Delivering a new National Care and Support Service

Radically changing how we provide care and support to people in Wales will be one of the defining challenges of the next Welsh Government. With an ageing population and a 10% forecast rise in local authority social care spending in 2025 alone, the pressures on the current mix of local authority and NHS services are already acute.

The government has committed to creating a National Care and Support Service over the next decade, with full implementation from 2029. But a rigid, long-term plan risks being overtaken by events. A better way is to accelerate delivery by combining clear political intent with practical, test and learn reform.

The first 100 days

In the first months, the government should:

Publish a clear ‘North Star’ – a political statement setting out outcomes and principles for reform, signalling urgency and accountability.
Assemble a multidisciplinary team of 12–15 people from across government, local authorities, NHS and social care providers, supplemented by service design, user research and technology experts. Crucially, the team must include people with deep frontline knowledge of care delivery.
Start with users, not solutions, mapping end-to-end journeys through the system using existing evidence from Audit Wales, the National Office for Care and Support, and the original expert group.
Launch small, bounded experiments in one or two local authority or health board areas. Example hypotheses might include:
- How can patients be discharged from hospital more quickly?
- How can staff make home visits more efficient?
- How can handovers between social care teams be simplified?
- How can people better track and manage their own care?
Work in the open, publishing weekly or fortnightly updates, holding monthly briefings with ministers, experts and the public, and being candid about uncertainties and lessons learned.

By the end of 100 days, the team should have disproved risky assumptions, exposed hidden friction points, identified regulatory blockers, delivered visible improvements for individuals, and laid out opportunities for further progress.

The next 2 years

Over the following two years, the focus should be on scaling what works and embedding reform:

Growing multiple empowered teams, each tackling a specific issue such as workforce shortages, new service models for home support, training provision or technology adoption.
Testing and refining models locally, then scaling successful ones across Wales while stopping those that fail to deliver.
Building transparency by publishing real-time data such as the number of people receiving care, patients awaiting NHS discharge, and pressure points in care packages. These metrics should underpin monthly ‘show and tell’ sessions with ministers, frontline staff and the public.
Developing the digital plumbing to support reform, not through buying a single system but by adopting “small pieces, loosely joined” – for example, using GOV.UK Notify for communications or GOV.UK Pay for transactions.

By the end of year two, the service should show measurable improvements in efficiency, user experience and public trust, with a foundation of empowered teams, open working and digital infrastructure ready for wider transformation.