New NHS-style social care system could take decades, Dilnot says

Sir Andrew Dilnot, the former chair of the 2008-09 commission that first recommended a universal, NHS‑style adult social care system for England, warned on BBC Radio 4’s Today programme that the cost of delivering such a scheme would be “very substantial”, likely exceeding £18 billion a year. Dilnot said Prime Minister Andy Burnham appears to be pushing for a model in which social care is completely free at the point of use, including residential costs, a promise that would require “well in excess of £18bn” in funding. Burnham, who has pledged to present his social‑care vision to voters at the next general election, has hinted that financing could involve tax rises but has not detailed how the money would be raised. The prime minister’s ambition to make the system “everyone contributes, everyone is covered” clashes with Labour’s 2024 manifesto pledge not to increase national insurance, income tax or VAT, leaving the financing question unresolved.

The financial challenge is compounded by the fact that England’s current system already leaves many people with huge bills, as only those with assets below £23,250 receive council support, while Scotland’s universal personal‑care model still subjects accommodation and living costs to means‑testing. The Health Foundation estimates a fully funded English model would cost about £18.5 billion annually, whereas a Scottish‑style approach might be roughly half that. Dilnot noted that even a capped‑contribution model, such as the £35,000 lifetime cap his commission proposed, would still represent a massive fiscal commitment. Labour MP Darren Jones suggested scrapping the pensions triple lock as one possible revenue source, but Institute for Fiscal Studies director Helen Miller warned that eliminating the lock alone would be insufficient, and additional tax measures would likely be required.

Dilnot’s remarks underscore how far the promised reform is from implementation; he pointed out that if the proposals only appear in Labour’s 2029 election manifesto, it would be three decades after Sir Tony Blair’s original royal commission and more than fifteen years since Dilnot’s own report. The timeline suggests that any NHS‑style system could take “many years, even many decades” to materialise, especially given past failures to deliver similar reforms under previous governments, including the abandoned lifetime cap under David Cameron and the “dementia tax” plan under Theresa May. While Burnham believes the costs could be lower than the Health Foundation’s estimate, the lack of a clear funding pathway means the prospect of a free, universal social‑care system remains distant, leaving current and future care users uncertain about how and when the promised changes might finally be realised.

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