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

Sir Andrew Dilnot, the economist who chaired a landmark commission on social care funding, has cautioned that creating an NHS-style system for England could take many years or even decades to deliver, telling the BBC that meaningful change now appears further off than previously suggested.

His intervention comes as Prime Minister Andy Burnham signals support for a sweeping overhaul under which social care would be provided free at the point of use, including residential accommodation costs—an ambition Dilnot believes would carry a very substantial price tag.

Speaking on BBC Radio 4's Today programme, Dilnot said Burnham's language pointed toward a system that is entirely free, a significant departure from the means-tested arrangements that currently leave many older people facing large bills for their care.

Unlike the National Health Service, adult social care in England is not universally free. State support is available to help people live more independently, including assistance in their own homes, but eligibility depends on a financial assessment that takes assets into account.

Under the present system in England and Northern Ireland, individuals with assets exceeding £23,250—including the value of their home—are generally not entitled to council help with care costs. Wales operates its own means-tested arrangements, while Scotland provides state-funded personal care to all adults assessed as needing help with tasks such as eating and bathing, though accommodation, food and everyday living expenses remain subject to means testing.

Dilnot argued that even a Scottish-style model would leave people in residential care confronting very substantial bills, something Burnham has said he wants to avoid. He said he would love to see a scheme in which all social care is government-funded, but warned that the cost would become very, very large.

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 figure would be lower, but he has not yet explained how he would pay for his plans. Dilnot suggested an NHS-style system could cost well in excess of £18bn, while a Scottish model might require roughly half that amount.

In an interview with the BBC's Sunday with Laura Kuenssberg, Burnham said his proposals would mean everyone contributes and everyone is covered, and he declined to rule out tax rises to finance the reforms. He promised to set out more detail in his conference speech on Tuesday.

However, Burnham indicated that any changes would not take effect before the next general election, because he wants to honour the commitments made in Labour's 2024 manifesto, 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.

Dilnot said that if proposals are ultimately included in Labour's 2029 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. He led that commission 15 years ago and its recommendations were accepted by the Conservative-Liberal Democrat coalition government under David Cameron, including a proposed lifetime cap of £35,000 on the amount people would have to pay toward their own care.

Implementation of the cap was pushed back to 2020, with Cameron citing pressure on the public finances, and the idea was eventually abandoned by subsequent Conservative governments. Dilnot said a system that caps individual contributions could still work well for elderly people, even if full government funding remains out of reach.

The history of social care reform in England is littered with stalled or discarded plans. Theresa May's Conservative government scrapped proposals that would have required people receiving care at home to pay the full cost if they were worth at least £100,000, after opponents branded the policy a dementia tax.

Burnham himself previously proposed a national care service when he served as health secretary in Gordon Brown's government, suggesting it could be funded through a compulsory contribution from people's estates after death. That idea was attacked by political opponents as a death tax, and the proposals went no further after Labour lost the 2010 general election.

Against that backdrop, Dilnot said change on social care is now further away than had been implied when Burnham first promised a new national care service for England in a speech in July, shortly after becoming prime minister. His remarks underline the scale of the political and financial challenge facing any government that attempts to bring social care into line with the NHS.

The funding debate has also touched on the state pension. Darren Jones, a Labour MP and former minister, told Laura Kuenssberg that scrapping the pensions triple lock was an option the government should consider alongside others as a way 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 maintaining it was also a Labour manifesto commitment.

For families currently navigating the care system, the practical consequences of delay are immediate. Many people requiring support at home or in a residential setting must sell assets or draw down savings to cover costs, while others reduce the care they receive to avoid exhausting their means.

Dilnot's warning suggests that without a politically viable funding mechanism, the gap between the NHS principle of care free at the point of use and the reality of means-tested social care is likely to persist well beyond the current parliament.