NHS-Style Social Care System Could Take Decades, Reformer Warns

A comprehensive social care system in England, modeled after the National Health Service (NHS), could be decades away from full implementation, according to economist Sir Andrew Dilnot. Sir Andrew, who chaired a commission proposing social care reforms 15 years ago, expressed concerns about the substantial costs and lengthy timelines associated with such an ambitious plan.

Prime Minister Andy Burnham has indicated a desire for social care to be entirely free at the point of use, including residential care costs. However, Sir Andrew noted that the financial implications of such a scheme would be "very substantial." With Burnham promising to present his plans to voters at the next general election, Sir Andrew suggested that significant change is "now further away."

Adult social care in England provides support to help individuals maintain independence, offering services such as home assistance. Unlike the NHS, social care is not universally free, leading some individuals to face considerable expenses. Burnham has stated that his proposals would ensure "everyone contributes, everyone is covered," and has not ruled out tax increases to fund the system.

While Burnham intends to detail his vision further, he has indicated that any proposals would not be implemented before the next general election. This aligns with Labour's 2024 election manifesto commitments, which include pledges not to increase national insurance, income tax, or VAT. Separately, Labour MP Darren Jones suggested that scrapping the pensions triple lock could be an option to consider for funding social care reforms, although this policy is also a Labour manifesto pledge.

The next general election is not constitutionally due until August 2029, potentially pushing the earliest implementation of major social care reforms to the end of the decade or beyond. Sir Andrew pointed out that if proposals are included in Labour's 2029 manifesto, it would mark 30 years since a royal commission on social care was launched and over 15 years since his own commission reported its findings.

Sir Andrew's concern stems from the implication of an "entirely free" system, which contrasts with the current means-tested approach in England and Northern Ireland. For individuals with assets exceeding £23,250, including their home, eligibility for state assistance with care costs is limited. Wales also employs a means-tested system. Scotland offers state-funded personal care for all adults assessed as needing help with daily tasks, but accommodation and living costs are still subject to means testing.

Sir Andrew stated that even a Scottish-style system would still result in significant bills for those in residential care, a situation Burnham aims to avoid. The Health Foundation has estimated that a universal social care system in England, fully funded by the government, could cost approximately £18.5 billion annually. Burnham believes the actual costs would be lower, but has not yet outlined his funding strategy.

Sir Andrew projected that an NHS-style social care system could cost "well in excess of £18bn," while a Scottish model might cost half that amount. He reiterated his belief that such a system could take "many years, even many decades before it came to fruition."

Previous reform efforts have encountered difficulties. Sir Andrew's own commission proposed a lifetime cap of £35,000 on care costs, a recommendation accepted by the Conservative-Liberal Democrat coalition government. However, the implementation was delayed and eventually dropped by subsequent Conservative governments. Other attempts, such as proposals by Theresa May's government to make individuals receiving home care pay the full costs if their assets exceeded £100,000, were abandoned after facing strong opposition.

Earlier, when serving as health secretary, Burnham proposed a national care service funded through compulsory contributions from estates after death, but this was met with opposition and did not proceed after Labour lost the 2010 general election.

A female care home worker helps support an elderly man leaning on a walking frame.