By Lord Bethell
Andy Burnham stood in a London care home on 29 July and spoke about his father, who lives with Alzheimer’s and does not know that his son is Prime Minister. “It is very, very personal for me right now and for my family,” he told the room. “We’ve kind of lived it in the last few years from the inside.”
Anyone who has cared for someone they love through dementia felt the force of that. I have. The slow goodbye is the hardest grief there is, because it begins years before the funeral.
His diagnosis is right too. As a health minister I watched the border between the NHS and social care become the place where good policy goes to die. Burnham gave the numbers himself: last month 13,600 people in England were medically fit to leave hospital and could not, largely because the care was not there for them, while around two million adults live with unmet care needs. It is nearly thirty years since the Royal Commission on care and, as he put it, “it’s shameful, to be honest, that politicians have put point scoring before fixing this issue.”
His best line deserves to stick: “Social care in England is as unfair as American healthcare. The vulnerable pay with everything.”
So this is not an argument against fixing care. It is a warning from someone who has sat in the room where big announcements are drafted. The real decision in any announcement concerns the people who are not in the room, the ones who will carry its costs without ever being named in it. This plan will be judged by what it does to them.
Start with the money. Burnham has accelerated Baroness Louise Casey’s commission to report by summer 2027 and promised fair pay agreements for care workers from 2028/29, saying they “should be the best paid people in society, not the worst”. Decent instincts. Expensive ones. The Health Foundation calculates that merely meeting demand in England will take an extra £8.3 billion a year by 2032/33, and that meeting demand while improving access and paying providers properly will take £18.4 billion.
Unless he breaks his party’s pledges on income tax, National Insurance and VAT, that money will be found inside the health envelope. The first budgets raided will be the ones with no lobby in the room: prevention, research and new medicines.
“…a country serious about dementia must build what makes new medicines affordable: early detection, cheap diagnostics and trial ready patients.”
That would be a historic error, because we are finally winning. Jeffrey Cummings’ annual pipeline review counts 158 dementia medicines in 192 clinical trials this year, up 40 per cent in a decade, with three quarters aimed at the disease itself rather than its symptoms and eight Phase 3 trials due to report in 2026.
Blood tests that can detect Alzheimer’s from a routine sample are recruiting in NHS memory clinics right now through the ADAPT and READ-OUT studies. Britain hosts roughly one in ten of the world’s Alzheimer’s trials, yet fewer than 1,000 of our 600,000 people living with dementia are enrolled in a Phase 3 study. The science is sprinting. The system is strolling.
Here is the fact that should haunt the Treasury. In June 2025 NICE rejected lecanemab and donanemab, the first licensed drugs shown to slow Alzheimer’s, ruling their benefits “too small to justify the additional costs” to the NHS. Dementia already costs the UK £42 billion a year, on course for £90 billion by 2040, and most of that bill falls on families.
The lesson is not that NICE was wrong. It is that a country serious about dementia must build what makes new medicines affordable: early detection, cheap diagnostics and trial ready patients. Care spending manages the cost curve; only science bends it. A care settlement that starves research is a promise to pay these bills forever.
Then there is the fiscal timebomb. The Office for Budget Responsibility reported in July that the triple lock will cost £15.5 billion a year by 2029/30, three times the forecast when it was introduced, and that state pension spending is heading from 5 per cent of GDP towards 9 per cent.
The over 60s now hold £3.84 trillion of Britain’s housing wealth, the majority of it. A universal care settlement funded from general taxation is therefore a transfer from working renters in Leigh and Golborne, the towns Burnham represented for sixteen years, to the wealthiest generation in our history. And the young get nothing like the pensioners’ guarantee. They will fund this settlement across their entire working lives with no certainty it survives until they need it.
David Willetts warned about exactly this bargain in The Pinch sixteen years ago, and every row since, over the bus pass, the winter fuel payment, the triple lock itself, has been a skirmish in the same generational fight. Care is the main battle. Mishandled, it could detonate under this administration.
Burnham knows the stakes. “This time we’re going to do it, right. We’re going to do it.” I believe him. Kemi Badenoch and Ed Davey were right to accept his invitation to talks. Here is what belongs on the table.
The Casey settlement must be twin track: for every pound of new money into care, a committed share into prevention, early detection and treatment. Michelle Dyson at the Alzheimer’s Society made the point within a day of the speech: “Getting social care right depends heavily on getting dementia care right, making the most of the new opportunities afforded by scientific breakthroughs.”
Her organisation’s polling finds four in five people want dementia made a national priority. This is not sentiment. Every case prevented or delayed is a carer kept in work, a hospital bed freed and a care package never commissioned. At The BARBARA Alliance, which I chair, we are building the national registry that will let anyone living with dementia, or at risk of it, volunteer for a clinical trial as easily as booking a jab on the NHS App.
Prime Minister, your father’s generation needs care and your children’s generation needs a cure. Write both into Casey’s terms of reference. Anything less will be remembered not as reform but as a transfer.
Andy Burnham | Baroness Louise Casey | Kemi Badenoch | Ed Davey | Michelle Dyson | Jeffrey Cummings | David Willetts
Lord Bethell is a former health minister and chair of The BARBARA Alliance.