Adult social care in England is at a breaking point. Without fundamental reform, the NHS will collapse under the strain of caring for people who should never have ended up in hospital in the first place. That is the stark warning from the prime minister, Andy Burnham, who has pledged to use his political capital to finally fix a system that has been ignored for decades.
So what exactly is social care? Adult social care provides state support to help people live more independently. This includes assistance at home with tasks like washing, dressing, cleaning, and cooking. Unlike the NHS, social care is not free at the point of use. In England and Northern Ireland, people with savings worth more than £23,250 are not entitled to any help with care costs from their local council. Different rules apply in Wales and Scotland. The system means that many people either go without the care they need or face enormous bills. The King's Fund, a healthcare think tank, says the current system is “punitive”, with one in seven people paying in excess of £100,000 for their care.
“Britain's social care system is in crisis. Here's why reform is urgent and what it means for you.”
The issue has been kicked down the road by successive governments. In 2019, Boris Johnson pledged to “fix the crisis in social care once and for all”. Five years later, in July 2024, Labour scrapped plans for an £86,000 cap on the amount anyone in England would need to spend on their personal care over their lifetime. Now, Burnham – who first proposed a universal system of social care back in 2009 when he was health secretary – says he will not leave office without bringing in “substantial change”. An independent review chaired by Baroness Louise Casey has been considering possible solutions, but its final recommendations are not expected until 2028. Burnham has said he wants to speed up that timetable.
Why does this matter for UK readers? Because the social care crisis is already affecting millions of families. When people cannot get the care they need at home, they end up in hospital – often blocking beds that could be used for other patients. This is a major reason why NHS waiting times remain high. The King's Fund warns that a “punitive system” means many people are going without care altogether. Reform could mean a new national system, possibly funded through taxation or insurance, where care is free at the point of need – like the NHS. But the big question is who pays. Conservative leader Kemi Badenoch has written to the prime minister to demand he rule out tax rises or increased borrowing to fund reform. The Liberal Democrats have urged cross-party consensus. Any solution will need to balance fairness, affordability, and public support.
Q: What is adult social care? Adult social care is state support that helps people live more independently, including assistance at home with tasks like washing, dressing, and cleaning. Unlike NHS care, it is not free at the point of use.
Q: Who pays for social care in England? People with savings over £23,250 are not entitled to any help from their local council and must fund their own care. Those with fewer savings may get some support, but the system means many face substantial costs – one in seven pay more than £100,000.
Q: Why has social care reform been so difficult? Previous attempts have stalled due to the high cost and political fallout. In 2010, Labour proposed a compulsory levy, which the Conservatives branded a “death tax”. More recently, Labour scrapped a planned £86,000 cap on personal care costs. The issue remains deeply divisive, with no consensus on how to fund a new system.
What happens next? Burnham is due to make a speech on adult social care on Wednesday, where he is expected to announce he is speeding up the Casey Commission rather than unveiling a full plan. The commission is not due to report until 2028, but Burnham wants to bring that forward. He has also said he will address youth unemployment and devolution in the coming weeks. The prime minister has not ruled out tax rises or borrowing to fund reform, but has not committed to a timeline for a new system. For now, the crisis continues – and the pressure on the NHS grows.