A VOICE FROM THE STREET

29th September 2026
 
Extra, extra, read all about it!

Social care and the bill we keep sending to tomorrow


By David Selves


   Andy Burnham has now said what kind of social care system he wants: one like the NHS, available to everyone and free at the point of use. In an interview on 27 September, he said everyone would contribute and everyone would be covered, although contributions might not be raised in the same way as NHS funding. He intends to put proposals in Labour’s next general election manifesto. That is a more definite ambition than another promise to hold a review. It also raises the harder questions: what care will be covered, what will it cost, and who will pay? The need is growing for reasons that cannot be wished away.

More people are reaching ages at which help with washing, dressing, eating and living safely becomes necessary. The Office for National Statistics projects that the number of UK residents aged 85 and over will rise from 1.75 million in 2024 to 3.6 million in 2049. Yet social care is also a service for younger disabled adults. In England, local authorities spent £11.5 billion on long-term care for people aged 18 to 64 in 2024–25, compared with £12.0 billion for those aged 65 and over. A policy framed only around pensioners would miss almost half the long-term spending.

The present rules surprise families because social care is not funded like the NHS. In England, a person can ask the council for a needs assessment. The council considers whether illness or disability prevents them from achieving at least two specified everyday outcomes and whether that has a significant effect on their wellbeing. A separate financial assessment determines what they must contribute. NHS Continuing Healthcare can fund the whole care package for someone with a qualifying primary health need, but that requires its own assessment. For 2026–27, England’s ordinary capital limits remain £23,250 and £14,250. Someone with assets above £23,250 generally pays the full cost of a care-home place. Between the limits, the assessment takes account of income and assumes an additional £1 a week for every £250 of capital. Below £14,250, income can still be used towards care: council support does not mean care is free.

How a home is treated depends on the circumstances, including who lives there and whether care is provided at home or in a care home. Social care is devolved, so different rules apply elsewhere in the UK. The scale is already formidable. English councils recorded 2.02 million requests for support from people new to social care in 2024–25. Those were requests rather than distinct people: removing repeat requests gives 1.39 million people. At the end of March 2025, 672,000 people were receiving long-term council support. Local authorities’ gross current expenditure on adult social care was £29.4 billion in 2024–25. These figures do not capture all privately purchased care or the enormous amount provided unpaid by families. Burnham has cited an estimate of around two million adults in England with unmet care needs.

How did we get here? We built a health service around treatment free at the point of use while leaving everyday care dependent on local budgets and personal means. Longer lives and complex needs increased demand, but successive governments delayed a durable settlement on entitlement and payment. Councils faced years of financial pressure. The government says cuts in social care funding between 2010 and 2018 contributed to an estimated additional half-million A&E attendances a year among over-65s. The proposed cap on an individual’s care costs was abandoned before it took effect. Families struggle at home; hospitals cannot always discharge patients who are medically ready to leave.

Burnham understands this history. In July he blamed his own generation of politicians for failing to settle the issue and brought forward Baroness Louise Casey’s plan for a National Care Service to next summer. He began work on the care workforce and opened cross-party talks. His father’s experience of Alzheimer’s has plainly made the issue personal. His September pledge gives those steps a destination: universal care without a charge when it is used. But “free at the point of use” describes the bill facing someone who receives care, not the cost of delivering it. Burnham has not yet settled how contributions would be raised.

Nor has he defined the boundary of the promise: whether every form of assessed personal care would be covered, and what a care-home resident would still pay for accommodation and ordinary living costs. In July he acknowledged the choice between a fully fledged service, a lesser version and something in between, each with a different price. Casey is to advise on the options. Until the entitlement and funding are specified, a family cannot know how much protection the pledge would provide. There is also a question of timing. A promise for a future manifesto does not change this year’s assessments, charges or shortages.

Better pay, training and continuity for care workers require money now. Preventative support at home may avoid hospital admissions and allow earlier discharge, but it would be reckless to count every hoped-for saving as cash already available. Burnham is addressing the long-term settlement; he must also show what will improve for people waiting for care today. That brings us to the triple lock. Each year, the state pension rises by the highest of earnings growth, inflation or 2.5 per cent. It has strengthened pension incomes: the Institute for Fiscal Studies calculated that the full new state pension was about 14 per cent higher than it would have been under earnings indexation since 2011.

But the guarantee can raise pensions faster than either wages or prices. As the older population grows, pensions, health and a universal care service would compete for funding from the same economy. Changing the triple lock alone would not pay for all of Burnham’s ambition, and many pensioners rely heavily on their state pension. Treating the budgets as unrelated would be equally dishonest. A credible settlement would set out the care entitlement first and publish its expected cost over decades, not merely the first year. Parliament could then consider a broadly based contribution, including income received after retirement rather than placing the burden solely on workers. It could examine whether some tax on estates should share the cost after death, and whether the triple lock should eventually give way to a more predictable pension guarantee with explicit protection for poorer pensioners.

These are choices, not measures Burnham has adopted. Each would need an assessment showing who pays and who benefits. None is painless. A levy on workers alone would load the cost of an ageing society onto younger people. Leaving care entirely to personal means exposes some families to enormous bills through no fault of their own. Protecting every asset regardless of means would ask taxpayers with fewer assets to subsidise inheritances.

​The value of a national debate lies in making those choices visible rather than disguising a tax rise as a free service. Burnham deserves credit for stating the principle: everyone contributes and everyone is covered. The test is whether his government can turn that principle into a costed offer stating what care is free, what people may still pay, how the workforce will be supported and when the new entitlement starts. We have had decades of agreement that care matters. Now we need an agreement the country can afford to keep.