Burnham proposes NHS-style social care system for England

Burnham sets out ambition for a universal social care system in England

Ninoda.com – Andy Burnham has said he wants England to move towards a social care system based on the founding principles of the NHS, with support available free when people need it and with the cost shared across society.

The prime minister intends to present the proposal to voters at the next general election, arguing that a lasting overhaul requires a clear public mandate. His approach would seek to ensure that every person contributes to the system and that every person can receive support, although he said its funding structure would not necessarily mirror the way the NHS is financed today.

“Everyone contributes, everyone is covered.”

Burnham has made social care reform a central part of his political agenda. He has also spoken publicly about the recent death of his father, Roy, who had Alzheimer’s disease. The experience has reinforced his view that the existing system leaves too many families facing uncertainty, high costs and difficult choices at vulnerable moments in their lives.

How social care differs from the NHS

Adult social care helps people retain independence when age, disability, illness or other circumstances mean they need assistance. It can include practical help at home, support with everyday tasks and arrangements that allow someone to live outside hospital or residential care for as long as possible.

Unlike NHS treatment, however, care services in England are generally not free at the point of use. People in England and Northern Ireland with savings above £23,250 are usually expected to pay towards their own care, rather than receive council help with the costs. Scotland and Wales operate under different eligibility arrangements.

Burnham pointed to Scotland, where adults assessed as requiring personal care can receive it without charge. That support can cover needs such as help with eating and bathing. He said England should not deny people an equivalent level of protection simply because of where they live.

“I am talking about a system that works on NHS principles because that is the only way you can make it work.”

He stressed that the changes would require careful design and should not create unnecessary pressure on public finances. At the same time, he declined to rule out possible funding options, saying that no approach had been excluded at this stage.

Cost, taxes and the pressure on hospitals

A universal scheme in England that removed charges at the point of use has been estimated to cost taxpayers £18bn annually. Burnham disputed that figure, saying the true cost would be lower. He argued that households already carry a substantial burden under the present system, particularly when people have to use savings or sell assets to meet care bills.

He described the current position as deeply unfair, comparing its impact on vulnerable people to the financial risks associated with healthcare in the United States. In his view, people should not face the possibility of losing everything because they require help in later life or during a period of serious illness.

Burnham also linked social care reform to the continuing strain on hospitals. Many patients who no longer need acute medical treatment remain in hospital because suitable support is not available for them at home or elsewhere in the community. Improving access to care could therefore affect both families needing help and the NHS’s ability to discharge patients safely.

“Broken social care will in the end break the NHS.”

The proposal is not being presented as an immediate policy change. Burnham said he would keep to manifesto commitments and acknowledged that some pledges made during the current Parliament could make rapid implementation difficult. Labour’s 2024 manifesto committed not to increase income tax, national insurance or VAT.

Asked whether people would all be expected to pay into the new model, Burnham said the principle would be shared contribution and shared coverage, but that the precise mechanism remained to be determined.

Casey review and cross-party discussions

Baroness Casey is reviewing social care and will advise on the most effective way to deliver reform. She had initially been asked by former prime minister Sir Keir Starmer to report in 2028. Burnham has requested that the work be brought forward, with the review now expected by next summer.

Burnham said the final proposals should be discussed across party lines in an effort to establish a durable consensus. He argued that the scale of the challenge means any replacement system needs support that can outlast one government or one parliamentary term.

“I don’t think you can reform this system without consensus.”

He said he would develop a detailed plan, put it before the public at a general election and allow voters to decide whether to endorse it.

Conservative shadow home secretary Chris Philp criticised the prospect of tax rises to fund reform. He said higher taxes would be unacceptable to his party, maintaining that the country is already heavily taxed. Philp said additional spending for social care or defence should instead be financed through savings elsewhere, particularly in the welfare budget.

Labour MP Darren Jones, who served as a cabinet minister in Sir Keir’s government, said Burnham was showing courage by confronting a difficult policy area. He noted that any reform would involve choices about priorities and spending, and said the detail of the proposal would be crucial.

The debate now centres on whether England can create a system that gives people more security without placing an unsustainable demand on taxpayers. For families facing care needs, the outcome could determine whether support is treated as a public service comparable to healthcare or remains dependent on individual means.