29th September 2026
Andy Burnham is preparing to tackle one of Britain's longest-running political problems: how people pay for social care when they become old, frail or disabled.
His ambition is for England to move towards a system much closer to the NHS, with social care provided free at the point of use.
That immediately creates an interesting question for Scotland.
Scotland already provides free personal care for eligible adults.
The Scottish system is not identical to the NHS and it does not mean every element of residential care is free. But the basic principle Burnham is discussing is already part of the Scottish system.
That gives Scotland a rather unusual position in this debate.
England is considering how to move towards something Scotland introduced more than two decades ago.
The problem Burnham is trying to solve
Social care in England is fundamentally different from the NHS.
Someone can receive NHS treatment without being asked to pay according to their savings.
Social care is different.
A person's financial circumstances can determine how much they have to contribute towards their care.
The current English capital threshold for council support is £23,250, a figure that has been frozen for many years. People with assets above that level can therefore face substantial care costs.
Burnham has described the existing system as effectively leaving people facing what he calls a "dementia tax", because families can see much of what they have accumulated over their lives consumed by care costs.
His proposal would spread the cost more widely across the population instead.
But there is an enormous question behind the principle:
How much would it cost?
The Health Foundation estimates that making all adult social care in England free at the point of use could require around £18.5 billion of additional annual spending, on top of existing expenditure.
That is a very large commitment.
And Burnham has not yet settled exactly how it would be financed.
He has said he is prepared to consider taxation and that nothing is currently off the table.
The detailed reform is expected to develop through the work of Baroness Louise Casey, whose review of social care has been accelerated under Burnham's Government.
Scotland provides an interesting comparison
Scotland introduced free personal care for older people in 2002 and subsequently extended eligibility to other adults.
The principle is that eligible people can receive personal care without paying for the care element itself.
This includes assistance with everyday activities such as personal hygiene, medication and meals.
But Scotland has not created a completely free social-care system.
People receiving residential care can still have to contribute towards accommodation, food and other living costs.
So saying "social care is free in Scotland" requires some qualification.
Nevertheless, the Scottish experience provides England with something extremely valuable:
a working example of a different approach.
It also provides an opportunity to examine the costs and practical problems that arise when a government makes such a commitment.
There is no free care system
Someone ultimately has to pay.
Under the NHS, the cost is collected through general taxation rather than presented as a bill when somebody becomes ill.
Burnham appears to favour moving social care in the same direction.
That would spread the cost across the population.
But spreading a cost does not make it disappear.
It simply changes who pays and when they pay it.
That is why Burnham has promised an "honest conversation" about the choices involved. He has suggested that additional taxation could be required, although the precise mechanism has not been settled.
Could this change the way families think about saving?
This is where the issue becomes particularly interesting.
People save for retirement partly because they want security in later life.
But under the present English system, someone requiring long-term care can see a substantial part of those savings consumed by care costs.
A system funded collectively through taxation changes that calculation.
The argument is not that people would no longer need savings.
It is that the risk of catastrophic care costs would be shared across society rather than falling disproportionately on people who happen to require long-term care.
Scotland has already been running the experiment
That makes this more than an ideological argument.
Scotland has experience of providing free personal care.
England can examine how the Scottish system operates, what it costs, how eligibility works and what gaps remain.
Equally, Scotland can look at the English debate and consider whether its own system needs further development.
Burnham's proposal is therefore potentially much more than another Westminster argument about taxation.
It opens up a question that affects every part of Britain:
Should the cost of needing care in later life be treated more like the cost of needing healthcare?
Scotland has already answered that question, at least partly.
England is now considering whether to follow.