In the aftermath of Andy Burnham’s speech to the Labour conference, media discussions are focusing on how to define social care and estimate its cost (How will Burnham’s national care service work – and how will it be funded?, 29 September).
Most arguments assume that any new system will look like the existing one, with services outsourced to large companies, using contracts without scope for innovation, with rigidly defined targets, often delivered using poorly rewarded, precariously employed migrant workers.
The reality is that many of the services needed by elderly and incapacitated people – such as cleaning, meal preparation, transport to medical appointments, household repairs and personal services such as podiatry, hair care, physiotherapy, counselling or therapeutic massage – are also required by others and are already freely available in local markets.
The trouble is that they are most often supplied by online platforms such as Uber, Deliveroo or Housekeep with no commercial incentive to address social need.
One solution would be to set up local platforms that supply these services to anyone, regardless of age or disability. If these platforms made sure that all staff were suitably trained, qualified and security-checked, and their vehicles suitably adapted, they could be attractive to all local residents, whose commercial use of them would help subsidise their costs. Social care recipients could be provided with access to them using a voucher system that would be much cheaper than setting up such services from scratch or bundling them in with huge outsourcing contracts.
With suitable public oversight, using platform technology for public good would also bring other benefits to the local economy. Services would be better for all. Workers could upgrade their skills and gain job security. And, instead of being siphoned off to tax havens, any profits could remain, as Burnham might put it, “in every postcode”.
Ursula Huws
London
Andy Burnham’s commitment to a national care service brings welcome clarity to a debate that has too often avoided difficult choices. But before deciding how to pay for care, we must answer a prior question: what should people be able to count on?
Reports that the proposed service may follow Scotland’s model of free personal care raise an important distinction. Removing charges for help with washing, dressing and eating could make a substantial difference. But social care is about much more than these tasks. When we in the coalition government developed the Care Act, we placed wellbeing at its heart. Its purpose extends to dignity, independence, relationships, participation and people’s control over their own lives.
There is a risk that defining a national care service primarily through free personal care narrows our understanding of what social care is for. The two need not be in conflict. Free personal care could form part of a wider national guarantee, grounded in the Care Act’s wellbeing principle and applying to people across adulthood.
The Casey commission has an important opportunity to help establish that wider promise. The question is whether the new service will simply change what people pay, or also strengthen the care and support that they can rely on to live their lives.
Paul Burstow
Former minister of state for care services, 2010-12
Andy Burnham’s decision that proposals for social care reform will not happen until after the next election is the latest instalment in almost two-decade saga of delays.
Since a Labour government first committed to social care reform in 2007, we have seen a succession of unfulfilled promises: the discarded Personal Care at Home Act 2010, David Cameron’s part-implemented Care Act 2014, Theresa May’s failed 2017 proposals, and Boris Johnson’s 2019 pledge on the steps of Downing Street to fix social care – delayed under Rishi Sunak, then scrapped by Rachel Reeves in 2024.
In the years since this saga of broken promises began, both of my parents were diagnosed with Alzheimer’s disease. One of them survives, and our family continues to wait for any meaningful help.
Families living through the reality of the social care crisis do not have the luxury of waiting for another election cycle. Mr Burnham needs to get a move on.
Dr Ruth Charles
Swavesey, Cambridgeshire
As a 69-year-old in receipt of 20 years’ teacher’s pension and a full state pension, I say by all means take money from pensioners. Scrap national insurance (a retrogressive tax) and increase income tax. Scrap all age-related tax benefits/exemptions. But please don’t hit the triple lock until the state pension reaches parity with most European states (Will pensioners be poorer as a result of Burnham scrapping the triple lock?, 29 September). It is mainly women who rely solely on this inadequate pension, and many of them live alone in rented accommodation. They are the last people who should be asked to make sacrifices.
Sarah James
Monmouth
As an 86-year-old, I’m sure I am not alone in having anxiety about paying for a care home if the need arises, and am delighted that Andy Burnham is determined to sort out the system at last. While the triple-lock pension increases are very welcome, I’d happily accept their change into simply keeping up with prices as a trade-off for never having to worry about paying for social care.
Michael Miller
Sheffield
