Care Without Cost
Our vision is of a National Care Service placing social care on the same footing as the NHS with free home care at its heart.
Free Home Care: A Stepping Stone to a National Care Service
By Dame Sally Powell, John McDonnell MP, Stephen Burke & Rebecca Eve Brocklebank
For those looking for boldness from the Labour Government, here’s a lesson from local government history that could transform care and our country!
On 20 September 2025, the Labour movement lost one of its most principled and dedicated champions of social justice, Iain Coleman MP. Elected to Parliament in 1997, Iain was renowned in his constituency for introducing free home care as Leader of Hammersmith & Fulham Council. For Iain, that legacy was deeply personal. After leaving school, his first job was as a care worker. Decades later, in a cruel twist of fate, after suffering more than 20 strokes and developing early-onset dementia, he came to rely on the very policy he had fought to introduce.
It was thirty-five years ago, in 1991, that Iain secured the support of fellow councillors and senior officers to implement universal, non-means-tested home care in Hammersmith & Fulham, removing charges for everyone who required home care regardless of personal wealth. This was a deliberate socialist reform: any taxpayer in the borough who needed support through illness, disability, dementia, or frailty could benefit. Everyone contributed, and the protection was available to all, should the throw of life’s dice not be kind to them.
Driven by Labour leadership, the scheme was ambitious and required disciplined financial management: cutting unnecessary costs, striking good commercial deals, and redistributing resources from residential care towards supporting people in their own homes. It worked. Free home care enabled residents to remain at home for longer, often indefinitely, on their own terms. In doing so, it removed what amounted to a local tax on disability, dementia, illness, and frailty. While other councils require people with more than £14,250 in savings (excluding their own home) to contribute towards their home care, and those with more than £23,250 to pay the full cost, Hammersmith & Fulham provides home care on the same basis as health care: free at the point of need.
The policy proved so successful that, despite the Conservatives reintroducing means-testing between 2006 and 2014, the borough abolished all home care charges once again in 2015. In the May 2026 local elections, Hammersmith & Fulham bucked the national trend, remaining firmly under Labour control. The popularity of free home care was reflected in the Conservatives’ pledge to retain the policy. Hammersmith & Fulham’s experience shows that where there is political will, there is a way, and it has been a model for Tower Hamlets, which followed suit in offering free home care from April 2025.
The outcomes in Hammersmith & Fulham speak for themselves. By June 2019, 7.5 people per 1000 were receiving home care, the highest of all London boroughs and nearly double the London average of 3.9. Adult Social Care Outcomes Framework data show that the number of people aged 65 and over in residential care in the borough fell dramatically, from 828.3 per 100,000 in 2014–15 to 219.5 per 100,000 in 2024–2025. This places Hammersmith & Fulham fourth nationally for the lowest number of older residents in care per local authority. The borough’s discharge outcomes are also strong: in 2023–24, 95.7% of people in the local authority area remained at home 91 days after discharge, placing the borough fifth nationally.
The financial case is equally persuasive. An NHS hospital bed costs around £562 per day to staff and maintain as of 2025–2026. In contrast, home care at the 2025–2026 rate of £22.36 per hour costs just £89.44–£134.16 per day for a four- to six-hour support package. Furthermore, in 2026–2027, only 16% of Hammersmith & Fulham’s £123 million adult social care budget is allocated to home care, while 33% is to be spent on residential care, despite the comparatively low numbers in care homes. Indeed, the Disability Law Service, following their research into the Hammersmith & Fulham model, with the backing of disability rights groups and charities, is now campaigning for the abolition of care home charges.
The arguments for free home care are compelling:
First, it’s fair and socially just. Disability, dementia, illness, and frailty should be treated as shared social risks, not individual financial liabilities. We do not means-test medical care, so why do we means-test help with basic health care such as washing, dressing, drinking, and eating?
Second, it aligns with most people’s preference for maintaining autonomy and ageing well in their own homes rather than in institutions, surrounded by family, friends, familiarity, and community.
Third, it’s economically rational. Preventative home care reduces falls, infections, dehydration, malnutrition, and physical and mental decline. It decreases ambulance call-outs, hospital admissions, delayed discharges, and readmissions. It’s also significantly cheaper than hospital beds and residential care.
Fourth, it supports unpaid carers, who are the invisible backbone of the system and save the public purse billions per year. Free home care reduces the risk of burnout, income loss, and ill health among carers, enabling families to sustain informal care arrangements and remain economically active.
Fifth, it strengthens integration between health and social care. When social care is unavailable, unaffordable, or rationed, the NHS absorbs the consequences, with hospitals becoming substitutes for community support.
Sixth, it aligns with broader social trends towards home working and care in the community, with advances in assistive technology, telecare, and artificial intelligence creating the conditions for a major expansion of home-based support.
Seventh, it complements innovations already being developed across the UK, including meals-on-wheels services, Shared Lives schemes, technology-enabled care, telecare, AI-supported social care tools, Hospital at Home programmes, integrated neighbourhood health teams, and age-friendly neighbourhoods.
Eighth, it would help grow the caring economy, creating skilled, community-based employment and supporting job creation in domiciliary care and allied roles in every town, city, village, hamlet, and homestead in the country.
Baroness Casey recently made the powerful observation that social care, unlike the NHS or the benefits system, has never had its own creation moment — no founding settlement, no defining national mission, and no equivalent of 1948. At the same time, many people across the country are frustrated by the pace and scale of national change.
We see free home care as a key stepping stone towards a National Care Service: a reform that can begin to take shape this year, with the potential to deliver the transformational change people are seeking, provide a modern Bevan-style legacy, and offer a policy that could help Labour win the next general election.
Just as Aneurin Bevan drew inspiration for the NHS from a successful local model in his home town of Tredegar — the Tredegar Medical Aid Society—we draw inspiration from Iain’s legacy in Hammersmith & Fulham. Like Tredegar for Bevan, the Hammersmith & Fulham model demonstrates that transformative change and socialism are not utopian: they’re deliverable.
Because care should not simply be a private act of love carried out silently by families behind closed doors, nor a patchwork of unequal provision depending on postcode or wealth, held together by workarounds, sticking plasters, and glue. It should be a national commitment and a collective responsibility we all share, recognising that care touches us all.
FAIR AND SOCIALLY JUST
Disability, dementia, illness and frailty treated as shared social risks, not individual financial burdens.
MAINTAINS INDEPENDENT LIVING
Keep your autonomy and age well in your own home rather than a residential institution.
ECONOMICALLY RATIONAL
Cheaper than hospital beds and residential care. Reduces falls, infections, dehydration, malnutrition and physical and mental decline.
SUPPORTS UNPAID CARERS
Redues the risks of burnout, income loss and ill health among carers enabling families to remain economically active.
INTEGRATES HEALTH AND SOCIAL CARE
When social care is unaffordable, unavailable or rationed the NHS absorbs the consequences through delayed discharges and readmissions.
ALIGNS WITH CURRENT SOCIAL TRENDS
Advances in assistive technology, tele care and artificial intelligence are creating the right conditions for a major expansion of home based support.
COMPLEMENTS EXISTING SOCIAL INNOVATIONS
Including Meals-on-Wheels, Shared Lives, Hospital at Home, integrated neighbourhood health teams, and age-friendly neighbourhoods.
PROMOTES LOCAL ECONOMIC GROWTH
Creating skilled, community-based employment in domiciliary care and allied roles in every town, city and village in the country.
‘Arsenal fan, devoted constituency MP and champion of the poor and vulnerable, Iain Coleman was also a lover of human foibles who found humour in the driest of circumstances. Above all he made life fun.’
- Andy Slaughter MP