Andy Burnham is well qualified to speak on the subject of what can go wrong with social care policy. As health secretary in 2010, he proposed reforms to be funded by a 10% inheritance levy. This was called a “death tax” by the opposition. It was never introduced.
Where Mr Burnham failed, none have subsequently succeeded. David Cameron accepted the recommendations of the 2011 Dilnot commission, which proposed a cap on the amount any individual would pay for care, but the cost to the exchequer thwarted implementation. Theresa May suggested plugging the money gap with a revised means test and no individual cap. This was branded a “dementia tax” by opponents and never saw the light of day.
Boris Johnson planned a “health and social care levy” alongside a means test. That fell foul of the Tories’ ideological allergy to tax rises. Labour’s 2024 election manifesto promised a “national care service”. Sir Keir Starmer then commissioned a review, led by Louise Casey, to explore reform options and report back in 2028, a timetable that made change before the next general election unlikely.
Mr Burnham has retrieved the Casey review from the long grass. It will now report next year. The prime minister has also called for a “national conversation” with a view to finding cross-party consensus on social care in England. He has invited the leaders of the Liberal Democrats and Conservatives (but notably not Reform UK or the Greens) for talks. Dame Louise will oversee a wider consultation exercise, taking views from the public. Lessons can also be learned from Scotland and Wales, with their devolved care models. This process is intended, in the prime minister’s words, to enable “more problem solving, less point-scoring” in the politics of social care.
The idea is laudable. In his speech on Wednesday, Mr Burnham was eloquent on the subject of what has to change in Westminster culture: the need to foster a climate where hard issues might be debated in good faith, without long-term national interests being sabotaged for short-term partisan advantage.
The prime minister was also refreshingly generous in his praise for care workers, recognising the technical and emotional challenges they meet for inadequate reward. He is right to say that they deserve higher wages and to make explicit the debt that all of Britain owes to a section of the labour force that is substantially staffed by immigrants.
Generosity of spirit is easier to dispense than money. Mr Burnham is new enough to Downing Street that he can afford to set out broad principles without being pinned down to specifics. That privilege will not last long. He admits that a commitment to grapple with an issue that is notoriously destructive of political capital is a gamble. Cross-party consensus will remain elusive if any revenue-raising mechanism is liable to be denounced as an unconscionable tax raid. The Conservatives and Reform UK, forgoing the opportunity to appear broad-minded, have already indicated that this is their position.
Mr Burnham has enough Labour MPs to enact change without opposition support. Reforms, and the contributions that pay for them within the fiscal rules, will form the basis for a future consensus if enough voters are persuaded they are necessary and fair. There is a long road to travel before that campaign begins, but the prime minister’s first steps are the right ones.
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