On Tuesday 29 July, Prime Minister Andy Burnham, Louise Casey and Health Secretary Yvette Cooper outlined the government’s approach to adult social care reform. Burnham said it was ‘shameful’ that decades of political point-scoring had come at the expense of meaningful reform and argued that he is prepared to spend political capital to deliver lasting change. The prime minister used the speech to make three key announcements.
First, Burnham confirmed that Louise Casey’s independent review of adult social care will be accelerated by a year, with final recommendations now expected by summer 2027. He said Casey had been asked to consider how the government could deliver a National Care Service, arguing that social care should become more preventative, person-centred and better integrated with the NHS.
Second, Burnham announced a renewed focus on the social care workforce. Building on the government’s plans to introduce a Fair Pay Agreement for care workers from 2028/29, he said ministers would explore wider reforms to improve pay, training and career progression. He also proposed creating clearer pathways between social care and NHS roles to help professionalise the workforce and improve recruitment and retention.
Third, Burnham announced the launch of cross-party talks on social care reform involving the Conservatives and Liberal Democrats. He argued that lasting reform would require political consensus and described the discussions as the first test of his commitment to a less adversarial style of politics. Burnham said common ground must be found if policymakers are to address challenges that have remained unresolved for decades.
Both Andy Burnham and Louise Casey signalled that future reform would involve greater scrutiny of private providers. Casey argued that there remains an important role for a mixed market in adult social care, but criticised providers perceived to be “profiteering” from care services. Burnham echoed these concerns, arguing that some parts of the sector have prioritised profit and cost-cutting over the quality of care and outcomes for vulnerable people. However, Burnham has historically adopted a pragmatic rather than an ideological approach to public service reform. As health secretary in the Brown-led government, he recognised the role that independent providers could play in increasing NHS capacity and reducing waiting times where they delivered value for patients and taxpayers.
As a result, he is unlikely to pursue reforms that materially reduce the private sector’s role in adult social care. Given the significant share of care capacity and expertise provided by independent providers, the prime minister is likely to be mindful of avoiding reforms that could destabilise the market by causing market exits and place further pressure on already stretched services. Instead, providers should expect a greater focus on accountability and transparency, clearer standards to improve the quality and consistency of care, and enhanced scrutiny of how public funding and provider profits are used. The NHS Modernisation Bill currently going through the Commons is one key place to watch if any substantive change is to come forward.
On funding, Burnham argued that significant improvements could be achieved through more effective use of existing resources before tax rises are considered. He highlighted the costs associated with avoidable hospital admissions and delayed discharges caused by inadequate social care provision, suggesting that greater investment in prevention could deliver substantial savings across the wider health system. However, significant questions remain about the long-term funding model for a National Care Service. Reports suggest officials are exploring options ranging from social insurance-style contributions to inheritance-based levies, although ministers have stressed that no decisions will be taken until Casey’s review is complete and the new prime minister remains constrained to some extent by Labour’s 2024 manifesto commitments on tax.
Phil Hope, GK’s Strategic Adviser and former care services minister under Andy Burnham at the Department for Health, who was directly referenced in the prime minister’s speech said: ‘The prime minister was clear that he wants to build a broad consensus around social care reform and move the debate beyond the political point-scoring that has hindered progress in the past. Bringing forward the Louise Casey review to 2027 creates an opportunity for that conversation to take place away from the pressures of a forthcoming general election. While concerns about profiteering were raised, there was little detail on the scale of the issue or how ministers might address it, making this an area the Casey review is likely to explore further.’
Steve Brine, GK’s Strategic Advisor and former health minister as well as chair of the cross-party Health and Social Care Select Committee said: ‘It was a hugely impressive performance from Andy Burnham with what was more a political than a policy announcement but his authenticity on the subject is welcome and important. It was really about creating the political conditions for reform rather than announcing the detail, but that day will come – along with who pays – and that is the next big moment. Casey’s challenge is to define what ministers actually mean by ‘National Care Service’ – is it about standards, funding, eligibility – and for the PM it’s how will someone’s experience be different in two, three or five years’ time? That’s ultimately how people will judge success.’
