What is Prime Minister Andy Burnham proposing for social care in England?

Prime Minister Andy Burnham is proposing an NHS-style social care system for England. He aims for a system where "everyone contributes, everyone is covered," potentially making social care completely free, including residential costs.

What are the main concerns raised about this proposed system?

Economist Sir Andrew Dilnot has raised concerns that the system could take decades to implement and would incur "very substantial" costs, potentially "well in excess of £18bn" annually. Funding mechanisms, such as tax rises or changes to the pensions triple lock, are also a concern.

When does Prime Minister Burnham expect to implement these changes?

Prime Minister Burnham has indicated that any proposals would not be implemented before the next general election, which is not due until August 2029. He plans to put his vision before voters at that election.

How does social care in England currently differ from the NHS?

Unlike the NHS, social care in England is not free at the point of use. Individuals with assets exceeding £23,250, including their home, are not currently eligible for council assistance with care costs.

NHS-style social care system for England could take decades, cost billions

A proposed new social care system for England, modelled on the National Health Service (NHS), could take decades to implement and would incur "very substantial" costs, economist Sir Andrew Dilnot told the BBC on Monday.

Sir Andrew, who led a commission that proposed reforms to the social care system 15 years ago, said Prime Minister Andy Burnham's vision for a completely free system, including residential costs, would be expensive. He told BBC Radio 4's Today programme that the cost of such a scheme would be "well in excess of £18bn".

Prime Minister Burnham told the BBC on Sunday that he intends to put his plans before voters at the next general election, which is not due until August 2029. Sir Andrew suggested that this timeline means change "is now further away" than had been implied when the Prime Minister first promised a new national care service in July.

Adult social care provides state support to help individuals live more independently, including assistance at home. Unlike the NHS, social care in England is not free at the point of use. People in England and Northern Ireland with assets exceeding £23,250, which can include their home, are not currently eligible for council assistance with care costs.

Prime Minister Burnham has stated that he believes social care in England is "as unfair as American healthcare" and has proposed a system in which "everyone contributes, everyone is covered." He refused to rule out tax rises to fund such a system, acknowledging it may be "difficult or unpopular" with some, according to the BBC.

The Prime Minister is expected to set out more details of his vision in a conference speech on Tuesday. However, he indicated that any proposals would not be implemented before the next general election, citing commitments in Labour's 2024 election manifesto, which included a pledge not to increase national insurance, income tax, or VAT.

Cost and Funding Challenges

Sir Andrew Dilnot suggested that an NHS-style social care system, where all care is government-funded, would be "very, very large" in cost. He noted that the Health Foundation has estimated a universal social care system in England, with the government funding all support, could cost approximately £18.5bn annually. Prime Minister Burnham said on Sunday that he believed the costs would be lower than this, but he has not yet detailed how his plans would be funded.

In Scotland, state-funded personal care is offered to all adults assessed as needing help with tasks such as eating and bathing. However, this does not cover accommodation, food, and everyday living costs, which are subject to means testing. Sir Andrew said that even a Scottish-style system would leave people in residential care facing "very substantial bills," which Prime Minister Burnham has said he wants to avoid. Sir Andrew estimated a Scottish model could cost half the figure of a fully NHS-style system.

Labour MP and former minister Darren Jones told the BBC's Sunday with Laura Kuenssberg that scrapping the pensions triple lock was an "option that the government should consider alongside others" to fund social care reforms. The triple lock policy guarantees that the state pension increases by the highest of average wage growth, inflation, or 2.5%. Keeping it in place is also a Labour manifesto pledge.

However, Helen Miller, director of the Institute for Fiscal Studies think tank, said that scrapping the triple lock would not be sufficient to pay for social care, and tax rises would likely also be necessary, according to the BBC.

Political Reactions and Historical Context

Shadow Home Secretary Chris Philp told the BBC that Prime Minister Burnham was suggesting Labour wanted "more tax rises" to pay for the reforms, adding that the Conservatives would not support this. Philp stated that the country is "already taxed too highly" and that if more money were needed for social care or defence, it would be found through savings elsewhere, particularly in the welfare budget.

Prime Minister Burnham has made social care reform one of his flagship policies, prompted partly by the experience of his father, Roy, who had Alzheimer's and died earlier this month, the BBC reported. He acknowledged that there is also a cost to the NHS due to the "huge number" of people in hospitals who cannot be discharged home because social care is not available.

Previous attempts to reform social care have faced significant challenges:

Sir Andrew Dilnot's commission recommendations, which included a cap on care costs, were accepted by the Conservative-Liberal Democrat coalition government led by David Cameron. However, implementation of the cap was delayed to 2020 and eventually dropped by subsequent Conservative governments, with Cameron citing pressure on public finances.
In 2017, then-Conservative Prime Minister Theresa May's government proposed that people receiving care at home would pay the full costs if they were worth at least £100,000. This plan was branded a "dementia tax" by opponents and was subsequently scrapped after a political outcry.
When Prime Minister Burnham served as health secretary in Gordon Brown's Labour government, his plan for a national care service suggested funding through a compulsory contribution from people's estates after their death. This idea was labelled a "death tax" by Labour's opponents and did not progress after the party lost the 2010 general election.

Prime Minister Burnham accused previous generations of politicians of "cowardice" for failing to reform social care. Liberal Democrat leader Sir Ed Davey said that Burnham could demonstrate his seriousness about fixing care by continuing the cross-party talks that began in July, according to the BBC. Reform UK's economic spokesman Robert Jenrick told the BBC that "Andy Burnham refuses to rule out his universal death tax."

Next Steps

Prime Minister Burnham has tasked Whitehall troubleshooter Baroness Casey with conducting a review on the "best way of doing it," bringing forward her report from 2028 to next summer. He has stated that he wants to "build consensus" through cross-party talks on the details developed by Baroness Casey. He added that he intends to develop a "very clear plan" and put it to the public at a general election, where it will be "tested and people will then be able to decide."