Andy Burnham, mayor of Greater Manchester, faces a challenge common to many western leaders: finding sustainable ways to fund social care for an ageing population. England’s current system relies heavily on means-testing, where individuals with assets over £23,250 must pay the full cost of their care. Burnham has proposed reforming this approach to establish a publicly funded social care system aligned with the National Health Service’s principle of free care at the point of use.

England’s model contrasts sharply with those adopted by other developed nations, many of which provide some degree of universal social care funded through taxation or social insurance. Nearly one-third of the European population is projected to be aged 65 or older by 2050, heightening the urgency behind these policy discussions.

In France, individuals over 60 are eligible for state-supported care based on an assessment of their impairment level. Those with moderate to severe needs receive an allocation personnalisée d’autonomie (APA), a care package funded jointly by the state and the individual. Financial contributions vary according to income, with low earners receiving full coverage, while higher earners can be responsible for up to 90 percent of costs. Residents in care homes also pay for daily living expenses, with no maximum limit on costs.

Denmark operates what is widely regarded as one of the most generous social care systems. Funded entirely through general taxation, care costs are fully covered regardless of wealth. However, those living in care homes still pay for basic accommodation and food—referred to as “hotel fees”—though housing benefits are available to those unable to afford them. A similar model in England has been estimated to require around £18.5 billion annually.

Germany’s approach relies on mandatory social insurance, with contributions deducted from income throughout working life and into retirement. When care is needed, individuals are assessed and assigned one of five dependence levels, determining an allowance that typically covers about half of their care costs. Family members, particularly adult children with incomes above €100,000, may be required to contribute financially once an elderly parent’s resources are depleted.

Australia offers comprehensive publicly funded clinical and essential care for those aged over 65, financed through taxation. While clinical care is fully covered at home or in residential settings, individuals must pay for non-clinical services such as accommodation and food, with charges scaled to financial capacity. Australia implements a lifetime cap on social care payments, set at A$135,318 (£71,000), after which individuals are exempt from further costs. A similar lifetime cap was unsuccessfully proposed in the UK under Boris Johnson’s government.

Japan, home to one of the world’s oldest populations, introduced a long-term care insurance system in 2000. All citizens over 40 pay a supplementary tax earmarked exclusively for social care funding. Those requiring assistance receive a state-funded allowance based on assessed needs, while contributing 10 to 30 percent of monthly care costs depending on income.

These varied international models illustrate the complexity of balancing public responsibility with personal financial contributions amid rapidly ageing populations. England’s current system remains among the most restrictive in the developed world, but proposals to reform social care funding highlight evolving debates over how best to provide equitable and sustainable support.