The debate over health care is long overdue The welfare state was originally established, wrote William Beveridge, to combat five giant evils: squalor, ignorance, want, idleness and disease. To these, Andy Burnham has added a sixth: "fear of old age." The shadow health secretary has a point. Over the next 20 years, the number of people over 65 will grow by half, imposing crippling costs on the NHS. Already, thousands of beds are occupied by those whose conditions - in particular dementia - are a product not of accident or disease, but the passage of time. Given that there is no money left to throw at the problem, the only solution is a radical change to how the health service works. This, to his credit, is something that Mr Burnham accepts wholeheartedly. In a speech to launch Labour's policy review on the subject, he proposed the same solution advocated by the Health Select Committee: investing in prevention rather than cure. Between 30 and 40 per cent of beds, he claimed, are occupied by elderly people who could be looked after at home - and handrails and home care are far cheaper and more popular than long hospital stays. So the basis of Labour's health policy will be to force mental health, medical and social care services to work together in the patient's interest. He pointed to the example of Torbay, where preliminary moves towards such a unified service have already resulted in significant improvements. Mr Burnham also spoke powerfully about his sister-in-law's experience with breast cancer, and about the NHS's current shortcomings (which will be highlighted again when the imminent report on lethal failings by the Mid Staffordshire Trust is published). Of course, making different bureaucracies work together is easier said than done - and many of Mr Burnham's other ideas were plain bunkum. He promised not to repeat the Tories" reorganisation of the health service, yet pledged to repeal not just Andrew Lansley's Health and Social Care Act, but "the rules of the market": a colossal upheaval. Where he condemned competition in the health service, we see it as vital. As for his ideas on social care, the suggestion of a compulsory levy, paid irrespective of need, should ring alarm bells: the last thing the middle classes need is another tax. Overall, however, this speech was both welcome and long overdue. Previous attempts to discuss such grave issues have all too often been shot down by hyperbole about "death taxes" or mindless invocation of the NHS's sacred-cow status. Now, at long last, all sides accept that the health and social care system must be transformed if it is to be preserved. Even if the parties disagree about the nature of reform, the fact that there is suddenly space for proper debate, rather than hysterical mud-slinging, is a very good thing indeed.