A National Care Service: our chance to rethink what care really means
The case for embedding intergenerational and relational foundations into our care system
Savannah Fishel (thinkitforward.net), Emily Abbott and Charlotte Miller (Intergenerational England)
Prime Minister Andy Burnham’s commitment to establish a National Care Service (NCS) is the most serious attempt to fix social care in decades, and it is overdue. Our care system remains a point of stark inequality. At the moment people most need support, families can be left to shoulder caring alone and to spend their life savings on the care they need. Free personal care, based on need rather than ability to pay, is a vital step toward restoring dignity, supporting our overburdened NHS and embedding fairness into public services.
The foundations this service is built on will dictate its success. Burnham has pledged a system that is “preventative”, “person-centred” and capable of relieving pressure on the NHS, and said that person-centred care should fit someone’s “faith, their language, their memories”. We agree. Those things are held in relationships: with family, with neighbours, and with the familiar faces of a street, a school gate or a community centre. They also show that need is not set by age alone. Systems are too often designed around chronological age, sorting people into children’s, adults’ and older people’s services. In reality, need sits where age meets identity: disability, ethnicity, faith, gender, sexuality, income and caring responsibilities.
So we propose adding two principles to Burnham’s list: the service must be relational, and it must be intergenerational.
An intergenerational fabric of care
Getting this right starts with how we define social care. Care is not simply a transaction delivered by services, but the practice of reciprocity, made possible through human connection. A NCS needs to recognise this, taking a life-course and relational approach. Life-course, because care needs arrive at every age: a disabled teenager moving into adulthood, a new parent with no family nearby, a 55-year-old caring for a parent and a grandchild at once, an older person back home after a fall. An estimated three in five people in the UK will provide unpaid care at some point in their lives, and working-age adults make up around 40% of people drawing on adult social care. And relational, because whether someone copes depends less on the package they receive than on the people around them.
How the service is paid for will shape its values and priorities. From 2030, savings from an adjusted triple lock will fund care in later life. This significant commitment will inevitably be viewed through the lens of wider generational tensions. Today’s pensioners paid in for decades on the promise that the state would be there in old age. Many of their children, now in their 50s and 60s, are caring for a parent while still helping their own adult children. Those grandchildren are renting into their thirties and doubt the triple lock will survive until they retire. Each story is real. Yet the debate is too easily framed as pensioners against workers, old against young.
Social care risks becoming the latest in a long line of issues discussed through a generational lens, rather than through an understanding of how families actually live and support one another. Housing is described as ‘boomers’ pulling up the ladder: by 30, millennials had paid £44,000 more in rent than baby ‘boomers’ at the same age. When the Winter Fuel Payment was restricted to the poorest pensioners in 2024, then largely restored a year later, coverage swung between an attack on pensioners and overdue fairness to younger taxpayers. The 2017 “dementia tax” was dropped within days after a backlash over older people’s homes and their children’s inheritance. Brexit, tuition fees and lockdowns were each framed as one generation paying for another’s choices. Headlines about ‘snowflakes’ and ‘boomers’ feed the fragmentation.
This matters because care depends on the relationships these debates wear down. A care system built on division will inherit it. A NCS is an opportunity to rebuild those ties instead.
Social care has been here before: the Relationships Project counts 25 commissions, reviews, white papers and inquiries in 27 years, and still no lasting fix. Baroness Casey’s Commission, due to report in summer 2027, has to be different. Through the Big Conversation on Care, it is asking the public what care should rest on and what role families and communities should play.
Prevention as health creation: the role of ‘neighbourisms’
Preventative care is too often reduced to keeping people out of hospital. That matters, but it is the very end of the line. True prevention is health creation. It means:
Preventing isolation before it calcifies into chronic loneliness.
Preventing a loss of confidence before someone stops walking to their local shop.
Preventing young families from burning out under unshared strain.
Preventing the quiet erosion of everyday connection between generations.
These are harder to measure than A&E admissions, yet they often decide whether people live healthy, active and dignified lives. Lacking social connection carries a mortality risk comparable to smoking up to 15 cigarettes a day. In the UK, lonely people cost the NHS hundreds of pounds a year more in GP, outpatient and hospital care, and among the most severely lonely, those costs are highest for the youngest and oldest adults. Loneliness hits both ends of life, which makes it a natural case for bringing generations together.
Savannah Fishel’s research on intentional housing (Beyond the White Picket Fence) examined intergenerational cohousing, tiny home villages and housing cooperatives designed to help relationships develop. In these communities, people look out for, rather than just after, one another, with the architecture and social infrastructure built for connection.
Savannah calls the everyday acts of care and interest between neighbours ‘neighbourisms’, and they were strikingly common, encouraged through intentional design. A neighbourism is the informal chemo-ride rota for a neighbour undergoing cancer treatment, a batch of meals for an overwhelmed new mother or a teenager spending an hour helping an older neighbour clear an overgrown path.
Our work at Intergenerational England points to an important distinction. Many communities are already multigenerational: people of different ages share the same street, shops and bus stop. That is co-existence, not connection. Being truly intergenerational means those generations know, rely on and give to one another. The shift from living alongside each other to living with each other is what turns that mix into support. When these everyday acts of care reach across generations, neighbourisms put intergenerational connection into local action, as people respond to one another’s needs with the time, skills and support they can offer.
Neighbourisms will never appear in a care package or statutory guidance, yet they are the shock absorbers of civil society, resolving manageable disruptions before they become the crises that overwhelm statutory services. They are also the most practical way into building community support: small enough that anyone can initiate, familiar enough not to require training, and rooted in a sense of civic duty: looking out for the people around you as part of being a citizen.
The pandemic showed how much of that capacity is waiting. In 2020 an estimated 4,300 mutual aid groups formed across the UK, and 750,000 people signed up as NHS Volunteer Responders in under a week, three times the target. Much of that faded once the emergency passed. A NCS could help it last.
Embedding care into communities
Much of this thinking is already embedded in the work of the community sector, where relationships, trust and informal support are central to how organisations work. But too often this work is undervalued, short-term funded, or integration with statutory care is poor.
The government is moving in the right direction. The 10 Year Health Plan commits to a shift from hospital to community through a new Neighbourhood Health Service. But a neighbourhood is more than the services located in it. Recent learning from six neighbourhood health partnerships reinforces the importance of balanced collaboration between community-led organisations and statutory services. This means investing in relationships for the long term, recognising the knowledge and assets already within communities, and giving community organisations the trust, resources and space to shape and lead approaches to health and care. It also means reflecting the diversity of the community sector in funding and evaluation, rather than expecting a single model to work everywhere.
This does not mean subcontracting state responsibility to goodwill. Neighbourisms can never substitute for skilled, professional care workers. Without relational infrastructure, though, even the best-funded NCS will be permanently overwhelmed by avoidable crises. Connection is social infrastructure, and like transport or housing, it needs to be planned and invested in.
Putting the principles into practice
The NCS cannot build affordable homes, repair community centres or tackle digital exclusion, all of which greatly impact our health outcomes. It will, though, set the rules for how care is commissioned, measured and paid for, and those rules will shape communities for decades. Connection across generations should be a central pillar.
None of this is untested. Intergenerational practice already happens in care homes, nurseries, schools, hospitals and housing schemes, often without being called that. Since 2018, Intergenerational Music Making has delivered more than 2,500 projects and trained over 900 people to lead them. Through Intergenerational England, we are leading The Age of Solidarity, a ten-year national programme starting in London, Surrey and Greater Manchester and growing to ten test and learn sites, each measuring change with the same framework. That gives the Commission and government a ready-made way to test a relational, intergenerational care system in practice.
We recommend:
Commissioning for connection: NCS commissioning, social value requirements and neighbourhood health plans should treat relationships as an outcome, not a by-product, measured in a way finance teams recognise and built on ONS wellbeing and social value methods.
Designing housing for connection: planning and housing policy should do more to support homes that make everyday interaction and communal living easier. In the UK, organisations such as the UK Cohousing Network, CDS Cooperatives and Housing LIN are advocating for policy changes to enable a wider range of communal housing models, whilst schemes such as Homeshare UK match older people with a spare room with someone seeking affordable accommodation, in return for a time contribution.
Sharing and protecting spaces: co-locating day services, care homes and nurseries, as Apples and Honey Nightingale does, creates opportunities for sustained contact. Relationships grow from shared routines and someone whose job is to make introductions. The places generations already share, such as libraries, halls, faith buildings and community centres, should be protected as part of local care infrastructure.
Challenging age stereotypes: funding and celebrating cross-generational initiatives, modernising language across media and politics, and learning from countries that are less age-segregated.
Growing the workforce across generations: adult social care will need around 410,000 more posts by 2040. Intergenerational programmes give young people early, supported experience of care settings and a reason to choose care as a career.
Investing in community partnerships: provide long-term funding and meaningful decision-making roles for community-led organisations, recognising them as essential partners of a NCS.
We welcome the ambition behind a NCS. But a genuinely preventative system should not simply intervene earlier; it should create the conditions in which people need crisis support less often. That means taking relationships seriously in how the service is designed, funded and judged.
The way the service is paid for already asks what generations owe one another. The way it is built should answer that question differently: not by setting old against young, but by making it easier for people of all ages to know, support and rely on each other. That is how neighbourliness becomes a civic habit again, holding up our public services rather than leaning on them.
The Big Conversation on Care runs until April 2027 and is open to everyone. Take part, and help make sure the NCS is built on relational and intergenerational foundations. To make that happen where you live or work, join us through The Age of Solidarity.
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