Burnham can’t take the politics out of social care reform

Burnham is right that the social care system has crumbled “while politicians pass it back and forth”. ¹³ https://www.gov.uk/government/news/pm-sets-out-new-path-to-fix-social-care-together-29-july-2026  The record of failure is staggering. Over the last three decades, every prime minister has promised to deliver reform, and all have largely failed.  

The burden of that failure has fallen on millions of people across England, most obviously on the people who rely on care to live “gloriously ordinary lives”. ¹⁴ https://publications.parliament.uk/pa/ld5803/ldselect/ldadultsoc/99/9902.htm  But also on the people – most often friends and family – who stepped in to provide care as the state receded. It has also fallen on the workforce, who carry out difficult, often skilled work for very little money and with little prospect of career progression.

Burnham said that he “would never forgive” himself if he did not do his “best to find a solution”. ¹⁵ https://www.theguardian.com/politics/live/2026/jul/29/andy-burnham-social-care-louise-casey-tories-kemi-badenoch-reform-nigel-farage-uk-politics-late…  Some might dismiss this as more political hot air. But personal and sustained commitment from a prime minister is a necessary first step towards reform on thorny issues. For that reason alone, the prime minister’s speech is a positive start.  

But if Burnham is truly to achieve reform in this vital sector he needs to confront the problems head on, pick his priorities and – as he has acknowledged - commit his own political capital to tackle the hardest of political choices.

The Casey review will not deliver a magic answer  

The problems in the sector are extensive. Decades of underfunding have meant that local authorities (responsible for organising publicly-funded care) have gradually rationed care. As a result, 40% fewer adults aged over 65 receive care compared to 2003/04, despite that population growing by 40% in that time. A person’s likelihood of receiving care depends heavily on where they live. When councils provide less care, friends and family step in to support loved ones, often leaving their jobs to do so. ¹⁶ https://www.instituteforgovernment.org.uk/publication/performance-tracker-local/adult-social-care  The professional workforce is poorly paid, resulting in high levels of turnover. Providers enter and leave the market with surprising frequency.

Problems in this creaking system spill over into other parts of the state. NHS hospitals struggle to discharge patients into care, leaving them in expensive hospital beds where their condition deteriorates. The legal duty to provide care puts immense pressure on councils’ finances, forcing cuts to services like libraries, road maintenance, and waste collection.  

The system works for very few people.

To deal with this, Burnham has laid out three priorities:

1. Launch a national care service, that’s integrated with the NHS
2. Improve pay, training, and progression for the workforce
3. Initiate cross-party talks to reach consensus on reform

In many ways, this approach is an extension of that which Starmer took when he was in office. Keir Starmer wanted a national care service. Starmer was the one who launched the Fair Pay Agreement process that Burnham intends to build on.

It was also Starmer who, in 2025, tasked Louise Casey with providing the details for his high-level ambition.  

Burnham looks set to rely on Casey for those same answers. He announced that Casey will bring her final report forward from the end of 2028 to mid-2027. That is a wise decision. Starmer’s timeline was always absurdly long, implicitly kicking reform into the next parliament, if at all.

But Burnham shouldn’t delude himself that Casey will deliver a set of answers that will remove his difficult political choices. If that is what he expects in a year’s time, he is setting himself up for disappointment.

Casey can assess the – already repeatedly-assessed – options. She can socialise the problems in the sector, outline how difficult the choices are, and help to build public support for reform. But she cannot magic away the difficult political choices Burnham has to make.

If Burnham wants to make progress this parliament, he will have to prioritise

After his speech, Burnham was asked about his priorities for reform – for example, preventing catastrophic costs, eligibility for care, and quality of care – and demurred, saying that he “would look at them all in the round”.  

It’s right to consider the care sector in its entirety, rather than patching up a flagging system. But if Burnham waits to reform the entire structure in one go, it may mean little progress before the next election. By the time that Casey reports, we will be 60% of the way through this parliament. At the same time, the NHS and local government are going through their own reforms, and the NHS is in a flat sprint to improve waiting times. In short, there is little time or capacity for wholesale reform in this parliament.

In that context, Burnham should be realistic about what he can achieve. What does he want to point to at the next election showing that he is on track to achieving his reforms?  

Cross-party consensus is a worthy goal, but the hard choices will ultimately fall to Burnham

Aiming for cross-party consensus at the start is a desirable approach. The policy area has become too politicised, with every party (including Labour) using previous reform attempts to land political blows. Burnham is right that this has stymied progress.

But Burnham is likely to end up faced with a choice between cross-party consensus or taking action. Ultimately, there are going to be some brutal political choices to come.  

Two areas that Burnham said he wants to address are high levels of unmet need and low pay. There are different ways to correct those problems, but all of them require more money. The question then becomes who stumps up that money? And how does it flow into the sector?  

These are questions of allocating resources between people with different interests. That is the nature of politics, and no amount of superficial political consensus will make that disappear.  If Burnham holds out for it, he will become just the most recent PM to fail to deliver social care reform.

Whatever Burnham intends to do, he will also need to take his party with him. He has said he is willing to spend his own political capital on this issue. Right now, as a new PM with new energy and riding higher in the polls than his predecessor, that is easy to say. He will need to stick to his guns when the press and the opposition are baying about tax rises or pensioners selling their homes. That will be the real test of his commitment.