Dilnot Warns NHS-Style Social Care in England May Take Decades to Deliver

Sir Andrew Dilnot, the economist who chaired a landmark commission on social care funding fifteen years ago, has cautioned that creating an NHS-style social care system in England could take many years, possibly even decades, to become a reality. His comments, made during an interview with BBC Radio 4's Today programme, cast doubt on the timeline implied by Prime Minister Andy Burnham, who has signalled his ambition to overhaul the current means-tested arrangements.

Dilnot observed that Burnham appears to favour a system in which social care is entirely free at the point of use, covering residential costs as well as support in people's own homes. The economist warned that the price tag attached to such a comprehensive scheme would be "very substantial," and he noted that because Burnham intends to seek a mandate from voters at the next general election, meaningful change has actually moved "further away" rather than closer.

Adult social care in England provides state-backed assistance to help people live independently, ranging from help with washing and dressing to residential placements. Unlike the NHS, however, it is not universally free when people need it, which means many individuals and families are left confronting enormous bills. Dilnot's original commission proposed a lifetime cap of £35,000 on what any individual would have to contribute towards their own care, a recommendation accepted in principle by the Conservative-Liberal Democrat coalition government under David Cameron.

That cap was never implemented. Its introduction was pushed back to 2020, with Cameron citing pressure on the public finances, and later Conservative governments abandoned the policy altogether. Other reform attempts have met similar fates. Theresa May's government withdrew plans to require people receiving care at home to pay full costs if they held assets of at least £100,000, following fierce criticism that it amounted to a "dementia tax." Earlier still, when Burnham served as health secretary in Gordon Brown's government, his proposal for a national care service suggested funding it through a compulsory levy on people's estates after death. Opponents branded it a "death tax," and the plan stalled after Labour lost the 2010 general election.

Speaking to the BBC, Dilnot said Burnham's description of an NHS-style system implied care would be "entirely free." He pointed out that in England and Northern Ireland, people with assets above £23,250, including the value of their home, are currently ineligible for council help with care costs. Wales also operates a means-tested system. Scotland offers state-funded personal care to all adults assessed as needing help with tasks such as eating and bathing, but accommodation, food and everyday living expenses remain subject to means testing.

Even a Scottish-style model, Dilnot noted, would leave people in residential care facing "very substantial bills," something Burnham has said he wants to avoid. The Health Foundation has estimated that a universal social care system in England, with government funding all support, could cost approximately £18.5bn a year. Burnham said on Sunday that he believed the true figure would be lower, but he has not yet explained how he would pay for his plans.

Dilnot suggested an NHS-style arrangement could cost "well in excess of £18bn," while a Scottish model might come in at roughly half that amount. He added that Burnham's remarks indicated he was imagining something that could take many years, "even many decades," to come to fruition. While Dilnot said he would "love to see such a scheme," he cautioned that "the cost would become very, very large." He also argued that a system capping the amount people pay towards their care "could still work well for elderly people."

In an interview with the BBC's Sunday with Laura Kuenssberg programme, Burnham said his proposals would mean "everyone contributes, everyone is covered," and he declined to rule out tax rises to fund the system. He promised to set out further details in a conference speech on Tuesday. However, he indicated that any changes would not be implemented before the next general election, because he wants to honour commitments in Labour's 2024 manifesto, which included a pledge not to raise national insurance, income tax or VAT.

Labour MP and former minister Darren Jones told Laura Kuenssberg that scrapping the pensions triple lock was an "option that the government should consider alongside others" to fund social care reform. The triple lock guarantees the state pension rises by whichever is highest among average wage growth, inflation or 2.5%, and maintaining it was also a Labour manifesto promise. The next general election is not due until August 2029, though Burnham could call one earlier.

Dilnot said change on social care "is now further away" than had been implied when Burnham first promised a new national care service for England in July, shortly after becoming prime minister. He noted that if proposals are included in Labour's 2029 election manifesto, that would be 30 years after Sir Tony Blair launched a royal commission on social care and more than 15 years since his own commission reported. The history of failed reform, he suggested, underscores how difficult it is to translate political ambition into a functioning funding settlement.

The debate now turns on whether Burnham can devise a credible funding mechanism that avoids the pitfalls that doomed previous attempts. With an ageing population placing ever greater demands on the system, and families across England still exposed to potentially ruinous care costs, the pressure for a durable solution remains intense. Yet the experience of the past three decades suggests that consensus on how to pay for social care is as elusive as ever, and Dilnot's warning serves as a reminder that bold announcements do not automatically translate into tangible change for those who need support.