Burnham Pledges NHS-Style Social Care for England, but Funding Questions Loom

Andy Burnham has announced his intention to deliver a universal social care system in England modelled on the principles of the National Health Service, promising that under his plan "everyone contributes, everyone is covered." The prime minister confirmed his ambition during an interview with the BBC's Sunday with Laura Kuenssberg, signalling that the reform will form a central plank of his party's offer to voters at the next general election.

Burnham said he would use a speech on Tuesday to set out his broader vision for the sector, with Whitehall troubleshooter Baroness Casey—who is leading an official review—expected to advise on the most practical route to implementation. The prime minister has already asked Baroness Casey to accelerate her work, bringing her report forward from 2028 to next summer, so that its findings can inform the cross-party discussions he says are essential to lasting reform.

The proposal would bring England into line with Scotland, where personal care is available to all adults assessed as needing assistance with everyday tasks such as eating and bathing. In England and Northern Ireland, by contrast, social care is means-tested: anyone with savings above £23,250 is currently denied council support with care costs. Wales and Scotland operate under separate eligibility rules. Burnham argued it is unjust that English residents miss out on the free personal care enjoyed elsewhere in the UK, describing the current arrangement as "as unfair as American healthcare," where vulnerable people can lose everything.

The prime minister was keen to stress that the changes would have to be introduced "carefully, without putting extra strain on the public purse." Pressed on how the system would be financed, he insisted "nothing is off the table at this moment in time." When it was put to him that a universal, free-at-the-point-of-use system for England could cost taxpayers around £18bn a year, Burnham disputed the figure, saying: "It's not that high." He pointed out that families already shoulder a "huge cost" and that the NHS itself bears a heavy burden because large numbers of hospital patients cannot be discharged home due to the absence of adequate social care.

Burnham did not rule out tax rises to fund the reforms, conceding such a step could be "difficult or unpopular" with some voters. He acknowledged the constraints of the current parliamentary term, noting that the 2024 Labour manifesto contained firm commitments on tax—including pledges not to raise national insurance, income tax or VAT—which would make immediate legislation difficult. "I have to keep people's trust," he said, indicating that the plan would instead be tested at a general election, where voters could decide on it directly.

The political reaction was swift and largely divided along party lines. Shadow home secretary Chris Philp accused the prime minister of paving the way for "more tax rises" and said the Conservatives would not support the reforms. He described tax increases as a "red line" for his party, arguing the country is "already taxed too highly" and suggesting that any additional funding for social care or defence should be found through savings elsewhere, particularly in the welfare budget. Labour MP Darren Jones, a former cabinet minister under Sir Keir Starmer, praised Burnham for being "very bold and brave" on the issue, though he cautioned that "politics is about prioritisation" and that the detail of the policy would ultimately determine its viability.

Liberal Democrat leader Sir Ed Davey urged the prime minister to demonstrate he is "serious about fixing care" by advancing the cross-party talks that began in July, warning that the plan "can't just be a series of No 10 headlines with no real action." Reform UK's economic spokesman, Robert Jenrick, was more combative, claiming Burnham "refuses to rule out his universal death tax" and accusing him of targeting people's homes because he is "too weak to cut the benefits bill."

The "death tax" label carries potent historical echoes. Burnham previously drew up plans for a national care service while serving as health secretary in Gordon Brown's government, proposing that it be funded through compulsory contributions, including from people's estates after death. Opponents seized on the idea and it was abandoned after Labour lost the 2010 general election. A similar fate befell Theresa May's 2017 proposal that people receiving care at home pay full costs if they were worth at least £100,000—branded a "dementia tax"—which triggered a political outcry and contributed to the Conservatives losing their Commons majority.

Burnham has made social care one of his flagship causes, speaking movingly about his father Roy, who had Alzheimer's and died earlier this month. He has accused previous generations of politicians of "cowardice" for failing to reform a system widely seen as unsustainable, though he acknowledged his own push carries political jeopardy. The core of his argument is that inaction is no longer tenable: "Broken social care will in the end break the NHS," he has warned, framing reform as essential not only for individuals and families but for the future viability of the health service itself.

What remains unclear is precisely how a universal system would be structured and paid for. Burnham said the details shaped by Baroness Casey would be subject to cross-party talks in an effort to "build consensus"—a recognition that previous attempts foundered when they became partisan battlegrounds. He described the model as one in which "everyone contributes, everyone is covered but not precisely necessarily in the same way that we currently pay for the NHS," leaving open the possibility of a hybrid funding mechanism that could include taxation, contributions or other levies. Until those specifics are published, the plan is likely to face scrutiny from opposition parties and voters alike, particularly given the sensitivity of tax pledges and the memories of past reform failures.