Andy Burnham as prime minister: what could it mean for health and care?

It is nearly certain that Andy Burnham will be the UK’s next prime minister. What could that mean for the future of the NHS and adult social care? 

Decisions, decisions: how to run the UK 

First will be the overall decisions Burnham has to make about running the country, which will have knock-on effects for the NHS and social care.  

Those decisions include his overall fiscal framework, which will affect how much government can spend on public services. An early sign of his approach will be whether and how NHS capital investment is reallocated to help fund the Strategic Defence Review.  

These overall decisions regarding running the country also include changes to the machinery of government, such as whether the new prime minister will continue with the abolition of NHS England. Staying the course is likely, not least because it was Burnham himself who coined the term ‘the world’s biggest quango’ (quasi-autonomous non-governmental organisation) to describe it, saying in Nick Timmins’ book: ‘You simply cannot have public money worth £100 billion without democratic accountability… If politics has a respectable role, it is obviously in providing accountability for taxation. And if that does not apply in respect of the NHS, then what does it apply to?’ 

But other machinery-of-government changes could be in play too, including whether Burnham will reverse the decision to deprioritise the health mission boards that could have provided a pan-government powerhouse to tackle the wider determinants of health.  

A Burnham premiership could include devolution on steroids if the Manchester experiment of devolving health powers is transplanted to other parts of the country when the soil conditions are right. That approach could mean: a return to the ‘levelling up’ agenda of previous governments, which could see swathes of national focus and funding heading northwards; a greater role for elected officials – like mayors – in how local health services are run; a renewed push on getting different parts of the country ready for their own devolution deals; and a return to a focus on ‘place’ that has been downplayed in national health politics since Sajid Javid left the Department of Health and Social Care. 

And it would be devolution for a purpose, rather than an end in and of itself. Health Service Journal editor Alastair McLellan notes how the prevention agenda could become the ‘one ring to rule them all’ of strategic shifts. It almost feels quaint to remember the heady days of Healthy New Towns and tackling obesogenic environments that promote weight gain and contribute to the development of obesity. Those days could be back again, with government initiatives like NHS Neighbourhood Health Services and Centres taking on some of the features of Greater Manchester’s Live Well initiatives that are trying to rewire how public services are organised and delivered. 

Finally, back to fiscal policy, Burnham could also follow the advice of economist Jim O’Neil, who highlighted preventative health care as one of the key areas where a borrow-to-invest fiscal strategy should focus. This additional route of investment might be a way of squaring the circle between a prime minister who might believe that ‘prevention matters more… than access’, but will nonetheless inherit a manifesto that commits him to delivering every NHS constitutional access standard by the end of this parliament. 

Decisions in health and care 

The second type of decisions are the ones Andy Burnham needs to make (or at least set the direction for) in health and care more specifically. The most obvious areas in play include the following. 

Adult social care

Burnham has repeatedly said he will not ‘flinch’ from the difficult political decisions that are needed to reform England’s adult social care system. Even if we know what he doesn’t want to do (‘flinch’), we don’t know what this will mean in practice. It could mean everything from asking the existing method of reform to ramp up (for example, by asking Baroness Casey’s commission to make a full report by the end of this year) and/or by presenting an alternative reform package funded through reforms of inheritance tax. 

The Health Bill

The NHS Modernisation Bill (Health Bill) includes proposals to: establish a single patient record; abolish NHS England and return more political control of the health service to ministers; and abolish the need for everything from a local Healthwatch to a council of governors. We don’t know Burnham’s view on all these issues, or whether he even wants to spend the legislative time and political capital that any health bill requires to pass. But there were reported qualms about the loss of patient voice in particular as a result of dissolving Healthwatch, which could mean a stay of execution for some of these bodies. 

Social media ban

While it may not have started out as a personal passion project, the social media ban for young people was clearly positioned as part of Sir Keir Starmer’s legacy as an outgoing prime minister. While Burnham has made supportive comments about similar proposals – and there are few chances in life to make a genuinely generational decision on society – the social media ban will be added to an already huge list of political hot potatoes as he enters office. 

Finally, there is the small business of the actual running of the health and care service. To take just the topic of workforce policy, the next prime minister will have to deal with the following. 

• The potential for further industrial action and demands for pay rises. 

• The next NHS long-term workforce plan that was already written but has been circling the publication runway for weeks, if not months. 

• Continued questions over how sustainable the adult social care sector can remain as immigration numbers continue to fall and domestic recruitment fails to fully pick up the slack. 

Overall, then, we are in for more change than we are ‘steady as she goes’. 

Opportunities and risks 

The new leader of the Labour Party will have the chance to define how the next generation experiences health and care. In their in-tray will be a colossal set of both opportunities and risks. 

Looking at the upsides, what could happen with Andy Burnham as our next prime minister? There’s the potential for a renewed health mission, adult social care reform on steroids and wider action on prevention. What’s not to like? 

The only cautionary note, then, is that I could have written virtually the same thing two years ago based on the Labour Party’s manifesto commitments. In that time, we have had new global conflicts, a faltering economy and the emergence of multi-party politics. 

New Labour’s slogan was once ‘things can only get better’. The past two years have shown that isn’t always the case.