Last week, Andy Burnham put forward a proposal to overhaul social care in England, advocating for an NHS-style system that would provide free personal care to all who require it, without charging at the point of use. Burnham, who has championed this plan as a cornerstone of his political career, claims the reform could protect individuals’ savings and homes by covering personal care costs such as assistance with washing and eating. However, the new system would not cover general living expenses for those in residential or nursing homes, including accommodation and food, which can still amount to tens of thousands of pounds. Burnham has acknowledged the complexity of fully funding the service and suggested its implementation might be delayed until the late 2030s.

An NHS-style funding mechanism for social care currently exists in the form of NHS continuing healthcare, which provides free care for certain seriously ill adults without means testing. Despite this, the system faces extensive criticism for failing many who need it most. Approximately only 20% of applicants in England are successful in securing funding, and even those with severe illnesses frequently find their applications denied.

Robert Jackman, 81, who suffers from dementia with Lewy bodies and Parkinsonism, illustrates the challenges faced by patients seeking funding under the existing system. Though his condition has deteriorated to the point where he is wheelchair-bound, unable to move his limbs, doubly incontinent, and nonverbal, an application filed by his wife in October 2024 was rejected on the grounds that he was not deemed ill enough to qualify. The couple pays £240 per day for 12 hours of private care at home, relying on their savings to cover annual costs exceeding £80,000.

Miriam Jackman criticized the NHS continuing healthcare process as ineffective and wasteful, highlighting that specialist assessments supporting Robert’s needs did not sway the panel’s decision. The approval process involves a two-stage assessment: an initial checklist of 12 areas such as cognition and mobility, followed by a full evaluation by a panel. Critics argue that the checklist disproportionately excludes those with dementia, and professionals familiar with the cases claim that local NHS bodies frequently fail to adhere to procedural requirements, such as involving sufficient healthcare staff in assessments.

Jon and Gill (surname withheld), residents of north London, report similar frustrations. Jon, 82, living with corticobasal degeneration and dementia, requires extensive care and has been denied NHS continuing healthcare despite multiple assessments. Jon’s wife Gill describes the assessment as dismissive, with social workers’ concerns overestimated severity repeatedly ignored. The couple now spends £2,500 weekly on care, with savings expected to last only two years before they must consider leveraging their property equity. They received formal rejection letters in June and have been advised to seek local authority support once their assets fall below £23,250.

Both families express deep disappointment with the current system’s complexity and opacity, questioning the fairness and efficiency of the continuing healthcare assessments. Advocates and organizations supporting applicants suggest that even under Burnham’s proposed reforms, a similar assessment process would remain necessary to manage means-tested costs such as accommodation and food, preserving the risk of inequitable access. Burnham’s reform proposal draws on Scotland’s model, where personal care is free but residents of care homes still face significant charges for accommodation.

As debates continue over funding, implementation timelines, and design, those affected by the system’s inadequacies urge swift and meaningful reform to prevent further financial and emotional hardship. Meanwhile, many remain caught in a bureaucratic process that they describe as stressful and disheartening, with no clear resolution on the horizon.