Sir Andrew Dilnot, the economist and architect of previous social care reform proposals, has warned that building a comprehensive “NHS-style” social care system in the UK could take decades and cost tens of billions of pounds.
Speaking on 28 September 2026, Sir Andrew cautioned that while the ambition for a National Care Service is significant, the practical and financial hurdles remain substantial. His comments follow a pledge by Prime Minister Andy Burnham to create a social care system that is free at the point of use, similar to the National Health Service.
Sir Andrew estimated that the cost of such a universal system would be “very substantial,” likely exceeding £18 billion annually. He suggested that such a transformation is a long-term project that would require a generational shift in how care is funded and delivered across the country.
The path to a National Care Service
The Prime Minister is expected to provide further details of the proposed National Care Service during a speech to the Labour Party conference in Liverpool on Tuesday, 29 September 2026. The government has indicated its intention to include these proposals in the manifesto for the next general election, which is currently expected in 2029.
To inform this transition, the Casey Commission, led by Baroness Casey, is conducting a “Big Conversation on Care” to gather public feedback. The commission’s reporting timeline has recently been accelerated, with findings now scheduled to be delivered in the summer of 2027 rather than 2028.
Despite the push for a universal service, Sir Andrew Dilnot has previously advocated for more immediate measures, such as a cap on individual care costs. His own commission first recommended a cap in July 2011, a policy that has faced repeated delays by successive governments.
Current eligibility and costs
At present, social care in England remains strictly means-tested. Under current rules, individuals with capital and assets—including the value of their home in many cases—exceeding £23,250 are generally required to pay the full cost of their care. This threshold has remained frozen since 2010.
Detailed information on how these assessments work is available through the NHS social care and support guide.
With major reforms unlikely to take effect before 2029, families currently navigating the system continue to face high costs. The debate over how to fund a free-at-the-point-of-use service continues, with questions remaining over whether a specific social care levy or changes to existing tax structures, such as the pensions triple lock, will be required to meet the estimated £18 billion annual price tag.