Prime Minister Andy Burnham has warned that the National Health Service (NHS) will 'collapse' without significant reform of the social care system, vowing not to leave office without addressing a problem that has eluded politicians for three decades. In his first sit-down interview as PM, Burnham signaled urgency, but the question remains: how will he pay for it?
A History of Failed Reforms
Burnham, who co-authored a 2010 white paper proposing a National Care Service modeled on the NHS, is the latest in a long line of leaders to tackle social care. Since 1997, at least 22 major reviews, commissions, and reports have attempted—and failed—to fix the system. The 2010 paper, which was not explicit about funding, was shelved after Labour lost the election two months later, with the Conservatives using the 'death tax' attack line.
In 2011, economist Andrew Dilnot recommended a lifetime cap on care costs of £25,000-£50,000. This led to the 2014 Care Act, which set a cap of £72,000 in England, but the coalition government delayed implementation to 2016, then to 2020. In 2017, Theresa May proposed raising the means test threshold to £100,000, but Labour branded it a 'dementia tax,' contributing to her loss of majority.
Recent Attempts and Setbacks
Boris Johnson's government finally set a cap of £86,000 for October 2023, funded by a 1.25% health and social care levy. However, Kwasi Kwarteng abolished the levy in September 2022, and Jeremy Hunt postponed the cap to October 2025. After Labour's 2024 election win, Chancellor Rachel Reeves said it would 'not be possible' to proceed with the cap. The party pledged a 'National Care Service' in its manifesto, and in January 2025, then health secretary Wes Streeting announced a commission chaired by Louise Casey to build cross-party consensus, with a final report due in 2028.
Burnham is keen to act quickly, possibly before the commission reports. 'Every month that goes past, the crisis deepens,' said Patrick Butler, the Guardian's social policy editor. 'The answers and options are already out there.'
Funding Challenges and International Examples
The core challenge is funding. Conservative leader Kemi Badenoch has offered to work with the government provided no tax increases or borrowing. Abby Jitendra, policy director at ThinkLabour, points to international models: Australia subsidizes care for lower incomes and caps costs via general taxation; Japan uses taxation, insurance, and individual fees. With care home fees rising 10% last year, the urgency is clear. Burnham's success may depend on finding a politically viable funding mechanism.
