordable social-care and end-of-life care costs.

Proposal 07 would establish a National Care Service as a targeted safety net for people who cannot reasonably afford the care they need.

The National Care Service would not be another NHS.

It would not attempt to become the universal provider of all social care. Its purpose would be to ensure that people are not left without essential care simply because they cannot afford it.

1. The idea

The National Care Service would focus on people who face serious or unaffordable care needs, including:

elderly people who need care and support;
people requiring long-term social care;
people without sufficient income or assets to meet necessary care costs;
people facing catastrophic care costs; and
people approaching the end of life who cannot afford the social-care support they need.

Measure	Proposed approach
Core purpose	A national social-care safety net for people who cannot afford essential care
Funding	1% National Care Levy on gross income
Use of levy	Ring-fenced for the National Care Service
Private preparation	Encourage social-care insurance, long-term care savings and related products
Relationship with NHS	Distinct from healthcare provision and not intended to recreate the NHS

An important admission

This proposal is not fully costed.

The principle is clear, but the financial architecture is not yet complete. The proposed 1% levy, eligibility rules, interaction with existing social-care funding and likely demand all require proper modelling before this could be presented as implementation-ready policy.

Manifesto 1.0 contains working estimates suggesting that a 1% Care Levy might raise roughly £30–35 billion a year and that a mature National Care Service might require an annual programme envelope in the region of £30–40 billion.

Those figures are illustrative working estimates — not a completed costing.

2. A safety net, not a monopoly

People who can reasonably prepare for their future care needs should be encouraged to do so.

private elderly-care insurance;
long-term care savings;
employer-supported care insurance; and
pension-linked care products.

The intention is therefore not for the National Care Service to become the sole provider.

Personal preparation where possible. Collective protection where necessary.

A mixed care system could continue to exist, while the NCS provides protection where individual resources are insufficient or where care costs become catastrophic.

3. The proposed 1% National Care Levy

Proposal 07 would introduce a dedicated:

1% National Care Levy on gross income.

Revenue from the levy would be ring-fenced for the National Care Service rather than absorbed into general government spending.

Proper modelling needs to determine:

what counts as gross income;
how employment, self-employment, pension and investment income would be treated;
whether any income or groups should be exempt, capped or treated differently;
what administration and collection would cost;
how behavioural changes could affect the tax base; and
whether the likely revenue would match the realistic cost of the NCS.

4. Eligibility and catastrophic care costs

The principle of a safety net is straightforward. Designing one fairly is not.

the income or asset level at which support begins;
whether there should be a maximum amount an individual is expected to fund personally;
what counts as a catastrophic care cost;
which end-of-life social-care costs should be guaranteed;
how family contributions should be treated;
how the NCS would work with local authorities and existing providers; and
what happens where healthcare and social-care responsibilities overlap.

5. Relationship with wider NHS reform

Proposal 07 sits within the wider care and health settlement, but it is deliberately narrower than the later healthcare reforms.

The National Care Service is about social-care affordability and protection against catastrophic care risk.

It is not intended, by itself, to determine how the NHS should ultimately be financed or organised.

NCS ≠ NHS 2.0.

6. The questions I want people to challenge

Would a 1% levy raise enough money to fund a meaningful care safety net?
Is gross income the right base for the levy?
Should the levy apply equally to wages, pensions, self-employment and investment income?
What should the eligibility threshold be?
How should assets, housing wealth and savings be treated?
Should there be a lifetime cap on the amount an individual is expected to pay for care?
How do we encourage private care insurance without disadvantaging people who could never afford it?
How should responsibility be divided between the NCS, the NHS and local authorities?
What workforce, pay, training and capacity would the model require?
Would the NCS reduce or increase administrative complexity?
Could the proposal create unintended incentives around saving, insurance or asset ownership?
Is there a better way to protect people from catastrophic social-care costs?

7. A proposal to model — not defend at all costs

This proposal should be treated as a framework for serious testing, not as a finished blueprint.

The next stage is to try to disprove it: test the assumptions, expose weaknesses, model the money and change the design where the evidence demands it.

If the 1% levy does not raise enough, change the model.

If the eligibility rules prove unfair, change them.

If there is a better way to protect people from catastrophic care costs, consider it.

Good policymaking should survive difficult questions.

8. Proposal 07 — the question

Can Britain create a sustainable social-care safety net that protects people from unaffordable care, encourages responsible preparation where possible, and can be financed credibly through a dedicated levy — without simply building another NHS-sized institution?

The idea needs proper modelling and scrutiny.

Let's test it.

Read. Question. Challenge. Debate. Contribute.

Manifesto 1.0 — A New Settlement for Britain