Andy Burnham's social care revolution will be swallowed by the system it inherits

I spent twenty years as an NHS doctor and then ran care services, and I welcome the ambition. The system I know is not short of good people. It is short of a plan.

But I have watched enough reform come and go to know how the argument now underway will go. Baroness Casey's review, the row over the triple lock, the question of which taxes might rise: all of it will be about how much money the system needs. That is the wrong place to start. The better question is what the money would buy, and how much of it the system as currently organised would quietly absorb before it ever reached a front line.

Here is one example.

Every care home, home-care agency, GP surgery, dental practice and pharmacy in England is required by law to write, maintain and regularly review a large body of policies and procedures, such as safeguarding a vulnerable adult, handling medicines, managing infection, and responding to a complaint.

And yes, I know policies and procedures aren't sexy. But when they fail, the consequences are what make the front page: a resident given the wrong dose, an infection that runs through a home, a safeguarding concern nobody acted on. These documents matter.

What nobody has noticed is that tens of thousands of separate organisations are each doing this work on their own, from the same national rulebook. A small care provider can spend weeks producing well over a hundred policies, then countless hours a month keeping them current. And nobody knows what it costs. In a country that plans to build a National Care Service, no one in government or the regulators has ever counted it. Multiply a few weeks of a manager's time by every provider in the country and you are not looking at a marginal figure. You are looking at a very large sum of public money, spent producing the same document over and over again, that has never once appeared in a spending review.

This is exactly the sort of thing the Casey review should be looking at. The fix is not complicated: do the common work once, nationally, to a standard everyone can trust, and let each provider adapt it locally. Parts of the NHS already do this. But not social care.

And policies are only the most visible symptom. Britain has the richest health data in the world and the most fragmented system for using it. A hospital consultant, a GP and a care home manager can all be looking after your mother without seeing the same record, because information in our system does not follow the person. Evidence that a service is safe is produced for one body, filed, and produced again for another. We do not have a data problem in this country. We have a coordination problem, and every one of those seams costs money that never reaches the front line.

The NHS, to its credit, has started to admit this. The Government's ten-year plan talks about moving from analogue to digital and giving every patient a single record. Those are now NHS principles too. If Burnham means what he says, a National Care Service has to be built on them from the first day - because a care service that is free at the point of use but still runs on paper, fax and forty different systems is not a new service.

So my plea to Burnham, and to Baroness Casey, is a simple one. By all means argue about how much more the country should spend on care. That argument is overdue. But as Burnham pointed out over the weekend, social care already comes with an enormous price tag. Before adding any extra money at the taxpayer’s expense, Burnham needs to set out, in detail and now, how much of the existing spend should be reprioritised, and make the case for changing how the system works in the same breath. The NHS principle worth borrowing is not just that care should be free. It is that some things are better done once, for everyone.

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Dr Devan Moodley is a former NHS Doctor and chief executive of Health Connect Global and OpenDoc, a health technology company working with more than 1,600 care providers.

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