Burnham Pledges NHS-Style Social Care for England, but Funding Questions Loom

Andy Burnham has set out an ambition to extend free social care to everyone in England, modelling the system on the founding principles of the NHS, and intends to put the proposal directly to voters at the next general election. In an interview with the BBC's Sunday with Laura Kuenssberg programme, the prime minister described a system in which "everyone contributes, everyone is covered", though he stopped short of ruling out tax rises, conceding that such a move could prove "difficult or unpopular" with some sections of the public. The intervention marks the clearest signal yet that social care reform will sit at the heart of his government's domestic agenda.

Burnham said he would formally unveil his "vision" on Tuesday, with Whitehall troubleshooter Baroness Casey, who is leading an independent review of the sector, advising on the "best way of doing it". The prime minister has made overhauling adult social care one of his flagship policies, a commitment sharpened by personal experience. His father, Roy, who had Alzheimer's disease, died earlier this month, and Burnham has repeatedly spoken about the strains the family faced navigating a system he regards as fundamentally unjust.

Adult social care provides state support to help people live more independently, including assistance in their own homes. Crucially, unlike the NHS, it is not free at the point of use. In England and Northern Ireland, anyone with savings above £23,250 is not entitled to council help with care costs, meaning many people must fund their own support until their assets are depleted. Wales and Scotland operate different eligibility rules, with Scotland notably offering free personal care to all adults assessed as needing help with tasks such as eating and bathing. Burnham argued it is wrong that people in England do not receive the same entitlement, describing the current arrangements as "as unfair as American healthcare, where the most vulnerable in society can lose everything, they can be wiped out".

The prime minister said his proposed system would operate on "NHS principles because that is the only way you can make it work", adding that change would have to be carried out carefully "without putting extra strain on the public purse". Pressed on how the reforms would be financed, he insisted that "nothing is off the table at this moment in time". When presented with an estimate that a universal, free-at-the-point-of-use system in England could cost taxpayers £18bn a year, Burnham disputed the figure, saying: "It's not that high." He also pointed to existing costs, both to families and to the health service, noting that a "huge number" of patients across England remain stuck in hospital because the social care required to discharge them safely at home is unavailable.

Asked whether everyone would be required to contribute, Burnham said: "It will be a system of that kind – so everyone contributes, everyone is covered but not precisely necessarily in the same way that we currently pay for the NHS." He confirmed that the detail being developed by Baroness Casey would be subject to cross-party talks in an effort to "build consensus" around a policy area that has defeated successive governments. Baroness Casey was originally commissioned by former prime minister Sir Keir Starmer to deliver her review in 2028, but Burnham has asked her to accelerate the timetable and report by next summer.

On the broader timeline, Burnham indicated that any legislation would be constrained by existing manifesto commitments, which would make it difficult to implement change during the current Parliament. The 2024 Labour manifesto contained firm pledges on tax, including a promise not to raise national insurance, income tax or VAT. "I'm going to say that we stick to the manifesto because I have to keep people's trust, and there are commitments in the manifesto that would make it hard to do in this Parliament," he said. Instead, he plans to develop a detailed proposal and "put that plan to the public at a general election", where it would be tested and voters would decide.

The proposal has already drawn political fire. Shadow home secretary Chris Philp said the prime minister was effectively signalling that Labour wanted "more tax rises" to pay for the reforms, and confirmed the Conservatives would not support them. Philp described tax increases as a "red line" for his party and said the country is "already taxed too highly", adding that any additional funding for social care or defence should be found through savings elsewhere, particularly in the welfare budget. Reform UK's economic spokesman Robert Jenrick went further, accusing Burnham of refusing to rule out a "universal death tax" and claiming he is "too weak to cut the benefits bill so he's coming for your home instead".

Support came from within Burnham's own party, with Labour MP Darren Jones, a former cabinet minister in Sir Keir's government, describing the prime minister as "very bold and brave" on social care. Jones nonetheless acknowledged the financial reality, saying: "Politics is about prioritisation and these things do cost money and so we'll need to see the detail of that policy." Liberal Democrat leader Sir Ed Davey said Burnham could demonstrate he is "serious about fixing care" by getting on with cross-party talks that began in July, warning: "This can't just be a series of No 10 headlines with no real action."

The political sensitivity of the issue is well established. Burnham previously produced a plan for a national care service while serving as health secretary in Gordon Brown's Labour government, proposing it be funded through compulsory contributions, including from people's estates after death. Opponents branded the idea a "death tax" and the proposals stalled after Labour lost the 2010 general election. At the 2017 election, then-Conservative prime minister Theresa May was accused of pursuing a "dementia tax" after suggesting people receiving care at home should pay full costs if they were worth at least £100,000. The backlash contributed to the Conservatives losing their Commons majority.

Burnham has accused previous generations of politicians of "cowardice" for failing to confront social care reform, though his own push is not without risk. He has been clear about his ambition but has yet to explain how any new system would be funded, leaving the central question unanswered ahead of Tuesday's speech. His framing of the issue, however, links social care directly to the viability of the health service itself: "Broken social care will in the end break the NHS." With Baroness Casey's accelerated review due next summer, cross-party talks already under way, and an election pledge promised as the ultimate verdict, the coming months will determine whether Burnham can succeed where his predecessors did not.