Prime Minister Andy Burnham has pledged to reform England's social care system, aiming to establish a new National Care Service comparable in scope and principle to the National Health Service (NHS). Speaking from Downing Street on Monday, Burnham emphasized his commitment to resolving long-standing issues in social care before the end of his tenure.
Burnham’s call for an overhaul reflects a persistent challenge faced by successive governments. Previous prime ministers, including Boris Johnson and Tony Blair, have made similar promises to address the funding and structure of social care, but comprehensive reform has yet to materialize. Burnham himself first advocated for a National Care Service during his tenure as health secretary in 2009 and now has the opportunity to advance this vision.
Currently, the means-tested system in England limits eligibility for state-funded social care to individuals with less than £23,250 in assets. Those exceeding this threshold are typically required to cover the full cost of their care privately. A recent report by the Nuffield Trust identified England as having the least generous social care funding system among 11 wealthy nations and regions. However, experts note that no countries offer entirely free social care at the point of use. For instance, Denmark, known for its comprehensive care, still requires residents to pay for accommodation and food in care homes.
Debate continues over the nature of the proposed National Care Service. Camille Oung, a fellow at the Nuffield Trust, explained that its definition remains unclear—whether it would be a centralized administrative organization or a system providing fully free services similar to the NHS is still undetermined. Experts suggest any transition to universal social care would necessitate a phased approach over several years.
Simon Bottery, senior fellow in social care at the King’s Fund, identified an immediate policy step: increasing the savings threshold for eligibility to qualify for public support. The current limit has remained unchanged for a decade, and raising it could extend assistance to more people.
Financial considerations pose a significant obstacle. According to estimates by the Health Foundation, delivering universal social care would require an additional £18.4 billion annually. Burnham has indicated a preference for funding reforms beyond raising income tax, advocating for a new “national care levy.” This levy, he suggests, could take the form of a 10 percent charge on estates upon death, effectively replacing the existing inheritance tax.
Such a flat-rate levy would introduce a death levy for millions of households whose estates currently fall below inheritance tax thresholds, potentially preventing the need for individuals to deplete their savings during their lifetime to pay for care. The rising cost of social care is a growing concern: financial advisers recommend budgeting around £100,000 annually for later-life care, with some estimates projecting nearly £1 million over the final three years of life in a care home.
Burnham framed the issue as urgent and overdue, criticizing three decades of inaction as “not defensible.” Noting the emotional and financial toll on families forced to sell homes to cover care costs, he stated, “How many people have lost their homes and their savings in that time? We need to face it and fix it.” His proposals mark a renewed effort to address a deeply entrenched social challenge in England.