Prime Minister Andy Burnham has unveiled plans for a universal social care service modelled on NHS principles, available without charge at the point of delivery. He framed the initiative as essential to address England's severely underfunded social care infrastructure and committed to presenting a comprehensive strategy to voters ahead of the next general election.
Speaking to a national broadcaster, Burnham stated that deteriorating social care systems pose an existential threat to the NHS itself. He described his proposed system as one in which "everyone contributes, everyone is covered", though he acknowledged the details would differ from how the NHS is currently funded. According to reports of his conference speech on Tuesday, Burnham will set out more detailed proposals for the universal model.
How would the system work?
Burnham's model would operate on NHS principles to ensure sustainability and fairness. Unlike the current system in England and Northern Ireland, where people with savings above £23,250 are not entitled to council support with care costs, his proposal would provide free personal care to all adults assessed as needing help with tasks including eating and bathing—similar to the system already available in Scotland. Burnham emphasised that the changes would have to be "done carefully, without putting extra strain on the public purse" and that "nothing is off the table at this moment in time" regarding funding mechanisms.
What are the financial implications?
Shadow Home Secretary Chris Philp cautioned that funding such a scheme would likely necessitate additional tax increases, framing this as a core boundary that cannot be crossed in any potential agreement on social care reform. When informed that estimates suggest a free-at-point-of-use system for all of England could cost taxpayers £18 billion annually, Burnham replied: "It's not that high." He noted that people already face substantial costs under the current system and compared England's social care arrangements unfavourably to American healthcare, saying the most vulnerable "can lose everything, they can be wiped out".
Burnham has previously declined to rule out tax increases as a means of financing social care reform. However, he also noted constraints from Labour's 2024 manifesto commitments not to increase national insurance, income tax or VAT. He stated: "I'm going to say that we stick to the manifesto because I have to keep people's trust, and there are commitments in the manifesto that would make it hard to do in this Parliament."
How will the plan be developed?
Burnham has invited opposition parties to participate in discussions on social care reform, signalling an attempt to build cross-party consensus on the issue. Whitehall troubleshooter Baroness Casey, who is conducting a review of social care, will advise on the "best way of doing it". Casey's review is being conducted in two phases, with an initial report due in 2026 and a funding phase not due until 2028. Burnham said that "everything is on the table" in the review's consultation on who should receive care and how it should be paid for.
Burnham stated: "I don't think you can reform this system without consensus. I will develop a very clear plan and I will put that plan to the public at a general election and that will be where the plan gets tested and people will then be able to decide."
Background: Burnham's long-standing commitment to care reform
Burnham's announcement builds on earlier warnings that the NHS faces potential collapse without urgent social care reform. He was a co-author of the Brown government's 2010 white paper that set out plans for a free-at-the-point-of-use National Care Service. Burnham has made reforming social care one of his flagship policies and has spoken of the experience of his father Roy, who had Alzheimer's and died recently.
What happens next?
Burnham intends to complete detailed planning for the national care service ahead of the forthcoming general election. Baroness Casey's final recommendations on how social care should be run and funded are now expected by summer 2027, with cross-party talks to follow on the proposals.
