In his first party conference speech as prime minister, Andy Burnham pledged to change the country – but warned of pain ahead as he puts his ideas into action. A panel of experts assesses his chances of success.

Risking it all for social care

Catherine Needham, Professor of Public Policy and Public Management, University of Birmingham

It was encouraging to see Andy Burnham give so much attention to social care in his speech. He even said he is personally willing to “pay a political price” to pursue a National Care Service. It looks like Labour may be suggesting something along the lines of the Scottish system, where people who are eligible for social care receive free personal care (with no means test). This was introduced in Scotland in 2002, first for people aged 65 and over and then extended to disabled people under 65 in 2019.

But from the Scottish experience, we can see that introducing free personal care into a system which remains underfunded and understaffed has had negative consequences. It has narrowed what is offered in home care to personal care, reducing support for broader needs such as cleaning, shopping and accessing the community.

It focuses on activity (so-called “time and task”) – like washing, dressing and meal preparation – rather than overall quality of life, falling well short of the aspiration of “a gloriously ordinary life”. It focuses support on people in crisis, rather than investing in prevention and early intervention to prevent, delay and reduce people’s need for social care.

Underfunded Scottish local authorities have to provide free personal care while also balancing their books. This can only be done by tightly rationing care, contributing further to the number of people whose needs are left unmet, and paying providers an unsustainably low rate.

England would do well to learn from Scotland about the risks of making care free at the point of use without taking an approach that addresses weaknesses across the whole system. Burnham must recognise the interconnectedness of key issues relating to funding, workforce and provider sustainability. His speech talked about bringing more money into social care by abandoning the pension triple lock by April 2030. Certainly, a clear funding plan will be essential to the viability of a National Care Service. But it is also important to acknowledge that a strong care ecosystem doesn’t start with the state. It starts with what enables people to flourish and lead good lives, and then considers how social care can make this possible.

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