A comprehensive NHS-style social care system for England could require many years or even decades to become reality, economist Sir Andrew Dilnot has cautioned following Prime Minister Andy Burnham's recent announcements on the issue.
Sir Andrew, who chaired a major commission examining social care reform 15 years ago, indicated that Burnham appears committed to making social care entirely free, including residential accommodation costs. Speaking on BBC Radio 4's Today programme, he stressed that implementing such a scheme would carry "very substantial" financial implications.
With Burnham committing to present his detailed proposals to voters at the next general election, Sir Andrew suggested that meaningful reform has effectively been pushed further into the future. The next general election is not scheduled until August 2029, though Burnham retains the option to call one sooner.
What is adult social care and how does it currently work?
Adult social care provides state-funded assistance to help people maintain independence in their daily lives, including support with household tasks and personal care. Unlike the NHS, which operates free at the point of use, social care in England requires individuals to contribute financially, creating significant financial burdens for many.
Currently in England and Northern Ireland, people whose assets exceed £23,250—including property—do not qualify for council-funded care assistance. Wales operates a similar means-tested approach. Scotland offers a different model, providing state-funded personal care to all adults assessed as needing help with activities such as eating and bathing, though accommodation and living expenses remain subject to means testing.
What are Burnham's proposals and what would they cost?
In an interview with BBC's Sunday with Laura Kuenssberg, Burnham outlined a vision where "everyone contributes, everyone is covered," and he declined to exclude tax increases as a potential funding mechanism. He committed to revealing comprehensive details during his conference speech on Tuesday. However, he indicated that implementation would not occur before the next general election, citing Labour's 2024 election manifesto commitments, which included pledges against raising national insurance, income tax, or VAT.
According to reporting on Burnham's universal social care model, the Prime Minister has already outlined his vision for an NHS-style system. Baroness Casey's review is being used to determine the funding approach, with Burnham indicating that Casey will advise on the optimal implementation method and that cross-party discussions will follow.
The Health Foundation has calculated that a universal social care system in England, with government funding all support, could cost approximately £18.5 billion annually. Burnham has suggested costs would be lower but has not detailed his funding strategy. Sir Andrew believes an NHS-style system could cost "well in excess of £18bn," though a Scottish-style model might cost roughly half that amount.
Labour MP Darren Jones told Laura Kuenssberg that eliminating the pensions triple lock was "an option that the government should consider alongside others" to finance social care improvements. The triple lock pension policy ensures the state pension rises by whichever is highest among average wage growth, inflation, or 2.5%, and maintaining it remains a Labour manifesto commitment.
Why has social care reform taken so long?
Sir Andrew pointed out that if proposals are included in Labour's 2029 election manifesto, this would mark 30 years since former Prime Minister Tony Blair established a royal commission on social care, and more than 15 years since his own commission delivered its findings. He noted that Burnham's recent July speech promising a national care service for England suggested faster progress than now appears likely.
Sir Andrew's own commission proposed a lifetime cap of £35,000 on care costs. The Conservative-Liberal Democrat coalition government, led by David Cameron, accepted these recommendations. However, implementation was postponed to 2020, with Cameron citing public finance constraints, and subsequent Conservative administrations abandoned the proposal entirely.
Other reform attempts have similarly stalled. Theresa May's Conservative government withdrew plans requiring people receiving home care with assets of at least £100,000 to cover full costs after opponents branded the proposal a "dementia tax." When Burnham served as health secretary under Gordon Brown, he proposed a national care service funded through compulsory contributions from people's estates after death—a concept opponents labeled a "death tax." These proposals progressed no further following Labour's defeat in the 2010 general election.
What is the timeline for the Casey review?
Baroness Casey's review is examining England's social care system in two phases, with an initial report on a national care service and a subsequent report on funding mechanisms. The review's first report is scheduled for 2026, while the funding phase is not due until 2028. Casey has stated that "everything is on the table" in the review's consultation regarding who should receive care and how it should be funded.
Burnham was a co-author of the Brown government's 2010 white paper that outlined plans for a free-at-the-point-of-use National Care Service, demonstrating his long-standing commitment to comprehensive reform in this area.
What happens next?
Burnham is scheduled to present his next comprehensive set of proposals during his conference speech on Tuesday. Baroness Casey's final recommendations on how social care should be administered and financed are now anticipated by summer 2027, providing a clearer picture of the government's direction on this critical policy area.
Sir Andrew expressed that while he would "love to see such a scheme" where all social care receives government funding, "the cost would become very, very large." He suggested that a system capping the amount individuals must contribute toward their care "could still work well for elderly people," offering a potentially more achievable middle ground between current arrangements and a fully universal model.
