Adult social care reform in England

Adult social care has been widely considered to be in need of reform since the 1990s. However, despite several proposals for major reform, successive governments have “failed to enact meaningful change”.

In September 2026, the Prime Minister outlined an intention to introduce a “National Care Service” in the next Parliament, which would provide “free personal care for older people”.

Previous reform proposals

Proposals for adult social care reform between 1997 and the 2024 general election included:

• A Royal Commission on Long-term care (1997) which recommended free personal care for eligible older adults. The UK government rejected this, but a version of the proposal was implemented in Scotland.
• The National Care Service white paper (2010) in which the Labour government set out plans to implement a system of free-at-the-point-of-use social care in stages from 2011, with individuals making a care contribution. The plans were attacked as a “death tax” and were not taken forward.
• The Dilnot Commission (2011), established by the Coalition Government, which recommended a cap on personal care costs and a more generous means test. The government accepted the reforms in principle, but altered some of the details. The Care Act 2014 provided the legislative framework for a cap on care costs but implementation was delayed before being cancelled.
• Proposals in the Conservative Party manifesto for the 2017 general election to amend the social care means test were attacked as a “dementia tax” and were not taken forward.
• A proposed cap on care costs (2021) by the Johnson government which committed to introducing an £86,000 cap on personal care costs and a more generous means test from October 2023. However, the plans were postponed by the Sunak government and then dropped following the 2024 general election.

Developments since the 2024 general election

In its manifesto for the 2024 general election, the Labour Party committed to creating a “National Care Service”, underpinned by national standards.

In January 2025, the government announced that Baroness Louise Casey would chair an independent commission on adult social care. The commission was to report in two phases: a first report in 2026 setting out recommendations for improvement in the medium term and a second report in 2028 setting out “longer-term recommendations for the transformation of adult social care”. Concerns were raised that this timeline was too slow.

Proposal for free-at-the-point of use personal care

Shortly after becoming Prime Minister, Andy Burnham emphasised his commitment to reforming adult social care and said he wanted social care “to operate on the NHS principle”.

In a speech on 29 July 2026, Burnham announced that the Casey Commission would now report in summer 2027 rather than in 2028. The previous two-phased approach was dropped.

In his speech to the Labour Party conference on 29 September 2026, Andy Burnham said he wanted to introduce a National Care Service in the next Parliament which was “free at the point of use [with] no care charges paid out of [a person’s] basic state pension”. The Casey Review would, he said, “advise us on exactly how”.

The Prime Minister also set out reforms to the State Pension triple lock from April 2030, which, he said, would “generate significant savings which we will use to build up our National Care Service”.

A press release issued following the speech outlined that the proposed National Care Service would provide “free personal care for older people”, but would not cover “bed and board [in care homes], for which existing means-tested council contributions will remain”.

The press release stated that the National Care Service would “be introduced in phases, so its scope can grow as the savings increase from adjusting the Triple Lock, and as workforce and provider capacity are built up”.

Other political parties criticised the proposal to make changes to the State Pension triple lock. Think tanks welcomed the commitment to reform but raised several unanswered questions, including how the reforms would affect working age adults.

Reform options, implementation and funding

The final section of the briefing provides brief information and links to further information on possible options for social care reform, including international examples. It also highlights what stakeholders have cited as the barriers that prevented the implementation of previous reform proposals.

In July 2026, the Health Foundation provided high-level estimates of the cost of three funding reform options:

• A Scottish-style system of free personal and nursing care for people aged 65 years and over in England: around an additional £6.5 billion in 2026/27, rising to around £7.5 billion 2035/36.
• A ‘cap on care costs’ of £86,000 and increasing the generosity of the means test: around an additional £0.5 billion in 2026/27, rising to around £4 billion by 2035/36.
• A universal and comprehensive social care system: an additional £18.5 billion in 2035/36.