Andy Burnham Must Find the Courage to Act

Following a fortnight of activity which possessed a more rhetorical than policy-oriented substance, Andy Burnham has now selected an almost unimpeachable cause as the first major test of his Premiership; reform to England’s withering social care system. The system in its current form is, it must be said, fragmented, unfair and ruinously expensive for an increasingly large number of families across the country. Its pressures universally buckle the already struggling local authority, render hospitals unable to discharge patients who possess no other port of call, and is borne by an undervalued workforce who are themselves supplemented by a small army of unpaid workers. Burnham is right in his summation that its reform can no longer be delayed.

Promising ‘problem solving, not point scoring’ in a speech last week, Burnham has now invited prominent opposition leaders Kemi Badenoch and Ed Davey to join him for cross-party talks on social care reform. He has also duly accelerated the Casey Commission into adult social care, whose final recommendations are now expected in summer 2027, a year earlier than planned. The Commission will impart lessons the Prime Minister hopes to harness in his tackling of the crisis, while this undertaking will ask what support the state should guarantee, and how the responsibility to care for vulnerable adults should be divided between individuals, family and the Government.

The hope, Burnham claims, is that a national conversation conducted in good faith can yield a durable settlement, one which prevents social care from devolving into the latest weapon to be wielded during the next election campaign. There is a certain allure to pursuing consensus in this manner; it sounds statesmanlike, but it can also prove an ample smokescreen for delay.

Britain’s social care crisis has not persisted due to a lack of diagnoses, commissions or policy options; successive governments, Tory and Labour alike, have considered a tapestry of reforms from universal provision and capped costs to compulsory insurance models funded by heightened taxation levied against property and estates. Whitehall lacks not for ideas to remedy the crisis, but ones which do not so clearly separate segments of society into fiscal winners and losers.

It is through this latter quest that Burnham’s appeal to consensus will almost certainly disintegrate. The desired destination seems clear enough; a National Care service, which, when operated in tandem with the NHS, would provide a comprehensive shield for families from catastrophic costs, while providing pay and progression for care workers, and shifting provision from crisis management towards prevention along the way. 

The route, however, remains conspicuously undefined. Granted, Burnham has not pretended to hold all the answers, simply calling for a ‘big conversation’ on the matter. Still, if one who occupies the office of Prime Minister is to ruminate about the extensiveness of a promised service, its guarantees and, most importantly, who might pay for it – then they’d best, at the very least, have the outline of a plan.

The hazard for Burnham is that he walks well-trodden ground, littered with political tripwires that have already been sprung by politicians far cannier than he, and most pertinently, previously by Burnham himself. Little is popularly discussed of Burnham prior to his Manchester Mayoralship, but it was from 2009 to 2010, that, during his tenure as Health Secretary under Gordon Brown, he first advocated for a National Care Service. Burnham proposed financing the venture through a compulsory levy on estates; a plan the Conservatives christened as a ‘death tax’, produced ‘Rip Off’ campaign posters for, and tanked the cross-party talks intended to sustain it. The policy never survived the approaching general election, in which Labour flatlined.

Assuming Burnham learns from his past mistakes, every other available path possesses similarly ominous traps. While a general tax would spread the burden most widely, it would necessitate a combination of higher taxes and an array of spending cuts elsewhere. Similarly, a compulsory insurance model could feasibly fund the service, but would be seen by most workers as nothing more than yet another sizeable deduction from their already besieged monthly pay.

This circle is made even harder to square by Labour’s existing commitments; a series of promises not to raise the principal rates of income tax, employee National Insurance or VAT, while simultaneously pledging better pay for carers, stronger protection for families and closer integration with the NHS. Burnham has both inherited these promises while simultaneously affirming his commitment to abide by the manifesto Labour were elected on. Burnham’s dilemma, however, remains. How can he expand the bill while closing off the broadest means of paying it?

It is in this sense that social care reform should be understood as representing a severe test of Burnham's consensual politics. Cross-party agreement serves as a viable starting point, allowing social care reform to outlast one Parliament and therefore render it harder for opponents to weaponise its associated costs. Yet consensus alone cannot dissolve the conflict which lies at the heart of the issue; consensus can only distribute responsibility for choosing between competing interests. In the end, someone has to pay.

The choice is especially dangerous for an exposed Burnham. He entered Downing Street uncontested a fortnight ago, remains strapped to promises made under his predecessor and must swiftly demonstrate that his premiership offers more than a mere change of tone. Voters must find the ‘breathing space’ that Burnham has sworn to provide, quickly, should his tenure prove more lengthy than Starmer’s. But, while a bruising dispute over taxation could quickly consume Burnham’s fragile goodwill, retreating into a carousel of consultations and commissions would expose a deeper weakness; that Burnham’s gentler brand of politics represents nothing more than a sympathetic form of delay.

To achieve adequate social care reform, some voters will pay more and some interests will lose out. That is inevitable. Burnham’s political standing will almost certainly suffer for it, especially while reform traverses its infancy, with all the teething issues that such a stage unavoidably brings. But reform without losers is a fiction, and leadership without risk can sink a Prime Minister as soon as deliver them. To sufficiently reform social care, Andy Burnham must find what his predecessors could not; the courage to act.

Image: Flickr/No 10 Downing Street (Lauren Hurley)

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