Burnham Unveils Plan for NHS-Style Social Care in England, Leaving Tax Question Open

Andy Burnham has set out an ambition to give everyone in England access to free social care, modelled on the principles that underpin the National Health Service, and intends to put the proposal before voters at the next general election.

In an interview with the BBC's Sunday with Laura Kuenssberg programme, the prime minister described the kind of system he envisages as one in which "everyone contributes, everyone is covered". He stopped short of ruling out tax increases to pay for the reforms, conceding that such a move could prove "difficult or unpopular" with parts of the electorate.

Burnham said he planned to lay out his broader vision on Tuesday, with Whitehall troubleshooter Baroness Casey, who is carrying out a review of the sector, advising on the most effective way to implement the changes. The prime minister has made social care reform one of his flagship policies, a commitment sharpened by his own family experience: his father, Roy, who had Alzheimer's disease, died earlier this month.

Adult social care provides state support that helps people live more independently, including assistance delivered in their own homes. The critical distinction with the NHS is that social care is not free at the point of use. In England and Northern Ireland, anyone with savings above £23,250 is not entitled to help with care costs from their local council, while Wales and Scotland operate under different eligibility rules.

Burnham argued that the current arrangement is fundamentally unjust. He compared social care in England to the American healthcare system, saying it is "as unfair as American healthcare, where the most vulnerable in society can lose everything, they can be wiped out". He added that the existing system imposes a "huge cost" on individuals and families.

The prime minister also linked social care reform directly to the health of the NHS, saying: "Broken social care will in the end break the NHS." He pointed to the substantial number of people in hospitals across England who are unable to be discharged home "because the social care isn't there" — a bottleneck that places sustained pressure on health service capacity.

Under his vision, Burnham said the system would operate on NHS principles because "that is the only way you can make it work". He noted that free personal care already exists elsewhere in the UK, and said he does not believe it is right that people in England are denied the same provision. In Scotland, personal care is available to all adults assessed as needing help with tasks such as eating and bathing.

The prime minister stressed that the changes would need to be "done carefully, without putting extra strain on the public purse," but insisted that "nothing is off the table at this moment in time" when it comes to funding. Asked about an estimate that a universal, free-at-the-point-of-use system in England could cost taxpayers £18bn a year, Burnham disputed the figure, replying: "It's not that high."

On how the burden would be shared, Burnham said: "It will be a system of that kind – so everyone contributes, everyone is covered but not precisely necessarily in the same way that we currently pay for the NHS." He said Baroness Casey's detailed proposals would be fed into cross-party talks in an effort to "build consensus" around a lasting settlement.

The review being conducted by Baroness Casey was originally commissioned by former prime minister Sir Keir Starmer, with a deadline of 2028. Burnham has asked her to accelerate the work so it reports by next summer. On the wider timetable, he said he would stick to the manifesto, explaining that "there are commitments in the manifesto that would make it hard to do in this Parliament". The 2024 Labour manifesto contained firm tax pledges, including a commitment not to raise national insurance, income tax or VAT.

Burnham made clear that any plan would ultimately be tested by the public. "I don't think you can reform this system without consensus," he said. "I will develop a very clear plan and I will put that plan to the public at a general election and that will be where the plan gets tested and people will then be able to decide."

The proposals drew immediate political reaction. Shadow home secretary Chris Philp said the prime minister was signalling that Labour wanted "more tax rises" to fund the reforms, and confirmed the Conservatives would not support them. He described tax increases as a "red line" for his party and said the country is "already taxed too highly", arguing that any additional money needed for social care or defence should be found through savings elsewhere, particularly in the welfare budget.

Labour MP Darren Jones, a former cabinet minister in Sir Keir's government, offered a more supportive response, describing Burnham as "very bold and brave" on social care. He added that "politics is about prioritisation and these things do cost money", while noting that the detail of the policy still needs to be examined. Liberal Democrat leader Sir Ed Davey said Burnham could demonstrate he is "serious about fixing care" by pressing ahead with cross-party talks that began in July, warning that the effort "can't just be a series of No 10 headlines with no real action".

Reform UK's economic spokesman Robert Jenrick attacked the plan directly, saying: "Andy Burnham refuses to rule out his universal death tax. He's too weak to cut the benefits bill so he's coming for your home instead." The jibe echoes a long and politically toxic history. As health secretary in Gordon Brown's Labour government, Burnham produced a plan for a national care service that would have been funded partly through compulsory contributions, including from people's estates after death. Opponents branded it a "death tax" and the proposals were abandoned after Labour lost the 2010 general election.

A similar fate befell the Conservatives in 2017, when then-prime minister Theresa May was accused of introducing a "dementia tax" over a proposal that people receiving care at home should pay full costs if they were worth at least £100,000. The policy triggered a political outcry and the Conservatives lost their majority in the House of Commons. Burnham has accused previous generations of politicians of "cowardice" for failing to confront social care reform, though his own push for change is not without jeopardy.