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24 September 2014updated 23 Jul 2021 11:24am

How does Andy Burnham plan to pay for integrating health and social care?

In 2012, the shadow health secretary admitted in his conference speech he didn't have "all the answers" for funding whole-person care. His speech this year shows this remains the case.

By Anoosh Chakelian

Just as Nye Bevan wrote to every household to introduce his new NHS, so I will write again in 2015 to explain what people can expect from our national health and care service.

This is what the shadow health secretary Andy Burnham told Labour party conference in his speech on the NHS today. Delivered in his characteristically passionate style, it received no fewer than three standing ovations (“a record for a non-leader?” as one party source commented). His lively address played smartly on the history of Labour and the NHS.

If Labour has enduring “trust issues” with the economy, it can always rely on being the party that is most trusted with the NHS. And Burnham used this for all it was worth today, echoing his leader’s speech by framing the election campaign in terms of which party can rescue the beleaguered health service:

Make no mistake – this coming election is a battle for the soul of the NHS. The fight of our lives.

But however well Burnham’s message was received – many observers are commenting that it was more impressive than Ed Miliband’s flat performance yesterday – the party needs to tread carefully regarding its shadow health team’s plans.

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Burnham has been plugging away at the idea of “whole-person care”, a joined-up health service covering an individual patient’s physical, mental and social healthcare, for some time.

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Even two years ago, in his 2012 conference speech – his first as shadow health secretary – he was calling for “one system caring for the whole person”. Back then, he admitted: “We don’t have all the answers. But we have the ambition.” Two years on, not much has changed.

Burnham’s attacks on the government’s “toxic” NHS reforms are not enough to counter the fact that his idea to integrate social care still has little substance. The cost of social care to the state would be huge, what with the health service’s tight funding situation and our stubbornly ageing population. Deciding how to fund this – which was not covered by Miliband’s new plans for boosting funding and making savings in the health service – will be extremely tricky. This is something Burnham hasn’t properly confronted.

A health industry insider tells me that even if local authorities wanted to provide more for social care, it would be at “an enormous cost to other services”. They also express doubt at how the cost of integrating social care would play politically with Middle England.

And what adds to this difficulty is that Labour’s leadership has not always embraced Burnham’s ideas. I remember this time last year at Labour party conference, it was widely rumoured that the shadow health secretary was to be reshuffled. Journalists seized upon Miliband’s comment that he was “foursquare behind Andy’s ideas”, rather than behind Andy.

This rumour developed because the Labour leader had initially been reticent about the “whole-person care” proposal.

It was only at the beginning of this year that Miliband shot down Burnham’s plan to fund his integrated health and social care service. The idea was to hand about £60bn of NHS money to local authorities to create the budget for it, something that was vetoed by both Miliband and Ed Balls.

And another of Burnham’s interventions – proposing a levy on people’s estates to pay for care of the elderly (ie a “death tax”) – was blocked by Balls in August.

There was no suggestion in the shadow health secretary’s speech to conference today that his team and Labour’s leadership have decided how to fund the integration of social care. It begs the question: what will Burnham end up writing in his Bevan-esque letter to the people of England in 2015, and will they want to receive it?