Andy Burnham has made reforming social care a key priority as Prime Minister, acknowledging that funding the sector will require “difficult decisions.” Burnham’s commitment follows decades of political struggle in the United Kingdom to address the rising costs and uneven quality of social care, an issue that has long eluded comprehensive government solutions.
The issue gained significant political attention during Theresa May’s premiership when her proposed reforms sparked controversy and were labeled a “dementia tax” by opponents. May’s plan included means-testing based on individuals’ housing wealth to fund at-home and residential care, a policy intended to make the system more sustainable but one that ultimately damaged her political standing. After public backlash, she introduced a proposed cap on personal social care costs, which critics argued disproportionately benefited wealthier households. Despite its unpopularity, some analysts have suggested May’s approach was fundamentally sensible, emphasizing that including housing assets in care funding is a logical way to protect public finances without broadly increasing taxes.
Burnham’s vision builds on earlier efforts, including a 2009 proposal to establish a national care service funded by a 10 percent inheritance levy on estates—a plan that was fiercely opposed and branded a “death tax” by political rivals. The phrase, revived by opposition groups with emotive imagery, has contributed to enduring skepticism about taxing inheritance to cover care costs.
While Burnham has not yet specified how his government will fund the reforms, he has repeatedly emphasized the need to end “profiteering” by private care providers, a stance echoed by his social care adviser, Baroness Louise Casey. Burnham has flagged the possibility of introducing caps on excess profits within the social care sector, a move that already exists in children’s social care and is expected to gain public support as a way to control costs.
Experts note that social care spending is a growing but relatively moderate component of UK public expenditure, expected to rise from 1.2 percent of GDP in 2030/31 to 1.8 percent over the following 45 years, while health and pension costs loom larger. Around half of the £26 billion spent annually by local authorities in England on social care supports working-age adults, with care for older adults constituting a smaller but highly visible segment.
The current system is widely criticized for regional disparities in entitlement and service quality. Inadequate funding for social care also burdens the National Health Service (NHS) and local government budgets, contributing to cutbacks in other public services.
Political debate continues over whether social care funding should rely predominantly on taxpayer money or contributions from service users, with concerns that broad tax increases could exacerbate intergenerational inequities and dampen work incentives. Some critics argue that relying on personal assets—including housing wealth—to fund social care is fairer, likening it to self-insurance against the costs of retirement and disability.
As Burnham moves forward, the challenge will be balancing political feasibility, fairness, and fiscal sustainability while overcoming public distrust shaped by past controversies and the complex realities of funding long-term care.