NHS-Style Social Care System Could Take Decades to Implement, Says Dilnot

Implementing an NHS-style social care system in England could span several decades, according to economist Sir Andrew Dilnot. The former head of the 2011 Commission on Funding and Care noted that Prime Minister Andy Burnham’s apparent desire for completely free social care, including residential expenses, would carry a “very substantial” price tag.

Speaking on BBC Radio 4’s Today programme, Sir Andrew observed that with Burnham intending to present these plans to the electorate at the next general election, the prospect of reform is now more distant than previously suggested. While Burnham first hinted at a national care service shortly after becoming prime minister in July, he recently indicated that any proposals would not be enacted before the next vote, aiming instead to honor the Labour Party’s 2024 manifesto commitments regarding tax increases.

Burnham, during an interview on Sunday with Laura Kuenssberg, suggested his reforms would ensure “everyone contributes, everyone is covered” and declined to eliminate the possibility of tax hikes to finance the system. He promised to detail his vision further in an upcoming conference speech. However, Labour MP Darren Jones told the BBC that abolishing the pensions triple lock—a policy guaranteeing state pension rises by the highest of wage growth, inflation, or 2.5%—could be one funding option, despite it being a manifesto pledge.

Unlike the National Health Service, adult social care in England is not free at the point of use, often resulting in significant financial burdens for individuals. Currently, those with assets exceeding £23,250, including property values, are ineligible for council support with care costs. In contrast, Scotland offers state-funded personal care for basic needs like eating and bathing, though accommodation and living expenses remain means-tested. Sir Andrew warned that even a Scottish model would leave residential care users facing hefty bills, something Burnham aims to avoid.

Estimates from the Health Foundation suggest a universal system funded entirely by the government could cost approximately £18.5bn annually. While Burnham believes the actual cost would be lower, he has yet to outline a funding strategy. Sir Andrew estimated that an NHS-style system could exceed £18bn, whereas a Scottish approach might halve that figure.

Sir Andrew expressed support for fully government-funded care but acknowledged the escalating costs. He suggested that capping the amount individuals must pay could still benefit elderly people, noting that his own commission previously recommended a lifetime cap of £35,000. Although the coalition government under David Cameron accepted this recommendation, implementation was delayed until 2020 and eventually abandoned by subsequent Conservative administrations.

Past attempts at reform have also stalled. Theresa May’s government withdrew plans for a so-called “dementia tax,” which would have required those with assets over £100,000 to pay full home care costs. Additionally, Burnham’s own 2009 proposal as health secretary, which included a posthumous contribution from estates, was dismissed as a “death tax” and dropped after Labour’s 2010 election loss. The next general election is scheduled for August 2029, though Burnham retains the option to call one earlier.