Burnham's NHS-Style Care Plan Could Take Decades, Dilnot Says

Sir Andrew Dilnot said Andy Burnham's plan for an NHS-style social care system in England could take decades to introduce.

Sir Andrew spoke to BBC Radio 4's Today programme on 28 September. He said a completely free scheme would cost a "very substantial" sum BBC. He said change was now further off because Mr Burnham had promised to put his plans to voters at the next general election.

Mr Burnham, the prime minister, set out his case on BBC's Sunday with Laura Kuenssberg. He said his proposal would mean "everyone contributes, everyone is covered". He refused to rule out tax rises to pay for it. He promised more detail in his conference speech on Tuesday.

He said the proposals would not be brought in before the next general election. He said that was to keep Labour's 2024 manifesto pledge not to increase national insurance, income tax or VAT. The next election is not due until August 2029.

Mr Burnham first promised a new national care service for England in a speech in July, shortly after he became prime minister. The pledge applies to England only. Social care is devolved, so rules in Scotland, Wales and Northern Ireland are set in Edinburgh, Cardiff and Belfast.

Labour MP Darren Jones opened up the funding debate further. He told Kuenssberg that scrapping the pensions triple lock should be considered alongside other options. The triple lock means the UK state pension rises each year in line with wage growth, inflation, or 2.5%, whichever is highest.

Cost is a key part of the argument. The Health Foundation estimated that a universal system in England, where the government pays for all support, could cost about £18.5bn a year. Sir Andrew said he believed an NHS-style system could cost well above £18bn. He said a Scottish-style model could cost about half that. He said there was a sign Mr Burnham was picturing a scheme that might take many years, even many decades, to happen. Think of it as the difference between free care for all, as the NHS offers for health, and a cap that limits what each person pays.

At present, the means test in England and Northern Ireland, the check on savings and property, means people with assets above £23,250, including their home, get no help with care costs from their council. In Scotland, state-funded personal care is offered to all adults assessed as needing help with tasks such as eating and washing. It does not cover accommodation, food and daily living costs, which are still means-tested.

Sir Andrew led a commission on reform 15 years ago. It proposed a £35,000 lifetime cap on what any one person would pay for care BBC. Reform of charges has been promised since the Dilnot Review in 2011. Plans have been dropped by different UK governments over 25 years. Sir Andrew has previously described the dropping of a plan as a "tragedy" BBC.

Mr Burnham is to hold talks with the Conservatives and Liberal Democrats on social care BBC. Phase One of adult social care reform will set out how to build a national care service, with a report due in 2026. Sir Andrew has previously said a three-year planning phase is too long. He said the government could set out what it wants to do by the end of 2025.

The broader context here is that the timetable matters more than the principle. A promise to legislate after the next election ties the policy to manifesto talks, cross-party discussions and spending choices that have not yet been made. For officials and advisers, the open questions are the funding base, the choice between a universal and a capped model, and whether any deal can hold while the lock on the three main taxes lasts until 2029.