How will Burnham’s national care service work – and how will it be funded?

Burnham was clear about the ambitious scale of his care vision – this was not simply change, it was about creating a whole new service: a “landmark policy, as significant as the creation of the NHS itself”. It would be a national care service, operating on NHS principles: free at the point of use and “where everyone contributes and everyone is covered”.

It was more emphatic than his last social care speech in June, when he said a national care service “could be fully fledged [NHS-style] or lesser options or something in between”. After the speech, however, the prime minister’s aides clarified the new service would not resemble what most people would think of as an NHS-style system; it would be based on the Scottish adult social care approach: free personal care, with individuals paying for accommodation (“bed and board”) costs.

Are we any clearer as to how it will be paid for?

Experts say an NHS-style care system would be expensive – possibly the most expensive option – costing about £18bn a year. A Scotland-style system would cost an extra £7.5bn a year, according to the Health Foundation. Assessing the costs depends what services are included in the offer and how the cost is divided between individuals and the state. Burnham said it would be fully funded from within the public spending envelope. He said savings from scrapping the state pension triple lock, starting in the next parliament, would be funnelled into the care service.

On its own this would not be enough to fully fund a universal NHS-style care service, according to the Institute for Fiscal Studies. It seems probable that raising taxes will be part of the mix. Burnham said a care service would lead to NHS savings by reducing pressures on hospitals. This may free up £2bn a year in the long term, according to the King’s Fund thinktank. But it added that such figures should be treated with caution.

Will individuals have to contribute to the cost of care?

Under a Scottish-style system, yes. Burnham said a future care system would give people “peace of mind” that it would protect their “homes and their savings” if they needed care in later life.

This clearly suggests people who do not qualify for state care support will not have their assets wiped out if they require expensive long-term care – though the prime minister did not spell out how this risk would be nullified. It seems probable, however, that individual’s assets would be better protected from care costs under a national care service, rather than being entirely insulated. Even the Danish care system – one of the world’s most generous according to the Nuffield Trust thinktank – expects individuals to pay for care home accommodation costs.

Who will provide the care?

Burnham was careful in his speech to thank care workers, recognising them as underpaid and undervalued. He apologised to them, saying politicians had let them down for too long. This was not just burnishing his pro-worker credentials but recognising that without a better paid, upskilled work force, providing a high-quality national care service is impossible.

It also paves the way for a government U-turn on overseas care worker visas. He said care services would be “for people, not profit” which may be tricky given that the bulk of adult social care provision is privately provided, although it may signal a crackdown on “obscene” care profits.

When will a national care service happen?

Burnham set out a broad schedule. Louise Casey will produce her independent report on social care in 2027, setting out what a national care service could look like and how it could be paid for.

A national care service would be in the next Labour manifesto, and were the party elected it would be introduced in the next parliament. It is a more urgent timetable than his predecessor, Keir Starmer, had envisaged, but some in the creaking care sector will worry it is not soon enough.

How much of a political risk is there?

Burnham admitted in his speech that he “may pay a political price” on social care but said he was prepared to do so in order to do what he thought was right. It seems unlikely that the Conservatives or Reform UK would support a national care service.

But Burnham clearly believes he has the time to “lay the ground” and win over a public that typically has little understanding of the care system or the sometimes catastrophic risks to their family finances under the current system.