Andy Burnham, as prime minister, has said England's adult social care system is "broken" and needs reform, a view shared broadly across politics even though there is no agreement on how to pay for it. Burnham previously led an earlier failed reform attempt in 2010, which was undermined by Conservative claims it amounted to a "death tax", but says he is now willing to spend significant political capital pushing changes through, potentially including a national care service run on "NHS principles".

Current arrangements are heavily means-tested: people with assets above £23,250 generally pay for their own care, while one in seven end up spending more than £100,000, sometimes forcing the sale of their home. Options being weighed include a fully free, NHS-style system estimated to cost £18.5bn a year by 2035-36, a Scottish-style free personal care model estimated at an extra £7.5bn, or reviving a lifetime cap on care costs, such as the Johnson government's shelved £86,000 cap, which was proposed by the 2011 Dilnot commission but never implemented.