Dilnot Warns NHS-Style Social Care in England May Be Decades Away as Funding Row Deepens

A sweeping overhaul of adult social care in England along the lines of the NHS could be many years — potentially even several decades — away from becoming reality, according to the economist who led the last major review of the sector. Sir Andrew Dilnot, whose commission proposed fundamental reform 15 years ago, told the BBC that the timeline now appears far more distant than ministers have suggested.

His warning comes after Prime Minister Andy Burnham signalled his ambition to create a national care service in which support is available to everyone, regardless of their wealth. Dilnot said the prime minister's language implied a system that would be entirely free at the point of use, including residential care — a commitment that would carry an enormous price tag.

Speaking on BBC Radio 4's Today programme, Dilnot said the cost of such a scheme would be "very substantial". He also noted that because Burnham intends to put his plans to voters at the next general election, meaningful change "is now further away" than previously implied.

Adult social care covers state-funded assistance that helps people live more independently, including help in their own homes with tasks such as washing, dressing and eating. The crucial difference from the NHS is that social care in England is not free at the point of delivery, meaning many older and disabled people face steep bills for their own support.

Under the current means-tested system in England and Northern Ireland, anyone with assets above £23,250 — including the value of their home — is not entitled to council help with care costs. Wales operates a similar means-tested approach. Scotland offers state-funded personal care to all adults assessed as needing help with daily tasks, but accommodation, food and general living costs in care homes remain subject to means testing.

In an interview with the BBC's Sunday with Laura Kuenssberg, Burnham suggested his proposals would mean "everyone contributes, everyone is covered", and he declined to rule out tax rises to pay for the system. He promised to reveal more detail in his conference speech on Tuesday.

However, the prime minister also indicated that any changes would not be introduced before the next general election, because he wants to honour Labour's 2024 manifesto commitments. Those pledges include a promise not to raise national insurance, income tax or VAT.

The funding question has already exposed divisions within Labour. Darren Jones, a Labour MP and former minister, told Laura Kuenssberg that abandoning the pensions triple lock was "an option that the government should consider alongside others" to fund social care reform. The triple lock guarantees that the state pension rises by whichever is highest of average wage growth, inflation or 2.5% — and keeping it is itself a Labour manifesto promise. The next general election is not due until August 2029, although Burnham could call one earlier.

Dilnot pointed out that if reform proposals end up in Labour's 2029 manifesto, that would be three decades after Sir Tony Blair launched a royal commission on social care, and more than 15 years after his own commission reported. His review recommended a lifetime cap of £35,000 on the amount individuals would have to pay towards their own care. The Conservative-Liberal Democrat coalition government under David Cameron accepted the recommendation, but implementation was pushed back to 2020, with Cameron citing pressure on the public finances. The cap was ultimately abandoned by later Conservative governments.

Other attempts at reform have met similar fates. Theresa May's government dropped plans to require people receiving care at home to pay the full cost if they had assets worth at least £100,000, after opponents branded the proposal a "dementia tax". And when Burnham served as health secretary in Gordon Brown's government, his own plan for a national care service envisaged funding it through a compulsory levy on people's estates after death. Opponents labelled that idea a "death tax", and the proposals stalled after Labour lost the 2010 general election.

The Health Foundation has estimated that a universal social care system in England, with the government funding all support, could cost around £18.5bn a year. Burnham said on Sunday that he believed the true figure would be lower, though he has not explained how he would pay for it. Dilnot said he thought an NHS-style system could cost "well in excess of £18bn", while a Scottish-style model might cost roughly half that amount.

The economist added that Burnham's remarks suggested he was imagining a project that could take "many years, even many decades" to deliver. Dilnot said he would "love to see such a scheme", in which all social care is government-funded, but cautioned that "the cost would become very, very large". He added that a system capping the amount people must contribute towards their care "could still work well for elderly people".

The political sensitivity of social care is difficult to overstate. Any reform touches on inheritance, property wealth, taxation and the deeply personal decisions families make about looking after older relatives. Critics of universal free care argue it would divert billions from other public services, while supporters say the current system is unfair and leaves people facing catastrophic costs simply because they develop care needs.

With Labour's manifesto constraints limiting tax rises and the prime minister unwilling to act before the next election, the immediate prospects for legislation appear slim. Dilnot's intervention suggests that, on the current trajectory, a genuinely universal care service for England remains a long-term aspiration rather than an imminent reality — and that the country may be waiting well into the 2030s, or beyond, before the promise is tested.