Prime Minister Andy Burnham has warned that the NHS “will collapse” if social care is not reformed, placing the issue at the centre of his government’s agenda. In his first major interview since taking office, Burnham said he would not want to leave without bringing “substantial change” to a system widely seen as underfunded and unfair.
Adult social care in England provides support for older people and working-age adults with disabilities, including help at home or in residential homes. Unlike the NHS, it is not free at the point of use. In England and Northern Ireland, people with savings or assets worth more than £23,250 are not entitled to council-funded care (the value of your home counts for residential care, but not for care at home). Age UK estimates two million older people in England now live with some unmet need for care.
“Andy Burnham’s social care reform plans explained: the broken system, failed attempts, and what it means for your savings and home.”
The system has been called “punitive” by the King’s Fund, and around one in seven people aged 65 and over face lifetime care costs of more than £100,000. Multiple attempts at reform over the past 16 years have failed, largely because of arguments over how to pay. In 2011, economist Andrew Dilnot proposed a lifetime cap of £35,000 on care costs, costing between £1.3bn and £2.2bn a year. The coalition government accepted it, but David Cameron delayed implementation after the 2015 election. In 2017, Theresa May proposed including the value of a home in the means test for home care – without a cap – which opponents branded a “dementia tax” and was dropped.
For UK readers, the stakes are personal. Many families face the prospect of selling their homes to pay for residential care, or struggling to afford help at home. Burnham has said that without reform, the NHS will “collapse under the weight of trying to care for people who’ve really not needed to end up in the NHS system”. He first proposed a universal system in 2009 when he was health secretary, and has long favoured a 10% levy on all inheritances to fund social care – a plan the Daily Mail has called an “£18 billion death tax”. He also hints at changing council tax, saying there is a “big case for land and business and property tax to be changed”, possibly replacing it with a proportional property tax or land value tax, and abolishing stamp duty.
Q: What is the current means test for social care in England? Currently, if your assets – including savings and, for residential care, your home – are worth more than £23,250, you must pay the full cost of your care. For care at home, the value of your home is not counted. Below that threshold, the council may contribute, but funding is limited.
Q: How much could a cap on care costs cost the government? Andrew Dilnot’s proposed cap of £35,000 was estimated to cost £1.3bn to £2.2bn a year at the time. Adjusted for inflation and an ageing population, the cost today would be higher. Another option is making social care free at the point of need, which would be far more expensive.
Q: What is Andy Burnham’s proposed “death tax”? Burnham has long supported a 10% levy on all inheritances to fund social care, which opponents call a “death tax”. The Daily Mail reports it could raise £18bn. Burnham has also suggested allowing people to defer payment until after death, a plan previously branded a “death tax” by the Tories.
Next steps: Burnham is due to make a speech on adult social care on Wednesday. He is expected to stop short of unveiling a full plan, instead speeding up the independent Casey Commission, which was due to report by 2028 but has been brought forward. The Prime Minister says he cannot put a timeline on creating a new system, but has promised to use “whatever political capital I have” to fix it.
