Andy Burnham proposes NHS-style social care for England, with funding undecided

Prime Minister Andy Burnham wants everyone in England to have access to free social care services under a system based on National Health Service principles. In a BBC interview published on 27 September, he said everyone would contribute and be covered, but left the payment method unresolved. He plans to put a clear proposal to voters at the next general election, making the promise a direction for reform rather than an adopted funding or delivery policy.

Burnham told the BBC: ‘I am talking about a system that works on NHS principles because that is the only way you can make it work.’ Asked whether everyone would have to contribute, he described a system in which ‘everyone contributes, everyone is covered’, while saying it would not necessarily be paid for in the same way as the NHS. His remarks do not specify what an individual would pay, which services would be free or how care providers would operate.

What would change for people needing care?

Adult social care includes support that helps people live independently, including help at home. Unlike NHS treatment, social care in England is generally subject to assessments of both need and finances. The current capital threshold for means-tested local authority support is £23,250, according to government guidance. That figure is not a universal test for access to council assistance: councils assess care needs and resources, while information and advice are available more broadly.

The government guidance also sets a lower capital limit of £14,250. Capital below that limit is excluded when councils calculate tariff income from savings, and councils may set higher capital limits for care outside a care home. Those rules show why a promise of wider coverage requires detailed decisions about eligibility, charges and the distinction between personal care and other support. Burnham has not announced those decisions in the BBC interview.

The funding question

Burnham said reform would have to be handled carefully without adding pressure to public finances, but told the BBC that ‘nothing is off the table’ on funding. When the interviewer raised an estimate of £18bn a year for a system free at the point of use across England, he replied: ‘It’s not that high.’ He did not give another figure, and the assumptions behind the estimate were not established in the interview.

The scale of the existing service is substantial. The King’s Fund reports that English local authorities spent £32bn on adult social care in 2023/24 and that 859,000 people received publicly funded long-term care. It says councils determine spending, drawing partly on central government grants, rather than working from one national social care budget. Those figures describe the current system; they are not a cost estimate for Burnham’s proposal.

The King’s Fund says most publicly funded care goes to people with the highest needs and lowest assets. People usually contribute from their income, local authorities assess need and fund eligible care, and independent providers deliver most services. It reports that, among new requests for support in 2023/24, about 42% resulted in a service, 27% in advice or signposting and 31% in no support. Any universal offer would need to explain how those assessments and services would change.

A plan for a later election

Burnham said Baroness Louise Casey, who is reviewing social care, would advise on the best way to make his ambition work. He said he had asked her to bring the review forward from 2028 to next summer and planned to set out his vision on Tuesday. He also said the details would be discussed across parties in an effort to build consensus before a clear plan was put to voters.

He said he would stick to Labour’s 2024 manifesto commitments, which include pledges not to raise national insurance, income tax or value-added tax. He acknowledged that those commitments would make major reform difficult in the current Parliament. In a separate Guardian interview on 26 September, Burnham said he wanted significant progress on social care before the next election, while describing stable public finances as crucial to wider change.

Political responses and precedent

Conservative shadow home secretary Chris Philp told the BBC that tax rises would be a ‘red line’ for his party. He said Conservatives would seek savings elsewhere, particularly in welfare, if more money were needed. Labour MP Darren Jones called Burnham’s position ‘very bold and brave’ but said the policy details were needed because reform would cost money. Reform UK’s Robert Jenrick attacked a possible ‘universal death tax’; that was his description of a potential funding approach, not a mechanism Burnham announced.

The argument has a history for Burnham. The BBC reports that, as health secretary in Gordon Brown’s government, he advanced a national care service proposal involving a compulsory contribution that could include estates after death. It did not proceed after Labour lost the 2010 election. That earlier proposal helps explain the political debate over funding, but it does not establish the terms of the new plan.

For now, the central questions remain open: what care would be covered, who would qualify, how contributions would be collected and how much the change would cost. Burnham has promised a vision and a later electoral plan. People who need care and those who pay for it cannot yet calculate what his proposal would mean for their own circumstances.