MS1 - Health and Social Care Levy

[Macmillan]

Boris Johnson, Prime Minister

Quote

Mr Speaker, with permission I will make a statement on the Government’s plans for health and social care. Our national health service is the pride of our whole United Kingdom, and all the more so after it has been there for us during the worst pandemic in a century, treating almost half a million patients, administering more than 88 million vaccines and saving countless lives. The inevitable consequence of this necessary and extraordinary action is that covid has placed massive pressures on our NHS. As we stayed at home to protect the NHS, thousands of people did not come forward for the treatment they needed. Like those who suffered from covid, these are all people we know: your aunt who needs a new hip, your neighbour who has problems with their heart and needs a pacemaker, or your friend at work who thinks that they should get that lump or cough checked out. So we must now help the NHS to recover, to be able to provide this much needed care to our constituents and the people we love, and we must provide the funding to do so now.

We not only have to pay for the operations and treatments that people decided not to have during the pandemic; we need to pay good wages for the 50,000 nurses who will enable that treatment and who can help us to tackle waiting lists that could otherwise expand to 13 million over the next few years. We now need to go beyond the record funding we have already provided, and we need to go further than the 48 hospitals and 50 million more GP appointments that are already in our plan. So today we are beginning the biggest catch-up programme in NHS history, tackling the covid backlogs by increasing hospital capacity to 110% and enabling 9 million more appointments, scans and operations. As a result, while waiting lists will get worse before they get better, the NHS will aim to be treating around 30% more elective patients by 2024-25 than it was before covid.

We will also fix the long-term problems of health and social care that have been so cruelly exposed by covid. [Interruption.] The Labour party certainly failed to tackle them. But having spent £407 billion or more to support lives and livelihoods throughout the pandemic—from furlough to vaccines—it would be wrong for me to say that we can pay for this recovery without taking the difficult but responsible decisions about how we finance it. It would be irresponsible to meet the costs of this permanent additional investment in health and social care from higher borrowing and higher debt.

So from next April we will create a new UK-wide 1.25% health and social care levy on earned income, hypothecated in law to health and social care, with dividends rates increasing by the same amount. This will raise almost £36 billion over the next three years, with money from the levy going directly to health and social care across the whole of our United Kingdom. This will not pay for pay awards for middle management; it will go straight to the frontline at a time when we need to get more out of our health and social care system than ever before. It will enable radical innovation to improve the speed and quality of care, including better screening equipment to diagnose serious diseases such as cancer more quickly; designated surgical facilities so that non-urgent patients are no longer competing with 

A&E; faster GP access to specialists, so people do not have to wait months to see someone in hospital to find out whether something is wrong; and new digital technology so that doctors can monitor patients remotely in their homes.

We will do all this in a way that is right, reasonable and fair. Some will ask why we do not increase income tax or capital gains tax instead, but income tax is not paid by businesses, so the whole burden would fall on individuals, roughly doubling the amount that a basic rate taxpayer could expect to pay, and the total revenue from capital gains tax amounts to less than £9 billion this year. Instead, our new levy will share the cost between individuals and businesses, and everyone will contribute according to their means, including those above state pension age. So those who earn more will pay more, and because we are also increasing dividends tax rates, we will be asking better-off business owners and investors to make a fair contribution too. In fact, the highest-earning 14% will pay around half the revenues. No one earning less than £9,568 will pay a penny, and the majority of small businesses will be protected, with 40% of all businesses paying nothing at all.

Although Scotland, Wales and Northern Ireland have their own systems, we will direct money raised through the levy to their health and social care services. In total, Scotland, Wales and Northern Ireland will benefit from an extra £2.2 billion a year and, as this is about 15% more than they will contribute through the levy, it will create a Union dividend worth £300 million.

However, we cannot just put more money in; we need reform and change. We need to build back better from covid. When the covid storm broke last year, 30,000 hospital beds in England were occupied by people who could have been better cared for elsewhere and who wanted to be better cared for elsewhere. That is 30,000 out of 100,000 hospital beds in our NHS, costing billions. Those beds cannot be used by people needing cancer care or hip operations, making it harder than ever to deal with the growing backlog in our NHS.

Too often, people were in hospital beds because they or their relatives were worried about the cost of care in a residential home, and that same fear kept many others at home without any care at all. This anxiety affects millions of people up and down the country: the fear that a condition such as dementia, one of nature’s bolts from the blue, could lead to the total liquidation of their assets, their lifetime savings and their home—the loss of everything, however great or small, they might otherwise pass on to their children—while sufferers from other diseases, who have to be in hospital for the majority of their treatment, have their care paid for in full by the NHS.

Governments have ducked this problem for decades. Parliament even voted to fix it, yet that 30,000 figure is an indictment of the failure to do so. There can be no more dither and delay. We know we cannot rely solely on private insurance because demand would be too low for insurers to offer an affordable price, and a universal system of free care for all would be needlessly expensive when those who can afford to contribute to their care should do so.

Instead, the state should target its help at protecting people against the catastrophic fear of losing everything to pay for the cost of their care, and that is what this Government will do. We are setting a limit on what people can be asked to pay, and we will be working with 

the financial services industry to innovate and to help people insure themselves against expenditure up to that limit.

Wherever you live, whatever your age, your income or your condition, from October 2023 no one starting care will pay more than £86,000 over their lifetime, and no one with assets of less than £20,000 will have to make any contribution from their savings or housing wealth—up from £14,000 today. Meanwhile, anyone with assets between £20,000 and £100,000 will be eligible for some means-tested support. This new upper capital limit of £100,000 is more than four times the current limit, helping many more people with modest assets.

As we fix this long-term, long-standing problem in social care, we will also address the fears that many have about how their loved ones will be looked after by investing in the quality of care, in carers themselves, and by integrating health and care in England so that older people and disabled people are cared for better, with dignity and in the right setting. My right hon. Friend the Secretary of State for Health and Social Care will be bringing forward a White Paper on integration later this year.

You can’t fix the covid backlogs without giving the NHS the money it needs; you can’t fix the NHS without fixing social care; you can’t fix social care without removing the fear of losing everything to pay for social care; and you can’t fix health and social care without long-term reform. The plan that this Government are setting out today—the plan I am setting out today—will fix all of those problems together. Of course, no Conservative government ever want to raise taxes, and I will be honest with the House: I accept that this breaks a manifesto commitment, which is not something I do lightly, but a global pandemic was in no one’s manifesto. I think that the people of this country understand that in their bones and can see the enormous steps this Government and the Treasury have taken.

After all the extraordinary actions that have been taken to protect lives and livelihoods over the last 18 months, this is the right, reasonable and fair approach, enabling our amazing NHS to come back strongly from the crisis; tackling the covid backlogs; funding our nurses; making sure that people get the care and treatment they need, in the right place, at the right time; and ending a chronic and unfair anxiety for millions of people and their families up and down this country.

I commend this statement to the House.

 

[Richard]

Keir Starmer, Leader of Her Majesty's Most Loyal Opposition

Quote

I thank the Prime Minister for advance sight of his statement—I think I had almost as much notice as the Cabinet. May I also thank everybody who works in the NHS and social care? During the darkest days of the pandemic they kept our health service from collapsing, they looked after the elderly when others could not and they rolled out the vaccine, which has finally provided the light at the end of the tunnel. Despite their efforts, we are facing the toughest winter in the history of our health service. Not only do we have the threat of another covid surge, but waiting lists for diagnosis and treatment have reached record levels, we risk cancer survival rates going backwards for the first time ever, and social care remains neglected and strained. It is a crisis, but how did we get here?

The pandemic has undoubtedly placed the NHS under huge strain, but that is only part of the story. A decade of Conservative neglect weakened the NHS. Waiting lists had spiralled—up 2 million before the pandemic. Targets were missed, on cancer, on accident and emergency, and on mental health, before the pandemic. The same is true on social care, with £8 billion cut, despite growing demand, before the pandemic. Carers were on poverty wages, without secure contracts, before the pandemic. There were 100,000 vacancies before the pandemic. And the Prime Minister has just referenced the 30,000 hospital beds occupied by those who should go into the community—this is before the pandemic—and he called that an “indictment of failure”. Who had been in government for 10 years at that stage? Just remind me. Prime Minister, an “indictment of failure” is an accurate description of the situation in our health service and social care before the pandemic, so the pretence that he is “only here” because of the pandemic is not going to wash. He is putting a sticking plaster over gaping wounds that his party inflicted. He made that commitment on social care before the pandemic, and he said he would pay for it without raising taxes before the pandemic.

Yes, the NHS urgently needs more investment, but the backlog will not be cleared unless the Government hit the 18-week target set out in the NHS constitution—the Prime Minister did not mention that. It was set and it was met by the last Labour Government. Let me ask a direct question: if there is to be improvement, Prime Minister, can you commit today to hitting the target and clearing the backlog by the end of this Parliament—yes or no? I know he likes to avoid these questions, but if he cannot answer that basic question, it is clear he has not got a plan.

Let me turn to social care. Under these proposals, people will still face substantial costs. I heard what the Prime Minister said, so I have another direct question for him: can the Prime Minister guarantee that under his plan no one will have to sell their home to fund their own care—yes or no? [Hon. Members: “He just told you.”] Well, let us hear him make the commitment, at the Dispatch Box, that under his plan no one will have to sell their own home to fund their own care, and then we will come back to it.

Social care is about so much more than this. The blunt and uncomfortable truth is that under the Prime Minister’s plans the quality of care received will not improve—there is no plan for that. People will still go without the care that they need—there is no plan for that. Unpaid family carers will still be pushed to breaking point—there is no plan for that. Working-age adults with disabilities will have no more control over their lives—there is no plan for that. Pay and conditions will not improve for care workers—there is no plan for that. Let me spell it out: a poorly paid care worker will pay more tax for the care that they are providing without a penny more in their pay packet and without a secure contract.

The Prime Minister shakes his head; my sister is a poorly paid care worker, Prime Minister, so I know this at first hand.

This is a tax rise that breaks a promise that the Prime Minister made at the last election, a promise that all Conservative Members made—every single one of them. It is a tax rise on young people, supermarket workers and nurses; a tax rise that means that a landlord renting out dozens of properties will not pay a penny more, but the tenants working in full-time jobs will; and a tax rise that places another burden on businesses just as they are trying to get back on their feet. Read my lips: the Tories can never again claim to be the party of low tax.

The alternative is obvious: a timetable and plan to clear waiting lists, just as we did under the last Labour Government, and a comprehensive reform plan for social care that deals with the inadequacies that I just pointed out and drives up the quality of provision—not just tinkering with the funding model. We do need to ask those with the broadest shoulders to pay more, and that includes asking much more of wealthier people, including in respect of income from stocks, shares, dividends and property. [Interruption.] Chancellor, I was listening. The Chancellor knows the numbers just as well as I do—he will have done the sums and we have done them. Tinkering and fiddling with dividends will not do it. The Government are placing the primary burden on working people and businesses struggling to get by.

As I have said to the Prime Minister, if the Government come forward with a plan to genuinely fix the crisis in social care and they have a fair funding model, yes, we will work together. Thousands of families who are struggling with the current system and only want the best for their loved ones deserve nothing less.

 

[Amanda Stockley]

Thank you Mr. Speaker,

And I thank the Prime Minister for advanced sight of his statement. I am glad to speak in this debate about the announcement of the government. Because it is important that we reduce the backlog that the NHS is experiencing. But Mr. Speaker...the Prime Minister seems to believe that the backlog was solely the result of the Covid pandemic. And I of all people don't deny that a massive pandemic has made working in healthcare a lot more difficult, but the problem has started long before. For years, the party opposite has pushed the government and the secretary of state into limiting our NHS. Dentistry and GPs have suffered for years under this policy of austerity. Mr. Speaker, the Covid pandemic has only exasperated the problems in our healthcare system. Under the ten years of Conservative Party rule, a gap of 50 billion pounds has emerged in the funding of the NHS.

And now, after ten years, the Prime Minister has announced to close this gap by pressing a tax burden on the hard working British people. A Health and Social Care  'Levy' is what the party opposite has dubbed it. Personally, I would call it a Health and Social Care 'Fine' on the people of Britain. The government has failed to keep up with growing healthcare costs for ten years. And now, they want to close this gap by increasing the tax burden. What a strange way to make the NHS fit for purpose again. Those are not my words, by the way. According to the NHS themselves, they have been playing 'catch-up' for years. They have made the government aware of the billions of pounds that they are missing in funding. They have said that there is a massive loss of workforce in several years. The Prime Minister has plegded that he wants to recruit thousands of GPs over the next few years: Mr. Speaker, the reality is, that the Covid pandemic has not increased, but diminished our GP workforce.

Mr. Speaker, there seems to be a new tendency in the Prime Minister's failing policies to stop the Covid pandemic. They claim they want to take care of the NHS. The reality is, Mr. Speaker, that they have failed to take care of the NHS for ten years. And this problem is one that seems to be limited to England only. In Labour-led Wales, Spending per person is more than 100 pounds higher than in England. And why is that? Because contrary to NHS England, Labour has not let a funding gap of 50 billion pounds grow in NHS Wales. And I also looked in the Conservative Manifesto. Do the members opposite know what it says? I shall remind them, and I paraphrase: 'We will not increase taxes'.

But Mr. Speaker, this is of course the entire strategy of the Prime Minister. After failing to fund the NHS adequately for years, he now wants to come out as 'the One who kept the NHS afloat'. A purely populist strategy, aided by his Brexiteer desire by leaving the vital EMA. Because he will keep saying that Britain 'led the world with the fastest vaccine rollout'. And I commend the NHS in providing more than 88 million jabs in this country, let that show on the record. But the Prime Minister seems to use his love for Brexit to show the people that it worked 'because we vaccinated faster than anywhere in Europe'. As if that was a positive thing.

I will come to the solutions, Mr. Speaker. This 'Levy' will take out hundreds of pounds from British families, which will make their cost of living only more problematic, in the name of 'funding the NHS'. But in reality, the Prime Minister is implementing a tax hike to bring back the funding that the NHS has required for twelve years. I do hope the benches opposite support Labour's proposals to stop this tax hike on working people, and instead make a proper social care plan? With Labour, our plan would include: enshrining the principle of 'Home First'. Really putting an emphasis on prevention and early intervention to lower healthcare costs. Increasing the living wage of care workers to no less than 10 pounds. Investing in training for care workers to improve health quality. And lastly, giving the more than 10 million unpaid family carers the proper training, information, and advice, to create safe workspaces to balance work and caring responsibilities.

In conclusion, Mr. Speaker. The party opposite has presided over a ten year backlog, rising from their inability to properly funding the NHS, leading to an fifty billion pound gap. Now, during Covid, this has become painfully visible in the growing backlog of patients awaiting proper care. The solution of the PM: increasing the tax burden, instead of reforming social care and creating a truly comprehensive NHS plan. I urge the members opposite to see trough this shameful, and frankly manifesto-breaking proposal by a Prime Minister who has broken multiple promises already.

Thank you, Mr. Speaker

[Steve]

Mr Speaker,

This tax rise - a tax rise, Mr Speaker, not his euphemistic "levy" - is the inevitable result of over eleven years of neglect, under-investment, and austerity. The chickens are coming home to roost, Mr Speaker. And the cost is being shoved on struggling hard-working families who have just come out the other end of a pandemic.

Don't get me wrong, Mr Speaker. I welcome more NHS and social care spending. But people should have no doubt that it is the result of the decisions that this Government has made that mean they will be poorer next year than this year. That it is the decisions of this Government that mean that this emergency increase in funding is necessary. That it is this Government that has squandered billions on contracts with its mates, purchased subpar PPE, and wasted billions on a top down reorganisation that - ten years on - has made care worse.

Unfortunately, Mr Speaker, the Government has also chosen precisely the worst tax to increase. They have done so out of political expediency at best. They have done so to save their own wallets at worst. The average worker will suffer twice: they will pay a higher tax, and they will face lower wages when their employers have to pay the extra tax on their wages. That will cost the average worker £360. Two earner families will be worse off by £720 on average next year.

But what about the buy to let landlord with a dozen properties? Not a penny more, Mr Speaker. Not a penny more.

What about the rich non-dom? Not a penny more, Mr Speaker.

What about the wealthy taxpayer who earns his money through capital gains on his immense assets, or through company profits? Not a penny more, Mr Speaker.

The opposition will no doubt say there is no perfect tax rise. But they have chosen probably the worst of all. It will cut the incomes of those just trying to get by. And it will leave the wealth, income, and position of those who already have plenty untouched. People will not resent paying more for their NHS, Mr Speaker. But they will, and they should, resent the fact that ordinary Britons are being asked to pay a disproportionate burden of extra funding for our National Health Service. 

The former Chancellor used to like to claim that we're all in this together. This deliberate, penny-pinching announcement puts pay to that claim once and for all. I hope the House will reject this so-called "levy" and demand the Government bring forward a fairer, more sustainable funding package for our health and social care services.

[Recks]

Mr. Speaker,

I rise today grateful to the Rt. Hon. Prime Minister for informing this House about his plans for the future of the NHS and social care in this country. I cannot help but agree with the Prime Minister that the global Covid pandemic has exacerbated the issues our health and social care sectors are experiencing. Thankfully, Mr. Speaker, we have seen the boons of Brexit with our swift vaccine rollout campaign - something that might be mocked by Hon. members opposite, but is truly saving lives and livelihoods.

You know, a few decades ago, leaving the European Union was relegated to think tank white papers, not even in the realm of realistic, feasible possibility. Yet, here we are and we've made it happen - and our vaccine rollout is the first fruit of that endeavor. Likewise, I suggest that we are in an era where true health and social care reform is being talked about in white papers but not yet within the realm of the possible. If, as Otto von Bismarck said, "politics is the art of the possible," then we must continue to advance the window of what is possible. That means looking at the white papers and evaluating where we must go not only today, not only in the next year ahead, but in the decades to come. That is the kind of vision I propose we bring to the floor of this House.

Mr. Speaker, when it comes to social care, we would do well to look at the facts and trends. We know that Britain is ageing as a society. We know that, as the economy heats up, fewer people will be able to afford family caretaking responsibilities. These dual trends, demographic and socio-economic, have existed before this pandemic and will continue beyond it.

The Rt. Hon. Prime Minister is undoubtedly correct in saying that a universal social care system, where state-provided services are the norm, would be enormously expensive and cost-prohibitive. What we need to do now is take a step back, Mr. Speaker, and evaluate where we must go moving forward. But to do that, first we must stabilize the ship of state.

The party opposite is claiming that we have underfunded the NHS, nevermind the fact that this levy would pour £36 billion over three years into the NHS and social care. If we are to address the crises faced by our health and social care systems in the near-term, we need to bring in the revenue to do so.

Yes, we ran on a Manifesto to not raise tax, but nobody could have seen the pandemic coming as it did just months after the 2019 election. At the same time, we will make historic investments in health and social care to come out of this pandemic while maintaining fiscal prudence. But this influx of new money must come with strings, with reforms, attached.

That is where I hope to expand upon a need for innovative, inventive policymaking. Establishing a "National Social Care Service" might have a nice ring to it, might have a popular flair, but it would be the wrong approach. It would subsidize those who don't need subsidy; it would rapidly eat up a large share of our budget; and it would be unfair to the younger generations who would have to pay twice the costs: once for current pensioners' benefits and once over for themselves.

The Rt. Hon. Prime Minister is right to say we cannot rely solely on private insurance, but I am encouraged that option will remain available. I am encouraged that this Government will work with the financial services industry to develop policies that integrate the private sector as much as the public sector.

I believe that forging ahead with public-private-individual partnerships is a necessity when it comes to social care. On the public side: we must invest in bringing social care settings up to best-in-class standards. And we must cover the less fortunate, including those who require care for their entire adult lives. On the private side, we must continue working with insurers to promote plans that work for everyday people. We must not overstep or set out to do what government cannot effectively do. Whitehall and local councils are good for establishing policies, but the civil service cannot deliver care for the entire nation. And for the individual, we should incentivize new tax-advantaged social care savings accounts. We shouldn't unduly penalize savings or those who save during their working lifetime.

Mr. Speaker, the British people are trusting the Rt. Hon. Prime Minister to use this levy for good purpose. We are not authorizing a blank cheque with the taxpayer's name into perpetuity. What we are doing here today is setting forth on a new path to invest in the NHS and to rethink social care.