Is Andy Burnham betting his premiership on fixing social care?

0:02This is a global production. Andy Burnham unveils his latest plans to reform social care, where so many other prime ministers have gone before and failed to achieve anything. Social care is as unjust and as inequitable and unfair as the American health care system. Ultimately, social care, if you're going to really deal with it, it's going to be really expensive. Will it this time be different?

0:31Ed Conway:I think social care in England is as unfair as American health care. The vulnerable pay with everything and it can completely leave them with nothing. That is quite the comparison to say that social care in this country is no better than American health care, where so many fall by the wayside if they haven't got the money to pay. Many a prime minister have found their political authority rapidly spent when they've tried to fix the problem of social care. Will Andy Burnham just be another? Welcome to the News Agents.

1:14The News Agents. It's John. It's Lewis. and this is a speech that I think everyone knew was going to come quite early in the Burnham premiership because it is something that Andy Burnham has cared about for a long time i.e. the problem of social care when he was health secretary at the tail end of the last Labour government he tried to effect some reform by his own admission in the speech today it was a bit too late in the day for that government he was trying to get cross-party cooperation it didn't happen he has signalled today among other things that he is potentially at some point willing to raise taxes to pay for a better elderly care system and as john said and he we played that clip at the start making that very arresting comparison which i think is absolutely spot on by the way that social care is as unjust and as inequitable and unfair as the american health care system except of course there is an even kind of more stark and glaring sort of juxtaposition in the uk because we have the opposite of the american health care system in the nhs so what we have is basically a system where if you have a healthcare problem of almost any description or kind, the NHS, however imperfect it can be and however sometimes you have to wait for care and it's rationed or whatever, but ultimately you will be able to get some care free at the point of use.

2:33Unless, of course, you end up with something like dementia or some other problem connected to your old age and it means you have to move into a care home where suddenly, unless you have assets of less than 23 000 pounds or so you yourself are expected to pick up the entire tab which has led has led to the financial ruin of many families yeah and i think that it's just worth dwelling on the attempts to change the health care system in america because if that's the comparison you're making then the obvious kind of person you would compare burnham to now is Barack Obama when he was trying to reform health care and introduced Obamacare, the Affordable Care Act, which, I mean, took a real political toll on Obama, where, you know, he was saying that, look, we've got millions of people in America who don't have any health insurance at all.

3:31And unless they turn up in a hospital in an emergency room with an emergency, they're not going to be treated, essentially. and you have in America now people who if they've got lousy insurance still struggle to get the basics of you know if you need insulin because you're a diabetic and you haven't got the right insurance policy and the number of times I stood behind people in a queue at pharmacies where they would say right well your insurance cover is gives you so much but you've still got to pay$140 for this pit of medicine and they say I haven't got$140 and the pharmacist says well I'm very sorry, then you can't have it.

4:07Now, Obama nearly kind of was taken apart by Obamacare. However, Donald Trump has promised to reform it and change it. And actually, it is an enduring symbol of Obama's success that the Affordable Care Act is still there. And the Republicans have not been able to find anything that would politically be as acceptable to so many Americans. So it's high risks but it's high rewards as well yeah absolutely i mean i thought that um comparison that he made with with american health care was deeply interesting not least because exactly john it brought to mind exactly that sort of 2009 10 period with with obama where there was huge public support for reforming health care given that so many tens of millions of americans were completely ineligible basically for health care in some cases literally ineligible to even get insurance if they had pre-existing conditions perfectly legal for insurance companies to refuse to insure someone because they had a pre-existing health condition etc etc etc but it was used in those early days tremendously successfully by the republicans but also the tea party movement which was incubating that time i was doing an internship in washington that time i remember it so vividly those first tea party protests and you know manning the phones in this congresswoman's office i was working in with literally i remember one woman actually like phoning up who had terrible osteoporosis and she phoned up and I spoke to her for about 60 minutes and she explained how terrible her health condition was and how her brother had had it and her father had had it and she couldn't get medical insurance but she said I'll be damned I will be damned if I ever have a government death panel and I was like what are you talking about like in in my country you'd be able to get free health care and she said yeah but what about my freedom and she said what about my freedom I said well madam what's what good is freedom if you're dead and she said that's a good point but anyway Right.

5:52But but like, you know, that it was it was it was a key part, a key part of of the kind of the early opposition to Obama. They lost the midterms and so on. And it shows it shows just how there are comparisons and we've got British parallels as well. When you are touching and trying to reform such a fundamental part of kind of, you know, social services, health care, social care, even if there's tremendous support for the reform it can be politicized and weaponized to the nth degree very very quickly Andy Burnham saw for that himself he's got the scars on his back he talks about it in the speech he's got scars on his back from when he was health secretary in 2008 9 10 and he tried to do something about this and he actually got some agreement with the then shadow Tory health secretary Andrew Lansley about a potential reform that was quickly pulled when David Cameron George Osborne kind of got wind of it and they ran in the 2010 election on the idea basically of a death tax and the brown government trying to induce a death tax to try and pay for social care.

6:52Theresa May as well in 2017 when she went into the election again trying to introduce a set of reforms on this, this time assailed from the left of the idea of a dementia tax. So this is really tough stuff and we already saw early on the early glimmers of this just today because Burnham has invited, because they wrote to him to ask for meetings, the Tory party and the Lib Dems to come into Downing Street to start a cross-party consensus because that's what Burnham says he wants. He wants to affect some consensus. But Nigel Avarage and Reform, who are not invited, already taking to social media to damn the proposals before they've even started to be developed.

7:28So the Prime Minister invites the leaders of the Conservative and Liberal Democrats to sit down and talk about social care, but does not invite Reform UK. This is the political establishment.

7:39Ed Conway:This is the uniparty in action. Perhaps this is because of our total outright opposition to anything with regard to death taxes being on the table. We are completely opposed to that in every regard. My guess is that's the main reason we've been excluded. I mean, I guess what's the point of inviting Mr Farage in if you're dead opposed to kind of anything that might lead to a solution of the problem? And so, you know, look, Nigel Farage has staked out his position very clearly. And the Tories as well have said there There can be no tax increases, but this has got to be funded. And therefore, that raises the question, which is, OK, well, how are you going to do it?

8:22I mean, I guess one difference between the US and UK is that in the US, you had very powerful lobbies of the insurance companies and the rest of it in the medical profession, not wanting to be pushed around and being told by Obama what they had to do, what they had to offer. And they had to be given massive inducements. This is about not so much what the private sector does. It's about how, you know, when you go into a care home, where does the money come from to pay for the care of your elderly relative who has got dementia? What do you do? You know, do you have to sell everything you've ever owned to pay for that health care?

8:59And so that is a question of state funding, I guess, you know, in Andy Burnham's case, talking about England. And there was a broad hint that it might need to see tax increases.

9:10Ed Conway:Firstly, you have to do more with what you've got. But I think Louise indicated some of what we would want to do in the fullest sense will require difficult, difficult decisions. But we will be honest with people about those. We will put them before the country at the right time and we will hopefully proceed with people's consent. I think that one thing, and we should maybe talk about the different options about what reform would look like. But I think one thing that everyone could and should agree about what Burnham said is that this, the lack of reform, the failure to grapple with this over 30 years that the government was saying today, number 10 was saying today that this is the 23rd review and 23rd attempt to look at this over the past 30 years.

9:56The failure for Parliament, of Parliament, over successive governments and successive decades to actually do anything about this is a shocking state failure. It is a shocking example of state failure and political cowardice. And Burnham essentially spoke in those terms and he was completely right about this. I mean, a few of the figures that we've got right now, we've got a creaking, almost Victorian style system of social care at precisely the time that demand has risen rapidly. Even in the past year, it's gone up 4%, 8 % higher than during the pandemic. We've obviously got far more older people now, got 12 million people over the age of 65.

10:34We've got hundreds of thousands of people waiting. In spring 2024, there were more than 400 ,000 people just waiting for social care assessments. right care packages reviews or direct payments and the workforce was still about 96 000 social care vacancies on any given day which is perhaps not surprising when we consider how little we pay many of the people who work in the industry and work in the sector who are doing backbreaking work working all hours god sends anti-social hours and deeply emotionally and physically taxing i remember doing tons of stories on social care during the pandemic and i remember speaking to endless numbers of politicians who consistently said that as soon as this is over, we've got to do something about social care.

11:15We've got to recognise what they've done. They've absolutely rescued us here and they've worked on intolerable conditions, often putting their own lives at risk, banging the drum, banging the saucepans, all of that nonsense, all that performative nonsense. And when we get to it, I have to say this, I thought it was an absolute low point of the Starmer government, a real low point. When Starmer, who just like Boris Johnson before him and prime ministers before that came along and said, we've got to do something about social care. It's an early priority for me. Starmer achieves a majority of over 160.

11:43He's got the political capital to do it. There's a commitment in the manifesto to do something about it. And what does he say? Well, he gets in and he says, right, we're going to ask Louise Casey to have a look at this. And she's not going to report until the late 2020. What? Like what? As the government said today, this is the 23rd review. No disrespect to Louise Casey at all. She's doing a great job. And one of the things, I mean, today, all Burnham really announced was that he is asking Louise Casey to bring forward her report to the middle of next year rather than reporting towards the end of the parliament, which is just absurd.

12:12They're trying, yes, it is true, to start a national conversation, but the political, you know, pusillanimity, frankly, of the Starmer government to basically put it into the long grass until the end of the late 2020s was just another example of state failure. So you've got to hand it to Burnham. I think he really does care about this. And he says that he is willing to spend whatever political capital he has. And this is where I think the Obama comparison is really interesting because Obama spoke in very similar terms as well. You know, when he was in office in the early, you know, he had lots to deal with, financial crash, all sorts of stuff.

12:41He was being told by his advisors, Rahm Emanuel, his chief of staff at the time, saying, Mr. President, you know, don't do this, steer clear of this. This is the third rail of American politics. And they turn around to him and they go, you know, you'd have to be feeling really lucky, Mr. President, to be going with this. And he just says, well, how lucky do you think I feel? I'm the first black president of the United States sat in the Oval Office, so I'm feeling pretty lucky. And he says, which is exactly the sort of language Burnham was using, I wouldn't forgive myself if I didn't at least try while I'm in office.

13:08And I thought that was a very interesting kind of window into Burnham's thinking on this, that he is willing potentially to expend a lot of political capital to at least do something, whatever that something is. But, you know, Lewis, you talked about a moment ago about the number of stories you did on this during the pandemic and the total sort of antediluvian state of our social care in this country. But it's not an abstract thing. I mean, who doesn't know? Who hasn't got relatives in that stage of their life where they are in need of social care and you're worried about how it's going to be paid for?

13:42Or you have friends who are grappling with that of an elderly parent or grandparent who's got dementia and they can't be, you know, there's nowhere for them to go. And they can't stay at home because of the vulnerability of that and trying to figure out how these things are going to shake down. I mean it affects millions and millions of people in this country including Burnham's own father including Andy Burnham's own father who doesn't know that he's become the prime minister this is real and I think that I really like the idea that you know when you know when Keir Starmer was prime minister and Kerry Baden-Ock says yeah let's I'll help you with you know some of these issues and gave a wide berth Andy Burnham said yeah come in come in let's talk about this let's see what we can do.

14:32I suppose the question comes and, you know, in that clip that we just played where he talked, well, in the longer term, we might have to do something, you know, about how we're going to pay for this. Yes. You know, you've got Andy Burnham at the moment saying a number of things which sort of cohere and sort of don't cohere. You've got Andy Burnham saying there is not going to be a snap election. And you've also got Andy Burnham saying there is not going to be any kind of breach of the 24 manifesto. But you have got him saying we might have to raise taxes. Well, hang on. How do you... I think where we are now is Andy Burnham is saying there is not going to be a snap election until such times as there might be.

15:11Well, I did think that... And he was, you know, he addressed that question of the election again. I did think that the timing of this, asking Louise Casey to bring the review forward to the middle of 2027, I can imagine that if Burnham has got in his head an idea of an election around that time, then that timing could be quite useful as some of the framing for that election. Because it's very clear what Downing Street are trying to do. And I think they're doing some success at the moment. They're trying to create the idea and impression that Burnham is a prime minister who is not ducking the difficult challenges.

15:42He's heading straight for them. He's not showing political cowardice. He knows what he wants to do and he's going for it. And you could imagine, look, these cross-party talks are all very nice idea. And Burnham's come by our routine is a very nice idea. and the problem solving, not point scoring, is a very nice idea. And it plays really well with the public. But as we saw from Farage there, and I think we'll see from the Conservatives as well, ultimately, social care, if you're going to really deal with it, it's going to be really expensive. Someone's got to pay for it. And by definition, that is going to be a highly contested political question with different answers, depending on your politics.

16:20And so I think the idea of everybody coming together on some common solution is unlikely. And I think Burnham knows that. And so you can imagine a world where the Casey Review is rejected by, say, the Conservatives and others. And he goes into an election which is in his head around that time, basically saying, we're going to implement this. We're not going to duck this. And this is our solution to do it. And it won't be the main thing probably that he runs on, but it's a kind of component of that strategy. And I thought it was an interesting, I mean, you know, who knows? And he probably hasn't made up his mind yet, but it's an interesting bit of extra framing that he might be able to use and deploy.

16:53if that is in his head. Yeah. And you know, you say it's unlikely and I'm sure you're right. I mean, you know, these huge political questions, you don't want to give your support if it means that the other party is going to be the main beneficiary of it. And Labour would be the main beneficiary of being able to claim a cross party deal on the future of social care. So I agree it's unlikely. But as you said, you know, Andy Burnham, when he was health secretary, came close to getting agreement with Andrew Lansley. So it's not impossible that you could get some, forge some cross-party consensus on the way forward on this.

17:29Very interesting. Have a listen to this. This is, I mean, it just kind of encapsulates the debate we're having about how this is real and how it affects so many people. This is Andy Burnham at a care home. Nice to meet you. I'm Andrew. Andy. I'm Andy. Andrew. Yes, that's it. You are the local candidate, are you?

17:51Ed Conway:Oh, no, I was a local candidate. I had a by-election a few weeks ago, but no, I'm now the Prime Minister. You're what? He's the Prime Minister. Well, a new one. Another one. I keep changing every time. I know, I know, I know. That was him, obviously, today in the care home where he did the speech, speaking to one of the residents there who thought he must be some local candidate, the fact that a politician has turned up there. I have to say, I've been talking actually about the comparisons in that particular moment, not generally, between Obama and Burnham. One of the actually American comparisons I've thought about more and more over the course of the last week is actually between Burnham and Biden.

18:32You know, Biden at his best was this sort of emoter in chief. You know, he was good at feeling people's pain and articulating it and feeling it and appearing to feel it. Burnham has a touch of that. Burnham really has a touch of that. You could see in the speech the way he was talking about it as well. In a way, on his best day, you know, with the best people in the world, someone like Starmer, because he's just a very different politician, would never quite be able to conjure. That sort of dripping in empathy is something Biden was very good at. Yeah. At his best, when he was a bit younger, and why he was so potent, actually, at his best.

19:00We think of him as he was towards the end of his presidency, but actually why he was so potent. And there's a touch of that, and you can see that connection with Burnham there as well. Absolutely. Absolutely. And in a moment, we'll be back talking about the economics of all of this.

19:30Well, we're joined in the studio now by Ed Conway, Sky News Economics and Data Editor and host of the Stuff Matters podcast. and author and general good guy. Not a rival, I should say. General good guy. Yeah. All right, how did you hear that? Well, we don't normally give kind of moral assessments on the guests, but it's nice to start. I think it's just saying he's a... No, I honestly, I think we should do that more. Do you think so? I think so, yeah, yeah. Bad, bad guy. What if we had to give moral assessments of each other? I think we'd be here for a long time. It's not a confessional box. Just because we've got a Catholic prime minister, let's not go too far.

20:08ed look we've been talking about social care in the first half and about some of the politics of it yeah can we consider now the economics of this of what it will cost how it would be funded what are the are there any easy solutions to this no no it's it is the hardest thing i i but i think

20:27Ed Conway:it's hardest as it's not it's not just the economics is it's the fact that it's like with inheritance tax no one no one particularly likes paying tax but having tax that happens at like the worst time of your life is always the worst thing and I think that's that's the issue that's what makes inheritance tax even though you kind of look at the data and say okay there's only this fraction of people who are paying it it's the notion that in your very worst few weeks you're having to pay extra money on top of all of the grief and I think it's kind of the same with social care we just we just don't want to think about those periods you know in particular kind of elderly social care but also kind of you know adult social care we we don't want to have to think about it and so having to think about it is this extra mental load and I realize this is not the kind of fiscal conversation and we can talk about that but it's this extra kind of mental load and i i think that's what makes it so kind of toxic and so yeah there are lots of fiscal kind of problems and challenges that it engenders we've got kind of an aging population um we we have a kind of a straightened public sector uh we've never really kind of thought about how to crack this uh we have a hodgepodge of a system and all of that stuff is true but i think ultimately it has just been so such a difficult one to have an adult conversation about and i think that you know like like you know as you've been talking about the interesting question i guess is whether because burnham has has made this something he actually genuinely wants to talk about rather than doing it by duty does it does it mean that that's different this time around that you have some actual leadership but it's the numbers are are tough you know albeit that it's you know it's like two and a half percent of gdp so it's not smaller than that the health system but it's like it's that and it's going up and up um and no one particularly wants to have to confront it 18 billion is the figure that's been doing the rounds if you're actually if you were serious about going to and obviously there's a sort of spectrum of options that you could do all the way from just putting more money to the existing system giving more money to local authorities to try and improve the kind of existing kind of quality provision right the way through to I think what Burnham originally wanted back in the late 2000s, which is basically to have a national care service and NCS integrated to the NHS, about 18 billion, which is what?

22:36Yeah. From pence on income tax, at least.

22:37Ed Conway:But that's the key point, Lewis, that, you know, it's hard to kind of separate that conversation from the NHS conversation, isn't it? Because ultimately, like, you know, we've got the NHS, which is kind of, you know, taxpayer-funded health system. It's a very different system in, you know, in Germany and most parts of Europe. And in most parts of Europe, not all, but most parts of Europe, this social care is kind of funded out of out of insurance and so you know the the super kind of grown-up thing to do about this would be to talk about the the broader health system and work out the extent to which that's functional but that while not quite as toxic as a conversation about social care from a kind of economic standpoint is is another conversation that no one really wants to have so clearly it's a good thing that that there is a prime minister now who believes clearly passionately that he wants to take this on.

23:24Ed Conway:But golly, I mean, how many, is it like 22 reviews that we've had since? Yeah, they're saying it's the 23rd. We should say, of course, as well, we're talking about patchwork of provision. I mean, even within the UK, there are different systems. So Scotland does have something much more akin to a kind of European model or a Danish model where it's sort of more free at the point of view. There are still sort of specific charges. But we're talking about England here because Scotland actually, as in so many areas of the public sector, has more largesse for its citizens. Exactly. And, you know, again, similar conversation about health.

23:52Ed Conway:I think, you know, there's a deeper issue here, which is that obviously we have an ageing population. We have the national debt is, you know, it's higher than it's been for a long, long time. And it's set to go higher. Social care is not the biggest thing that's going to be pushing that up in the future. you know things like the triple lock are a bigger miscreant if you want to call it you know use that word uh charge worth they'll probably get in trouble for that but that's a bigger part of the explanation for why it when you look at the office for budget responsibility doing all of these lines going off into the future showing what's going to happen to the national debt it goes up and up and up a large part of that is the aging population and the impact on health pensions but social care is a part of that and that's the bigger conversation that we that we need to have but it's it's uncomfortable you talk about the bigger conversation that needs to be happening and you talk about you know france germany where there are big insurance based kind of policies in place for the delivery of health care there's that's not going to happen is it i mean i can't see it's it's like the kind of it's a shibboleth you can't touch the national health service it is and change it alter its funding model i can't see any no pull it you know I mean, I think only a Labour government would have the political space to do it.

25:08But this Labour government, I can't see a Labour government. I think they're having then the juxtaposition between the NHS system that we have for the average Labour MP. As soon as you start to introduce the idea of an insurance model and where that might go, politically, I just can't quite see.

25:21Ed Conway:Well, again, it's back to this point that Andy Burnham wants to make, which is like, don't please try not to just use this to score political points. That's why he's kind of bringing everyone in, because it's obvious what the attack line is if you're trying to do that, is privatising the NHS. But frankly, I think, you know, it's no bad thing. And it's weird. This this last few weeks has been weird, hasn't it? It's been a bit like a kind of election campaign, hearing various different kind of almost quasi manifesto pages. But on on interesting stuff like the technical education. And, you know, I know I know that's that's that's another story.

25:50Ed Conway:But again, a longstanding issue with the UK education system, which we've been talking about not just for years, But literally since like a century and a half ago, we were bemoaning the fact that we didn't have very good technical education in this country. There was a Royal Commission about how they did technical education back in 18 something or other. So much better in Germany. And so the fact that, you know, this new government wants to talk about this stuff is great. The issue is that ultimately, and this is a broader economic thing, ultimately, when you're in that position, you know, in charge of the country, you have enormous constraints and you have to disappoint people with some of your decisions and at some point Andy Burnham has to disappoint some people and let down some people either this is a spectrum either we pay through out of general taxation in which case we all pay and some end up paying more than others we introduce a cap on care costs i.e.