Andy Burnham chose not to make social care the centrepiece of his first speech as prime minister. Instead, rough sleeping was named as his top priority upon entering 10 Downing Street. Given that earlier attempts at overhauling social care have flopped, he was wise not to over-promise on day one. Louise Casey, who is leading the independent commission on the issue, says that “an honest conversation with the nation” is needed. If Mr Burnham agrees, he will have to wait before making any big announcements. The public outreach phase of her work has not even begun.
Social care has personal significance for Mr Burnham. In recent days he revealed that his father’s Alzheimer’s means that he does not understand that his son is the prime minister. But he was right to name social care as an area on which “to expend quite a lot of political capital”. If public trust in politics is to be lifted from its current low base, and faith in the welfare state restored, politicians need to show that they are capable of gripping these seemingly intractable problems. For relatives of people with unmet needs, and others who see the system’s flaws closeup, feelings of helplessness and injustice can undermine confidence in society and the state overall.
Mr Burnham’s previous effort at solving the social care crisis ended when the Conservatives won the 2010 election. Plans for a “National Care Service”, drawn up when he was health secretary, were scrapped. Since then, the issue has grown more complicated and challenging. While the increased demands on councils and families from an ageing population were predicted, the rise in working-age people receiving social care due to illness or disability is only partially understood. In the year to 2024, councils in England spent £10.4bn on working-age adults, and £11bn on older people.
Funding is where previous plans have come unstuck. The most popular option in the pre‑2010 consultation was for people to receive free care in return for a compulsory contribution, but hopes of cross-party cooperation collapsed when the Tories labelled it a “death tax”. Mr Burnham’s most recent remarks suggest that this is still his preferred solution. On Monday, he told journalists that social care should be delivered “on an NHS basis” – implying a public service free at the point of delivery and funded by some form of taxation (though not income tax, as this was judged in 2010 to be unfair on working-age people).
Other options could include a new form of social insurance or a combination of private and state payments. In his 2011 report, Andrew Dilnot recommended a cap on lifetime care costs to protect people from the enormous expense of – for example – an elderly parent who lives for a decade with Alzheimer’s. This proposal was also dropped.
One thing that has not changed is the need to stagger reform. Overhauling such complex arrangements will take time. Most social care is supplied by private companies. At some point Mr Burnham will have to decide whether this should continue, and whether the current friction between health and care systems can be smoothed as part of his devolution drive. Lady Casey has a strong track record as a troubleshooter. But Mr Burnham is right to foresee that he will need to expend political capital. The past 15 years have shown how difficult reform will be, but also how worthwhile.
