New leader, new direction?
Where will Andy Burnham take health and social care?
Andy Burnham has been notably quiet about the future direction of the NHS under his premiership. Yet our health system may be approaching its most significant transformation yet: a systemic shift towards a model that is integrated, community-based, and regionally managed. So, what do we know about where he may take the NHS?
Empowering regional leadership
Burnham believes that devolution, place-based working, and the mayoral model offer the best route to delivering truly integrated public services.
The principle is straightforward: local leaders are best placed to understand and respond to the distinct health challenges and population needs within their own communities. According to Simon Opher, MP for Stroud, ‘Delivery demands one thing above all: real devolution of power, budgets and control.’ (New Statesman 2.7.26)
By empowering regions, local systems can test new ideas and approaches on a manageable scale before successful initiatives are expanded and adapted to meet the needs of different communities.
Prioritising prevention
Drawing on his experience as both a former Health Secretary and former Mayor of Greater Manchester, Burnham has ambitious plans for the future of health and care. According to Alastair McLellan writing in the Health Service Journal:
‘Mr Burnham is comfortable with the “three shifts” that constitute the government’s proposed health reforms. But where Starmer/Streeting placed the shifts in the following order:
analogue to digital
hospital to community
treatment to prevention
Mr Burnham will reverse that priority.’
In 2025, as part of the Government's 10-Year Health Plan, Greater Manchester was selected as England's first Prevention Demonstrator site, exemplifying a community-focused approach to public service delivery. This model emphasises investment in the foundations of everyday life, such as housing, air quality, and access to education and employment opportunities, as the fundamental components of health and key to preventing ill-health rooted in social and economic inequalities.
The approach brings together health and community services at neighbourhood level, with the VCSE sector playing an integral role. In doing so, it provides a potential blueprint for the rest of the country.
By addressing the underlying causes of health inequality, it is anticipated that, over the long term, this model will enable people to live healthier lives for longer while reducing pressure on acute and crisis services.
The future of the NHS
Burnham's emphasis on devolution contrasts with the Government’s recent centralising approach to the NHS and he has been critical of the merging of ICBs.
As a result, further restructuring may follow, with NHS organisations becoming more closely aligned with mayoral boundaries and neighbourhood health services redesigned to involve local authorities far more directly in planning and delivery.
The future of social care
Burnham’s vision extends to integration between health and social care, creating a national care service which mirrors the universal nature of the NHS and aims to eliminate current inequalities in social care provision.
This model would spread financial risk across the population as a whole, protecting individuals from high care costs while creating greater stability within the care provider market.
In practice, this would mean that a person's journey from hospital to home would be coordinated by a single, integrated team with a full understanding of both their medical needs and their home circumstances. By pooling budgets and reducing administrative complexity, a National Care Service could enable people to leave hospital as soon as they are clinically ready, improving patient outcomes while freeing up hospital capacity.
Conclusion
Taken together, these proposals point towards a markedly different vision for health and social care: one that is locally led, prevention-focused and built around the needs of communities. It represents a significant departure from the more centralised model that characterises recent NHS reforms.
As Jeremy Hunt (Health Secretary 2012-2018) has argued, as Prime Minister, Burnham will have a unique opportunity to turn the world's most bureaucratic health service into one of its most innovative. However, this scale of change requires sustained political commitment. With only three years until the next general election, the immediate challenge may be less about completing the transformation than establishing a direction of travel that integrates health and community provision.
References
Devolution is the best medicine for the NHS - New Statesman
What a Burnham premiership will mean for the NHS | Leader | Health Service Journal
England’s First Prevention Demonstrator: Opportunities for Greater Manchester and its VCFSE sector