How should England pay for social care? Germany, Norway and Sweden take very different routes

Published: September 30, 2026 12.17pm BST

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Prime Minister Andy Burnham has brought forward the deadline for Baroness Casey’s report on social care reform to 2027, from the original 2028.

He has now proposed widespread changes to how social care is funded at the Labour party conference in Liverpool. His plan is a National Care Service, which he says will be as significant as the creation of the NHS.

Previous attempts to improve social care in the UK have done little for people who need a home carer, a day care place or a residential care home. The main barrier is cost, and residential care is the most expensive element of dementia care, for example.

Any of us may need social care at some point, so it makes sense to think about how it is paid for while we are well. The details of how a National Care Service would be funded have yet to be fleshed out. Other European countries offer some useful comparisons.

Germany, Sweden and Norway

Across Europe, social care often lags a few steps behind healthcare, with little linkage between the two. I grew up in Germany, so I know how different its model is from the British one. Scandinavia, where taxes are generally high, has lessons for England too.

In Germany, everyone pays into long-term care insurance out of their monthly income. Anyone who needs support, such as help with cleaning or personal care at home, or a place in a residential care home, can apply for a needs assessment, much like in England. The difference is that the level of support depends on the person’s needs, whatever their local authority can afford.

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Families may have to contribute if the bill is high, as with residential care, but if they don’t have enough savings, the state pays the rest.

As in many countries, Germany’s population is ageing, so the government increasingly has to top up care costs where insurance and family contributions fall short. That is why it is proposing that adults without children pay more into the insurance than those with children. The idea has been widely criticised, and nothing has changed yet.

Norway and Sweden take a different route. The Scandinavian countries are known for high taxes, but also for well-funded support such as parental leave, universal health coverage and care.

In 2024, Norway spent 4.3% of its GDP on long-term care, the international term for the kind of support we call social care. This is higher than in 2019, according to official statistics, with Norway still leading the European comparison.

Sweden is not far behind. In Germany, figures for long-term care expenditure are often mixed with wider health-care expenditure. Of the 12.4% of GDP spent on health, 12% was funded via the mandatory long-term care insurance.

Both countries charge social security contributions, but set them up differently. In Sweden, only the employer pays. In Norway, employees and employers both do, and the contributions are higher in Sweden. Because people and their employers pay in from the first pay cheque, care and parental leave are easier to access when needed.

Norway’s system works a little like some UK workplace pension schemes, such as those in higher education, where employee and employer both pay in. Germany’s long-term care insurance is, in some ways, the social care equivalent of the NHS: everyone contributes, and everyone can claim support when they need it.

Asking individuals to carry the cost alone looks unworkable, especially given the rising cost of living in recent years, and it would be unpopular. A better route to Burnham’s National Care Service may be the Norwegian or Swedish model of contributions, combined with savings elsewhere in government. We need something that matches the NHS and gives people the right care to stay in their own homes or be well supported in a care home.