Dilnot Warns NHS-Style Social Care in England May Be Decades Away

Sir Andrew Dilnot, the economist who chaired a landmark commission on social care funding, has cautioned that establishing an NHS-style system for adult social care in England could take many years—possibly even decades—to become a reality. Speaking to BBC Radio 4's Today programme, he said the direction of current political discussion suggests that meaningful change is now further away than it appeared just months ago.

His warning comes amid renewed debate over how to fix a system that has long been described as unsustainable. Unlike the NHS, social care in England is not free at the point of use, meaning many older and disabled people face substantial bills for support that helps them live independently, including assistance in their own homes.

Sir Andrew's intervention follows comments by Prime Minister Andy Burnham, who has signalled his ambition for a social care system that mirrors the NHS in its universality. In an interview with the BBC's Sunday with Laura Kuenssberg, Burnham said his proposals would ensure "everyone contributes, everyone is covered"—a phrase that Sir Andrew argued implies a system that is entirely free, including residential care costs.

According to Sir Andrew, delivering such a scheme would carry a "very substantial" price tag. He pointed to analysis by the Health Foundation, a health think tank, which estimated that a universal social care system in England—with the government funding all support—could cost around £18.5bn a year. Sir Andrew suggested the true figure could be well in excess of that, though he noted that a Scottish-style model, which provides free personal care but still means-tests accommodation and living costs, might cost roughly half as much.

Burnham has promised to set out more detail on his vision in a conference speech on Tuesday. However, he has indicated that any reforms would not be implemented before the next general election, which is not due until August 2029, though he could opt to call one earlier. Burnham has said he wants to stick to Labour's 2024 election manifesto commitments, including a pledge not to raise national insurance, income tax, or VAT.

That stance has left the question of funding unresolved. Labour MP and former minister Darren Jones told the BBC that scrapping the pensions triple lock was "an option that the government should consider alongside others" to pay for social care reform. The triple lock guarantees that the state pension rises by whichever is highest of average wage growth, inflation, or 2.5%, and retaining it is also a Labour manifesto promise. The suggestion has already sparked debate about the trade-offs involved in funding any expansion of social care.

Sir Andrew, who led a commission whose recommendations were accepted by the Conservative-Liberal Democrat coalition government under David Cameron, said the timeline for change now looks longer than when Burnham first promised a new national care service in July, shortly after becoming prime minister. He noted that if proposals are included in Labour's 2029 manifesto, it would be 30 years since Sir Tony Blair launched a royal commission on social care and more than 15 years since his own commission reported back.

The current means-testing rules illustrate the scale of the challenge. In England and Northern Ireland, people with assets worth more than £23,250—including the value of their home—are not entitled to council help with care costs. In Wales, social care is also means-tested. In Scotland, state-funded personal care is available to all adults assessed as needing help with tasks such as eating and bathing, but accommodation, food, and everyday living costs remain subject to means testing. Sir Andrew argued that even a Scottish-style system would leave people in residential care facing very substantial bills—precisely the outcome Burnham says he wants to avoid.

The economist said he would "love to see" a scheme in which all social care is government-funded, but he cautioned that the cost would become "very, very large." He suggested an alternative: a system in which the amount individuals must pay towards their own care is capped. His own commission proposed a lifetime cap of £35,000, a recommendation that was accepted in principle but later delayed to 2020, with Cameron citing pressure on the public finances. Subsequent Conservative governments eventually dropped the idea altogether.

Reform efforts have repeatedly faltered. Theresa May's government abandoned plans to make people receiving care at home pay full costs if they were worth at least £100,000, after opponents branded it a "dementia tax." Earlier, when Burnham served as health secretary under Gordon Brown, his proposal for a national care service suggested funding it through a compulsory contribution from people's estates after death. That idea was attacked as a "death tax" and went no further after Labour lost the 2010 general election.

Sir Andrew's latest comments underscore the political and fiscal difficulties that have frustrated social care reform for decades. While there is broad agreement that the current system is unfair and underfunded, consensus on how to pay for change remains elusive. The prime minister's promise of an NHS-style system has renewed hope among campaigners, but the experience of previous attempts suggests that translating ambition into legislation will be a slow and contested process.