REFNATION
WelfareEnded 28 Sept

Should the UK create an NHS‑style social care system, free at the point of use?

Yes 62%No 38%1,274 votes cast

Adult social care in England is means-tested, with people holding assets over £23,250 usually paying all costs for home or residential care, unlike the free-at-point-of-use NHS. Prime Minister Andy Burnham pledged on 27 September 2026 an NHS-principle national care service where everyone contributes and is covered, to feature in Labour's next manifesto. The system faces severe pressures including council overspends of £715m, workforce shortages, delayed discharges from hospitals and rising demand from an ageing population with complex needs.

Jump to opinions· 54

The most-respected arguments came from No voters, led by a warning that this would be “A system we can’t afford”. Yet Yes won, and its supporters made the case that care belongs alongside healthcare as a shared obligation, not a private risk.

The strongest Yes voices connected universal cover to practical pressures as well as principle. One described patients “stuck until social care can be organised”; another called paying for care “the natural concomitant of a universal NHS”. Others proposed tax rises and reform of private provision, rather than claiming the service could simply be added at no cost.

No voters returned to the question of limits: one asked, “Why should I as a PAYE pig pay” for someone else’s care, while another said “demand is infinite and supply is limited”. The two sides often talked past each other: Yes argued that families already face the consequences of a failing system, while No questioned whether a universal model could fund care without displacing other services.

That tension is sharper than a simple public-versus-private argument. A highly respected No case called for “binning off the private equity vultures” while retaining personal contributions; on the Yes side, one proposal paired higher National Insurance with a death duty and a “state-run, non-profit model”. Both were grappling with who pays and where the money goes, even as they disagreed about whether the answer is universal cover.

The vote favoured shared coverage; the room’s most forceful doubts were about the bill, not the need for reform.

“Yes, paid for via a small increase in national insurance, and 10% death duty, but it needs to be done hand in glove with rooting out the private providers that are fleecing their residents and families. A state-run, non-profit model will make it cheaper to run and cost each of us less in tax going forward.”

YES case · CivilBeacon86 · 4 respects

“Just stop it being an international health service.”

NO case · JoFrench · 8 respects

62%
Yes · 788 votes
38%
No · 486 votes
LeftCentreRight
Spread the wordShare
Debate

54 Opinions

Sign in and vote to share your opinion.
Octig· 71
The Defence-Minded Conservative
Voted yesC. Right lean

It's part of caring for people

The Inclusive Pluralist
Voted yesC. Left lean

The NHS and Social care is a mess id like to know how this will be funded but in principle it is a Yes. Maybe the wealth tax on the rich 1% and on big businesses.

The Early-Days Independent
Voted noCentre lean

Older people don’t deserve to be taken into a lawful system of protection that will implement power over personal choices, finances and futures. Govt should pay liveable wages to care providers who offer options, with staff that don’t create communication problems for the most vulnerable, likely a bit deaf & by nature less likely to be familiar with accents from afar.

ant78· 21
The Practical Right
Voted yesRight lean

We the tax payers contribute via council tax for social care in our area. They need to centralise it from tax payers and have a level of care compared to your NI contributions like your pension

The Common Ground
Voted yesLeft lean

On paper, brilliant idea. It will mean tax rises, including raising NI to a sensible level. It's called National Insurance, everyone pays in, everyone gets help with health and social care. Because of the ridiculous nonsense of not wanting to increase payments over the years, eye sight, hearing, and teeth care, now cost more than some can afford. We want quality of life for all, we must all contribute, or have a US type system, only the rich get decent health/social care

Fletch· 394
The Homefront Interventionist
Voted yesC. Right lean

Your NI number should be linked to your NHS number and British Border Force should be called when a non British National comes in to verify details

JoFrench· 241
The Fortress Economist
Voted noRight lean

Just stop it being an international health service.

Geedon· 97
The All-Rounder
Voted noRight lean

There’s too many foreigners abusing even our NHS because it doesn’t require enough evidence of being an indigenous Briton. I’m aware of even Americans that will move here to get treatment at our expense. Those that can pay should pay, but I question where the money is going because it’s not going to the nurses!

Mark19· 384
The Firestarter
Voted noRight lean

The devil will be in the detail. Who pays how much? Is the payment tapered by age or salary? What age will you start paying and end paying? I cannot vote yes until I know how the government propose this working.

CCWales· 240
The Common Ground
Voted yesC. Right lean

This used to be standard until larger numbers of people developed Alzheimers. That's when the Government decided to separate out social care needs & medical care needs; almost as if social care is a "luxury", and Alzheimers is a "lifestyle choice". This was the first step to privatisation by stealth, with very little protest from a society that hates its elderly.