Andy Burnham became Prime Minister this week, and social care providers across England are asking a question they have posed to every new leader for over 25 years: will this new PM finally fix it? Two MPs from opposite sides of the House gave us their verdict on what a Burnham premiership means for the sector; this piece looks at the policy Burnham himself has spent fifteen years arguing for, and whether he can actually deliver it.
Why free personal care keeps returning to the political agenda
Free personal care is not a new idea. It is one of the oldest unresolved debates in English social policy. In 1999, the Royal Commission on Long Term Care recommended that personal care costs should be covered by the state and funded through general taxation. This separated the argument for state responsibility from the argument for means-tested housing and living costs. At the time, the government rejected this main recommendation due to cost concerns, and the discussion came to a halt.
It resurfaced in 2011 with the Dilnot Commission, which determined that the existing funding system was not fit for purpose and proposed a cap on lifetime care costs instead of free personal care. This formed the basis for the Care Act 2014, but even the cap was repeatedly delayed and then finally dropped in its original form by the government that followed. A later attempt to fund care reform through the 2021 Health and Social Care Levy, a 1.25 percentage point rise in National Insurance intended to raise around £12 billion a year for health and social care, was itself repealed within twelve months. That is a useful reminder that the problem is not only agreeing a policy, it is making a funding mechanism survive contact with government once it exists in law.
Scotland chose a different approach entirely, introducing free personal care in 2002 under the Community Care and Health (Scotland) Act, a policy that is now widely accepted and popular there. However, England has spent the last two decades debating the same principle and rejecting or postponing it each time the issue has come up. This history is significant because it represents the pattern Burnham must break, rather than starting from a blank slate.
What Burnham has actually committed to
It is important to differentiate between discussion and actual promises. Burnham has, in the past, during his time as Health Secretary, argued for a National Care Service based on the same fundamental principle set out by the 1999 Commission: that personal care should not depend on an individual's wealth. His conviction on this point is not new. Back in 2010, as Health Secretary, he proposed a compulsory 10 per cent levy on all estates to fund social care, a policy the Conservatives attacked with election posters branding it a "death tax". The idea he is floating now as Prime Minister, a national care levy to replace inheritance tax, is a direct descendant of that same fight.
As Mayor of Greater Manchester, he advocated to trial free care at the point of use for all of your life at the regional level, funded by pooling health and care budgets and replacing charges with a new tax, though he was explicit at the time that the mayor did not have the powers to impose any such tax or levy himself and was asking national government to grant them. As Prime Minister, Burnham has emphasised that fixing social care is urgent, describing the current system as "broken" and the failure to fix it as "not defensible", and saying too many people have lost their homes and life savings while politicians let the problem drag on. He has said he would look at the effects on inheritance tax and care charges, and has confirmed he does not "resile" from earlier comments about scrapping inheritance tax in favour of a care levy. He has also said he is prepared to spend significant political capital on the issue.
However, he is yet to outline a fully detailed, funded, national legislative commitment to free personal care, and he has not defined a funding mechanism or timeline with precision. The Greater Manchester vision served as a testing ground and a clear statement of intent, but it does not automatically translate to national government. The gap between promises and an actual funded legal entitlement is exactly where previous efforts at reform have failed.
The financial arithmetic: where the numbers get difficult
Estimates of the cost of implementing a Scottish-style free personal care system in England vary widely and depend heavily on the assumptions made, and that variation is itself telling. The Health Foundation's latest modelling estimates the cost of free personal and nursing care for people aged 65 and over at around £6 billion in 2026/27, rising to approximately £7 billion by 2035/36. Earlier analysis for a House of Commons committee inquiry estimated the same policy, with different eligibility and uptake assumptions, at about £7 billion by 2021 and £14 billion by 2030/31.
The difference between these figures hinges on a few design choices: where the means-tested threshold currently stands compared to where it might be eliminated, whether personal care is defined narrowly (washing, dressing, eating) or more broadly (including housekeeping and support tasks), and how much additional demand the policy generates once the charge is removed. Scotland's experience is instructive here: introducing free personal care led to a clear increase in demand that could not be explained solely by demographic change. Any credible costing for England must account for that behavioural response, rather than just applying current usage rates to a free service. None of the published estimates factor in working-age adults, who already account for roughly half of local authority social care spending, suggesting these figures likely underestimate the true cost of a genuinely universal policy.
The legislative and structural barriers
This aspect of the debate receives the least attention in political discussion, but it significantly affects whether Burnham's mayoral ambitions can translate into national delivery. The 2015 Greater Manchester devolution deal pooled around £6 billion of health and social care spending under a joint board, which allowed the region to integrate commissioning and change how services were organised locally. However, it did not give the mayor, or Greater Manchester as a whole, the authority to change the national means test or the underlying entitlement to care, and Burnham himself has previously acknowledged he lacked the power to raise a tax or levy for social care without Westminster's agreement. Eligibility, charging rules and the basic framework of who pays what are dictated by England-wide primary legislation, mainly the Care Act 2014, which grew out of the Dilnot recommendations rather than the free personal care model.
Adapting a regional ambition into a national free personal care entitlement therefore requires new primary legislation passed at Westminster, not just administrative devolution or the will of the mayor, however sincere. This process is slower and more contested, and it also puts the policy in front of a Treasury that has resisted this reform under every government since 1999, and that saw its own 2021 attempt at a dedicated care-funding levy repealed within a year of it becoming law.
What the sector actually needs from any reform
Funding reform is necessary, but it is not enough on its own. Providers are clear about the other part of the equation: the workforce. The latest Skills for Care data shows that the adult social care vacancy rate has dropped to 6.2 per cent, its lowest level in a decade. Still, the sector needs an estimated 410,000 additional posts by 2040 to keep up with an ageing population. Overseas recruitment, which has been crucial to workforce growth over the past four years, is now declining sharply following the removal of a dedicated international visa route. Any free personal care policy that increases demand for care, which Scotland's experience suggests it will, needs a workforce plan alongside the funding plan. A funded entitlement that providers cannot staff is not a solution.
Providers are also navigating a more immediate, commercial version of this uncertainty. With public funding policy unresolved for a quarter of a century, operators relying on self-funders have had to build long-term occupancy and positioning strategies without knowing if or when the market rules might change — see our analysis of what families actually pay in care home fees today. This is precisely the environment in which clear, well-targeted marketing strategies for care homes and nursing homes become more critical, built on referral networks and reputation management that hold up under commissioner scrutiny. Providers cannot wait for Westminster to resolve the funding issue before they need to fill beds and convey value to families considering self-funded care today.
Verdict: credible commitment or familiar promise?
Burnham brings something his predecessors lacked: a personal, decades-long belief in this issue, dating back to a funding fight he was already fighting and losing in 2010, rather than a policy adopted for just one parliamentary term, plus direct experience of trying to establish a version of this at regional level. He has also signalled he is willing to spend real political capital on it, and Baroness Casey, who chairs the independent commission on adult social care, has confirmed direct contact with him and indicated her interim report, due later this year, will propose "quite big" changes rather than incremental ones — see what the sector itself thinks the Casey Commission needs to deliver. Phase one of that commission, setting out an implementation plan for a national care service, is due to report in 2026; the harder phase, long-term funding recommendations, is not due until 2028, though there are signs Burnham wants that timetable brought forward.
Against that, he now faces the challenge that every government since 1999 has failed to meet: passing a funded, national entitlement through Westminster, against likely Treasury resistance, at a time when his own political position is new and untested, and the fiscal backdrop is no easier than it was for Blair, Brown, Cameron or Starmer, all of whom looked at some version of this same reform and stepped back from it.
A realistic assessment is that a complete, national, Scottish-style free personal care policy is unlikely to arrive quickly. The more plausible near-term outcome is a partial one: accelerated recommendations from the Casey commission, a clearer statement on funding principles, and gradual movement on eligibility rather than full abolition of the means test at once. For a sector that has waited so long, even that would be a significant step forward. Whether it becomes the full entitlement that this debate's history has promised, but repeatedly failed to deliver, will depend on whether Burnham's administration is willing to legislate the cost, not just name it, and on whether whatever it legislates survives longer than the last funding mechanism did.
