Health in Focus: Yvette Cooper & Social Care

Yvette Cooper and her new ministerial team now officially have a foot in the door, and can stake their claim on the new Burnham agenda. The appointment of Alison McGovern as Minister for Social Care is the most notable point for the Department, taking on responsibility for adult social care, palliative care, hospital discharge, mental health, and disabilities. While broad in scope, this role sees a departure from former Minister of State for Care Stephen Kinnock’s brief, which included primary care and general practice. Announcing her appointment on Instagram, McGovern noted her pride in tackling the ‘overlooked’ issue of adult social care and diagnosed its disarray at the hands of the Tory Government and cuts to councils over 14 years. No doubt, McGovern and retained Secondary Care Minister Karin Smyth, who holds the portfolio for health devolution in England, will be working in tandem to deliver localised health policy through the lens of Manchesterism.

McGovern’s description of adult social care as overlooked, while true, does not acknowledge the structural inhibitors that have led to its failures and policy paralysis over recent decades. Burnham’s urgent call to action by labelling adult social care the perpetrator of an NHS on the brink of collapse would usually serve as a wake-up call for policymakers, professionals in the industry, and the public. Rather, it diagnoses the same symptoms which have perpetuated this growing sense of gloom and irrevocable nature of the adult social care system. The word ‘overlooked’ paints a picture of a democratic state that has chosen, through political, monetary, social, or cultural factors, to disregard adult social care. The reality is far more complex than individual decision making from Ministers, party caucuses, or policy experts, but it stems from the nature in which adult social care has become an untouchable policy. On the surface, previous attempts have been misguided, resulting in the incessant and crude labelling of a ‘dementia tax’ and a ‘death tax’. Such a media reaction likely explains why Burnham called out the damage of political point-scoring and short-term media headlines to the issue. Building a cross-party coalition is the first step to achieving a deliverable consensus for reform.

The second sits in the intersection of a confusing paradox. The last few years have shown MPs frightened of any policy that could negatively affect the elderly; winter fuel payments led to media backlash and collapsing political capital for a party with a near-supermajority, and the triple lock isn’t even flirted with, let alone touched, by major parties despite organisations like the National Institute of Economic and Social Research calling it unsustainable. A well-known element of this stems from the fact that older people are more likely to vote, contributing to political strategies operating from the assumption that their voices are kept in the tent. From this outlook, adult social care, a policy that primarily concerns older people, would be at the top of the Government’s priorities to reform and improve, yet it has faced years of inaction and decay.

Adult social care is a fragile issue, steeped in emotional pain, personal sacrifice and arbitrary unfairness. Some people may have parents who pass away instantaneously and never enter the system, while others can be saddled with hundreds of thousands of pounds in debt to tend to their loved ones, especially when long-lasting debilitating conditions like dementia are involved. This creates a scenario where those before adult social care are fearful of the issue, sweep it under the rug and hope its failures won’t touch their family. Those involved in adult social care fear becoming the guinea pig for wide-scale reform of an overly complex and unequal system. Further, fear and mistrust are a plague on modern politicians’ political will; Blair’s astronomical approval ratings seem like a pipe dream in the divisive nature of modern politics. Burnham himself has managed to reach positive figures, while Starmer sat plunged at the Mariana Trench of ratings for around two years.

Without the public buy-in, policies become difficult, and adult social care is either an issue people do not want to think about or do not trust a politician to deliver. When there is no mandate for change from the public, media intensity becomes hotter and political tensions become sharper and more damaging, leading to policy paralysis and leading to the status quo being reinforced. However, reforms can be delivered and a vision for adult social care, not just a policy paper, is needed to shape public perception on the issue. That is where Burnham must deliver.

The problem of adult social care is clear, catastrophic costs, undervalued workforce, widening gaps in provision and rising dissatisfaction. Burnham has the policy, the Dilnot Commission, including the ‘cap and floor’ model, proves an absence of ideas and passable reforms was never the issue. But he must gain the political. He has the sheer volume of MPs to pass legislation but he must bring the public on board. To truly achieve this, Burnham must build a narrative about what adult social care can provide for people, not what it should provide in the worst situations. This involves reframing the debate away from rationalising higher care costs as a means of greater and more bureaucratic public expenditure but to how a properly funded and fairer adult social care system can create a more just transition into later life, build a society built on solidarity and frame adult adult social care as a social good. Burnham must confront this tenuous issue of adult social care, deliver a vision that puts people’s families and pockets at the centre, and give a reason why change is required, not just how.

Elsewhere, McGovern will also have to contend with developments within the assisted dying debate. Recently, Burnham said the debate on assisted dying should wait until adult social care and palliative care funding is fixed, noting that it is very challenging to introduce this wider debate when people aren’t receiving the right care. With Lauren Edwards MP set to reintroduce the Bill to Parliament in September as a highly prioritised Private Member’s Bill, its repassage through the Commons will prove important and a unique political conundrum for Burnham. His outlined position is no doubt personal, and he may offer this from his point of view as a mere one MP of 650. Or he may take a more distinct approach and look to politicise the issue from the perspective of preventing the failures of adult social care from causing further harm. Politicising the issue is something the Starmer Government steered clear of, allowing MPs to vote on a personal basis. However, to convince the public of his mission to fix the broken adult social care system, deciding to grant a policy which many argue could cause more harm than good to older people may run juxtaposed to this agenda. An important decision lies here, and will no doubt increase scrutiny on the forthcoming Bill.

Another notable inclusion in the ministerial team is Chris McDonald, who will be the Minister for Science, Innovation and Investment. McDonald will look to bridge the gap left by the dissolution of the Department for Science, Innovation and Technology, ensuring that science and its ties into healthcare and medtech stay grounded and are not deprioritised in the departmental reshuffling. Medicines, medtech, research, and rare diseases will now be split across two Ministers, McDonald and James Frith, the Parliamentary Under-Secretary of State for Health Innovation. While Burnham has been silent on this area of healthcare, it looms prominently in the background of the health policy debate. Recent changes to the Innovative Licensing and Access Pathway, MHRA-NICE Aligned Pathway, NICE Thresholds and VPAG rebates are institutionalised and their benefits will be assessed in forthcoming cycles. However, challenges lie just around the corner, most notably on NHS adoption, and complexity surrounding the NHS reorganisation and its effects on specialised commissioning and the formulation of Offices for Pan-ICB Commissioning (OPICs). On the one hand, the new Ministers, and specifically McDonald, will be welcome news for pharmaceutical companies who will hope this bridge between health and business will tie in life sciences funding and improved access to medicines. On the other hand, recent changes to the NICE threshold and ambitions to increase spending from 0.3% to 0.6% have been criticised by health economists, citing a potential increase of excess preventable deaths. Burnham may opt to target this space for cuts to unlock funding elsewhere, delivering on his core missions in adult social care and maintaining manifesto commitments on waiting lists.

The Health Bill also produces a political conundrum for Burnham. While key cabinet Minister Wes Streeting has probably washed his hands of the NHS, his legacy is maintained through the Health Bill, with Karin Smyth responsible for the Bill’s passage. With the abolition of the NHS, many powers and responsibilities were left homeless, and comprehensively the Department of Health and Social Care has brought most of them under its remit. This includes elements of commissioning, power to direct Integrated Care Boards (ICBs), medicine and data governance standards, digital infrastructure, and most notably, Healthwatch, which has become a key contested point in the Bill. Burnham’s devolution agenda proposes moving power away from Whitehall towards local powers – exactly what the Bill does not do. With the Bill pending a Report Stage and Third Reading, summer recess has given Burnham and the new health team ample time to morph the Health Bill, which was not in the manifesto, into a new Burnhamite vision for the organisation of the NHS. Any amendments to elements of the Bill may look to preserve local voice in decision making whilst maintaining the core rationale to cut overall bureaucracy in the overly bureaucratic maze of the health service.

Burnham’s premiership and Yvette Cooper’s tenure could provide a fundamental shift in the apparatus of the healthcare system. Immediate challenges on the Health Bill persist, but through carefully considered amendments it also provides the opportunity to begin turning the wheels on the devolution of care, immediately solving longstanding bureaucratic challenges and structural pain points, and beginning the pathway towards reforming adult social care and revolutionising local healthcare integration. Meanwhile, planned pharmaceutical investment could prove a challenge for Burnham, who will face pressure from health economists and the voices on the left who will ask for money to be redirected from ‘pharma giants’ to hospital beds. Most prominently, adult social care has the greatest capacity to be a legacy Burnham can point to. While past governments have been willing to talk about symptoms, diagnosis and solutions, delivering this, and importantly how it is delivered, can be a defining legacy for a Labour Government whose definition has been hard to find.

For more on how Andy Burnham’s tenure in leadership has been received by the press and public so far, read our overview of key stories and perspectives of his first few weeks as PM.