What Burnham could mean for adult social care

The prospect of Andy Burnham becoming prime minister is bound to quicken the pulse of all but the most cynical advocates of social care reform. As a principal architect of the 2010 white paper Building the national care service, he has remained an enthusiastic evangelist for what became Labour’s flagship social care policy (notwithstanding that 15 years later, the current government has had to set up an independent commission to work out what it would mean in practice). 

Earlier this month, Burnham reiterated his commitment: ‘It is urgent, the need to fix social care, and I personally would look at all of the implications of that in relation to inheritance tax and care charges and everything. I wouldn’t flinch from it.’  

Burnham’s passion and commitment to reform social care is undeniable, fuelled by personal frustrations with the care of his father, who has Alzheimer’s. Imagine if he could emulate Tony Blair’s relentless and single-minded focus on the Northern Ireland peace process or ‘education, education, education’. The personal commitment of the prime minister could be a game changer, as we glimpsed briefly when Boris Johnson threw his weight behind the idea of a care levy to pay for a cap on care costs. With a general election potentially 3 years away, some smartly crafted actions on social care could offer a big win and demonstrate to a distrustful electorate that progress is possible.

It would be unwise to assume that past pronouncements will be a reliable indicator of future policy. Since stepping away from Westminster 10 years ago, Burnham’s been on a journey in which his worldview of health and care has been reshaped through the prism of Manchesterism and a commitment to tackling health inequalities through devolution, prevention and health improvement. This should allay the fears of some that a national care service would mean the absorption of social care into the NHS, a prospect that would fill many (including most folk in the social care world) with horror. Given his dedication to devolving power to local government, a Burnham version of a national care service is unlikely to rely on a centralised model of delivery akin to the NHS. 

Competition for Prime Minister Burnham’s time, energy and commitment will be intense. Given other pressing domestic policy challenges and a volatile geopolitical landscape, there is a risk social care reform will be dwarfed by issues such as defence spending, EU relations and energy costs. The queue for additional resources is long at a time when economic growth remains limited. Having been relegated to the back so often in the past, will social care be at the front of the queue this time?

There’s also a risk of repeating own goals that have bedevilled previous governments’ attempts to reform social care. Leading with plans for a care levy or some other form of property or inheritance charge risks reigniting the infamous ‘death tax’ row regarding Burnham’s previous plans in 2010. While investment in social care will be vital to reform, a new administration would be best advised to focus first on the ‘offer’ for the public. Baroness Casey’s ‘Big Conversation’ with the public could be a helpful tool to raise awareness of the benefits of good social care – and Burnham has already suggested he would bring forward her recommendations. 

Another area of possibility arises from new ministerial and senior advisory appointments, creating space for different energy, ideas and approaches. The choice of chancellor may well turn out to be more significant than the Secretary of State for Health and Social Care. The fortunes of social care, like all other public services, will depend crucially on the ability of the government to achieve economic growth. As US President Lyndon Johnson put it, the first rule of politics is ‘to be able to count’. But above all, it will require sustained political commitment to reform at the highest level of government. 

Richard Humphries (@richardhumphries.bsky.social) is a Senior Policy Advisor at the Health Foundation.