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Economist Sir Andrew Dilnot has expressed the view that establishing an NHS-style social care system in England may take several decades before being fully realized. Speaking on BBC Radio 4’s Today programme, Sir Andrew, who headed a commission recommending reforms to social care 15 years ago, commented on Prime Minister Andy Burnham’s apparent ambition to provide social care free at the point of use, including residential care costs. He warned that such an initiative would involve “very substantial” expenses and suggested that with Burnham planning to present these proposals ahead of the next general election, any significant reform now seems more distant.
Currently, adult social care in England provides state assistance to help individuals live more independently, such as home-based support, but unlike the NHS, this care is not free at the point of use. Many people face significant bills because help is means-tested. For example, individuals with assets exceeding £23,250, including property, are typically not entitled to council assistance for care costs. This contrasts with Scotland, where state-funded personal care is available to adults assessed as needing support for daily tasks, though accommodation and living costs remain means-tested. Sir Andrew noted that adopting a Scottish-style system in England would still leave many facing “very substantial bills,” which Burnham hopes to avoid.
Burnham has indicated that his plans would ensure “everyone contributes, everyone is covered,” while not ruling out tax increases to fund such a social care system. However, he has also suggested these plans would not be implemented before the next general election, respecting Labour’s 2024 manifesto commitments that include no increases in national insurance, income tax, or VAT. Meanwhile, Labour MP Darren Jones has proposed that abandoning the pensions triple lock—an existing policy guaranteeing annual increases in the state pension based on wage growth, inflation, or 2.5%, whichever is higher—could be one funding option, although maintaining the triple lock remains part of Labour’s current manifesto pledges. Helen Miller of the Institute for Fiscal Studies has warned that dropping the triple lock alone would likely be insufficient, and tax rises would probably be necessary.
Sir Andrew also pointed to the length of time social care reform has already been under consideration. The original royal commission on social care was launched by Tony Blair around 30 years ago, and Sir Andrew’s own commission published its report over 15 years ago. He expressed skepticism about quick progress, noting that if Labour only includes these proposals in its 2029 manifesto, the sweeping reforms conceived back then will still be decades away. Sir Andrew emphasized that while he would “love to see such a scheme” where all social care is funded by the government, the financial burden would be exceptionally high, potentially costing well over £18 billion annually based on estimates from the Health Foundation. He suggested a capped system, like the £35,000 lifetime cap his commission previously recommended, might be a more feasible way to protect elderly people from excessive charges. However, previous attempts to implement this cap have stalled, with delays under David Cameron’s administration and subsequent Conservative governments dropping the idea altogether.
Past reforms have faced political setbacks. For example, Theresa May’s government abandoned proposals to require those worth at least £100,000 who received home care to pay the full cost, amid accusations of a “dementia tax.” Earlier, when Andy Burnham was health secretary during Gordon Brown’s tenure, his proposal for a national care service funded by compulsory contributions from deceased people’s estates was dismissed as a “death tax” and was never pursued after Labour’s 2010 election defeat. These historical challenges underscore the complexities facing any major overhaul of social care provision in England
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