National Care Service

Debate between Caroline Nokes and Alison McGovern

Thursday 15th October 2026 Commons Chamber

[The Minister for Social Care and Mental Health (Alison McGovern)]

With your permission, Madam Deputy Speaker, before I make a statement on the creation of the national care service, I want to pay my own tribute to Sir David Amess and his family. We are all thinking of them today, and I am reflecting in particular on how much Sir David gave to this House.

It is in the news this week that Audrey Joughlin is celebrating almost 80 years of service in the NHS. This remarkable lady has been working in the NHS since the day it was founded in 1948, and today she is volunteering at the Royal Liverpool hospital. I want to also wish a happy birthday to my constituent Vibeke Nicklin, who is turning 80, having spent 60 years as a nurse caring for patients.

When I read about these women, I feel nothing but pride; to know that they are from my home town in Merseyside just about makes my heart burst. These incredible women show what a wonderful thing it is that people are living longer—more grandparents are living to see their grandchildren as adults—but it also sets a test for our generation of politicians. When Audrey began her career, there were fewer than 6 million people aged over 65 in the UK; today, that figure is over 13 million. According to the Office for National Statistics, by 2050, 18 million people will be aged 65 and over; the number aged 75 and over will rise to more than 10 million; and the number aged 85 and over will have doubled. As the Prime Minister said yesterday, we cannot turn away from the question of social care. People who depend on care deserve better, and the dedicated staff deserve better, too.

This issue of social care has often been overlooked for two reasons. The first reason is who does most of the care. I can explain this simply in three words: working-class women. Working-class women never get a fair hearing in this country, but those in social care need to be heard right now. The second reason is what happens to people when they experience a failing care system. It is not that people do not like talking about getting old; too many people who go through our care system are traumatised by the experience, and it is too hard for them to talk about it. As the Prime Minister said at the Labour party conference, social care workers often feel invisible. Who can blame them, when 80% of care workers working for independent providers receive within 10% of the minimum wage?

We are all looking forward to the findings of Baroness Casey’s important review, but the truth is that we cannot afford to wait for her to finish that work before getting on with the job. Ask any family who have gone through the nightmare of trying to sort out care for their loved ones—the status quo cannot be accepted. Beyond the immediate impact on families, the NHS is paying the price of our failure to get a grip; hospitals are dealing with 999 calls from a failing care system, and we have the appalling spectacle of corridor care in hospitals across the country. If we carry on like this, our broken social care system will break the NHS, too. We cannot let that happen.

We on the Government Benches remember that we were elected on a manifesto that said that we would build a national care service, improve the lives of the people who draw on care, and build a system that puts people before profit, and we are already working hard to deliver Baroness Casey’s early recommendations, whether on motor neurone disease, dementia or safeguarding. That is why the Prime Minister has taken the decision to build a national care service, with free personal care, adjusting the triple lock to make it possible. Baroness Casey will report next summer; meanwhile, we will prepare the ground now for the new service.

I am sick of people looking down their nose at social care staff, who do a highly skilled job that could provide the young people of this country with a great career. Yesterday, I spoke to our partners at Skills for Care about our workforce action plan. At the heart of this is a commitment not just to older generations who need care, but to younger generations who just need their chance in life. Being unemployed for any period can damage someone’s confidence, but doing a skilled job like social care can give people a sense of pride, and a pay packet they earn themselves. That is why we will offer thousands more academy places to help young jobseekers into good jobs in care, and are bringing in the first national collective pension scheme dedicated to care workers; and it is why we have already passed the Employment Rights Act 2025, which gave more than a million people—many of them care workers—access to sick pay, and raised the minimum wage. We will introduce the first fair pay agreement in adult social care, backed by half a billion pounds. It will put care workers under the protective umbrella of collective bargaining and give them the power that they deserve—not just as a one-off, but forever.

For unpaid carers, we have announced the biggest expansion to the carer’s allowance since the 1970s. We will soon appoint the first unpaid carers’ champion to be a voice for people who provide unpaid care.

For too long, social care has been a Cinderella service, with care staff held back by not having the tools they need to look after people. Recently, however, we have been making good progress. Digital social care records are helping to reduce paperwork and improving the quality of information available to staff, which is vital for good care and saving precious time. Today, I can give the House the update that digital records are now used by 84% of care providers, compared with just 72% when this Government took office, and 92% of people who draw on care are now benefiting from that modernisation.

We are supporting the adoption of preventive technology that was the stuff of science fiction just 10 years ago—home monitoring kits to identify infections early, reminders to avoid missed medication, and specialised sensors to detect and prevent falls. If we can put the best technology in the hands of skilled and emotionally intelligent people, the result will be working-age adults with self-determination, choice and independence in life, and older people at home for longer, in better health, and with a much, much better chance of dying at home, in comfort and in dignity, when the time comes. As my right hon. Friend the Secretary of State for Work and Pensions said on Tuesday,

“A good retirement…is about more than income.”—[Official Report, 13 October 2026; Vol. 791, c. 198.]

There are those who say that we cannot afford the national care service; I say that they are asking the country to pay for the cost of failure. This issue is not going away. If our response to the test of an ageing population is simply to find an even larger bucket of sand to stick our heads in, the impact on the NHS—already plain for all to see—will only grow worse.

If the decade after 2010 taught me anything, it is that we do not save money by tearing chunks out of the fabric of our society and then making the NHS pick up the pieces. Most importantly, if we improve population health, people will have a much better quality of life. I do not pretend that it is easy, but our pensioners deserve security and peace of mind. Our national care service will be better for them, families and the NHS. It will ease the pressures we see today; failings in our social care system mean that many pensioners are kept in hospital for longer than they need or want to be, because social care beds are unavailable. The cost of inaction will only be more pressure on the NHS through more ambulance call-outs, more A&E admissions, more corridor care and more people stuck in hospital when they do not have to be there.

We are at a crossroads. Our choice is: either pay the financial and human cost of the failed system that we have now, or build the national care service, stabilise our public finances and enable people to live happier and healthier lives. I urge colleagues to think of not just the consequences of inaction, but what it means for our constituents if we get this right. In place of fear, the rising population of elderly people we represent can grow old in a good society. Instead of corridor care, we would have a thriving NHS, in which unnecessary admission was prevented and people who become unwell recovered quickly and enjoyed their life. Care workers would be recognised for their work, and all of us would gain peace of mind about what happens later in life.

When Audrey began her lifetime of service to our country, she was part of a generation that left the greatest legacy that anyone could hope to build. It meant that when a person falls ill, they never have to worry about the bill. Today we have the chance to carry her generation’s torch into the 21st century, and to leave to our children and grandchildren something as significant as the creation of the NHS. We are ripping off the plaster. I commend this statement to the House.

[Madam Deputy Speaker (Caroline Nokes)]

I call the shadow Secretary of State.

--- Later in debate ---

[Alison McGovern]

My hon. Friend is right that at the heart of the problems we have in the social care system are the way in which the workforce are looked down upon by others and the problems with low and uncertain pay in too many areas. We are cracking on with the fair pay agreement for all the reasons that I mentioned and that she knows only too well. It is about time that social care was seen as the great and fantastic career that it is.

[Madam Deputy Speaker (Caroline Nokes)]

I call the Liberal Democrat spokesperson.

--- Later in debate ---

[Alison McGovern]

I thank my hon. Friend for all she did as a Health Minister and for raising that extremely important question. It is an often overlooked fact that in end-of-life care, the members of staff who might see a person and their family the most will be social care staff. If we cannot get the NHS working together with social care for people when they are dying, we will not be able to do it at any time. That is a priority for the work that we can do before the Casey review, and I will happily meet my hon. Friend to discuss that further, if she would like.

[Madam Deputy Speaker]

I call the Father of the House.

--- Later in debate ---

[Alison McGovern]

I thank my hon. Friend for that contribution. He is absolutely right: people feel as if the current system is a fog, at best. It is totally fractured, and it is too hard to navigate for people already dealing with some of life’s biggest challenges. Those Co-op values are an important factor in our thinking as we move forward with the national care service. He mentioned the Prime Minister’s comments yesterday; I am glad to confirm that those are exactly the values that we want to bring to this discussion. We are trying to ensure that people are empowered and have their voices heard, and that they work together for the good of those who need care.

[Madam Deputy Speaker (Caroline Nokes)]

I thank the Minister for her statement.

Terminally Ill Adults (End of Life) Bill

Debate between Caroline Nokes and Alison McGovern

2nd reading
Friday 11th September 2026 Commons Chamber

[Madam Deputy Speaker (Caroline Nokes)]

As the hon. and very experienced Member will know, that was not a point of order and not a matter for the Chair, but I am sure the Minister has heard her.

[Alison McGovern]

I also respect my hon. Friend and, though it was not a point of order, the House will have heard what she said. I am attempting to address the points that have been raised in the debate, particularly on procedural matters, on social care and palliative care, which I turn to now.

Palliative care is extremely important and has been raised many times within the debate. As the Chair of the Select Committee set out, we are developing a modern service framework for palliative and end-of-life care. The framework is clinically led and evidence-based, to support sustained improvements in outcomes for patients and carers, including by systematically identifying, measuring and reducing health inequalities and reducing unwarranted variation in access, in experience and in outcomes. As part of that work, we expect all integrated care boards to complete a needs assessment so that we can get a detailed understanding of their current and future population, including people of all ages with palliative care and end-of-life needs. That is vital in order to commission services that best meet the need while providing value for money. Many hon. Members raised the importance of doing that, and particularly of reducing unwanted variation. I acknowledge that and I will be working with Members across the House to deliver that modern service framework.

Members quite rightly mentioned the hospice sector. We provided a £125 million capital boost to funding for adult and children and young people’s hospices. I say to hon. Members that I have heard the points that they have made, and I know we have more to do. Many hon. Members and friends will know that in July, I lost my own mum, so I had a very practical education in this topic, and that experience will shape how I take this work forward.

To conclude, I thank all hon. Members once again for all they have said. They will understand how difficult it is when we are sharing personal experience, as many of them have done today, and I am really proud of everybody who has done so, difficult and challenging though this issue is. I thank all Members who have given me their sympathy over recent months and weeks. It has been so appreciated.

The Government remain neutral on whether the Bill should become law, but it is our serious responsibility, should Parliament pass it, to ensure effective implementation within the framework provided by the legislation. On that basis, we would provide technical support to the promoter if Parliament chooses to progress the Bill.

That said, I will repeat the comments made by the right hon. Member for East Hampshire from the Opposition Dispatch Box, which I now say on behalf of the Government. This is a deeply challenging issue for us all, for the public and for the constituents we represent. In discussing this issue, we must model the best behaviour of this House—having respectful, thoughtful, careful debate, listening to one another and understanding our very different perspectives. I think that we have done that today. I hope that, whatever happens in the Division, we will be able to continue to show those behaviours and give this serious subject the deep respect it deserves.

Local Government Reorganisation

Debate between Caroline Nokes and Alison McGovern

Thursday 18th December 2025 Commons Chamber

[The Minister for Local Government and Homelessness (Alison McGovern)]

As I said to the House yesterday, we need to set local authorities on a plan for financial sustainability, after 14 years during which the Tories decimated local government, and local government reorganisation is a part of that journey.

Having layers of councils is both inefficient and ineffective. With one council in charge in each area, we will see quicker decisions to grow our towns and cities and to connect people to opportunity. Residents will see more preventive care; a family needing special educational needs support and help with housing, for instance, will need to contact only one council, rather than being passed between two. Residents will also benefit from more financially stable councils, with combined services delivering for a larger population, providing for efficiencies and better value. That is why reorganisation is a vital part of our change: stronger local councils equipped to generate economic growth will improve local public services and empower their communities. As we break for Christmas, I would like to thank colleagues in this place and councils across the country for working with the Government to deliver this process.

We want to make these changes in this Parliament. We have already reached a number of key milestones, including the Secretary of State’s decision to implement two new unitary councils in Surrey. We have now received proposals from all 20 remaining invitation areas and a consultation is open on 17 of those proposals from six invitation areas. I expect to launch a consultation in early February on proposals for the remaining 14 areas that seek to meet the terms of the statutory invitation; that consultation would be for seven weeks. I remain committed to the indicative timetable that was published in July, which will see elections to new councils in May 2027 and those new councils going live in April 2028, subject to Parliament.

Local government reorganisation is a complex process involving the rewiring of local services to bring housing, planning, public health and social care all under one roof. When councils have told us about the limits they are working within and the capacity required for reorganisation, my ministerial colleagues and I have heard them. In recent weeks, as final proposals have been submitted, the number of councils voicing such concerns have grown.

Many councils across the country—and of all stripes—have expressed anxiety about their capacity to deliver a smooth and safe transition to new councils, alongside running resource-intensive elections to councils proposed to be abolished shortly. They have expressed concerns about the time and energy spent managing elections to bodies that will shortly not exist, only to run an election a year later. We have also heard from councils querying the value for taxpayers of spending tens of millions of pounds running elections to bodies that will not exist for much longer. Councils are telling us that where capacity is a problem, postponement would free up resources to be concentrated on local government reorganisation and the delivery of good services.

This Government believe in devolution and local leadership. We do not wish to dictate local decisions from Whitehall without consultation; instead, we will listen to local leaders. It is right that the Secretary of State considers the concerns that have been raised with specific relevance to the areas they have come from. Capacity will vary between councils, and that is why the Secretary of State wants to hear from local leaders who know their areas best and understand their own local capacity. He is therefore today seeking the views of council leaders regarding their local capacity to deliver local government reorganisation alongside elections.

To be clear, should a council say that it has no reason to delay its elections, there will be no delay. If a council voices genuine concerns, we will take these issues seriously, and would be minded to grant a delay in those areas. To that end, the Secretary of State is minded to make an order to postpone elections for one year only to the councils that raise capacity concerns. We have asked for representations from councils by no later than midnight on 15 January, and will then be in a position to make an informed decision.

I will continue to update the House on this and other important milestones for reorganisation as we deliver on this vital agenda. I commend this statement to the House.

[Madam Deputy Speaker (Caroline Nokes)]

I call the shadow Minister.

--- Later in debate ---

[Alison McGovern]

I thank the hon. Gentleman for his response. I will do my best to respond to a couple of his substantive points. He said that the Opposition are supporting local leaders who are engaging in the process in good faith, and I thank him for that, despite his other comments where he indicated that perhaps his party is not supporting the move to towards unitary councils, which we know are more efficient and effective, as I said.

On the hon. Gentleman’s important point about the Electoral Commission, the Secretary of State will take that under advisement, and will take any issues raised seriously. As I mentioned, we want to take an approach that puts local insights first. He mentioned councils that do not support a delay. As I said, that is fine; there is no problem with that at all. We want to support local leaders through what we are doing.

The hon. Gentleman mentioned planning, which is extremely important, given the desperate need to build more homes; in fact, part of the motivation for moving to unitary authorities is to get that work done effectively and efficiently. He also asked about social care, which is an extremely important area. A lot of change is going on in social care, not least through the work in the Department for Health and Social Care on changing how NHS England works. I am working closely with colleagues in that Department on that, and I am happy to engage further with him on it.

The position on elections is as it has always been. The starting point remains that elections go ahead unless there is a strong justification for them not going ahead. Today, we are writing to local leaders who have raised concerns and made justifications to us, to ask them to set those out, so that an informed decision can be taken.

[Madam Deputy Speaker (Caroline Nokes)]

I call the Chair of the Housing, Communities and Local Government Committee.

[Florence Eshalomi (Vauxhall and Camberwell Green) (Lab/Co-op)]

I thank the Minister for her statement. I appreciate that she outlined that she has listened to valid concerns from councils about reorganisation. I have raised with Ministers the uncertainty that councils will face in transitioning into new councils, and in running vital day-to-day services.

I am a bit disappointed in the Minister, in that this announcement has come so late in the day. This is an issue of grave importance to so many hon. Members right across the Chamber, but many of them will not be here today to raise their concerns with her. In addition to the Secretary of State’s comments two days ago, he said this when he appeared before the Select Committee on 11 November:

“Where the elections are intended to go ahead, they will go ahead.”

What has changed since then?

The deadline is in a few weeks—the Minister asked that representations be made no later than 15 January—which leaves councils little time to prepare, if we are to make sure that we inform the Electoral Commission as well. What advice would she give to election officers who are planning elections, which takes time and costs money? Should they go ahead or should that work be paused? After that date, when will the final decision be made? Can Members have sight of that date?

We appreciate that local government reorganisation is complex, but we cannot have a situation in which the Government keep postponing elections. Local elections are vital and a sign of a healthy democracy.

[Alison McGovern]

I thank the Chair of the Select Committee for raising those points. First, I take seriously her point about the timings. She will understand that it has been a particularly busy time, given all that is happening in the Department, but I absolutely accept her point. I have been in touch with many Members of the House on reorganisation, funding and other matters, and I anticipate that I will also be in touch with Members over the rest of the year, and very much in the new year as well.

My hon. Friend asked, “Why now?” We have had representations from a number of councils undergoing reorganisation—albeit by no means the majority, as most councils that are reorganising are not due to have elections in any case—and we think it is important that we take stock of their views on capacity constraints. My hon. Friend also asked about timings; we have asked the councils to come back to us quickly, and we will take decisions swiftly.

[Madam Deputy Speaker (Caroline Nokes)]

I call the Liberal Democrat spokesperson.

--- Later in debate ---

[Madam Deputy Speaker (Caroline Nokes)]

The hon. Gentleman will know that that is not a matter for the Chair. I am reluctant to allow continuation of debate via the mechanism of points of order, unless the Minister wishes to respond.

[Alison McGovern]

I have responded.