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- [00:00]
Ben Chu
This BBC podcast is supported by ads outside the UK.
- [00:06]
Podcast Announcer
This Monday.com ad was created by a team of people and AI agents. Reese, our content agent, wrote the copy based on our best practices, like mentioning Monday.com three times. That was the second. Johnny, our coordination agent, built the timeline and kept everyone aligned. Olivia, our human creative director, stayed in the loop because agents are great, but they don't always know when a joke lands. She she had one note tell listeners it only takes minutes to build an agent. So minutes create your own AI agent today on Monday.com when maintaining your daily wellness rituals is important to you, the change in routine during the summer can feel daunting. Kachava's new travel packs help you stick to your daily ritual even when you're on the go. Just one packet of Cachava's all in One Nutrition Shake provides complete nutrition with 25 grams of protein, 6 grams of fiber, greens, adaptogens and much more. So you'll be fueled and ready for wherever life or your summer adventures take you. No fillers, no nonsense, just the good stuff your body craves. Plus, it actually tastes delicious. But you can try it for yourself because the variety pack includes all six delicious fan favorites. Chocolate, vanilla, chai, matcha, coconut, acai and strawberry. So instead of worrying about sticking to your daily ritual, simplify it with Cachava. Go to kachava.com and use code NEWS for 15% off. That's K A C H-A-V A.com code NEWS
- [01:38]
Adam Fleming
hello. Occasionally there is a news story and you realize I'm so glad this podcast exists because it means I can get my really smart colleagues together. We can talk for quite a long time and go into quite a lot of detail and by the end of it we will all be better off as a result. And that has happened today because Andy Burnham's done another big intervention in his first fortnite as Prime Minister, this time his thoughts on reforming social care in England. And for newscasters who have complained that all of his announcements, or most of them, have been about England, I suppose that's just the way this cookie has crumbled with this Prime Minister. But this is such a good episode with so many insights from people who've been covering these stories and looking at the trade offs for decades in some cases, that it's definitely worth listening to this episode of Newscast Newscast, Newscast from the BBC.
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Podcast Announcer
Humanity's next great voyage begins.
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Andy Burnham
You know, alike my buses, I'll come on to them.
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Ben Chu
I see that he was, I guess,
- [02:34]
Alison Holt
the mayor of a town Ooh la la.
- [02:36]
Ben Chu
Thinking about it like a panto helped. Do we play music now or what do we do?
- [02:40]
Alison Holt
And what will you do? Stare at a wall.
- [02:43]
Adam Fleming
Hello, it's Adam in the newscast studio and we're going to focus this whole episode on the thorny issue of adult social care in England. Although there are knock on effects because social care has to be delivered well in every country in the world. And so I've assembled three of my great colleagues to help me understand what Andy Burnham was saying at his speech today at a social care facility run by a Jewish char in North London. Please welcome back to the newscast studio, BBC social affairs editor, Alison Holt. Hi, Alison.
- [03:09]
Alison Holt
Hello.
- [03:10]
Adam Fleming
And you've been covering social care, and I mean this, respectively, a very, very long time.
- [03:14]
Alison Holt
Yes.
- [03:15]
Adam Fleming
How many years do you think you've had on this beat?
- [03:16]
Podcast Announcer
Now,
- [03:19]
Alison Holt
I don't even dare count it, but I will say I interviewed andy Burnham in 2009 when he was launching his plan for a national care service the first time around, the first time round. So I do feel I've been here.
- [03:32]
Adam Fleming
And of course the point about that was he was announcing it too late. In the lifetime of that Labour government, it was never going to happen because there was an election less than a year away.
- [03:40]
Alison Holt
Exactly. So it then his plan was to put a £20,000 levy on people's estates after they died to fund a national care service that in the general election became dubbed a death tax.
- [03:56]
Adam Fleming
By the Conservatives.
- [03:56]
Alison Holt
By the Conservatives. And in a sense it also started this real political football which I'm sure we'll get into, which went on for years. Death tax, dementia tax, death tax, et cetera.
- [04:06]
Adam Fleming
Yeah. And also famously, Ken Barlow from Coronation street did an advert for the Conservatives about the so called death tax in that election.
- [04:13]
Alison Holt
My, you do have a good memory.
- [04:15]
Adam Fleming
I mean, it's quite a famous moment of British electoral history. So I'm not going right into the archives there. Also joining us, Ben Chu from BBC Verify. Hello, Ben.
- [04:23]
Ben Chu
Hello, Adam.
- [04:23]
Adam Fleming
And Jim Reed, our health correspondent's here too. Hello, Jim.
- [04:26]
Jim Reed
Hey, Adam.
- [04:27]
Adam Fleming
Right, so, Ben, you've been looking at some numbers and also a bit of political history as well. Yeah, yeah, that's right. And Jim, you've just got quite a lot of experience of, of the things that have been going wrong in the system thus far.
- [04:37]
Jim Reed
Yeah, I've been speaking to families today, reacting to the announcement and every time you speak to any family that's caught up in this, honestly, your heart just goes out to them because they've often been through the absolute Wringer. And it does bring back just how many people are affected by this. There's some statistic that I think is pretty much everyone in the country knows someone or has had to deal with these kind of issues, but yet they are not talked about perhaps as much as they should be.
- [05:03]
Adam Fleming
Although Alison will come onto the details, if we call them details of Andy Burnham's speech today. But that whole idea of the pain that families go through, the hard work it is for the workers and how terrible it is for the people who need the care a lot of the time was a big feature of this speech from Andy Burnham, wasn't it? Yes. Also talking about his own life.
- [05:21]
Alison Holt
Absolutely. He referred to his father who has Alzheimer's, and, you know, praised the staff. There was, there was one lovely phrase where he talked about the way they communicated with him, brought out the, the essence of his dad. And so he was celebrating that, but also talking about the, the difficulties and the, the horror of navigating this system. And like Jim, you know, I've spoken to so many families who, they arrive at this point of a crisis in their family's life because it might be a younger person with a disability or it might be an older person with dementia or. And they're confronted by a confusing system. Often they think the NHS will help them, but it doesn't because it's about personal care help with day to day living.
- [06:12]
Adam Fleming
If you were diagnosed with cancer, you'd be put on a very clear pathway about what care you'd get from the NHS for that. But with social care, it's a total minefield.
- [06:20]
Alison Holt
No, you have to go to your local council. Quite often you'll be means tested. If you have more than £23,250 in assets, income and savings, then you get no help at all. If you have less than that, then you will get some help, but you'll still pay charges. A lot of people still pay charges and there is a general sense of unfairness amongst the people you speak to. They say we've paid taxes for years and here we are and we are really struggling and we are worried about the future.
- [06:55]
Adam Fleming
And Jim, one of the other things that Andy Burnham majored on today was the knock on effects on the nhs. So echoing one of the. The things he said to Laura in her interview over the weekend about the risks to the NHS of not solving this.
- [07:07]
Jim Reed
Yeah, there's a stat and I'm sure Ben will come on, talk about this. Every day In England, roughly 13,000 people are in a hospital bed that don't need to be there. And that's why some of these conversations, I think, about money are so difficult, because you're trying to weigh up the direct cost of potentially bringing in these policies with the indirect cost of sort of not bringing them in, and therefore the knock on effects on the health service. And that's why some of these calculations are just so difficult, I think, for. For the media, the public, for politicians to get their head around.
- [07:36]
Adam Fleming
Give us some of the numbers then. Ben, what's a good way of making a spreadsheet?
- [07:40]
Ben Chu
Here's a way of thinking about it. So in England, Cause we're talking about the English system at the moment, we spend roughly 30 billion pounds a year of public money on social care. So that's about 1% of the economy. And that's been rising quite rapidly over the past, you know, 15, 20 years as the population has got older and as need has gone up. But it's not been rising fast enough to meet the need that's out there. So that's why there's so much, as Alison and Jim have been saying, pressure on the system. So much of a sense of it's underfunded and it's unfair. So that's a key number to bear in mind. Then you've got what do we spend on the health system in England? And that's about £200 billion. So it's much, much more we spend on health than social care. So those are the two. And the argument is if you spend more on social care, you'll reduce some of those bills on the overall health budget as well. So it's estimated by the King's Fund, this health think tank, that those stats that Jim was talking about are costing the NHS in England about 2.7 billion pounds every year, because you can't discharge those people into the system, even though they're clinically fit, because of those, the dysfunction of the social care system. So potentially invest more in social care, you'll reduce that overall bill. So that's something to bear in mind. Some other things to bear in mind is how much is it actually going to cost to do some of the reforms that have been floating?
- [09:00]
Adam Fleming
Yeah, I think we'll come on to that next because it is a big spreadsheet. But let's dive into what Andy Burnham was actually saying. We've set the context really well there, I think. So he gave a sort of numbered list, which I always love when a politician helps you with taking your notes and then holding them to account later. And number one on the list was getting Baroness Casey to do her existing review into reforming social care, but doing it a year earlier. And here is what Andy Burnham said about that.
- [09:25]
Andy Burnham
Social care is different. It has to be person centred. If it's not person centred like the brilliant care provided here at Jewish Care, then it won't be what people would recognise. Social care. You don't want to over medicalize care, but it has to be very integrated with the rest of the system. It has to be preventative in its character, it has to be person centred. And that's what we're asking Louise to give us her report on how do we deliver a national care service in England that sits alongside the National Health Service works in a similar way that is highly integrated and can optimise the journey of a patient. If a patient's leaving home to hospital, back as quickly as possible and there's no delay.
- [10:17]
Adam Fleming
Now, Alison, just on that bit of jargon, person centered care, I'd covered that as a concept for years and I didn't really know what it meant because I just thought, hang on, it's a doctor, a nurse, a care worker, they're caring for you. How can it not be person centered? Until I saw an example of somebody I know suffering from a really serious condition. Condition. And actually they were treated by sort of 10 different people who did their bit of the job rather than focusing on the person that needed the help. Is that what person centered care is trying to avoid? Yeah, trying to solve.
- [10:46]
Alison Holt
It's trying to look at what that individual needs. And that's a really good example about. Rather than having 10 different people asking the same story over and over again
- [10:57]
Adam Fleming
and doing their own little bit.
- [10:58]
Alison Holt
Doing their own little bit, but not joining those bits up. That's. If you avoid that, you have more person centered care. But the other bit of it is actually finding out what helps that person. It might, if it's a long term condition, it might not be about something medical or. Yeah, something medical or health related. It might be simply trying to get them involved in a club so they're not so lonely. It might be making sure that they can get out into their garden so they can enjoy. That is looking at what makes that person feel better and helping them do that. So that, you know, the argument is, and the evidence is that improves people's lives.
- [11:45]
Adam Fleming
And also, Jim, back to the NHS point that the PM was making. He said, well, actually quite often you have a care worker who can't solve the problem of the person they're looking after at that point. So they call 999 and then that person is whisked away in an ambulance and they're into the hospital system, which could be a terror, terrible place for them to be to solve that initial problem.
- [12:02]
Jim Reed
Yeah, I thought that was a really important part of the speech, actually, when you started talking about that. I mean, we cover these subjects all the time in the BBC health unit and often you go into hospitals and you go to frailty wards in particular, and they are full, full of people that really want to go home. And there's some statistic, as soon as you've been in hospital for more than a week or so, actually the time it takes you to leave hospital starts growing almost exponentially. So the idea behind all this, and this is the kind of thing we talked about so many times before, is to avoid people going into hospital in the first place through some of the stuff that Alison was just talking about, but also through things like community care. And Andy Burnham was talking about how the number of community nurses has been cut quite dramatically across England over the last 10, 15 years. Now, these are all the kind of like, they're not the sexy bits of the nhs, you know, they're not cancer care, these are not brain surgery. But these might be the bits that actually can cut the amount we're spending on the health service by a significant amount if we can refocus the system properly.
- [13:04]
Alison Holt
One example that is often being given to me by care staff of how good social care can work. It's a really sort of down to earth thing. They say that if an older person has a good level of social care, they get to know their care worker. If they develop some sort of infection, like a urinary tract infection, a uti, which is very common, that care worker is more likely to pick it up. They might just take their temperature and then ring the GP and say, I'm a bit worried here, what should we do? And then the GP can prescribe antibiotics or whatever is appropriate. Therefore that person doesn't end up in hospital. If it's left untreated, then the danger is that they become more confused, that they fall and then something that is relatively small turns into an emergency and
- [13:52]
Adam Fleming
we'll come on to the social care workforce, the people who are noticing those things in a second. But, Ben, just on that timing point about Louise Casey's review, I remember correctly, she didn't. And I had a long conversation with her when we did our episode at hey Festival, an episode that people can listen to again on sounds. So she was gonna do a sort of Evidence review, initial sort of scoping thing that I was thinking was gonna come out about now and then she would do her final recommendations in 2028. Yeah. So it sounds like maybe we won't get the initial thing at all, but she will do the final thing a year early.
- [14:23]
Ben Chu
Yeah. So labor obviously came in promising to scope out a national care service, and then Keir Starmer last year said Louise Casey was gonna do it with back in 2026 this year, but the final thing not before 2028. So that was widely perceived as being it being kicked into the long grass, effectively, because it was so controversial and potentially expensive. So what Andy Burnham has announced today is that he's going to bring the final report to 2027. He said this time next year, which is actually a little bit later than he initially suggested in a Guardian interview before he was bm. He wanted to do it so quicker but slower. Yes. At the same time, he suggested he wanted the final thing back by the end of this year. So he's had to bow to reality a little bit there. Maybe Louise Casey has told him it's not feasible to do the whole thing by then, but he's definitely accelerated the timetable. And the feeling is you need to get it going if you're going to produce something and act on it before the next general election.
- [15:14]
Adam Fleming
And, Alison, just on this big branding, I mean, I don't mean that in derogatory way, but of a national care service, that's one of those things where you can sort of, kind of instinctively imagine what it is, but then you start to think about how that is implemented and how it's run and who runs it and what it is, and it then gets a little bit kind of murkier.
- [15:32]
Alison Holt
Well, I would say it's a phrase that has been used by lots of different people to mean lots of different things that. I don't know if you remember. I think it was during COVID The badge.
- [15:41]
Andy Burnham
Yeah.
- [15:44]
Adam Fleming
Yeah. Matt Hancock didn't have anything to announce one day at a covert press conference, so he came out wearing a badge saying, care, and said, I want the. The care workers to be taken as seriously as nurses. Yeah.
- [15:54]
Alison Holt
So it can mean an awful lot of things. We haven't had any detail on what the Prime Minister thinks a future care service should look like. I mean, in the past, he has talked about free at the point of use in a similar way to the nhs, but that can actually mean a lot of different things. I mean, Scotland provides free personal care, but there are limits to the amount of Money, and it's generally a complicated system, but you could have a much more generous a system which Ben will know will cost a huge amount more in the end. There are a set of choices which politicians need to make and some of those decisions will be shaped by the amount of money they believe that we want to spend.
- [16:43]
Adam Fleming
Yeah. And we'll do the money in a second. But Jim, I was intrigued in the Burnham speech that rather than talking about some of those things that Alison was mentioning there, like free at the point of use, delivered on NHS principles, he was talking about a National Care Service as an organization that could sort of plug into the National Health Service like they were two Lego bricks.
- [17:01]
Jim Reed
Yeah, Use that phrase, integrated quite a lot.
- [17:05]
Adam Fleming
Other construction toys are available.
- [17:08]
Jim Reed
It's interesting. It feels to me that what they are thinking about doing here, reading between the lines, is maybe not having the money, the funding, the resources that they'd like at the start of this process. So bringing in things in a more of a kind of staggered way. So what you might see to begin with maybe in this Parliament, is some stuff around care home staff and the way they're funded and the way they're paid, and that might perhaps end up in a situation like Alison was talking about there, where we have free personal care like in Scotland, but with this kind of ultimate ambition to do something perhaps more ambitious in the longer term. Now, looking at the public finances, and I'm sure Ben can talk about this better than me, it feels unlikely they're going to have time to do that in the short term. But there does seem to be a bigger ambition here than just repeating the policies that are in place in Scotland.
- [17:56]
Adam Fleming
Well, to repeat my excellent Lego analogy, I'm not trying to get any freebies here. So basically the NHS is like, you know, those big green square base plates that you get, and then the National Care Service will be built up by different colored bricks that get added on to the green base plates. Anyway, let's leave that metaphor behind. And Ben, I mean, Andy Burnham talked about there's a full on way of doing this, there's a medium fat way of doing this and there's a minimum, minimum fat way of doing this. He didn't use that phrase. But what are we talking about there in terms of prices?
- [18:23]
Ben Chu
Yeah, well, I think you can think about it in terms of are you trying to cap the costs for any individual in the system, which was broadly what the Dillnot report, remember in 2011, Andrew Dillnutt, the economist, who was asked to look into that, his approach was to say let's try and cap the costs that any individual has to face. And he's put a low cost, actually pretty low 35,000. So no one will have to spend more than that on their care. So that's one way of doing it
- [18:46]
Adam Fleming
and that's what Boris Johnson was going to do, but with a higher cap,
- [18:49]
Ben Chu
at a higher cap of 86%. So accepting the principle, but putting in a higher cap another way is to increase the means test threshold so people do get state funded support, but only as Alison was saying, if their means are below around £23,500 you could raise that significantly so more people get the benefit of the state funded support to maybe £100,000. Again that's what Boris Johnson planned to do, that's what Theresa May planned to do and that's what Dillnot proposed. So that's another way. And then you could go, well let's just say what people get for free, go to down the Scottish route for example and say people get free personal care or say really ambitious, a national care service. So basically it's like the NHS free at the point of use. Now full credit to the Health foundation because they've done some kind of really good costings of these proposals. They estimate to do the cap on what people have to pay over the lifetime of £86,000 would cost in today's money around an extra £4 billion a year. So this is on top of that £30 billion I mentioned earlier. So it costs a bit of money. It's not revolutionary. That may be the kind of organic thing that the government could do to do the Scottish system free personal care guarantee. They estimate in England that would cost another seven and a half billion pounds a year in total spending. And to go full on NHS style care system, that's really quite significant. That's about 18 and a half billion pounds according to the Health Foundation's calculations, extra a year on top of the 30 billion. So they're the kind of ballpark figures. We don't know what Casey will recommend or what Burnham will pick up. But that gives you a sense of the extra spending involved.
- [20:34]
Adam Fleming
And Alison, this is a really hard question for you to answer, so I apologize in advance. But putting together all the clues. So Louise Casey has said quite a lot about what she's trying to achieve. The Prime Minister has said quite a lot today and has said quite a lot in the past. Which, which of those many options we were just brainstorming there seems like the most likely one or have they not given away any clues about that.
- [20:54]
Alison Holt
So I spoke to Louise Casey this morning and she was saying that first off, she thinks that there are a lot of efficiencies within the system getting rid of that duplication that we've talked about between the NHS and social care. So I think she thinks that relatively quickly you can start to see a difference if you. As to the big picture. Do you know, I wouldn't want to bet on any one of them, because what they've also launched today is what they're calling the big conversation on care, where they want to tap into the values that drive us as a society and what we feel is right in terms of what we should be providing people with who need social care. And also what are the trade offs, how much are we prepared to pay? And. And they seem to be putting a lot of weight on that, both in terms of shaping reforms, but I would also say in terms of putting pressure on the politicians to, you know, knocking their heads together effectively and saying, come on, you've got to agree, a solution. Because if you do have a clear idea of what we as a society think, then in theory that should push politicians to a solution and we can
- [22:08]
Adam Fleming
talk about the politics in a second. But just in terms of the trade offs, I suppose the trade offs that have always existed in this conversation, since I've been covering it, is do you have a situation that provides certainty for every single person but is funded a bit by everyone who might not experience those circumstances, or do you leave people to deal with it with their own resources? Or do you have a mixture of the two, where this state steps in once you've lost all your resources or to prevent you losing all your resources?
- [22:38]
Ben Chu
Yeah, I think it's basically, do you
- [22:40]
Adam Fleming
pay for everything or do you pay for a bit?
- [22:42]
Ben Chu
Well, what you kind of described, the second option is what we kind of have at the moment, because the state does step in, but only when you're. You've got used up most of your money. So it's. There is state support and it's relatively significant in terms of the overall cost, but it's not enough. It doesn't meet people's expectations. So what. In terms of what Alison is saying in the big conversation, we do need to decide as a nation what we are, what we think is fair, and then we need to decide how we are going to fund it. It and how we think it's a fair way to fund it as well. So these are. This is why it's founded attempts over the past 2015 years is because we've not got that clear as a society, as a country on, on those issues and whatever we do, they can't move
- [23:22]
Adam Fleming
on because labor wanted it to be a form of inheritance tax and the Tories said, oh no, we want it to be a cap on the cost so that no one faces catastrophic costs, but you probably will have to pay something. That's been the dividing line. Jim, we spent ages talking about point one, which is about the Casey review and what he wants her to. To look at point two, the social care workforce so the people who are actually delivering it. And so much of that boils down to the whole 15 minutes appointments thing.
- [23:47]
Jim Reed
Yeah, he talks about that in quite a lot of depth. I thought it was quite interesting that he spent the first bit of that speech talking about how the care, a lot of the care that he'd experienced either personally or through speaking to people was very, very good. And he kept paying, almost patting staff on the back and saying, you're doing a great job, and then went on to the problems afterwards. I think that was deliberate. I think there's this idea that, that, you know, social care is. Is the kind of thing you go into work work for if you have to. It's very lowly paid, it's very lowly skilled and he wants to get out of that kind of bit of the conversation. So he talks about that in quite a lot of detail. And there is this review going on anyway, which should report back in 2028, what's called a fair pay agreement with people working in social care. So what you might, and what he is kind of talking about today is kind of bolstering that or suggesting that can be bolstered up. So that could end up in a situation where there is better qualifications, better standards and e better pay for people working in that sector. Because the idea is if you increase pay for people working on the front line, then you're not going to have all these staffing shortages. And when you speak to people working in care homes and people running care homes, that comes up often as the number one problem in which they're having to deal with not getting enough well qualified staff.
- [25:01]
Alison Holt
Yeah, I think it's crucial. A lot of people work in care because they're passionate about it. They've often had personal experience, perhaps caring for a family member and that has made them want to. To give more so they don't do it for the pay. But increasingly they are being asked to do more and more complex things that might once have been done by A district nurse even, but the pay doesn't reflect that. And one of the things that, that quite often happens is that, you know, people, someone will start climbing the ladder of qualifications and then they'll go to the nhs, because at the NHS they will get paid several thousand pounds a year more for the same, what is virtually the same job. And they will also have a pension. They'll have, it will be a salary rather than zero hours. They'll have the sort of sustainable working life that we all need to live our own lives.
- [26:05]
Adam Fleming
And it's also basic things. I just remember hearing a piece on the Today program about carers not being paid for the car journey from house to house, even though they're still on the clock and they're still working and just what a drain that is to know that that's how you're employed.
- [26:18]
Alison Holt
Yeah. And one of the reasons for that can be the way in which they're commissioned, the way in which that care is bought by local authorities. They don't all do this, but some will just pay for the time in front of the client. And, well, what happens when you're getting from A to B? And if that's not factored in, your pay is very, very low.
- [26:42]
Ben Chu
It is worth bearing in mind, Adam, that the way that the care is delivered in terms of, as Alison was saying, local authorities commissioning these private independent providers to providers, is very different from the NHS system, obviously, where it's sort of a state run system. You can imagine though, the cost implications of putting care workers on a similar status to NHS workers in terms of their ability to push for higher pay. Now that may well be a sensible thing to do in the long term to keep costs down for all the reasons we've been discussing. But you can imagine concerns in the treasury of putting this permanent workforce in a kind of putting them on par with NHS workers in terms of the costs there. So I've been talking about the cost of kind of delivering it in the current system to do a complete overhaul and as I say, put them on a par with NHS workers. The cost will be even higher. And it is worth saying if they do go for those more expensive options, it's very hard to see how they can deliver that without putting up taxes. And that will be a political consideration
- [27:39]
Adam Fleming
when again to compare the care workforce to the nhs. You can imagine a world where the, the, the care workforce, which is now one thing, goes on strike overpay, like resident doctors and nurses and consultants have done.
- [27:51]
Ben Chu
Yeah. The delivery mechanism that they have at the moment has been a way for the treasury to, to keep the cost down. Now, you can say that's bad or that's good for various reasons, but losing that mechanism will be a concern for the treasury for sure.
- [28:02]
Alison Holt
One of the, the things the Prime Minister announced today was that there was going to be, there is going to be a ministerial committee that I, I get the impression is there to drive through change. It will include the Health Secretary, Housing Secretary, but also John Healy, the Chancellor, which is really interesting because. Because talk to anyone who's been involved in past plans for social care reform and they say you have to get the treasury on board if you actually want to make change. So again, I think that's quite an interesting indicator that they're tying the treasury in at that very early stage.
- [28:42]
Adam Fleming
Well, that just reminds me of when I was the chief political correspondent and doing the Tory version of this every single day and trying to get my head around it at 5 o' clock in the morning. And yeah, I mean, they did get the treasury in on board that time, but it involved a quite large increase to national insurance contributions, which they called the Health and Social Care levy. But there was a whole argument about the fact that it would go to the NHS for the first few years and then gradually the amount the NHS got would go down and then the care system, it would gradually go up.
- [29:08]
Ben Chu
And it's worth thinking about the history of that because what happened to it, it was cancelled by Liz Truss and eventually Rishi Sunak's and their explicit argument was this isn't the time to be raising taxes, so you're gonna run up against that same argument. Putting up taxes is going to make the economy less progressive. It's unfair on people to pay more in taxes. It's going to hold back economic growth. So Burnham, if he does want to fund this through a tax rise, will have to deal with all those objections.
- [29:34]
Jim Reed
And if you look at the comparison with the NHS again, the NHS recently announced in England a 10 year workforce plan. So you've got long term planning, you don't have that for social care at the moment. I think that's one of the things when you talk to people who run care homes, they would really like to see a bit more long term planning. But also it's interesting how now that subject butts up against other bits of government policy, not least immigration policy. A lot of people working in care homes come from overseas. There's lots of pressure on migration and kind of cutting that number down as well.
- [30:01]
Adam Fleming
So people say the health and social care Visa was abused.
- [30:04]
Jim Reed
Exactly. These are not easy questions for the Government to deal with in isolation.
- [30:08]
Adam Fleming
Right, point three that Andy Burnham made, and we've spent about two hours on the first two points, so let's do this one quite quickly. It was the cross party talks that he wants, Alison. You hinted at that earlier on. Here is Andy Burnham answering your question, Alison, about how those cross party talks will go better than. Than previous cross party talks.
- [30:23]
Andy Burnham
If I look back to that experience that I had as Health secretary in the 2005-2010 parliament, we probably left the reform too late in that Parliament and it got too close to a general election. And learning from that, that's why I'm bringing forward one of the reasons why I'm bringing forward Louise's review, because I think it's better to do it sooner and further away from an election. And that answers another story for the media, doesn't it, that there's no election on the horizon. I think it's best to deal with it early and to listen, because often what we can do is then drop a solution out late, engage now, now, don't have cross party talks when a solution is emerging again, which is what we did back then, build it with people. So do it now. Get people in now and start talking, understanding the different perspectives. I don't know whether it's possible to find agreement, but let's give it a try.
- [31:32]
Adam Fleming
But where they've ended up is Ed Davy, the Lib Dem leader, zooming in from his holiday. Kemi Badenok, the Tory leader, not going and sending, Stuart Andrew, the Shadow Health spokesperson, and the Greens and Reform not invited at all because they don't count as the two main opposition parties in Parliament.
- [31:49]
Alison Holt
Yes, it doesn't bode particularly well, but I mean, Andy Burnham on the inviting the Conservatives and the Lib Dems, said that they had asked for a discussion with him. So. Well, let's hope. Let's. Let's see what comes out of it. I mean, I think its political agreement is important, but in the end, we have had attempts at cross party talks before.
- [32:17]
Adam Fleming
Even quite recently.
- [32:18]
Alison Holt
Quite recently. You know, also. Well, the last decade we've had had a lot of cross party talks. In the end, it's about the action at the end of it, and there is not that much time. I mean, by the time Louise Casey delivers her report next summer, there will be under two years to the next general election.
- [32:41]
Adam Fleming
And as we know in politics, summer stretches out to sometimes November, when they want to do things slowly.
- [32:47]
Alison Holt
I think there's a real Danger that we will end up tight against the next general election or too tight against the next general election. But there is also, you know, this has gone on for a long time. It is having an impact on the nhs. More importantly, it is having an impact on a huge number of people's lives. So at some point we do have to, you know, forget the cliche, but grasp the nettle and do something.
- [33:12]
Adam Fleming
And, Ben, the Tories have already named their price for agreeing to any solution. They say no tax rises and no extra borrowing to pay for it.
- [33:18]
Ben Chu
Yeah, well, given the numbers we've talked about, that's very. Going to be almost impossible to square, isn't it? If Andy Burnham wants to do anything which is comprehensive and ambitious.
- [33:26]
Adam Fleming
Well, unless the Tories would say you cut the welfare bill quite a lot and then you could pay for it with that.
- [33:30]
Ben Chu
Yeah, well, that would be their argument. I think it is worth saying cross party talks is one thing, but intra party talks, because there's been a lot of disagreement within parties about how to deal with this. So David Cameron had a plan which Theresa May tore up, saying the Dilnutt plan was unfair. Boris Johnson had a plan and that was scrapped by Rishi Sunak and Liz Truss because it raised taxes. So it's very, very difficult to even get agreement within a single political party, let alone across 3, 4, 5 parties on how to approach this.
- [33:59]
Adam Fleming
Alison, just another question that came up at the. The PM's event today. Sam Coates from Sky pushing him for a position on assisted dying. And here is what Andy Burnham said.
- [34:11]
Andy Burnham
My position on assisted dying, I. I take the view that that debate, and I don't say that there shouldn't be a debate at some point about those issues. Personally, I think there's something that needs to happen first and that's the fixing of the funding of palliative care and social care. I think it is very challenging to introduce that wider debate in a context of people not receiving that care and having the peace of mind about that care.
- [34:49]
Adam Fleming
Right, so that's Andy Burnham clearly thinking on his feet there. Jim and Alison, think on your feet. Now, what have we gleaned from that answer, if any?
- [34:56]
Alison Holt
I thought it was really interesting that he was tying that big issue that as a society we are wrestling with into improving social care and palliative care. And it's certainly one of the strong arguments that has been made is that if you get that care better, if you improve it, make it easier to navigate, then people will not feel a burden. As, you know, obviously they're Not a burden. But, but, you know, it will make it easier to, it will encourage people not to, to go for assisted dying. But, but I'm afraid I'm, I'm, I haven't got any deep thoughts.
- [35:37]
Adam Fleming
No, sorry. That sounds pretty deep to me. I mean, if that was, if that was shallow, I mean, I'm impressed, Jim.
- [35:43]
Jim Reed
Yeah. I think the flip side, in a way of what Alison's saying, and this is the argument that people use, is that if you have poor palliative care, you might end up in a situation where people are pushed into choosing assisted dying when they, they don't need to. And this is an argument which has been used very much last year through, through all the debates. I thought that the answering on his feet thing, I think is a really important point because it did feel like he was literally not making up that answer. But you could hear the kind of the cogs working as he was saying it. And he's, you know, he's a very inexperienced Prime Minister. Let's be honest here. I want to if that comment, how that comment is going to play out when we get into September and potentially a new backbench bill that goes through the whole process all over again. He did say there should be a debate, so he certainly wasn't ruling out that coming forward, but he certainly did
- [36:29]
Adam Fleming
is a debate the same as legislation.
- [36:30]
Jim Reed
And he did not seem, overall, he did not seem particularly keen, did he? I think is a fair way to go on that idea.
- [36:35]
Adam Fleming
And rather than being neutral on it. Yeah, he sounded like he was opposed to the government. The Prime Minister would have been neutral.
- [36:42]
Jim Reed
The other thing I thought was really interesting is when he brought up the US healthcare system system and he said that social care in the UK or in England at the moment is as unfair as the US health system. And I kind of looked up when he, when he was saying that. I think that is quite a bold statement to make when you think about the media narrative in this country and people think about the US system as failing. An interesting comparison, I mean, well, we
- [37:06]
Adam Fleming
could do a whole other podcast doing that essay question, what are my thoughts? Alison, last question to you. And there's so much commentary about Andy Burnham's comms and his delivery and his demeanor and what he's wearing that day and whether it's the appropriate dress code for meeting a foreign leader at an aircraft carrier. There was an interesting moment at this event today, wasn't there? What I'm, and I'm not clear what was actually going on there with the notes. No, Notes thing.
- [37:31]
Alison Holt
I didn't see any notes at all
- [37:33]
Adam Fleming
because basically not say, oh, I've got a script, but I'm going to throw it away.
- [37:36]
Alison Holt
He did, he started off by saying that, as I say, I didn't notice any notes sitting there, but perhaps, you know, I could have missed that. It certainly felt like he was speaking from the heart on this one. Towards the end I felt like he, he, he was slightly teary in terms of, you know, he was saying, I might fail, but I'm really going to try. And he was talking about his father and you can see how personal it is to him.
- [38:12]
Adam Fleming
I just think on that point, though, he was so fluent and interesting and compelling today. And whether you agree or disagree with what he thinks and what he's doing, the actual performance was quite compelling. Just think back to what Laura was saying at the Weekend On Newscast. I'm sure you all listened to that episode which was saying, Andy Burnham supporters see a slight risk that then the days where he has to stick very religiously to the scripts because he's talking about, about Ukraine or something to do with the finances and it could move the bond market. It'll just become glaringly obvious that that's not the real Andy Burnham that day.
- [38:42]
Ben Chu
But now is the time to do it, isn't there when impressions are being formed of him to pull out all the stops. And I'm sure a lot of it was rehearsed, like a lot of the lines you can tell, and he had a lot of information in there. It was very fluent, as you say, performance. And he made a structured, coherent argument that lasted, what was it, 15 minutes?
- [38:57]
Alison Holt
Yeah, about 15 minutes.
- [38:58]
Ben Chu
So.
- [38:59]
Adam Fleming
And it does hit all the bits of the press release that went out in advance.
- [39:02]
Alison Holt
So few of us, I imagine, are good enough and fluent enough to produce without having thought it through very carefully that point, point, point. So I'm sure that there was practice and there was thought that went behind it, whether or not there were scripts.
- [39:21]
Adam Fleming
I mean, Alison, you've done a fairly good job of that here right now, so thank you very much.
- [39:26]
Alison Holt
So kind.
- [39:27]
Adam Fleming
Ben, thanks to you too.
- [39:28]
Ben Chu
Thank you, Adam.
- [39:28]
Adam Fleming
And Jim, good to see you as well.
- [39:29]
Jim Reed
Thanks, Sam.
- [39:31]
Adam Fleming
And that's all for this episode of Newscast, apart from to say, another big breaking news story today. I can't believe this is true. The BBC has confirmed Celebrity Mastermind will not be returning. Now, obviously we had no prior knowledge of this and learned about it from the press office at the same time as everyone else, because if we had had prior warning about it, we wouldn't have been teasing Henry Zephan about being on it in the near future because that was just cruel. But we obviously didn't know. So we have gone to to Henry Zeffman for comment. He sent us a meme from Peep show of Mark. That's the one played by David Mitchell saying, how do I feel? Empty. Check. Scared. Check. Alone. Check. Just another ordinary day. So at least he is sticking to the one of his specialist subjects as he learns the terrible news that he'll never be on Celebrity Mastermind. Unless maybe another channel wants to pick it up up and buy it from the BBC. Could I start a channel and then pay for it? I don't know. Or could we find a way of recreating it for Henry? And that really is it for this episode of Newscast. It's been a really interesting one though, and thank you for listening to it. We'll be back with another one very soon. Bye bye. Newscast.
- [40:44]
Podcast Announcer
Newscast from the BBC.
- [40:45]
Jim Reed
Well, thank you for making it to the end of another newscast. You clearly oozed stamina. Can I gently encourage you to subscribe
- [40:52]
Adam Fleming
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- [40:54]
Jim Reed
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