From Manchester to Westminster: How Andy Burnham's social care revolution could play out

Social care in England has spent too long in a holding pattern. The structural pressures are well understood, the reform agenda has been articulated many times over, and the consequences are being felt in every local authority area.

Yet previous governments have promised transformation and delivered deferral. When Sir Keir Starmer’s administration postponed the introduction of a care cost cap, as recommended in the 2015 Dilnot Report, until 2028, it highlighted a broader pattern: structural reform of social care funding requires a level of political commitment that has historically evaporated when it meets fiscal reality.

Past attempts to find financial headroom to invest in social care have both failed to deliver and ended political careers on being labelled ‘death tax or ‘dementia tax’.

Andy Burnham's arrival in Westminster should change the terms of the debate. Having spent nearly a decade reshaping health and care in Greater Manchester – integrating services, championing neighbourhood working, and insisting that housing, employment and community were as important to health as clinical intervention – he brings to Number 10 not just a reform agenda, but a lived model of what reform can look like in practice.

The crucial question for councils, providers, carers and families is whether what worked in Manchester be made to work for England?

Why social care is personal for Burnham

Social care is not, for Burnham, an abstract policy brief. As Mayor of Greater Manchester, he saw at first-hand how a fragmented system – featuring health and social care operating in silos, housing agencies disconnected from care commissioners, and employment support running on separate tracks – produces worse outcomes and higher costs.

He also saw that the market model underpinning adult social care was producing systemic instability, with providers operating on thin margins, a workforce chronically underpaid and undervalued, and local authorities trapped in commissioning cycles that prioritised price over quality.

It is against this backdrop that Burnham has signalled a desire to rethink care as a public service rather than a market commodity, drawing a parallel with his stated positions on utilities and transport. For those operating in the sector, this signal carries obvious implications, even if the precise policy design is still to be worked through.

What Burnham has announced in adult social care

The Prime Minister has asked Baroness Louise Casey to fast-track her final review, originally due in 2028, to summer 2027, with the review examining how to build a National Care Service that integrates with the NHS.

Alongside this, Baroness Casey launched the “Big Conversation on Care”, a public engagement initiative seeking the views of up to one million people, due to conclude by April 2027.

Burnham has also announced plans to expand the existing social care fair pay agreement into a broader workforce reform that aims to improve pay, training, job security and career progression for care workers, including creating progression routes from social care into NHS positions.

Conservative and Liberal Democrat leaders have been invited to cross-party discussions, reflecting his awareness that durable change requires a degree of political consensus that has eluded every previous administration.

The vision of an NHS-style model for adult social care is enormously ambitious and whatever vision the government pursues must be rooted in reality. The sector features a broad range of for-profit and not-for-profit organisations, the vast majority of which deliver excellent person-centred care.

There are particular questions around the independent sector. Suggestions that public funds may be restricted to non-profit providers would require careful consideration of how responsibilities are transferred and how councils maintain access to existing high-quality provision. Continuity of high-quality services that support independence, health and wellbeing must be the priority in any change project involving care.

As we have seen with healthcare, however, there continues to be an important role for private providers for those who choose a higher standard of care, and we would expect to see this replicated in adult social care.

Developments in children's social care

The government has confirmed five new regional care co-operatives (RCCs), bringing the total to seven and extending the model to more than 100 local authorities across England.

RCCs are partnerships operating across multiple local authority areas to deliver better outcomes for children in care. The development of RCCs predates Burnhams premiership, but demonstrates a model for care that recognises some services are delivered best at a regional level. This footprint will be familiar to Burnham from his days as Mayor when Greater Manchester was an RCC pathfinder region. From pathfinder experience, this model has real potential to shift the dynamic in local children's care markets.

Alongside RCC expansion, four new fostering hubs will go live before the end of the year, a consultation has launched on new simplified fostering standards aimed a reducing process and focusing on outcomes, and applications have opened for the £23.1m Home Again programme.

This will fund up to five RCCs to provide children with the most complex needs – those at risk of being deprived of their liberty – with a single, co-ordinated plan drawing together social care, health, education and youth justice.

The decision to reframe fostering standards around quality and relationships, rather than minimum compliance requirements, is both welcome and overdue. The emphasis on enduring, loving relationships as the organising principle for the standards reflects a maturing understanding of what children in care actually need – not bureaucratic process, but stability, trust and belonging.

The Home Again programme addresses what is arguably the most intractable challenge in the current system – children whose needs are so acute, and whose situation so complex, that the system has too often responded by attempting to contain rather than genuinely support them.

“The aspiration to bring social care, health, education and justice together around a single tailored plan for each child is exactly the right instinct. The harder question, as with so much in this reform programme, is whether system partners can be brought together in a genuinely collaborative way, rather than simply co-ordinated on paper.

What 'Manchesterism' tells us about what comes next

The most useful lens through which to understand where the Burnham government is heading is not a policy document, but a philosophy. At its core, 'Manchesterism' rests on a conviction that the right answers to complex social problems are rarely found in Whitehall, and that places, communities, organisations and people closest to the challenge are better positioned to design effective responses.

This conviction has practical implications. Greater devolution of power and budget to regions and places is already one of Burnham's first major policy positions.

On neighbourhood working, the Greater Manchester model, and initiatives from authorities in the region, have often been cited as exemplars of how to reduce avoidable emergency admissions, support earlier intervention and ease pressure on acute services.

The likely continuation of local government reorganisation will help bring together a broader set of local services, facilitating a more holistic approach to care – one that recognises, as the Manchester experience has shown, that factors such as employment and housing have a significant impact on care outcomes.

The Wigan Deal – a pioneering public service reform created by Wigan Council over a decade ago that fundamentally shifted local government from a top-down service provider into a true partnership with communities – continues to be held up as an example model of how to take the public on a journey to transform how local services are run. Work with Greater Manchester has continued in recent years under the “Progress with Unity” banner.

As a champion of local empowerment via devolution, and with a constituency within Wigan, Burnham will be well aware of the lessons that can be learned from this exercise in having honest conversations with citizens and stakeholders about the systemic challenges and constraints that exist, and the solutions available, even if they aren't going to be universally popular.

On workforce, 'Manchesterism' insists the people who deliver care are not an afterthought to system design – they are the system – and they are also citizens within the community who contribute to its prosperity.

Burnham's commitment to improving pay, training and career progression for care workers represents a genuine departure from a tradition in which workforce has too often been treated as secondary to structural reform, and an asset to be deployed for service delivery.

Approaches to the private sector are currently less clear. Burham’s track record indicates a willingness to work constructively with the private sector, though also a recognition that some public services require a degree of public control and even public ownership rather than reliance on markets.

At the same time, we see messaging from government, particularly in the area of children’s services, about the need to eliminate profit. What is clear, particularly from recent messaging on public value criteria in contracts, is that organisations seeking to work with local and national government will be expected to demonstrate they are investing in citizens and communities, such as through work to support people into high-quality employment.

The challenges ahead

The government should consider where capacity for implementing reforms will come from at a time when local government reorganisation and devolution is already consuming significant time and resource within local authorities.

The outcome of the Casey Commission is just the start – planning will need to begin now if the sector is to transition toward a new model of care from 2027.

For those operating in the sector today, waiting for a comprehensive national settlement before acting is not a viable strategy. The direction of travel is clear, with an emphasis on collaboration to deliver outcomes that reflect the priorities of neighbourhoods and communities.

The organisations navigating this best are those planning for a range of outcomes, identifying what can be done now with partners, and pursuing a vision that works for their place.

Burnham has arrived at Number 10 with a clearer sense, via his Greater Manchester proof of concept, of what social care reform should look like than any Prime Minister in recent memory,

Whether Manchesterism can be scaled, political commitment can be sustained, and system can absorb transformation on multiple fronts simultaneously will ultimately determine the success of this mission.

James Arrowsmith is a partner at Browne Jacobson.