Dilnot Warns NHS-Style Social Care in England May Take Decades as Funding Row Deepens

Plans to create an NHS-style social care system in England could take many years, possibly even decades, before they become reality, according to Sir Andrew Dilnot, the economist who chaired a landmark commission on the issue 15 years ago. Speaking to BBC Radio 4's Today programme, Sir Andrew said the latest political momentum behind reform appeared to have slowed rather than accelerated, telling listeners that meaningful change "is now further away" than it seemed only months ago.

His intervention comes amid growing debate over how to fix a system that, unlike the NHS, is not free at the point of use in England. Adult social care provides state support to help people live more independently, including assistance in their own homes, but many users face substantial bills because eligibility is tightly means-tested. That contrast with the health service has fuelled calls for a universal model, yet the question of who pays remains unresolved.

Sir Andrew said Prime Minister Andy Burnham appeared to favour a system in which social care would be completely free, including the costs of residential accommodation. He warned that the price tag for such a scheme would be "very substantial", and noted that Burnham has promised to put his plans before voters at the next general election. Because of that commitment, Sir Andrew argued, reform has effectively been pushed beyond the current parliamentary term.

Under existing rules in England and Northern Ireland, people with assets worth more than £23,250, including the value of their home, are not entitled to council help with care costs. Wales also operates a means-tested system. Scotland is different: state-funded personal care is available to all adults assessed as needing help with tasks such as eating and bathing, but accommodation, food and everyday living costs are still subject to means testing.

Sir Andrew said that even a Scottish-style model would leave people in residential care facing "very substantial bills", something Burnham has said he wants to avoid. In an interview with the BBC's Sunday with Laura Kuenssberg programme, the prime minister suggested his proposals would mean "everyone contributes, everyone is covered", and he declined to rule out tax rises to pay for them. He promised to set out more detail in his conference speech on Tuesday.

However, Burnham also indicated that any changes would not be implemented before the next general election, saying he wanted to honour Labour's 2024 manifesto commitments, which included a pledge not to raise national insurance, income tax or VAT. The next election is not due until August 2029, though the prime minister could choose to call one earlier. That timeline means voters may have to wait years before the shape of a reformed system becomes clear.

The funding question has already exposed divisions within Labour. Darren Jones, a Labour MP and former minister, told Laura Kuenssberg that scrapping the pensions triple lock was "an option that the government should consider alongside others" to pay for social care reform. The triple lock guarantees that the state pension rises by whichever is highest of average wage growth, inflation or 2.5%, and retaining it was also a Labour manifesto promise.

Sir Andrew pointed out 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 back. His review recommended a lifetime cap of £35,000 on the amount individuals would have to pay towards their own care. The coalition government led by David Cameron accepted the recommendation, but implementation was delayed until 2020, with Cameron citing pressure on the public finances, and the idea was eventually abandoned by later Conservative governments.

Other attempts at reform have also failed. Theresa May's government scrapped plans to make people receiving care at home pay full costs if they were worth at least £100,000, after opponents branded the proposal a "dementia tax". Earlier, when Burnham was health secretary in Gordon Brown's government, his plan for a national care service suggested funding it through a compulsory contribution from people's estates after death. That idea was attacked as a "death tax" by political opponents and went no further after Labour lost the 2010 general election.

The Health Foundation has estimated that a universal social care system in England, with the government funding all support, could cost around £18.5bn a year. Burnham has said he believes the true cost would be lower, but he has not explained how he would raise the money. Sir Andrew said he believed an NHS-style system could cost "well in excess of £18bn", though a Scottish model might come in at roughly half that figure.

He added that Burnham's remarks suggested he was imagining something that "could take many years, even many decades before it came to fruition". Sir Andrew said he would "love to see such a scheme", where all social care is government-funded, but cautioned that "the cost would become very, very large". He suggested that a system capping the amount people must pay towards their care "could still work well for elderly people", offering a middle path between the current means-tested approach and full universal provision.

The renewed scrutiny places social care back at the centre of Westminster's political agenda, but it also highlights how often reform has been promised and then shelved. For families currently navigating the system, the practical consequences are immediate: without eligibility for council support, many face selling assets or draining savings to pay for care. For the government, the challenge is balancing competing pledges on tax, pensions and public spending while designing a system that can command lasting cross-party support. Sir Andrew's warning suggests that, on the current trajectory, the wait for a lasting settlement may be far from over.