Andy Burnham, the prime minister, has declared that the adult social care system in England is broken and requires urgent reform. He stated he is willing to 'expend a lot of political capital' to push through changes, acknowledging the process could be long and costly. This view is widely shared across the political spectrum, though there is no consensus on how to fund the overhaul of what is often described as an outdated and fragile system held together by 'sticking plasters and glue' and propped up by unpaid carers.
Previous reform attempts and challenges
Burnham previously led an unsuccessful legislative attempt to reform adult social care in 2010 while serving as secretary of state for health. That effort was derailed by Conservative claims that it would be funded through a 'death tax'. Despite this, Burnham has said he will not flinch from big policy decisions and is prepared to invest significant political capital in his ambitions.
Cost of social care reform
The expense of reform depends on the design, scale, and type of support offered, as well as how costs are shared between the state and individuals. Currently, many English taxpayers contribute to local authority adult social care budgets through council tax and may also pay for their own care under a heavily means-tested system. People with assets above £23,250 generally fund their own care, while those below may qualify for council support. One in seven individuals end up paying social care bills exceeding £100,000, sometimes forcing them to sell their homes.
Reform options under consideration
Proposals aim to improve the lives of vulnerable individuals while protecting them from excessive costs. Options include providing some care free regardless of income or limiting the financial impact of catastrophic care bills. Burnham has discussed a national care service for England run on the 'NHS principle', though he has not detailed what this means. An NHS-style free-at-the-point-of-use system would cost an estimated £18.5 billion annually by 2035-36, making it the most expensive option but transforming England's care system into one of the most generous globally.
Free personal care and cost caps
Another alternative is a free personal care service similar to Scotland's, where the state pays for hygiene, meals, medication, and general wellbeing for adults at home or in residential care, but not for housework, laundry, shopping, or day care. According to the Health Foundation thinktank, extending free personal care to over-65s in England would cost an extra £7.5 billion by 2035-36. Previous English governments have pursued a lifetime cap on care costs, most recently set at £86,000 with a means-test floor of £100,000, but this was postponed by the Conservatives and scrapped by the current Labour government. The estimated cost of this model would be £4 billion annually by 2035-36.
Tax implications and public opinion
Whichever option is chosen, significant extra government investment is likely, potentially through increases in general taxation, wealth taxes, national insurance, or compulsory social insurance. Polling indicates the public has low understanding of adult social care and its funding, and it ranks lower than issues like the cost of living or the NHS. According to the King's Fund thinktank, satisfaction with social care services is low, but the public is open to the state covering a greater share of costs.
Political positions on reform
The Conservatives support reform in principle but oppose any policy involving tax rises. Liberal Democrat leader Ed Davey said he would work towards a consensus, adding that 'everyone must get the care they need and no one should lose their home as a result'. Reform leader Nigel Farage opposes any care levy on assets after death, calling it a 'death tax'.
