An OVID Health article by Jenny Ousbey
…my answer wouldn’t start with funding. It would start with a story.
Because the biggest political challenge in social care isn’t designing a new system. It’s helping the public understand the one we already have.
Today, millions of people assume there is a social care system. In reality, as Baroness Casey recently put it: “what we have is a patchwork of councils, NHS organisations, benefits, charities, private providers and approximately five million unpaid carers somehow holding everything together.”
Andy Burnham appears determined to do something few politicians have managed for decades: spend genuine political capital on social care reform. As he recently declared: “If there’s one area I’m going to expend quite a lot of political capital, it’s going to be on social care.”
The question is whether this is finally the moment reform happens, or simply the latest chapter in a story of good intentions meeting political realities head-on. With only one victor so far.
Navigating the Bermuda Triangle
Social care has become Westminster’s equivalent of the Bermuda Triangle. Governments enter with ambition and emerge years later with reports, reviews and unfinished legislation – scarred, like Theresa May, from the wounds inflicted by both the media, the public and opposition parties during the 2017 General Election.
Burnham knows this better than most. His vision for a National Care Service as Health Secretary never made it past the 2010 election. Andrew Dilnot’s proposals for capped care costs won widespread expert backing but stalled. Boris Johnson’s reforms collapsed before implementation. Successive governments have recognised the problem, yet none have hoisted themselves over the finish line.
Andrew Dilnot put it perfectly when he told me: “We know what to do – we just need the courage and persistence to do it.”
The lesson from the past 15 years isn’t that solutions don’t exist. It’s that political commitment rarely survives long enough for them to emerge from the depths of the Westminster ocean.
Why this moment feels (tentatively) different
For the first time in years, three factors are at play – even though I feel like we’re at that moment where any wrong move could be utterly terminal.
First, we have a Prime Minister whose commitment is personal, not merely political.
Burnham has spoken openly about his father’s experience with Alzheimer’s (to the extent he is tragically unaware his son is Prime Minister) and the frustrations families face navigating care services. Major reforms often happen when leaders feel an issue rather than simply understand it.
However, David Brindle, former Public Services Editor at the Guardian and leading social care policy journalist, feels Burnham has already gone too far in stoking expectations. He told me: “This is still a long game. We’re looking to the next parliament for meaningful change. He needs to walk back the more excitable speculation but meanwhile offer two or three early (and relatively cheap) changes that signal broader intent.”
Second, Baroness Casey’s review is providing an opportunity to build public consent before introducing policy.
And third, demographics are removing the option to delay. Today, around 13 million people in the UK are aged over 65. By 2075, that figure is expected to reach around 21.5 million, with the fastest growth among those aged over 85.
But perhaps the most overlooked reality is that social care is no longer primarily an ageing issue.
Local authorities now spend almost as much supporting working-age adults with disabilities, long-term conditions and complex needs as they do supporting older people. The traditional image of social care being solely about care homes and ageing parents no longer reflects reality.
The communications mistake government keeps making…aka don’t take my house!
This is where I think Burnham and Yvette Cooper need to be careful.
Every social care debate eventually arrives at funding.
- Inheritance tax.
- Property wealth.
- Care levies.
- Asset protection.
- “Dementia tax.”
The politics becomes toxic almost instantly. The public hears one message: “The Government wants my house.”
The reform effort then dies shortly afterwards. Snuffed out in a puff of Westminster smoke. The 2010 plan died the moment it got labelled a death tax. Theresa May’s 2017 manifesto gamble on care costs became the “dementia tax” within days. Boris Johnson’s care levy fared little better. The pattern is so consistent it should be treated as a design constraint, not bad luck.
Richard Humphries of The King’s Fund recently argued that any new government would be wise to focus first on the public offer before the funding mechanism.
I think he’s right. Because social care has a branding problem.
The sector talks about crisis. The public hears decline.
The sector talks about pressure. The public hears cost.
The sector talks about delayed discharge. The public hears an NHS problem.
Yet social care’s real value lies somewhere entirely different. That’s the story government needs to tell. Not that social care rescues people. That it enables them. Not that it costs money. That it creates value. Not that it sits behind the NHS. That it sits alongside it.
The forgotten workforce and the smart question
Another political reality is that reform without workforce reform isn’t reform. More than half of unpaid carers report increasing caring responsibilities. And, according to Carers UK, women in midlife are 50% more likely than men to have caring responsibilities.
Over a third of carers who leave employment say better social care support would have prevented them reaching that point. The economic consequences extend far beyond the care sector itself. A more effective care system isn’t simply a health policy intervention. It’s a labour market and productivity intervention.
And increasingly, it’s an economic growth intervention. Senior Counsel at OVID Health, Niall Dickson CBE makes exactly this point, calling for a clearer assessment of the wider economic value created by investing in social care. For too long, policymakers have viewed social care as expenditure.
The smarter question Cooper and Burnham should be asking their SpAds and civil service teams, is what happens when it works.
What success actually looks like
I asked Sir Andrew Dilnot, the man whose name has become synonymous with the social care funding debate, why reform has repeatedly failed to stick.His answer was blunt: “We failed in 2015 because with the end of the coalition the government was no longer committed. We failed in 2022 because Johnson left office a couple of months before implementation was beyond the point of no return. We failed in 2024 because despite Wes Streeting’s on-the-record commitment in the election campaign, the new government reneged. We know what to do — we just need the courage and persistence to do it.”
Three different governments, three different excuses, one identical failure point: political will evaporating before delivery.
Paul Burstow, the former Care Minister (I was his former political adviser) who’s seen this from inside government too, is more optimistic than I expected but no less clear-eyed about the risk. He puts the odds of meaningful reform at around 70%, “but of a fully funded, durable settlement at nearer 25%.” His worry isn’t that Burnham lacks conviction. It’s that “political momentum produces a headline National Care Service without resolving entitlement, funding, workforce and delivery.”
Where it all falls apart is when Cooper and Burnham have to answer, without stumbling, these questions:
- Who gets what?
- Who pays?
- Who delivers?
- How do we recruit and retain the workforce?
Those questions don’t fit neatly into a political slogan, but without answering them, reform remains an aspiration and a soundbite on This Morning or The One Show, rather than a legacy Burnham can own.
Dickson, who commissioned Derek Wanless’s landmark 2007 review as CEO of the King’s Fund, offers something close to an actual blueprint: unify local NHS and social care budgets so the financial incentive to keep people stuck in hospital beds disappears; legislate a clean split between care costs and accommodation costs, so personal care can be free at the point of delivery, genuinely aligned with the NHS principle Burnham keeps invoking, while accommodation costs are met from housing wealth for those who have it.
Fewer than 5% of people who enter permanent care ever return home, so the “selling the family home” framing that’s poisoned this debate for fifteen years is largely a fight about inheritance, not about elderly people losing their houses out from under them, Dickson told me.
The opportunity for providers: get ready to be loud
For care providers, this isn’t simply a policy debate unfolding in Westminster. It’s the biggest strategic repositioning opportunity the sector has seen in decades.
The organisations that will shape the future conversation will not be those talking loudest about the crisis. They will be those demonstrating outcomes: where they have innovated, how they have improved lives in their communities, where they have enabled AI driven care, and how they have fundamentally prevented pressure from falling on the NHS and families across the country.
The sector has an extraordinary story to tell. The challenge is that too often it has been so risk averse, and understandably so concerned about the latest CQC inspection or changes to migrant employment regulations, that it has not always told that story well or loudly enough.
Valerie Michie, CEO of Choice Care, shared with me that Burnham should “resist the temptation to fall back on the tired language of crisis or to draw simplistic parallels with the NHS. Too often, the debate focuses only on older people, when around half of publicly funded adult social care supports adults of working age. Social care is different: more local, more diverse and more flexible. Reform will only succeed if government starts by recognising those strengths and builds on them.”
Government needs to stop talking about care as crisis management and start talking about it as what it actually is: skilled, purposeful work that enables people to live full, independent lives. Lead with older people and you’ve already lost half your audience before you’ve said a word about money.
As Suzanne Lawrence, experienced Chair/CEO in the care sector, told me: “Many public sector providers don’t want to accept the risk associated with high acuity needs and the public disapprobation which accompanies an error or mis-step, so (Burnham) should tread carefully before demonising private providers.”
And that brings us back to where we started. If Andy Burnham and Yvette Cooper asked me for one piece of advice, it would be this:
Don’t start with structures. Don’t start with funding. Don’t even start with reform.
Start by helping Britain understand what great social care looks like.
Because the public won’t support a new settlement until they can see the value of the one being proposed. And after 15 years of commissions, reviews and false starts, that may be the most important reform of all.
What do you think? Is social care finally approaching its “NHS moment”, or are we heading for another cycle of ambition without implementation?
Article originally published on LinkedIn on 24th July
