PM accelerates social care reform

Prime Minister Andy Burnham has committed to ending "decades of political drift" on social care, setting out a new cross-party approach focused on workforce reform and integration with the NHS.

Personal Commitment & Lived Experience

Drawing on lived experience with his father's Alzheimer's, Burnham told the event that care teams should be "the best paid people in society, not the worst." He described the current social care system as "as unfair as American healthcare," where "the vulnerable pay with everything and it can completely leave them with nothing." Angela Rayner, who worked as a homecare worker for Stockport Council, shared her own experience of "tough, physical shifts for wages I struggled to get by on," underscoring cabinet-level commitment.

Workforce Reform: The Building Block

The government has agreed a Fair Pay Agreement for social care staff to come in 2028/29, which Burnham described as a "massive building block" of a National Care Service. Beyond pay, Burnham wants to reform training and create progression routes for young people, including pathways from social care into NHS positions.

Casey Commission: Accelerated Timeline & Public Engagement

Burnham has asked Baroness Louise Casey to bring forward her review by a year—from 2028 to summer 2027—focusing on how to deliver a National Care Service. Casey has launched the Big Conversation on Care, a public consultation process addressing questions about when the state steps in and who pays, which she describes as "a game changer." Out of 22 previous social care reviews, no government has consulted the public on reform options.

National Care Service: Four Core Principles

The system must allow seamless movement between hospitals, home care and community services; be fully and sustainably funded; start with prevention to support independent living longer; and put citizens' needs at the heart, removing budget silos between organisations.

Funding & Efficiency First—But "Difficult Decisions" Coming

Burnham indicated existing resources can be used more effectively before tax rises. He cited £2.5bn a year lost through unnecessary hospital admissions from social care settings and prolonged stays once patients are medically fit to leave. However, he was explicit: reform will require "difficult decisions," and he committed to being honest with people about these and putting them before the country "at the right time." This signals that full-scale reform will likely require funding decisions beyond efficiency gains alone, though Burnham recommitted to Labour's manifesto pledges not to raise income tax, National Insurance or VAT.

Profiteering

Burnham stated there is profiteering in the sector and "unnecessary and dangerous" cost cutting on the backs of vulnerable people, explicitly saying: "We do have to be sure that there isn't profiteering in the system. I think that is where we absolutely draw the line." By profiteering, he means money being taken out of organisations unscrupulously rather than reinvested in care quality, staff pay, training, and conditions—a practice he said occurs in both adult and children's social care. 

Cross-Party Engagement

Burnham initiated cross-party talks with the Conservatives and Liberal Democrats, describing this as "the first big test" of ending political point scoring. He framed these talks as "just the start" of a months-long process, not a major summit. Burnham noted that his experience as health secretary in 2009-10 convinced him reform was left too late then, too close to an election, and that "it's better to do it sooner and further away from an election."

Governance & Ministerial Leadership

Yvette Cooper will chair a new ministerial group to accelerate reform across workforce, system reform and Commission delivery, including appointment of a Dementia Tsar later this summer. Cooper, whose mother has dementia, said: "We cannot keep walking away from this problem."

Assisted Dying Positioning

Burnham said the funding of palliative care and social care must be "fixed" before assisted dying is considered in England and Wales, signalling he will not personally back the current bill.

Actions you can take now

• Engage with the Casey Commission's Big Conversation and encourage your staff and the people you support to do so.
• Respond to our Workforce Survey to help build our evidence on key issues like Sick Pay changes, recruitment of young people and zero hour working.
• Think about how you explain profit and margins in your organisation if people ask about it, as this issue comes into focus.