Dilnot warns universal social care plan may take decades and cost over £18bn a year

Creating a social care system in England that is free at the point of use could take decades and cost substantially more than £18 billion a year, leading economist Sir Andrew Dilnot has warned.

Sir Andrew, who led an influential government commission on social care funding, questioned the timetable and expected cost of Prime Minister Andy Burnham’s proposed National Care Service. The plan is intended to place social care on a similar footing to the NHS, with costs shared across the population rather than falling heavily on individuals who develop significant care needs.

Burnham has described the present system as deeply unfair and pledged to make social care reform a central commitment at the next general election, expected by 2029. However, detailed proposals—including how the new service would be funded—have not yet been published.

Sir Andrew said the model being described appeared likely to cost “well in excess” of £18 billion annually and suggested it could take many years, potentially several decades, to become fully operational. He also warned that meaningful reform now appeared further away than had been implied when Burnham first announced his plans in July.

The government has brought forward Baroness Louise Casey’s review of adult social care, with its recommendations now expected in summer 2027. Ministers have said the work will inform plans for a National Care Service, while insisting that improvements to the existing system will continue before the review is completed.

Funding remains the central political challenge. Burnham has said the eventual system should operate on the principle that everyone contributes and everyone is covered, but ministers have not committed to a particular tax or funding mechanism.

England’s social care system is currently means-tested, leaving many people responsible for substantial costs. The Health Foundation estimates that a more limited system of free personal and nursing care for people aged 65 and over would cost an additional £6 billion in 2026–27, rising to around £7 billion by 2035–36. A broader NHS-style service would be considerably more expensive.

The warning underlines the distance between promising universal care and creating a workable service. For people currently struggling to access or pay for support, the concern will be whether another long period of consultation leaves urgent problems unresolved while the larger reform remains years away.

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