Sir Andrew Dilnot, who led a social care reform commission 15 years ago, has indicated that Prime Minister Andy Burnham’s vision for a comprehensive NHS-style social care system in England could take decades to realize. Dilnot told BBC Radio 4 that Burnham appears to want social care to be entirely free, including residential costs, at a cost described as “very substantial.” With Burnham planning to present his proposals to voters at the next general election, Dilnot suggested meaningful implementation has become more distant.
Burnham indicated in recent interviews that his social care vision would operate on a universal contribution model where everyone participates and receives coverage, without ruling out tax increases. However, he has committed to adhering to Labour’s 2024 election manifesto pledges, which included promises not to increase national insurance, income tax, or VAT, meaning implementation would not occur before the next general election scheduled for August 2029. Some Labour figures have suggested examining options such as scrapping the pensions triple lock as a potential funding mechanism, though think tanks have noted such measures alone would be insufficient.
Dilnot estimated that a fully NHS-style system could cost “well in excess of £18bn” annually, referencing The Health Foundation’s estimate of approximately £18.5bn yearly for universal government-funded social care in England. He contrasted this with a Scottish-style model, which could cost roughly half that amount but would still leave people in residential care facing substantial bills. Currently in England, individuals with assets exceeding £23,250 are not entitled to council assistance with care costs.
This represents another chapter in a lengthy history of failed social care reforms. Dilnot’s own commission proposed a lifetime cap of £35,000 that was initially accepted but implementation was delayed and eventually abandoned. Previous reform attempts, including Theresa May’s proposals branded a “dementia tax” and Burnham’s earlier “death tax” concept during Gordon Brown’s government, similarly failed to advance. Dilnot expressed support for a fully government-funded system but acknowledged the substantial financial implications involved.
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