– in the House of Commons at 1:37 pm on 8th September 2021.
I inform the House that Mr Speaker has selected amendment (c) in the name of the official Opposition. I remind the House that, under the terms of the business of the House order of today, the amendment will be moved formally at the end of debate.
I beg to move,
That provision may be made for, and in connection with, the following—
(a) the imposition of a tax on earnings and profits in respect of which national insurance contributions are payable, or would be payable if no restriction by reference to pensionable age were applicable, the proceeds of which are to be paid (together with any associated penalties or interest) to the Secretary of State towards the cost of health and social care but where expenses incurred in collecting the tax are to be deducted and paid instead into the Consolidated Fund, and
(b) increasing the rates of national insurance contributions for a temporary period ending when the tax becomes chargeable and applying the increases towards the cost of the National Health Service.
Supporting health and social care in the aftermath of a pandemic and amid the worst health crisis for 100 years, laying the long-term basis for social care for generations to come—there are few if any greater peacetime challenges for any Government, and that is why it is an honour to be opening this debate today.
As the House will know, yesterday the Prime Minister announced a plan to tackle the NHS backlog, put the adult social care system on a sustainable long-term footing and end the situation in which those who need help in their old age risk losing everything to pay for it. The Government’s plan will make a difference to the lives of millions of people across this country, and it will be funded with a record £36 billion investment into the NHS and social care.
What estimate has the Minister made of the impact of these measures on the ease or indeed the difficulty of securing continuing NHS care?
That is an extraordinarily wide-ranging question, and there are many ways in which impacts could be assessed. My right hon. Friend will be aware that the Government will be bringing forward a social care Bill, and there will be a Budget at which this measure, fiscal measures in general and the wider consideration of the fiscal position will be considered. In the documents published in relation to today’s debate, there is of course a sustainability analysis of the impact of the measure on different parts of the country, by background and socioeconomic income, and there is also a substantial plan published by the Government in relation to the Health and Care Bill.
If I may, I will just proceed a little bit further, and then I will be happy to give way.
In order to pay for a significant increase in spending in a responsible and fair way, the Government have announced a new 1.25% health and social care levy based on national insurance contributions. This Ways and Means motion enables the Government to introduce the levy and temporarily to increase national insurance contribution rates until it takes effect.
Will my right hon. Friend tell the House how much the 1.25% increase in national insurance will cost the NHS on top of its current payroll?
My hon. Friend will be aware that public sector bodies have been adjusted for in the numbers that have been published, and therefore the numbers that have been published are net of the impact on the public sector.
I understand that for a couple of years this tax revenue goes to the NHS, not to care, to get the waiting lists down. By how many will the waiting lists be reduced, and what is the plan for using this money to actually cut them?
Of course, it is impossible to say in advance what the impact will be, but I would direct my right hon. Friend to the remarks of the Institute for Fiscal Studies where it said that
“based on detailed analysis to be published later this week…this could be enough to meet the pandemic-related pressures on the NHS.”
I think that is a fairly—
No. I have already taken a few, and I will go on a bit further, if I may, and then I will take some more interventions. [Interruption.] Well, the hon. Gentleman has had a fairly substantial go at points of order already, and I welcome his later intervention.
The levy will apply UK-wide to taxpayers liable to class 1 employee and employer, class 1A, class 1B and class 4 self-employed NICs. However, it will not apply where taxpayers pay class 2 NICs or class 3 NICs. It will be introduced from April 2022, and then from April 2023 the levy will also apply to those working over the state pension age. As my hon. and right hon. Friends will understand, it takes time for Her Majesty’s Revenue and Customs to prepare its systems for such a major shift. That is why, in 2022-23, the levy will be delivered through a temporary increase in NICs rates of 1.25% for one year only. All revenues generated by this increase will be ring-fenced and paid to NHS England, NHS Scotland, NHS Wales and the equivalent in Northern Ireland.
Does the Minister not recognise the burden he is placing on small businesses, many of which the Government completely excluded and failed to support during the pandemic, in their now having to pay this extra levy, as opposed to making a fair taxation system that falls on those who can pay the most?
The hon. Lady will be aware that, because of the employment allowance, the bottom 40% of businesses will pay nothing and the next 40% will pay an average of £450. So this does not fall heavily on the bottom end of businesses, and of course it comes in a context in which the Government have provided over £400 billion of support to business and to the nation as a whole in the course of fighting the pandemic. In that sense it is, and it has been recognised to be by reputable independent commentators, a broad-based approach.
From April 2023, once HMRC systems have been updated, a formal legal surcharge of 1.25% will replace the temporary increase in NICs rates, which will return to their previous level. Again, this revenue will be ring-fenced in law for health and for social care only. As the Chancellor stated yesterday, this levy is no stealth tax. That is why the exact amount that each employee pays will also be visible as a separate line on their payslip. Finally, the levy will be administered by HMRC, and collected by the current reporting and collection procedures for NICs—pay-as-you-earn and income tax self-assessment.
I want to ask the Minister: how much money is actually going to get to local authorities to deliver social care at the frontline? Can I refer him to paragraph 36 of the Government’s document, which we got yesterday? It says that £5.4 billion in adult social care will be provided from this levy, but that will be spent on the reforms that are in the document. It also says that all the other pressures on social care that local authorities have now, demographic and otherwise, will be paid for from council tax and the social care precept, which is council tax by another name. So are we expecting the pressures on social care to be funded not from this document, but actually from further rises in council tax? Is that the honest situation?
I am grateful to the hon. Gentleman, and I am also very grateful to him for actually reading the document, which many of his colleagues may not have done, and he is absolutely right to draw attention to that section. What the levy does, of course, is to provide a very substantial form of funding for social care. The question of the capacity of local authorities, which is of course a matter of great interest to Government and an area that we have supported significantly in the last year or two, will be considered in the Budget in the normal course of things.
If I may, I will now set out why a levy based on national insurance is the best way to raise the funds needed for the Government’s plan for health and social care. The first reason is that there is already a clear precedent. Indeed, in 2003 the then Labour Government increased these same NICs rates by 1% specifically to put more funding into the NHS. Within the NICs system there is, as Members across the House will know, already a long-standing ring-fenced proportion of receipts directed to the NHS.
The second reason is that this is a fair method. Businesses will play their part. In fact, the largest 1% of businesses will contribute 70% of the revenue. However, existing NICs reliefs and allowances will also apply to the levy. That will mean, as I have said, that 40% of all businesses will not be affected due to the employment allowance. When it comes to individuals, those earning more will pay more. Conversely, at least 6.2 million people earning less than the NICs primary threshold will not pay the levy at all.
The third reason why a levy based on NICs is the right approach is that it has worked elsewhere. France, Germany and Japan have all increased social security contributions to fund social care provision. Finally, the question of how to fund health and social care is one that applies to a whole nation. NICs are set on a UK-wide basis, and the levy therefore provides a clear UK-wide solution.
Would the right hon. Gentleman put on the record for the House the consequentials for public bodies that are employers? They would normally be expected to pay this, but I understand there are some mitigations. Perhaps he could explain that, because in the time we have had we have not been able to get to the bottom of it.
The overall fiscal approach is set out in detail in the document that has already been referenced by Mr Betts. We will be presenting a Bill in due course, which will have further explanatory notes and a tax information and impact note associated with it, and of course we have a Budget in which the wider fiscal position will become clear, so the House is not going to be short of information about how this will land.
Finally, if I may, I will just remind the House why this levy is so important. As the Prime Minister and the Chancellor set out yesterday, the levy will enable the Government to tackle the backlog in the NHS. It will provide a new, permanent way to pay for the Government’s reforms to social care, and it will allow the Government to fund our vision for the future of health and social care in this country over the longer term.
I thank the Minister for giving way. I have two points. He talks about the Government’s vision for health and social care, but with their obsession with outsourcing, that does not match the Scottish vision for health and social care. This is a devolved area. Why is the Minister not using tax, which the Scottish Government control? We have already been slagged for three years in this place for putting a penny on income tax bands to fund health and social care in Scotland. Why is he hitting Scottish taxpayers again, and taking power away from the Scottish Government?
Nothing could be further from the truth. All parts of the UK need a long-term solution to fund this health and social care position sustainably, including Scotland and the Scottish Government. Scotland’s own Audit Scotland has said that more money is needed in the Scottish social care system, and an independent review of adult social care said that more money needs to be provided. Of course, there is a Union dividend from that policy, in that Scotland, Wales and Northern Ireland will benefit by an average of 15% more than is generated by their residents. That is £300 million a year on average.
The Government have acknowledged that this policy involves a breach of the manifesto. They have done so directly, they have done so plainly, and they have done so honestly. But I would put it to the House that, in a deeper sense, this measure serves to redeem a promise and discharge an obligation. It is a profoundly Conservative thing to do, to provide for future generations without increasing our borrowing, without increasing spending, and in way that is sustainable and grips a nettle that for too many years has been ignored by the Labour party. With that in mind, I commend the motion to the House.
There are two tests for the package announced yesterday. First, does it fix social care? Secondly, is it funded fairly? The answer to both those questions is no. It is a broken promise, it is unfair, and it is a tax on jobs. At the general election less than two years ago, the Prime Minister said to voters:
“Read my lips, we will not be raising taxes on income or VAT or national insurance.”
The Chancellor of the Exchequer—I am not sure where he is today—went further and solemnly said:
“Our plans are to cut taxes for the lowest paid through cutting national insurance.”
The Government have broken their legally binding promise on international development, they are breaking it again on the triple lock, and the country is now littered with Tory broken promises torn from the election manifestos of all Conservative Members—promises that they made to their constituents and their country. Promises used to count for something; today the Tory word, and guarantees from the Prime Minister, count for absolutely nothing at all.
I will take an intervention from the hon. Gentleman, and perhaps he can tell us what he put on his election leaflets.
I thank the hon. Lady for giving way, and I remind her that the Conservative party won on the basis of its election manifesto, and the Labour party lost. In the interests of fairness and for the people of this country who voted for her party, will she outline to the House what the Labour party’s plan is to fix social care, because so far we have heard nothing?
I will come on to that in a moment, but that sums it up. You went into the election with a set of promises, and now you are breaking them one by one.
Order—[Interruption.] Hon. Members should resume their seats. This is an emotionally charged debate—I fully appreciate that—but as Mr Speaker has pointed out, Members must not use the word “you” unless they are referring to the Chair. Please remember that.
I will clarify: Conservative Members are breaking their promises one by one by one. The Government will claim that that is all down to the pandemic, but in March this year—a year into the pandemic—the Chancellor promised that national insurance would not go up. He said,
“this Government are not going to raise the rates of income tax, national insurance or VAT…Nobody’s take-home pay will be less than it is now”.—[Official Report,
Another Tory promise up in flames. That was not before the pandemic; it was a year into it, and a matter of months later this bombshell on work to fund social care is a broken promise. It is unfair, and it is a tax on jobs.
My hon. Friend is making the right sort of points. Government Members do not like it, but they need to listen to it. Does she agree that when the Prime Minister signed the guarantee on the tax lock in the 2019 general election campaign, he also told the country that he had an oven-ready plan for reforming social care, prior to the pandemic? He cannot have signed the tax lock, as well as having a plan for social care, if one of those things was not exactly true.
I would go further than my hon. Friend: neither of those things were true, because the Government have no plan for social care and we have a tax increase. The sad truth at the heart of this so-called health and social care levy is that it will not deliver on social care for at least three years from now, and even then it is uncertain when the Government might allow some money to trickle down. Under the Prime Minister’s plan, many will still face the threat, as my right hon. and learned Friend the Leader of the Opposition set out today, of selling their home to fund care. Many of those with a house worth £186,000—that includes many constituents of Conservative Members—will still have to sell their home to fund £86,000, within the cap. That is before the costs of living in a care home. How does the Minister expect his constituents to pay for care without selling their home? I will happily take an intervention from him—
Perhaps Kevin Hollinrake will explain what he put in his manifesto to his constituents.
I was delighted to sit on the Housing, Communities and Local Government Committee—the Chair of the Committee is in his place now—during its joint inquiry with the Health and Social Care Committee. Some 24 Committee members, 12 of whom were Opposition Members, recommended a solution based on national insurance. The shadow Secretary of State for Health and Social Care also proposes a solution based on national insurance. Why does the hon. Lady now say that that is the wrong option, and what is her plan if it is the wrong option?
We should be looking at all forms of income, not just income from people who go out to work. A landlord who rents out a number of properties will pay nothing, whereas his tenants in work will. That is not fair, and that is why we cannot support the motion this evening. The Minister told us three important things today.
The hon. Lady has accused the Government, who have published a plan, of having no plan, when in fact the Labour party has absolutely nothing to offer on this topic. On the question she raises, the Resolution Foundation said in its report that the cap will offer support that will recognise higher care costs in different parts of the country, and the increased generosity of the means test will have relatively more impact in lower-wealth regions, in the north-east and other parts of the country.
With all respect to the Minister, I asked how he would suggest that one of his constituents with a house worth £186,000, and no other savings, will pay £86,000 for their care without selling their home. It is clear that he does not have an answer to that question, because there isn’t one.
The Minister has had a chance and he did not manage it. I will take an intervention from my hon. Friend.
Seventy per cent. of my constituents own their own home. The average house price in my constituency is £98,000. My constituents on lower than average wages in the country will be asked to contribute more in national insurance. Is it not manifestly unfair that they will still have to find £86,000, and the only place they will find that is out of the £98,000, so as to fund millionaires in south-east England to pass on the whole of their inheritance to their children?
My hon. Friend makes the point very well. People will still have to sell their homes to pay for care under these plans. There were three important points—
I have already taken an intervention from the Minister, and he did not answer the question. [Interruption.] Okay, I will take the intervention on the basis that he answers the question that I and my hon. Friend Chris Bryant have asked: how on earth does someone pay £86,000 when their house is worth £98,000 or £186,000? Let’s have the answer.
I am surprised that the hon. Lady did not recognise the point about geographic impact that I made in my last intervention, but let me just point out that the Government have published a Build Back Better plan, which contains specific case studies of the impact of this measure. That is where she should look for an answer to her question.
The Minister is wasting the House’s time, because he is not answering the question.
There were three important points in the Minister’s opening speech. The first was that it is impossible to say what the impact of these proposals will be on waiting lists. The second was that spending for local authorities will be considered in the Budget. There is no detail at all about what money local authorities will get, and we are being asked to vote for a tax increase without a plan to fix social care. The third point the Minister made, in answer to the Chair of the Public Accounts Committee, my hon. Friend Dame Meg Hillier, was that councils will pay this levy as employers, so they will face increased costs but without any guarantee that they will get additional money to fund care. This is not a plan to fix social care.
There is no plan for care workers, who were underpaid and undervalued before the pandemic—before being sent out on to the frontline by this Government without the personal protective equipment that they needed. Some £8 billion was cut from social care by Tory Governments in the years before the pandemic, ignoring the rising demand, with care workers paid less than they can live on. This Government are not interested in bringing employers and unions together for a positive plan for the future of social care. They are not interested in making the care sector a career of choice, with decent pay and conditions and proper investment in skills.
We know that half a million care workers are needed by 2030. There were 100,000 vacancies in social care before the pandemic. That is only set to increase, with the GMB predicting 170,000 vacancies for care workers by the end of the year—one in 10 jobs unfilled. Labour’s plans will prioritise older and disabled people, shifting the focus of support towards preventive early help, and our guiding principle will be “home first”, because that is what the overwhelming majority of people want.
Just a second ago at the Dispatch Box, the Minister referenced a plan. He was asked repeatedly by those on the Government Benches how this money will be spent, and in response to every one of their interventions he said, “Wait for the forthcoming White Paper. Wait for the forthcoming Bill.” Is this not the biggest blank cheque that this Government or any other have ever asked us to pay, and would it not be irresponsible for us to do so without their telling us how they are going to spend it?
The truth is that the Tories are all tax and no strategy. When it comes to the NHS and social care, last year the public clapped them; this year the Tories tax them. There are far too many outstanding questions, with no detail published yesterday. What other tax rises on working people are set for further down the line, given that the Prime Minister refused to rule them out yesterday? Will council tax have to rise to make the sums add up? How will the Government relieve the burden on councils and care homes? Again, there was no detail on that yesterday, and there is no detail today.
Mike Padgham of the Independent Care Group said:
“It’s not clear how the money is going to…the front line.”
That means that providers will be squeezed, and working conditions and pay impacted. This just does not add up.
We all recognise the significant crisis in the social care system, but is that not just another broken Conservative manifesto promise? They pledged to approach this in a manner of cross-party consensus. The manner in which they are bringing forward these out-of-the-blue taxation measures on some of the poorest working people in this country does nothing to build that consensus; it just broadens the gap that we know many families face in meeting the costs of social care.
My hon. Friend is exactly right. The Conservatives walked out of cross-party talks in 2010, and despite offers from my hon. Friend Liz Kendall, they have never resumed.
So much for the plan; what does this mean for ordinary people funding it? The Chancellor’s tax on jobs does not just let down those needing care or working in the care sector; it is a tax on all those in work. As daily covid cases continue to climb, the only shielding that the Government are interested in is protecting the wealthiest few from paying more tax. As I said, a private landlord owning and renting out multiple properties will not pay a penny more, yet their hard-working tenants who work for a living will be hit hard. It is deeply unfair.
Does my hon. Friend agree that the question on everyone’s mind is, “When is my operation going to happen?” The Health Secretary does not seem to be able to answer that basic question. When will the waiting list be over? When will we stop having to wait for crucial operations?
That is exactly the question that all our constituents ask, but as the Minister has failed to say today when the backlog will be cleared, we have to wonder whether this plan adds up, and when any money at all will be available for social care.
The incomes of working people just are not of interest to this Government. I asked the excellent staff of the Library to examine the impact on a typical worker in constituencies such as mine in Leeds West, the Minister’s in Hereford, and the Chancellor’s. Let us imagine that our worker is a new police constable—a single mum with two children, earning £26,000 a year. She rents her home in the private sector. She is eligible for universal credit. What have this Government done for her? [Interruption.] Hon. Members laugh, but they will not be laughing when constituents come to their surgeries and ask why this Government are taking money away from them.
No, I think the hon. Lady should listen to this. What have this Government done for that worker and her family? The Chancellor has frozen her pay this year. The Chancellor has frozen her income tax personal allowance. The Chancellor is taking £20 a week away from her and her family in universal credit, and her council tax bill has gone up by £80. Now the Chancellor is coming back for more and asking for 1.25% of her income in national insurance. Why do this Government keep coming after the same people time after time, asking ordinary working-class people to pay more of their incomes?
If we add it up, the total cost to that worker and her kids—this is all of our constituents—will be an extra £1,234 next year. That is not just a one-off. Analysis from the New Economics Foundation shows that 2.5 million working households will be hit by the Tory double whammy of cuts to universal credit and an increase in their national insurance. Put that on your leaflets at the next election.
I will give way to the hon. Lady. I will be interested to hear what she is going to say to her constituents at her surgery.
I would be interested if the hon. Lady would let us know at which point “massive global pandemic” appeared in any of the commitments made during the 2019 general election, and whether the Labour party would continue to have unfunded promises for which we would have to borrow from the market or whether they would continue to kick the can of a gnarly problem down the road. Constituents of mine have been worried about social care all summer. It is a problem that people have ducked for generations. We are doing it in a way we can afford.
I am not sure what the constituents of South Ribble will make of that, but I know what they will think after seeing less money in their pay cheques time after time because of decisions by this Government. There are choices, and they are difficult ones. This Government are choosing to tax ordinary working-class people. Labour would ask those with the broadest shoulders—the wealthiest in our communities—to pay more. This Government make a different choice; they can justify that to their constituents.
I will give way to the Chair of the Select Committee.
I bring my hon. Friend back to paragraph 36, which I asked the Minister about, which seems absolutely key. There is no clear money coming from the levy to social care. That is what the Government said. I think the Minister said it would all be revealed in the spending review. Paragraph 36 states:
“The Government will ensure Local Authorities have access to sustainable funding for core budgets at the Spending Review. We expect demographic and unit cost pressures will be met through Council Tax, social care precept”.
On top of all the other hits that working families are going to get, can they expect an above-inflation rise in their council tax next year to pay for the Government’s failure to fund social care properly?
I think many councils and the people who work for them and provide social care at a local level will be incredibly worried about what they are hearing from this Government, which is that council costs are going to go up while they are getting no additional money.
I will give way again in a moment, but I have taken a lot of interventions—a lot more than the Minister.
In contrast, who has been shielded by the Chancellor? Which types of income will be paying no additional tax after today? They include those who get their income from financial assets, stocks and shares, sales of property, pension income, annuity income, interest income, property rental income and inheritance income. Well, fancy that. I do not doubt that the champagne glasses were clinking in Mayfair last night toasting the Chancellor, but not in Mansfield, not in Middlesbrough, not in South Ribble and not in Thirsk either. Some 95% of the revenue the Government plan to raise from this tax bombshell comes from employment. What a contrast.
Let me just make this point.
What a contrast. Yesterday, Amazon reported an additional £1.9 billion-worth of sales, but it is paying only £3.8 million more in corporation tax, with much of its profits diverted to Luxembourg. Yet with the changes announced yesterday, a graduate on a typical entry-level salary will now pay a marginal tax rate of almost 50%. And not a word from the Chancellor or any of his Ministers about any of that. Politics is about choices and there are other ways to raise this money. The Chancellor wants the country to believe that—[Interruption.] Sales on property or on financial assets such as stocks and shares—there are no additional taxes on people who get their incomes in that way, but plenty of additional taxes on ordinary working-class people.
The Chancellor wants the country to believe that this is the only way to do it, but the point is that it is not. The Prime Minister and the Chancellor have deliberately chosen to go after those who are working hard for their money. Labour understands—I understand—how hard people work for their wages. I do not believe that the Chancellor considers the lives of people outside this place in any detail before he takes decisions like this. The Government, as was mentioned earlier, are rushing this through without publishing a proper analysis of the impact on jobs, on different parts of the country and on different incomes. They are not even allowing proper amendments. Members will know that we are limited in how we can amend the motion this evening. That is why we have put forward what we can: an amendment calling for an assessment of this tax on jobs—an assessment that the Chancellor is unwilling to provide.
I will give way just twice more: to my hon. Friend Alex Sobel and then to Laura Trott.
In my constituency and in my hon. Friend’s constituency next door, we have many people right at the start of their working lives paying, as she says, nearly 50% in tax after this change and very high rents in the private rented sector. They effectively have no disposable income. Their dreams of ever owning a home are being destroyed by Conservative Members. Does she not agree?
My hon. Friend speaks well of what our constituents in Leeds North West and Leeds West will be facing with that double whammy of universal credit and the national insurance increase, in addition to the other tax increases from this Government. I will take a final intervention and then I will start to wind up.
I thank the hon. Lady for giving way. There is an obvious precedent for this national insurance rise to raise money for the national health service, which is from 2003. Were Labour wrong to raise national insurance for the national health service in 2003?
We had a clear plan to bring down waiting lists, a plan that this Government are sorely lacking. The economic circumstances are different, too. The Government’s tax on jobs comes at the worst possible time. Businesses create jobs and will drive our recovery. Labour is a party that is pro-worker and proudly pro-business, too. I am proud of the decisions that the former Prime Minister and the former Chancellor made that brought down waiting lists to their lowest ever level—targets that have never been met under 11 years of Tory Government. We want business to succeed, to invest more, to employ more, to pay more and to create more wealth.
These are still precarious times, with many businesses in all our constituencies not yet back to full capacity and others considering how they are going to repay the loans taken on during the pandemic. What do the Chancellor and the Minister think the effect of this tax rise on jobs will be? That has not been set out. It could mean an attempted squeeze on wages and conditions, even higher prices for customers, or the scaling back of recruitment and growth plans. It will affect people and it will affect the Exchequer, too. It is a false economy. The Chancellor and the Minister do not need to take my word for it. The British Chambers of Commerce described it as:
“a drag anchor on jobs growth” and believes it will
“dampen the entrepreneurial spirit needed to drive the recovery”.
Make UK says it is
“ill-timed as well as illogical”.
The CBI says that it
“will directly hurt a business’s ability to hire staff at a time when businesses have faced a torrid 18 months.”
The Federation of Small Businesses says that
“this increase will stifle recruitment, investment and efforts to upskill”.
They are joined by the trade unions. The TUC says it is wrong to hit young people and low-paid workers
“while leaving the wealthy untouched.”
We agree with businesses and we agree with our trades unions, too. They are right. This is a tax on jobs. It is a tax on the economic recovery and we will not support it.
Let us go back to the key questions that need answering. Will this plan deliver what is promised for our health and social care sectors? No. Will it clear the NHS backlog by the end of this Parliament? No—and the Health Secretary says no. Will it give social care the resources it needs for the next three years? [Hon. Members: “No.”] Is there a plan to reform social care? [Hon. Members: “No.”] Will it create more and better paid jobs in the economy? [Hon. Members: “No.”] Is it fair across the regions? [Hon. Members: “No.”] Will people be prevented from selling their homes to fund their care? [Hon. Members: “No.”] Will this tax bombshell help our economic recovery? No. Is it the last tax increase in this Parliament? No. This whole thing is unravelling. No wonder that Ministers are in a desperate rush to get it through. The Chancellor is absent today. Perhaps he has gone for a swim.
Covid has tested the people of our country like nothing else in any of our lifetimes. After the last year and a half the country deserves a much better future, a recovery that enhances and enriches all our lives and in all parts of the country. Social care is a huge challenge and there are other challenges coming too. We need to do things differently. Labour’s test is simple: does it fix the problem and does it do it in a fair way? The answer to both of those questions is no. That is why Labour will vote against this unfair, job-taxing, manifesto-shredding tax bombshell this evening.
Order. As Members can see from the Annunciator, there is a five-minute limit on all Back-Bench contributions. We will start with Mel Stride.
I rise to welcome, broadly, the motion. It seems to me that social care is one of those issues that parties of both colours have grappled with for many years, yet now we are at last at the point where a Government have the courage and are sensible enough to actually come forward with some realistic proposals. As to the breaking of manifesto commitments, no party ever wishes to do that, but listening to the Opposition it seems to me as if the global pandemic never occurred, as if the economy never shrank by the greatest level since 1709 during the great frost of that year, as if millions of jobs were never imperilled, and as if this Government never had to step in fiscally in a way that probably no Government outside wartime have ever had to do, and with such positive effects.
When it comes to the honesty or otherwise of what the Government have done, I think they have been upfront, very clear and very honest in making it clear that they have broken that commitment, unlike, I have to say, the less straightforward way in which, repeatedly in this debate, the Opposition and the shadow Chancellor have ducked the fundamental question: what is the Opposition’s alternative plan? In response to an intervention by my hon. Friend Laura Trott, the shadow Chancellor, when asked why Labour had supported an increase in national insurance in 2003, said, “Well, we had a plan.” I humbly remind her that that was 18 years ago. What we need to see now is a plan from the Opposition, as well as the criticism.
The right hon. Gentleman and I have known each other for a very long time. I just hope that he could explain to my constituents why it is right that practically everybody in the Rhondda would have to sell their home to meet the £86,000 cost, whereas next to nobody would have to do so in his constituency.
First, the hon. Gentleman’s knowledge of my constituency is obviously rather deficient, because I expect that mine shares many characteristics in common with his. I do not dispute the fact that any major fiscal move, such as putting up national insurance and bringing in this levy in this manner, will have associated complexities and difficulties. My pledge to the House is that the Treasury Committee will, I am sure, after private discussion, decide that we wish to look more closely at a number of the issues that are being raised in this debate, including the one that he mentioned.
Let us be honest about the options that were available to the Treasury. How could we have squared the circle and funded £10 billion-plus a year? The first thing that the Treasury could have done is to seek to cut expenditure in other areas, yet I have no doubt that if it came forward with any proposals of that nature, the Opposition would have fiercely resisted that as austerity all over again. We have to understand that on the current projections, there are many unfunded commitments, including, for example, keeping our railways going, going for net zero, additional funding that will be needed for school catch-up and so on.
Given the right hon. Gentleman’s experience on the Treasury Committee, does he not agree that a tax hike of this scale could—if it was necessary—be much more fairly and equitably carried out if the tax burden was spread across a number of different taxes, rather than 100% of the burden being landed on one single, narrowly based tax?
I will come back to the hon. Gentleman’s point, but let me just stick with the options. The second option was to lean into growth, to assume that we could grow our way out of this problem. We have just had a huge contraction of the economy. We are not yet back up to the pre-pandemic level, although the Bank of England thinks that we may arrive at that point some time towards the end of the year, and we have many headwinds to growth ahead of us, not least the bottlenecks in supply chains, the labour shortages that we have witnessed in certain areas, and many other issues.
The third thing that the Treasury could have done is to borrow more money, and that is probably what the Opposition would have done in this situation. Despite the fact that the Bank of England now seems to feel that there is more money—I suspect that the Office for Budget Responsibility will confirm that around the time of the Budget— because the economy is doing a bit better than we expected, probably to the tune of about £25 billion, it would be a very brave Chancellor who started to borrow yet more and more, knowing that one day it is possible that the markets might turn around and look at the United Kingdom and decide that they no longer have confidence to lend to us. That would be a very dark day.
I will not, actually, because I am very low on time.
That is the sword of Damocles that hangs regularly over the head of our Chancellor, so that leads us to taxation. If we look at taxation and the amounts involved here, there are only three taxes that we could consider. About two thirds of all tax is raised through income tax, national insurance and VAT. We then ask ourselves, “What criteria are we going to apply to the tax measures to test whether they are the right ones or not?” There are at least two. One is that we should look after the least advantaged in our society—the lowest-paid—and the second is that we should look after those who are the youngest, who have borne the greatest brunt of the economic consequences of the pandemic.
I will not—I am very short on time. We are looking to the younger generations, to some significant degree, to fund predominantly the needs of elderly people and social care. If we look at those taxes, income tax rises would have been very progressive—there is no doubt about that. We would have had to have about twice the level of increase that we are looking at with national insurance to have raised the same amount of money. I think we need—the Minister made this point—a UK-wide solution to this, not one based on income tax, where, of course, elements of income tax are devolved to other nations across the United Kingdom.
If we put up VAT, that would be hugely regressive, particularly at the level of income received rather than expenditure. That would therefore have been wrong. We are also up at 20%, I think—near the upper limit of where VAT should be, given the distortionary consequences of going further.
That inevitably leads us to national insurance, just what Labour was led to in 2003. The original proposal, it seems to me, failed both of my tests. If we just put up national insurance, it would have been regressive. It would have hit the poorest hardest, but what is right about the Chancellor’s approach is that he has extended it to those beyond the state retirement age and those receiving income by way of dividends. That critical move makes this, in general, the right approach.
There are many issues that the Committee will no doubt look at. One of them is that a regrettable consequence of the increase in the employer’s national insurance rate is that it will exacerbate the so-called “three people problem”, whereby the different tax treatment of the employed, the self-employed and those receiving income through their own company will be widened, with consequences for IR35. I am out of time, but I support this motion today.
I would like to start by giving the UK Government some credit: they are absolute masters of illusion and deflection. Trying to get them to simply answer a question is like pinning jelly to a wall. Their Ministers are astonishingly unperturbed by going out to argue for policies that entirely contradict the cast-iron promises they made when they stood for election. We on the Scottish National party Benches are clear that raising national insurance is a blunt tool to fund social care, likely to disproportionately hit young people and lower earners. Our SNP amendment (a) would have forced the UK Tory Government to come clean on the distributional impact of this policy.
We would love to be able to amend the motion more broadly, but as Chris Bryant pointed out, we have limitations on our ability to do so this afternoon, which is hugely frustrating. Our amendment therefore covers the impact by age, because we know that young people will be affected worst; by income, because we know that national insurance is regressive and will hammer lower earners; by wealth, because those with unearned incomes stand to be the big winners and the key political motive here appears to be for the Tories to bail out their well-heeled voters against losing their inheritance; and by place of residence, because this is a UK tax for an English policy crisis and, within England, the Resolution Foundation is clear that this policy will benefit the south-east the most. It is of no surprise to me that the UK Tory Government’s national insurance hike and the “back of a fag packet” plan announced yesterday are already drawing criticism from all sides—from The Daily Telegraph, the Daily Mirror, the Cabinet and Back Benchers.
My hon. Friend is making a number of very important points. An anonymous member of the Cabinet is quoted in The Daily Telegraph as being very critical of this policy:
“If you get all your income from investments and property you don’t pay a penny but if you work your guts out for minimum wage you get clobbered.”
Can my hon. Friend hazard a guess as to what the Tories have against taxing unearned income?
I would be very curious to know why that is. I was going to read out that very quote, because even three former Conservative leaders, including a former Prime Minister and three more former Chancellors, have spoken out against this move. To complete the quote that my hon. and learned Friend mentioned, this person, an anonymous member of the Conservative party, said:
“Putting up National Insurance would be morally, economically and politically wrong.”
They went on to say:
“After all that’s happened in the last 18 months they can’t seriously be thinking about a tax raid on supermarket workers and nurses so the children of Surrey homeowners can receive bigger inheritances.”
Well, yes indeed they are.
Is it not the case that the talk is about making life better for social care staff, but actually, they are exactly the people who will lose £1,000 a year in the universal credit cut and will now face this extra cost?
My hon. Friend is absolutely right. They are the people who can least afford it and who have worked the hardest through this pandemic, who this Government should be thanking, not taxing.
We are being asked to vote today on measures that the Institute for Fiscal Studies has described as “better than doing nothing”, which is about as charitable an analysis as is possible of this policy.
In a second. Very few people would dispute the need for action on health and social care in England. However, an increase to national insurance contributions is not the fairest way to go about it. I would be interested to know why the hon. Gentleman thinks it is fair for his constituents.
The hon. Lady made reference to the IFS. She will know that the IFS has noted that over the past 10 years the health spend in Scotland has grown by 1.2%, whereas in England it has grown by 3.6% on a like-for-like basis. Surely it is astonishing that she would vote against £1 billion of extra investment for Scotland’s NHS.
What the hon. Gentleman fails to understand is that we are starting from very different points. He does not acknowledge that, and he does not understand it.
The response from equality and anti-poverty groups has been absolutely damning. The Women’s Budget Group has said:
“We believe there is a fairer way to fund social care. This is because, as they currently stand NICs are more regressive than income tax—with a lower threshold at which payments start, and a higher rate threshold beyond which employees pay a lower rate.”
The Resolution Foundation has described the policy as “generationally unfair”. Paul Johnson of the IFS has said:
“Remains the case pensioners will pay next to nothing for this social care package—overwhelmingly to be paid by working age employees”.
There are many ways in which this policy could have been made progressive, one of which would have been to look at the upper threshold for national insurance, which has not been addressed. A young graduate will now have a marginal tax rate higher than a rich Conservative on the Government Benches.
The hon. Gentleman makes an excellent point. For young people who have perhaps struggled through this year, who have graduated and who are going out into the world of work, it is a real hammer blow to their prospects.
Many families are already facing a historic £1,040 cut to their annual incomes and are staring down the barrel of impending cuts to universal credit and working tax credit. The Joseph Rowntree Foundation has described the new levy as adding “insult to injury”. The New Economics Foundation has calculated that 2.5 million working households will be affected by the £20 a week cut to universal credit and the increase in national insurance. On average, they will lose out by £1,290 in the next financial year. Working households are doing their very best to put food on the table and support their children, and this cruel UK Tory Government caw the legs from under them.
If the hon. Gentleman can explain why that is fair to the families who have been working so hard, I will be glad to give way.
I wonder whether the hon. Lady has popped out to the Vote Office and picked up the distributional analysis that the Government have published, which shows the impact across the deciles of income in this country: it just does not bear out what she is saying. I encourage anybody out there to pick up that analysis and have a look.
I have seen a different analysis from the New Economics Foundation; I urge the hon. Gentleman to look at it, because it gives a very different picture from the one that the Government are presenting today, which is why we need more analysis of the policy before the Government go forward with it.
The policy will also have an impact on our recovery from the pandemic. Businesses, which have weathered such a challenging year, have spoken out against it in the strongest terms. The Federation of Small Businesses has called the national insurance hike
“anti-job, anti-small business, anti-start up”,
pointing out that the increase to national insurance will
“stifle recruitment, investment and efforts to upskill and improve productivity in the years ahead.”
Is the hon. Lady worried that the Government appear to be increasing taxes at a far earlier stage of the economic recovery from the pandemic than similar economies?
The hon. Lady is absolutely correct. The Government have learned nothing from the austerity that caused so much damage with the last crash. They are about to repeat their mistakes, and those on the lowest incomes will be hammered most, again.
The Institute of Directors has called the hike “political opportunism” and has highlighted the tax on dividends, which will hit sole traders and small company directors, many of whom were completely and unjustifiably excluded from UK Government support during the pandemic. It really does rub salt in the wounds.
I am grateful to the hon. Lady for giving way on that excellent point. In my constituency in Reading, many of the same families will be affected; she is wise to point that out, and I reiterate that point. It appears that the same very hard-working groups of people, many of whom are key workers or are with small businesses, are being affected disproportionately by this unfair tax rise. At the same time, it is not solving the fundamental problems with social care.
Absolutely. It does nothing to resolve either issue, and it makes it all the harder for people who have suffered so hard during the pandemic and been excluded from support to get back on their feet and bring money back into the economy. It makes no economic sense whatever.
Of course, the unjust effect of the national insurance hike will be compounded in Scotland because the Prime Minister is proposing that Scottish tax contributions be used to fund England-only policies. My constituents and people across Scotland are generous people, and I am sure that very few of them would begrudge the principle of funding the NHS and fixing social care after the pandemic, if indeed they had any faith that this Government were capable of fixing anything. But as things stand, the Scots, Welsh and Northern Irish stand to be taxed twice: first for the health and social care system that they actually receive from their own Government, and then for the NHS and social care in England, for services that they do not have access to, where money more often than not appears to be squandered on dodgy contracts and cronyism scandals.
We know from the United Kingdom Internal Market Act 2020 and other Tory Brexit legislation that we cannot trust Government Members to respect our hard-won devolution. I am not reassured in the slightest by all the talk yesterday from the Prime Minister about directing money raised from the new levy into health and social care services in Scotland.
The hon. Lady is making a very important point. Is she aware of any discussions having been held between Treasury Ministers and SNP Scottish Ministers or Labour Ministers in the Welsh Government? It seems to me that the British Government are using a UK-wide tax to fund English priorities.
The hon. Gentleman is absolutely correct on that front. These are not our priorities; we already have these services in our own nations.
If Conservative Members will just calm down for a little minute, I will try to bring them in at some point. I want others to get in to make their speeches—gie’s peace.
It is not for the Prime Minister or anybody else in the UK Government to direct how devolved budgets are spent. The Ways and Means resolution ties the money to NHS Scotland, not to our democratically elected Scottish Parliament and Government—a further undermining of decision making, showing a lack of understanding of how services are provided in Scotland. We have had no assurance from the UK Tory Government about the extent of the Barnett consequentials that will be generated from the spending. I seek clarity on that today.
SNP Members cannot support measures that are so manifestly unfair to our constituents and whose financial consequences amount to a pig in a poke. The Resolution Foundation has pointed out that while health spending may go up, spending on other areas such as local government has gone down compared with pre-pandemic plans. [Interruption.] Local government, of course, provides a significant proportion of the social care that Tory Members, who would do better to wheesht and listen than to chat away in the corner, claim to care about.
The hon. Gentleman has done more talking than listening in this place. It would be useful if he sat down.
The spending cuts will have an impact on Barnett consequentials. It would be just like this UK Tory Government to appear to give with one hand while picking Scotland’s pockets with the other. A new Tory poll tax that punishes those on the lowest incomes is being forced upon Scotland by a Government we did not vote for.
If the hon. Gentleman wants to explain that to his constituents, I would be very glad to hear it.
The hon. Lady is making a serious speech with lots of very pertinent points, many of which I disagree with, but the fact is that we have come to the crux. This action by the Government will actually deliver more than £1 billion of extra funding to Scotland’s national health service. The real reason SNP Members oppose the motion is that they would rather Scotland’s NHS were poorer than that Scotland benefited from being a part of this United Kingdom. That is the fact.
We already spend more per head on the NHS than is spent in England. We already have better services in Scotland than in England. This policy is an entirely regressive form of taxation that does nothing for the hon. Gentleman’s constituents and does nothing for mine.
Scotland already spends 43% more per head on social care, which allows us to be the only nation that delivers free personal care and has extended it to people under 65. That was why we raised the extra 1p on tax, for which Scots are already paying and from which they are already gaining. That should be controlled by the Scottish Parliament.
My hon. Friend speaks the absolute truth. There is a huge contrast between what the Government propose and what is already being delivered in Scotland.
Some have said, “What’s your alternative?” Well, fixing England’s social care crisis is not for the SNP to decide, quite frankly. Having heard evidence when I sat on the Select Committee on Communities and Local Government some years ago, I know that successive UK Governments have failed to act and have ignored the evidence as difficulties mounted. Now the Prime Minister has come to this House in haste, shamelessly using covid as cover.
I will, because we served on the Communities and Local Government Committee together.
I am very grateful. In respect of the sufficiency of Scottish social care budgets, there is now an 11-week wait in parts of Scotland for discharge from hospital into a care home. Is the hon. Lady honestly saying that she does not need extra resources for Scottish health and social care?
The hon. Gentleman should look at the comparative figures in his own constituency. I am not saying for one second, and I would never say, that everything in Scotland is perfect, but we are making good progress on that, and we intend to make more progress.
The social care funding announced by the Government may in the end amount to as little as 20% raised by this tax hike, and not even for a few years. The British Association of Social Workers has said that this raises more questions than answers, and that it needs the funding for services right now, not at some point in the future. The early analysis across the board today demonstrates that the sheen is already coming off this policy. In contrast, the SNP has used its time in government to introduce health and social care integration, self-directed support and the Carers (Scotland) Act 2016. We have health and social care partnerships on the ground working away to deliver more integrated services to our constituents. Free personal care has been available in Scotland for adults aged 65 or over since 2002, extended in 2019—as was pointed out by my hon. Friend Dr Whitford—to people of all ages who require it. Yesterday the Scottish Government’s programme for government set out the timetable for establishing our national care service, the most significant public service reform since the creation of the NHS.
This is a Westminster power grab on devolved healthcare and the democratic institutions of Scotland, Wales and Northern Ireland. The Government are taxing our people to pay for their chaotic mishandling of health and social care in England. They are undermining our recovery by putting a tax in employers. They are punishing working people on low pay by cutting their universal credit and hiking taxes on their meagre wages. This is no Union dividend, as the Prime Minister likes to claim; it is a Union dead end, and the people of Scotland must have the choice to take the fastest road out of here to independence.
Let me start by congratulating the Government on grappling with what I think is a very difficult issue—actually, it is probably “the” issue for our generation to deal with—of how we ensure that older people have dignity in their old age, and how we deal with an ageing population. However, I do not believe that the way in which we are proposing to do it, through national insurance contributions, is the correct way.
There are three reasons why I think this will be particularly damaging to areas such as the one that I represent. First, ours is an area with low incomes. The lower a person’s income, the more that person pays, as a proportion of that income, in national insurance contributions. The national insurance rate on incomes above £50,000—before these changes—is just 2%. So those on the lowest incomes pay the most proportionately in national insurance contributions.
Secondly, ours is an area with low property values. An £86,000 cap on contributions, or even a £100,000 asset floor, may be right for other parts of the country, but in my constituency, where the average property price is £170,000 or £180,000, by the time people hit that damping floor of £100,000, they would have had to pay the equivalent of 50% of their property value in care home fees.
I thank my right hon. Friend for raising an important issue, with which I too have been grappling since yesterday’s announcement. Does he agree that it would be wonderful to hear from the Government that they may consider looking at regional disparities in house prices when setting the floor?
What a brilliant suggestion—one that I was about to make myself. I think that the Government should think about both the £86,000 contribution and regional house prices when considering that damping floor.
Thirdly, ours is an area with historically high unemployment. National insurance, as we have all called it during election campaigns, is in fact a jobs tax. It is a disincentive to the creation of new jobs, and those already in work will see, for instance, pay rises suspended as the wage bill goes up for employers just for employing people in their businesses. That is why I think that national insurance is the wrong tax to use for the people in my constituency. They are hit just as hard by this appalling social care issue as people anywhere else, but, for us, I would have much preferred it if the Government had looked at income tax, which, as we heard from the Chair of the Treasury Select Committee himself—my right hon. Friend Mel Stride— would be much less regressive.
My constituency has similar house prices, and I know that my constituents share these concerns. As for the point about income tax, the advantage of taking this tax from national insurance is that the cost is shared between workers and businesses, but smaller businesses will not pay, for reasons that the Minister has already given. Is this not a better way of sharing cost across business and employees, which will actually affect lower earners in our constituencies less than the income tax alternative?
I thank my hon. Friend for making that point, but I do not agree with her. I do not think that we have to consign ourselves to one tax to deal with this issue. It is perfectly possible to put up income tax, which is a much fairer way of taxing people across the income scale, and, of course, picks up wealthy pensioners with very large pensions, picks up dividend income, and picks up rental income, which was mentioned from the Opposition Front Bench. It picks up all of our income, while at the same time allowing us to look at different ways to tax business. I have said before that I think we should have an online sales tax—an Amazon tax, as it is called—which the Treasury has previously said could release about £2 billion. That is not enough, but we could increase employers’ NI only, and we could increase corporation tax. This problem needs to be tackled with a cocktail of funding, not just one tax. But if we are to use just one tax, I do not believe that NI is the correct one.
No, I will not. I have already given way twice.
I congratulate the Government on trying to look at some of the concerns that many colleagues in northern constituencies have about low income, high unemployment and low property values, and I congratulate them on raising the floor to £100,000. I think that that goes some way towards dealing with the issues that concern many of us, although, certainly from my point of view, it does not solve them.
What also concerns me greatly is that this tax is not actually a health and social care tax; it is a Trojan horse for an NHS tax. The Government themselves say that in the first few years of this tax, nigh on 100% of it will go towards supporting the NHS. That is quite right, in that the NHS does need more money, but if it is an NHS tax, which will be hypothecated and listed on pay slips, we should call it that, rather than calling it a health and social care tax.
When the time comes to move the money from the NHS to health and social care, what Government of any political hue are going to cut £12 billion from the NHS budget? If we create an NHS tax, we have an NHS tax forever. It will never go down; it can only go up. No party is ever going to stand at an election saying, “I’ve got a good idea. Vote for me—I will cut the NHS tax.” I think there is a huge danger for us in creating such a hypothecated tax and listing it on people’s pay slips. It is fundamentally un-Conservative, and in the long term it will massively damage the prospects of our party, because we will never outbid the Labour party in the arms race of an NHS tax.
As a Conservative, I believe that the way to fund public services better is to grow the economy, to make the cake bigger. This change makes the cake smaller, because it is a jobs tax—and not even that: those who live in a low-wage, low-property-price, high-unemployment economy will get a smaller slice of it at the end of the day. They will have both a smaller cake and a smaller slice.
I hope that the Government will take the opportunity to think again. I welcome the new money for the NHS, but throwing other people’s money down a bottomless pit does not become a good idea if we put the NHS logo next to it. If we are going to fund the NHS, if we are going to give it more money, before the Government ask the House and us as Members of Parliament to approve that, they should show us the plan. We cannot measure the NHS by what goes into it; we have to measure it by what comes out at the other end.
For those reasons, with a heavy heart, I will not be supporting the Government this evening.
I look forward to seeing Jake Berry in the Division Lobby tonight. What we witnessed yesterday was a Budget in all but name. It was a Budget sprung on this House with minimal warning and leaked to friendly newspapers over the weekend, but with scant detail being made available to Members of this House in a statement full of the deliberate obfuscations that have come to define this most slippery and unreliable of Prime Ministers. And today the Government are attempting to bounce it through the House before their own Back Benchers rise up in revolt. Some things are abundantly clear, despite the Government’s attempted sleight of hand. This announcement cynically breaks a guarantee personally signed by the Prime Minister at the last election that he would not put national insurance contributions up. That was one of two solemn manifesto pledges that he tore up yesterday, which makes me ask why anyone should believe what any future Tory election pledge says, ever again.
While proclaiming that they are the party of low taxation, the Conservatives have ushered in the largest tax rise in generations and now preside over a country with the largest percentage tax take in peacetime, but it is not a fair tax system. It continues the shift in tax liabilities away from those who make their income from owning assets to those who work. It exacerbates the three-body problem with self-employment, encouraging evasion, and it leaves wealth largely unscathed. It will exacerbate the unfairness and inequality that scar our society and that have been highlighted by the covid pandemic’s unequal effect on the poor and vulnerable. This tax hike has been presented by the Government as an historic move to fix the social care system, but in reality it is nothing of the sort.
If the hon. Lady is so against this increase in national insurance contributions, why did she vote for one in 2003? Can she say what happened to NHS productivity as a result in the decade that succeeded it? I can, and it wasn’t pretty.
We had the Wanless report, rising real wages and a buoyant economy, and we did a lot of work with civil society and communities before we introduced the rise. We did not just pull it out of a hat like a rabbit. It led to a 6% increase per year in funding for the NHS, not the 3.5% that this measure will lead to.
The Member has outlined the effect on the vulnerable and on employment. Would she accept that this is going to affect young people hard as well? People who cannot afford to purchase a house are going to be taxed to ensure that people who have an asset are protected.
The right hon. Gentleman makes an important point, especially given the effect on those young people who are having to repay their student loans, which takes their effective marginal tax rate close to 50%. We have to look at the fairness of that.
This is not a plan to reform social care. A mere 15% of the extra £36 billion raised in the next three years is earmarked for social care and the mechanisms by which that will be dispensed are unclear, but vital to any prospect of an improved outcome. Indeed, they are so unclear that the Minister could not give us any insight into them during his opening remarks. This new money will not be available until 2023 and it will therefore not help a single family struggling now with the catastrophic cost of paying for their loved ones to access social care. It is far from certain that the NHS will not simply swallow up all the money allocated from the tax increase to try to tackle the backlogs in the NHS caused by Government cuts and exacerbated by the effects of the covid pandemic.
This new money will not make up for the huge cuts that this Government have been responsible for making to the social care system in the past 11 years. Age Concern estimates that 1.5 million people in need of care have been denied it as a result of the 7.5% per head cut in funding that this Government have delivered since they were first elected in 2010. The burden has fallen on family members and unpaid carers, many of whom have had to put their lives on hold to deliver care to loved ones with little or no support. The huge cuts to local authorities over the same period have stretched the care system beyond breaking point, yet the Prime Minister had nothing to say about any of that yesterday.
No, because I would run out of time.
This is not a plan for social care, even though the Prime Minister is claiming that it is. The system needs fundamental reform, but this is tinkering at the edges. A real reform of social care would involve wholesale change from top to bottom. It would deal with those who require care now, not ignore them and their needs as the Government have done. There is nothing for them in the Prime Minister’s announcement. A real reform would have a plan for care workers and their future, with training, career progression, decent pay and an end to zero-hours contracts, to low minimum wage remuneration, to 15-minute appointments with no pay for the time it takes to drive from one client to another and to fragmented contracts that wreck lives.
At the moment, there are 112,000 vacancies in the care sector, and staff turnover is 34% a year. That indicates the need for fundamental reform. The pay for working in an Amazon warehouse or a supermarket is higher than the pay for caring. Surely that is wrong. The covid pandemic and the shameful betrayal of care workers and those who require care, which unfolded during the first wave of covid-19, told us all we needed to know about the ramshackle nature of a system that this Government have allowed to teeter on the verge of collapse for the past 11 years.
The Prime Minister’s announcements are totally inadequate to the scale of the task, if there really is a plan to fix social care. All that those who work in care got out of his statement was a tax rise and no pay increase. Those trying to access care now got nothing. Those trying to provide domiciliary care were not even mentioned, and nor was the growing army of carers. Protecting the assets of those needing to access care for long periods is not a substitute for fundamental reform of the system; it is not a plan for social care. It is a sign that the Government are dodging a long overdue and necessary reform. The Prime Minister’s so-called plan breaks election promises. It is half-baked, inadequate and unjust.
I rise as a member of the Health and Social Care Committee to support this measure today, and as I do so I would like to direct Members’ attention to my entry in the Register of Members’ Financial Interests. I sit on the Health and Social Care Committee, and only yesterday morning in the Committee we heard from two patients who talked clearly about the delays that they faced in accessing care in the NHS. The first was a lady called Shirley Cochrane, who sadly had an aggressive form of breast cancer. During her time on an NHS waiting list, waiting for treatment, she felt alone and said that she was not listened to and did not get the attention she needed. The second was a gentleman called James Wilkinson. He had myocarditis, a condition that I know a little bit about myself, having had that condition in the past. While waiting for aortic valve replacement surgery, he had the surgery cancelled three times.
We face an enormous challenge. In that same Committee, we heard from the Health Foundation, which talked about the enormous sums that would be needed to solve this backlog. It also talked about the number of consultants, NHS staff and nurses that would be needed to increase capacity in our NHS. Opposition Members need to understand that, if we are going to face up to the enormous challenge that our NHS and social care system is facing, it has to be paid for. It cannot just be borrowed. If they have a better way of paying for this, they need to outline it now.
When the lady from the Health Foundation was giving evidence to our Committee yesterday, she said that three things were needed to resolve the backlog. Those three things were more money, more capacity and a plan. I have been involved in health politics for 15 to 20 years, and every single review that I have seen the NHS conduct has said that it needs more money, more staff and a plan. That has happened under Labour Governments and under Conservative Governments. So if we are going to go ahead with this plan, which I support, we need to ensure that it goes with reform and innovation too.
With his wealth of experience in health politics, does the hon. Gentleman accept that we do not know, because the Secretary of State for Health and Social Care has not outlined it, how many of the people on waiting lists will actually be seen and dealt with, and that this is a bit of blank cheque?
We will not approach the backlog unless we have the money and capacity to fund it, and that needs to go hand in hand with what I said about innovation, new pathways and new ways of working. I remember talking to someone who told me that we had three years’ worth of innovation in the NHS in just three months because of the pandemic. New ways of working and new pathways were adopted.
Every time we talk about innovation in our NHS and new pathways—the accelerated access review, the “Innovation Health and Wealth” report and a new life sciences strategy all talk about innovation and new ways of doing things in our NHS. But those new ways of doing things need to be spread at pace and at scale. There is no excuse not to do it now. If it works in one part of the NHS, it will work in another. Culturally, the NHS needs to grasp the nettle and spread that innovation and new ways of doing things so that we can get productivity and outcomes for patients. Now is the time to do it.
The Health and Social Care Committee, of which the hon. Gentleman is a member, estimated last autumn that there was a £3.9 billion funding gap in social care. I assume that he agreed with that report. Can he explain, therefore, how this levy will deliver £3.9 billion a year for social care? I have not seen any figures showing that at all.
Having no plan will not provide the £3.9 billion, and Labour Members have indicated today that there is no plan.
This is a significant tax increase. I am a Conservative, so I do not like tax increases, but I also understand that an enormous thing happened between the manifesto and now. There has been a global pandemic, and Labour Members seem to have missed that fact. We need to shorten waiting lists, we need to do something about it and we need to correct it.
I have given way twice, and I would like to continue because I want to make another important point.
This tax, this levy, needs to be accompanied by reform. The Health and Care Bill is in Committee, and it is really important. The way incentives are geared within the system is one reason we can power through elective waiting lists. We pay for care through a system of tariffs. I urge Ministers and others to think carefully about how we pay for elective procedures in our NHS, because any system of tariffs needs to ensure that hospitals are paid properly for carrying out procedures. There need to be proper incentives for hospitals to carry out hip, knee, cataract and hernia operations, which are the majority of the backlog, as well as treating cancer, heart conditions and everything else. If we are not able to find the right levers within our NHS system to ensure that we power through those elective procedures, we will not be able to solve some of the more serious operations at the end.
Innovation tariffs, for example, would also help by encouraging new ways of doing things. We cannot have a system where, financially, trusts and our NHS are not incentivised to do the things they need to do to be more productive. They should not pursue short-term financial measures when we really need incentives to make sure that they do the right thing.
I will be marching through the lobby to support the Government today, because this is really important.
I have given way a few times.
We must grasp the nettle of NHS reform, backed with finance so that our NHS staff have the bandwidth to deal with the needed reform. That bandwidth is capacity and money. If that does not happen, we will borrow more and spend more in the long term and this ever-lasting round of more staff, more money and more plans will go on and on.
I urge hon. Members to support the Government’s motion today.
It is pretty obvious that there has been a major funding crisis in local government over the past 10 years. Local councils have had bigger cuts to their budgets than any other part of the public sector, around 30%.
My hon. Friend is right to highlight the importance of local government, unlike the Minister, who barely acknowledged its existence. Does he agree that the last decade of ideological austerity and cuts by this Government has meant that local government budgets have been slashed by up to 50%, directly contributing to this crisis?
I have made my position clear on the extent to which local government has been unfairly cut compared with other parts of the public sector.
Across the piece, local councils of all political persuasions have done a brilliant job of protecting their communities over the past few years. They have done it by giving priority to social care, but that has still meant real-terms cuts due to the demographics, with more older people, with people with learning disabilities living longer and with increased costs and demand for children’s social care—demand for the latter two has gone up faster than the demand for elderly care over the past few years.
In protecting social care, there have still been real-terms cuts. There are 1 million more elderly people not getting care who would have received it in the past. Other services, such as parks, libraries, buses and highway safety, have all been cut by up to 50% in local authorities across the country. We are repeatedly asking our constituents to pay increased council tax, often for care services they are not receiving, when the services they do receive are being cut to shreds. That is the reality.
As representatives of both parties in the local government sector said to the Select Committee on Housing, Communities and Local Government, we cannot sort out the funding problems in local government without sorting out the funding problems in social care. That is the reality.
We are in the middle of a Select Committee inquiry, and we will be taking evidence from Ministers. I hope they will start to explain to us how the care plan will solve that problem. The Housing, Communities and Local Government Committee and the Health and Social Care Committee have received estimates that the funding gap for social care alone is between £2.5 billion and £4 billion a year, which does nothing to restore services to the level they should be at or to address the real problems of low pay, which will eventually destroy the service because it will not be able to recruit people as alternative jobs, such as at Amazon, pay so much more. That is simply the reality.
How much money will come from the levy? Paragraph 30 is the only bit that talks about money: £5.5 billion over three years. The gap is between £2.5 billion and £4 billion a year, yet we know the £5.5 billion has to fund: the cap and floor system, which will be at least half of it, maybe more; and the £500 million for workforce training, which is welcome. The money goes nowhere near funding the current gap, let alone bringing about any improvements or bringing people into the social care system who are currently excluded. It just does not do it.
The Government have said they will
“ensure local authorities have access to sustainable funding for core budgets at the spending review”.
All will be revealed in the spending review, but the key bit is that the Government say they expect
“demographic and unit cost pressures” will be met
“through council tax, social care precept”.
We have had 5% council tax increases year on year, and a lot of it has been to fund social care, so we are going to get above-inflation council tax increases again, are we? If we say national insurance payments are regressive, council tax is now regressive, too. That is the reality.
Yes, the hon. Gentleman is absolutely right. As always, he is making some very good points. I thoroughly enjoyed my time with him on the Select Committee.
We did two reports on social care, and we made a recommendation in 2018 to fund social care through the national insurance system. Does the hon. Gentleman still support that recommendation?
Yes. However, may I just say to the hon. Gentleman that it was a slightly different recommendation from what the Government are proposing now? I have our report here, just by chance—I thought I might be asked the question. We talked about the rate at which national insurance would be paid—this was to cover the points that Jake Berry made about low-paid areas. We talked about paying right the way up the income scale. We talked about extending it to pensions and unearned income, and about it not being paid for by the under-40s, who have been really badly hit by this pandemic, and we ought to be doing our best to protect them. In paragraph 95, we also made the important point that people should not have to sell their homes to pay for social care and proposed instead
“that a specified additional amount of Inheritance Tax should be levied”.
We all agreed to that. That system is a lot fairer; people would pay according to the value of their home and it would not be that people in constituencies such as the right hon. Gentleman’s, where house prices are relatively low, end up paying a bigger percentage of the value of their home to fund care than people in areas with higher house prices. I stand by that recommendation. It is a different proposal from the one the Government are now putting forward.
I want to come back to the point for the Minister. There is a crisis in social care, and we have all got that; we all have constituents come to us begging for social care. They are really concerned about having to sell their home, but sometimes it is about not being able to get into a care home or get the care at home they need. Most social care should be delivered in the home where people live. The reality is that there simply is not a proposal in this so-called “plan” to give local authorities that money that is needed to both fund the existing gap and to extend social care to the many people who have been denied it because of the cuts in the past few years. Furthermore, the alternatives will be: bigger rises in council tax—the Government have almost signalled that in this report; or further devastating cuts to other services received by most of our constituents, who do not get social care but have to pay for it. This is a recipe for disaster. Eventually, when it works through, everyone will see that there is no plan for social care here, because there is no funding for social care that will deliver the sort of social care system we all want to see.
For a low-tax Conservative, it is relatively easy to attack this measure—indeed, I could spend my entire five minutes doing so. I could quote the fates of previous conservative Governments, whether led by President George Bush in America or John Major here, who have put up taxes dramatically—John Major did so in a recession—and been punished at the polls. It is relatively easy to attack this measure but much more difficult to provide an alternative. The manifesto point need not be laboured. Labour produced a manifesto with all sorts of spending promises in 2005 and, arguably, they had more chance of foreseeing the global crash in the markets that followed during that Parliament than we ever had in foreseeing a pandemic. So I do not think the manifesto attack holds water.
I declare an interest, as it has always been a principle that once someone reaches pensionable age they get their state pension and do not go on paying national insurance contributions. Many people will feel aggrieved about the position on that; a constituent has written to me angrily saying, “I am 68. I stopped paying NICs at 65 and now you are asking me to pay them again.” That is a fair point, but this meets the challenge of, “Why should we subsidise pensioners at the same time as we are increasing NICs on the young?” Again, it is easy to attack but difficult to come up with an alternative.
The point about London and the south-east is an easy point of attack. Someone can buy a pleasant house in my constituency for less than £100,000 but that would not buy them a shoebox in London. Are we actually subsidising people who own million-pound houses in London? They can spend 30 years in a care home and can pay a very small proportion of that, because they can leave £900,000 to their children.
All these attacks can be made, but what is the alternative? That is what I ask the Labour party. They will not be a credible alternative Government unless they come up with a plan. I will happily give way to any Labour MP who says, “Right, I do not want to increase NICs. I shall increase income tax.”
I am struggling to understand the argument made by those on the Government Benches. In 2016, £350 million per week was promised to the NHS once we left the European Union. We have left the EU, but what has happened to the £18 billion? Should the NHS not automatically expect that money, given that on
It is very nice to be intervened on by somebody who has no chance of forming a Government.
I am afraid that all this talk of a wealth tax or a tax on dividends does not even begin to meet the problem. If we have a wealth tax, what happens in respect of two old-age pensioners who have almost no income and just have a capital asset? Is it fair—
Does my right hon. Friend accept that this may be a fairer system if those in receipt of a pension but not working were asked to contribute to it in some way? Let us consider the position of people who are going to work in Tesco in Haslingden—it is in the constituency of my hon. Friend Sara Britcliffe, but on the border with mine—and are struggling to buy school shoes for their kids or pay their mortgage. Why should they pay so that a relatively well-off pensioner does not have to?
May I say to my right hon. Friend that he gave one of the best speeches this afternoon? It was thoughtful and incisive, and at least he is trying to develop an alternative argument. The Government—this is the problem with being in government—are faced with a crisis now and they have to find the money now. Regretfully, nobody has come up with a better plan than this. I am no toady to the Government, and I say to them that I do not think they can solve these problems by our constantly becoming a tax-and-spend party, as that is simply not going to wash.
We have been spending money like there is no tomorrow. I know there is a pandemic on, but the furlough scheme is riddled with corruption. I know from massive anecdotal evidence in my constituency that many companies are ripping us off left, right and centre. So the Government have to have more of a vision that they articulate: that we accept that there is a pandemic, that the NHS is in crisis and that we have to do something about care homes, but we do have a plan to control public spending. I know that the Chief Secretary agrees with me, but he may not want to leap to the Dispatch Box to say that now, especially as a reshuffle is imminent.
There are innovative solutions we can use to try to encourage people to take more control of their healthcare. John Major was hardly a fanatical right-wing Conservative, but he offered tax relief to pensioners who took out healthcare—we have never even considered that. The argument could be made that rather than having arbitrary limits such as £86,000, we could base this on the value of the house. So there are alternatives available.
I wish to articulate one thing before I sit down, and it relates to state insurance. I am trying to develop an alternative plan in the future. We know what Germany does and we know that it has an excellent system. Lord Lilley argued yesterday in a paper, and the Dilnot commission argued, that there is an alternative to all this. The Government dismiss private insurance straightaway. It is true that private insurance companies will not take over this burden alone, because they cannot foresee how many people will be very frail and stay in care homes for a long time. But why can we not have a system by which we underwrite private insurance? The state would offer insurance. Once someone is of pensionable age, they would enter the scheme. There would be a modest charge on their home, based on the value of the home. The premium, on average, would be covered by the Government, not by the person. On average, it would be £16,000 a year and it would be the covered by the Government, but that individual would have that peace of mind. That is an innovative scheme. It was suggested by the Dilnot commission. I do not understand why the Government have simply just ruled it out and said, “We have looked at private insurance and it simply will not wash.”
Many of us will be supporting the Government tonight—I know it is a bit of a cliché to say, “With a heavy heart”. We will be doing so because we recognise that the NHS is in crisis. However, we say to the Government: “When you just pump more and more money into a socialist construct like the NHS, you get lower and lower productivity. So we want to look at outcomes. We don’t want to just accept this argument that we are in an arms race with the Labour party, because they will always offer more than us.” So we want some answers from the Government on serious plans for the future and on controlling waste and low productivity in the NHS. We want to know how much of this money will actually go into the care home system. We can then vote for the Government with an easier conscience.
It is a pleasure to follow Sir Edward Leigh, who made a thoughtful speech, but I have to take issue with him about the Labour Government pumping money into the NHS and it going nowhere. Which party set targets for things such as A&E waiting times and the reduction of waiting lists and achieved them while in government? The Labour party. Where the right hon. Gentleman and I agree—he is a former Chair of the Public Accounts Committee, and I have the honour of being the current Chair—is that it is vital that we measure the effectiveness of every pound of taxpayers’ money spent against delivery for citizens and taxpayers. This proposal fails woefully on that.
This is another headline from the Government with no detail attached. Parliament has been bounced, but even the Prime Minister’s party and Cabinet were not involved in the decisions about how the money is to be raised and what it will be spent on. It is clearly an announcement without a plan. There is no plan, other than to put money into the NHS for three years. We all recognise the need there, but the message is being deliberately muddled. Where is the plan for care workers? Nothing. Where is the plan for skills for care workers? Nothing.
Where is the plan for a stable market? There are 25,000 or so care providers or residential care properties in the UK, mostly small, private providers. Their market had been shaken to the core before covid, but covid has really wracked them hard, and there is no support, plan or promise—anything—for them. What about the money for local authorities? I completely associate myself with the remarks of my hon. Friend Mr Betts earlier and a number of Conservatives yesterday, including my constituency neighbour, Nickie Aiken. There is also no plan on domiciliary care; more of us will receive care in the home than in institutions.
This proposal is about protecting the capital assets of the wealthiest. I am a London MP, and this proposal will protect a lot of people in London who are like me: a homeowner in London with a wealthy asset for whom £86,000 is a small percentage of the home I own. Jake Berry made an excellent speech highlighting the real challenge in this respect. I worry that the Government are using this proposal as another opportunity to try to buy votes in London for the next London mayoral election. Nothing seems to stop them in their ability to attack our London Mayor and try to buy people in. We have to make sure we have a policy for the whole country.
There are not even any targets for the NHS funding that is going in. The Minister came to the House and rattled through his speech at pace without answering any of these important questions. It is important that we tackle the NHS backlog, but with £12 billion a year on a base NHS budget of around £150 billion—of course, during the pandemic it has gone up by around £60 billion—that is still going to be a challenge. We need to make sure we are getting outcomes and we need to measure them. The Secretary of State for Health and Social Care himself admits that he does not know whether tackling the backlog will be possible in three years; I think it will be a huge challenge.
Let us look at the challenge on finances. By 2038, compared with 2018, there is a projected 90% increase in costs for adult social care for those aged 18 to 64 and a 106% increase in costs for adults over 65, so of course something needs to be done. The Public Accounts Committee has looked repeatedly at the social care market, of which the Department of Health and Social Care has responsibility for oversight. That includes looking at skills and the supply of places, but it has woefully failed—it has failed on drug prices and on making sure that the market and the workers in it are skilled up properly. Of course, there was also the woeful failure on personal protective equipment, where the Public Accounts Committee concluded, in—of course—a cross-party report, that care homes had been “thrown to the wolves” because of what happened.
The inequality really bites. As others have highlighted, wealthy pensioners on good private pensions will not pay an extra penny. That includes those who have retired early because of the Osborne pension reforms. Senior civil servants and so on who are able to retire at 55 on a full pension can then work again, and they may pay money on their new earnings but not on their pension. They are earning way more in their pension than the minimum wage and will not pay an extra penny from that.
In my constituency, we have more private renters than homeowners and more people who rent socially than either of those two options. They do not have assets that need to be protected; they need the insurance to get good social care. They do not have income from assets that they will ever benefit from. Of course, many of the people who do own their own homes have interest-only mortgages. A whole generation is coming through—generation rent—without an asset, worrying about whether they can afford to pay into a pension and unable to afford today’s rent. This proposal just hammers that generation to the benefit of people like me—as I move through my 50s towards retirement—who have an asset. This proposal does not work. There is no plan.
This is a massively important debate on a subject that comes into our constituency surgeries every week—it has done since the day I came into this House, and did when I was working for Sir Teddy Taylor all those years ago. This is not new. What is new is a Government attempting to address it. I sat on the Opposition Front Bench for four and a half years as a shadow Health Minister. Previous Governments have looked at this issue and tried, but at the end of the day, to be really honest, Conservative and Labour Governments have kicked the can down the road. So for once, we are trying. Is it perfect? No, it is not going to be perfect. I will come in a moment to a couple of points that I agree with my colleagues on.
What we cannot do is keep borrowing. Markets are low; we can keep borrowing. We could go to that wonderful private finance initiative market that previous Labour Administrations went to and that we are still paying for now. Lord Darzi came up with a fantastic plan for how to deal with elective surgery in the market without having over-capacity in the NHS. The only problem was that contracts were issued that meant that these companies were being paid even though they were not doing the operations. So nothing is perfect and everybody wants to try.
It is very easy to be in opposition and throw the can across—that is what Oppositions do—but when the crunch comes, these are the hard decisions. I am a fiscal Conservative and a working-class Tory, so I love all this class rubbish that keeps being thrown across the Chamber. It is absolute, complete and utter tosh. At the end of the day, our constituents look to us for guidance and to try to solve their problems. They do not really care where we come from in life and what we end up doing; at the end of the day, that is what they want us to do.
No, I am not doing to give way, because lots of other colleagues want to speak and every time I give way, I get an extra minute—and I have just lost half a minute by saying that.
We can say to ourselves, “Is this perfect?” No, it is not. Is this going to help? Yes, it is. Are more people going to pay more in taxation? Have we broken a manifesto commitment? Yes—and Governments in previous Administrations have done that for years, and that happens when the public expect us to act on something that has come literally out of the blue. What has come out of the blue? Covid. We have had to borrow unbelievable amounts of money to keep people’s, jobs, incomes and livelihoods going. We cannot keep doing that, so we have to turn around and say, “Is there a way?”
We heard from the Chair of the Treasury Committee that there are myriad other ways to deal with this issue. We have also heard the minutiae of how national insurance contributions come into it, but at the end of the day it seems that national insurance is probably the way to do it. I have one criticism. In my constituency, we still have more than 12,000 council properties. Many of those residents want to buy their property on right to buy. They cannot do so because the maximum discount means that the mortgage is still too large. Having just over an £80,000 cap is not fair nationally. It is really difficult if someone has a property below that level. In parts of the country, £86,000 will buy such a property, but in my constituency, that money would buy a quarter of a one-bedroom flat. That has to be wrong, so we need to look at how we address the issues that were raised by colleagues earlier.
I have one further thing to say. Frankly, anybody watching this debate, especially the earlier engagements, would have been disgusted by what they saw—partisanship, chips on the shoulder, class war, this war, that war. People do not give a monkey’s about that. They want us to come here and do a job, which is to help them and their loved ones. It is about time Opposition Members got off their butts and did it.
Yesterday, the Prime Minister said that universal social care would be too expensive. That is exactly what the Conservatives said about the NHS in 1945 when they voted against it 21 times. They have argued that since and they will do so again if given the chance, as we heard from Sir Edward Leigh who, just minutes ago, described the NHS as a “socialist construct”.
A universal need demands a universal and freely accessible solution. None of us knows with certainty what will happen in our lives. Through disability, illness and old age, many of us will come to rely on social care if we do not do so already. The care we receive should not be a lottery based on wealth and postcode. We should all have the security of knowing that there will be someone to look after us no matter what. The NHS is there for all of us if and when we need it from the cradle to the grave. It has long been time for the social care system to provide the same.
We need a national care service funded by progressive taxation, including a wealth tax. The Prime Minister’s plans could not be further from that. Even the free market Adam Smith Institute condemned them as “morally bankrupt”, saying that the Government was asking
“poorer workers to bail out millionaire property owners.”
That comes just weeks before the Chancellor will plunge hundreds of thousands of families into poverty with his universal credit cuts.
Mr Deputy Speaker, you would struggle to design a more unfair and economically illiterate social care policy if you tried. Less than £1 in every £6 of the money raised will go to social care in the first three years of the plan. It is a triple whammy that the Government are presenting us with today: nowhere near enough money; not ringfenced for social care; and low-paid workers are funding it.
Why is it that Amazon is paying only 7.5% of its income in tax while a graduate on a standard starting salary is expected to give up around 50%? Let us be clear what this is really about; it is about protecting the inheritances of the very wealthy. What is the Government’s excuse for raising taxes on struggling people and for breaking their manifesto pledge? It is covid-19. We have heard it again and again today. I have seen at first hand, as have my former colleagues in Nottingham, how social care was in crisis well before the pandemic, and this Government cannot use covid-19 as a cover for 11 years of Tory failings, and they cannot use it as an excuse to take money from those who have been on the frontline and not from the billionaires who have profited from the pandemic, increasing their wealth by more than a fifth.
When I use the word “plan”, I am being generous. This is not a plan. It does nothing to fix the system that is broken at its core. A constituent emailed me about her experience. She is a care worker in the community. Her wages have not increased for four years. She does not get any travel expenses, pension contributions or sick pay. She works extremely long hours to make ends meet and often earns less than the minimum wage once she factors in travel and expenses. At the same time, her mum is terminally ill and has been waiting for five weeks to get support. She wants to be with her mum in her final weeks, but she is doubtful that she will be able to afford to get time off. Sadly, disgracefully, her story is not unusual, because our social care system does not work for those who rely on it or for those who are employed in it.
Instead of grappling with these deep-rooted problems, this Government are yet again, as Sir Mike Penning admitted, kicking the can down the road. Instead of giving our care workers the pay rise that they deserve—[Interruption.] Will Government Members be quiet while we talk about the service that care workers have given during the pandemic? They deserve a pay rise, but instead Members on the Government Benches will be voting tonight to make sure that care workers are paying so that their wealthy donors do not have to.
How much longer must my former colleagues in the care sector wait for change? How many more families will be consigned to poverty because their care worker mum brings home less than the minimum wage? How many more disabled and elderly people will be confined to their homes, unable to live the kind of life they want? Anything less than a national care service, funded by a tax on the wealthy, not low-paid—
It is a pleasure to follow Nadia Whittome, but I must disagree with her that the Government are kicking the can down the road. We are doing precisely the opposite by trying to tackle what is a very difficult problem, as everybody has already described. As many Members have said, politics is about choices. Ultimately, the choice is this: either we put more money into the social care system and borrow extra; or we decide not to tackle the problem, and allow it to continue and continue. I wholeheartedly support the Government in trying to tackle what has been a very difficult problem for a very long time.
I thought it would be useful to address in my remarks some of the criticisms of the plan that need pushing back on rather strongly. Many speakers have said that it would be better to use income tax, not national insurance. I disagree, because national insurance is paid by both individuals and employers; it is a broader-based tax, which raises more money. And guess what? By having a broader-based tax, everybody is going to benefit. It is not bad to have a more broadly-based system, where everybody in the country is going to benefit.
Certain Opposition Members have said that a wealth tax on the wealthy, in and of itself, will somehow fix all the problems. I am afraid that we are dealing with billions of pounds—£12 billion, £13 billion or £14 billion—and no wealth tax in the world has been designed to yield anything like that amount, so that would not deal with the problem.
Many Members have suggested that this levy does not deal with social care at all. The point is that it deals with both health and social care; they are linked. Therefore, by accelerating money in the next 18 months to two years to deal with the backlogs that have developed in the health system due to covid, we actually help to deal with the social care problem. Then, as is very clear in the documents, from October 2023 more money will flow more directly into the social care system, so the levy deals with both these things.
It is worth addressing the point made by many colleagues on the Government Benches—including my constituency neighbour, my right hon. Friend Sir Mike Penning, and others—that this is somehow unfair because certain parts of the country, such as my own, have higher house prices and others have lower house prices. That is an observable fact. However, there are many problems with doing something much more complicated. First, it would be difficult somehow to change a system on the basis of fluctuating house prices in every county, region or district council. It is also difficult to come up with those differences when, yes, certain areas have higher house prices, but then there are also higher costs for social care in different parts of the country. It is much better to have a broad-based system that is broadly the same across the country, although I am in agreement with certain hon. Friends that the Government should look at all possible options in detail as we look to implement the tax.
I turn to the idea about which I have heard so much from Opposition Members: that this tax is somehow not progressive, but regressive. They think that if they keep repeating that, it will make it true. I took a look at companies. Let us think about big companies versus small companies. The smallest 40% of companies will pay nothing extra as a result of this measure. The next 40% will pay, on average, about £400 more. The smallest businesses are really not going to be paying a lot of national insurance.
Let us turn to individuals and consider the richest individuals. Somebody who earns a very high amount—let us say £1 million a year—will, by my maths, be paying £12,500 extra as a result of this measure. A basic rate taxpayer pays something like £3.40 a week. I am afraid to say to the Opposition that this is a progressive, fair and broad-based way of dealing with the problem.
In addition, we need to think about outcomes. Members on both sides of the House have made the fair point that the money, in and of itself, does not deal with the problem. Yes, we need better pay for carers. Yes, the system needs to be better. Yes, we need to be sure about what we are getting with the money. Yes, there needs to be reform. We should study all that, and work with the Government over the next few weeks and months as the White Paper comes out. I will be supporting the Government in the Lobby this evening.
I want to begin by congratulating the Government Whips on bulldozing this proposal through with such great haste. They have done their job today. They have prevented a Back-Bench rebellion. They have used their own Back Benchers as cannon fodder. It will not be the charlatan in No. 10 who pays the price for broken promises and tax rises that hit the young and the low-paid; it will be those Tory MPs hung out to dry: some of them unexpected victors in 2019, and some of them quite good MPs, but with small majorities. When the emails and the messages of complaint start flooding into their offices, and when the refusals ever to vote Tory again start to hit home, it will not be the occupant of No. 10 who has to suffer—he will have flitted on to his next fantasy—but those who are betraying the very people who voted for them. They will be left to pay the price.
I am very grateful for the hon. Gentleman’s concern about our future job prospects, but I would much rather be standing for a party that is willing to invest in the NHS, to be the party of the NHS, and to try to fix the problems in social care. I would much rather have those job prospects than be a Back-Bench Labour MP who stands for nothing, has no plan and has weak leadership.
Well, that was a wonderful intervention. The hon. Gentleman has not only been hung out to dry; he has been brainwashed in the process.
This is a measure built on deception. There was a promise of no tax rise or national insurance rises, yet this is a tax rise to hit young workers; to hit people who will never get the opportunity to buy a house; to hit the self-employed struggling to get back on their feet, many of them ignored by this Government during the pandemic; to hit employers struggling to get their businesses back on track who now face a tax on jobs; and to hit the low-paid battling to keep life and limb together who will end up subsidising others whose assets they can never hope to match.
Only last year, the Government were boasting about raising the national insurance threshold and now they are squeezing the very same people. What happened to the promise to raise the threshold to £12,500 by the end of this Parliament? This is money to pay for two things: first, to subsidise those who hope to inherit large properties from elderly relatives; and secondly, to cover for the disastrous cuts in the NHS over the period the Tories have been in office. Even on their own reckoning, only about £5.3 billion of this tax grab will ever make it to social care. We were promised that a plan was ready, that it was a priority, that the PM would get cracking within his first 100 days, and that it would fix the crisis in social care once and for all—none of it true.
Age UK estimates that there are about 1.5 million people in need of help with daily living who do not get it. This tax rise will not address those issues. It will not help people needing help with washing, dressing, eating and taking their medicines. This is a broken tax promise: a penalty for those who took a chance on voting Tory at the last election. On social care, it is a fiction and a deception from people whose promises will never again be given any credence.
I very much welcome the fact that the Government are taking action to properly fund social care and the NHS in this country. As my right hon. Friend Sir Mike Penning said, previous Governments and previous Prime Ministers have recognised the challenge of funding social care and the NHS, but it is this Prime Minister and this Government who are taking the brave step of bringing forward concrete proposals to address it.
We have heard much over the past few days and the past few hours from those on the Scottish National party Benches about how horrified they are by these proposals to increase funding for Scotland’s NHS. Astonishingly, they seem to oppose the billion pounds of extra funding that Scotland’s NHS will benefit from this year. It is astonishing. I just do not understand how they can possibly explain that to their constituents and justify such an irrational decision.
I am happy to hear from the hon. Member why she has made that choice.
As the hon. Gentleman well knows and as has been made clear to him in the remarks I made, funding for the NHS is not the issue here; the issue is raising taxes disproportionately on the backs of his and my poorest constituents. I would be interested to hear what he will tell his constituents when they come to his surgery about it.
These proposals will result in Scotland’s NHS and services that our constituents use getting a billion pounds extra each year to help deal with the backlog of treatment, the GP shortages and the whole catalogue of other issues that Scotland’s NHS is dealing with. It is nonsense to pretend that social care is not an issue in Scotland as much as it is in the rest of the United Kingdom. Indeed, the SNP Scottish Government in Edinburgh has called for action on social care in the past. They have said that they intended to increase investment in social care in Scotland, but they have also been clear that their plans required extra resources. Their planned reforms
“can only be delivered with increased investment.”
Their independent review of adult social care said
“more money will need to be spent on adult social care over the long term.”
Further to that, Audit Scotland recognised that “more investment is needed”. The Scottish Government admitted in their August 2021 consultation that the proposals for a new national care service were not yet funded.
In Scotland, as I said earlier, we already spend 43% per head more on social care. If the hon. Gentleman is moaning about Scotland, he can perhaps imagine the problem here. Scotland has a plan: the Feeley review, the national care service, a human rights approach and extending free personal care and free provision to all home care. What we are not happy about is the idea that suddenly the Prime Minister will meddle in a completely devolved area of health and social care, and we will have the same outsourcing and fragmentation that England has struggled with since 2012.
Nothing in this plan undermines the devolution settlement. This plan provides our constituents with more investment for NHS services across Scotland. What the hon. Lady seems most upset about is this United Kingdom Government delivering that resource for something that the Scottish Government had previously asked for, and she admits that, which is frankly astonishing. It is beyond belief that the SNP opposes these proposals, which would raise much-needed extra resources for the NHS and the social care sector in Scotland. Scotland, Wales and Northern Ireland will benefit by an additional £2.2 billion a year as a result of the levy and an equivalent increase to dividend tax rates.
There is a clear Union dividend from this policy. Scotland, Wales and Northern Ireland, taken together, will benefit around 15% more than is generated from their residents, equivalent to around £300 million a year. The hon. Ladies and Gentlemen on the SNP Benches shake their heads. How on earth can they justify opposing this extra money coming into Scotland? Scotland will receive £1.1 billion in extra funding over the coming year.
We must ask why the SNP is so opposed to this extra money coming to Scotland and our NHS. That is certainly what my constituents in the Scottish borders are asking. They have witnessed the remarkable job that our NHS heroes have been doing during the covid-19 pandemic, but they also recognise the massive challenges now facing Scotland’s NHS: delayed operations, GPs under pressure, rural health services being withdrawn and waiting lists growing and growing. Yet, when offered extra funding from the UK Government to help address that and to tackle the social care crisis, the SNP says no. The SNP says no to extra funding for Scotland’s NHS.
The hon. Lady says “rubbish”. Should I say “rubbish” to my constituents who have had their operations delayed time and again and those who cannot get access to a GP in their surgery because of decisions made by the Scottish Government, who blame a lack of resource and repeatedly blame the UK Government for not funding them enough? Here we have it: £1 billion more coming to Scotland and the SNP says no. It is typical SNP grievance politics. It is not about solutions or making the lives of our constituents better; it is about grievance, grievance and more grievance. The NHS in all four parts of the UK needs significant investment to tackle the lasting effects that covid-19 has had on services and we must work as one United Kingdom to tackle the collective challenge.
It is also true that the SNP Scottish Government have not prioritised investment in the NHS during their time in office. As I referenced earlier, the IFS has noted that, in the last 10 years, spend on health in Scotland has increased by just 1.2% as a proportion of total expenditure compared with 3.6% in England on a like-for-like basis. Therefore, despite all the spin we hear from SNP Members, Scotland’s NHS needs this extra investment.
Some in the SNP have been complaining that the policy is some sort of attack on the devolution settlement. That is utter, utter nonsense. It is true that devolved Administrations will be required by law to spend their share of the revenue raised by the levy on health services in 2022-23 and, from April 2023, on health and social care services. It is also true that some elements of the new revenue will be spent directly by the UK Government for the benefit of all four nations, including on purchasing vaccines to help defeat the virus. However, there is no requirement for the Scottish Government to implement the same policies as the UK Government. The devolution settlement is protected. So the SNP is really going to oppose this extra funding coming to Scotland’s NHS and social care services.
I very much welcome the announcement. It has been a tough decision for the Prime Minister and the Government, but it is the right decision. More funding for our NHS and social care services should be welcomed by everyone in the House. It baffles me completely why the SNP so strongly opposes it.
This national insurance increase is a point of no return for the Tories. It is an unfair way to raise the money needed for our NHS and social care, with those who earn the least and the young paying for those who are already well off. It is the biggest single tax increase in 70 years, which will see the highest level of tax paid in the UK in peacetime, and as my hon. Friend Mr Betts pointed out, the Government’s own document says there is more to come in council tax increases. We have already had increases and precepts imposed on council tax. When the Tories got caught out because they cut 20,000 police officers, they put a levy on council tax to pay for police officers and this year they put on a 3% levy—£600 million—to go into social care. They have had their hands in people’s pockets for several years now and they have not taken them out.
Let us be clear: the claim that the Tories are the party of low taxes and a small state is over. The argument in the future will be about how we invest in public services and how we value the workers who work in them. People earning as little £10,000 will pay the increase. People who can afford to pay more, such as hon. Members on these Benches, should not rely on them to pay increased taxes: they should be asked to pay their fair share. People who have to count every penny to survive on a daily basis—to buy food and to pay rent, travel costs and household bills—have to budget day by day to live and they will have to tighten their belts, but those of us on higher incomes who could pay more and whose lives will not be changed by this increase will not have to tighten our belts at all.
My hon. Friend Steve McCabe pointed out one of the areas that will suffer most. It is those areas where the Tories talk about levelling up that will be the hardest hit by this tax increase. What of their local economies, with the tax the Government are taking out of those economies that will not be there to be spent in local businesses? There is no levelling up in this tax the Tories are imposing, and there will be less money to circulate in those economies. It is not fair that those people we clapped during covid—care workers, delivery workers, shop workers, postmen and postwomen, and many more who kept our economy going during difficult circumstances—will be asked to pay a disproportionate amount through this tax increase.
There is no going back for the Tories from this day forward. Whatever happened to the pledge the Prime Minister made in 2019 that no one would have to sell their home to pay for care and that he would co-operate across the House and discuss the way forward on how to deal with the issue of social care? That is yet another broken promise from this Prime Minister. If a person is property rich and cash poor, how are they going to be able to avoid having to sell their homes? The £86,000 is a Kensington cap. Outside London, in many areas the cap is far too high and will lead to people losing their homes.
There is no plan for social care in what the Government have announced so far. The Tories have behaved here today as if these problems had just been created and had just emerged because of the pandemic, but nothing could be further from the truth. The waiting list was 2 million before the pandemic hit, and they took £8 billion out of social care. Where was all the hand-wringing and all the concern about social care and the NHS back then? They are using the pandemic as cover for 10 years of cutting public services and underfunding our national health service. How are they going to explain to their constituents that they are being forced to pay this increase to pay for 10 years of Tory neglect?
I am sure that, like many constituents, many of us across this House have personal experience of the need for these measures. In my family, a much-loved family member sold her house during the time of the last Labour Government. I had another family member who had a bad back, but did not want to bother the NHS at the time; unfortunately, it was a lot more serious than that. We do not want that to continue indefinitely. Particularly after a pandemic—and this is why I asked my question to the Prime Minister earlier—we do not want people holding back their concerns and their needs from their GPs and the NHS, with this feeling that they should not bother them because it is under so much stress.
I am so pleased that the Government are grappling with these really long-term intractable problems. It is important and it has a real impact on our lives—all of our lives. But exceptional circumstances require exceptional measures and hard decisions. They are difficult decisions for all of us on the Government side of the House who believe—and our beliefs have not changed—that taxes should be as low as possible, that services should be available to all, but that the state should do as little as possible because people do things for themselves better than the state. There is no easy answer, and I welcome the difficult decisions that this Government are taking. To lead is to choose, and that is what we are doing—making difficult decisions.
I commend the comments of my right hon. Friend Mel Stride, the Chair of the Treasury Committee, who evaluated the alternatives. Alternatives such as austerity and spending cuts are not welcome and would also be criticised. There is increased borrowing. This Government put their hands around this nation during the pandemic and spent £400 billion to protect people’s jobs and livelihoods. However, increased borrowing also has a profound effect on the lives of individuals, because it has a profound effect on the economy and its future prospects. I absolutely reject the proposition that this is the end of conservatism, or that this means our principles have changed, because it does not. Because we are responsible, pragmatic, realistic, and willing to lead, I believe people will understand. If we say to people that there is a need and we are going to address it, but that there is no cost, they will know that is not true, nor is it honest.
As Conservative Members have said, we want innovation and a determination that the NHS does not become the insatiable beast that swallows up funds indefinitely, and we must keep a grip on that. It is important that that goes hand in hand with innovation and reorganisation to make this work, and to make it as efficient as possible for all people in this country, and across the United Kingdom.
I welcome these measures. They are not easy, but this is the job we are here to do, so I welcome the Government’s initiative and their implementation of them.
Many who voted for Brexit in the hope of securing £350 million a week for the NHS, or who voted for the Conservative party in the belief that taxes would not be raised, must feel very disillusioned. Today, just nine months since leaving the EU, and after another Johnson broken promise, they are being taxed to pay for health and social care. In recent months, the Prime Minister has broken promises on the foreign aid budget, on his commitment that there would be no checks on goods moving between Great Britain and Northern Ireland, and on the triple lock on pensions. We all understand the impact of the pandemic, but it should not be used as a shield to mask the Prime Minister’s broken promises. His promise to fix social care once and for all predated the pandemic. Indeed, we have waited more than two years for the plan, which the Prime Minister promised the nation in his first speech was “already prepared”, to materialise.
The 2019 manifesto also committed the Conservatives to deliver a social care plan through consensus and with cross-party support. People are asking what happened to that consensus. Instead, the Prime Minister is pushing this grossly unfair tax through Parliament, allowing as little time as possible for proper scrutiny—the kind of scrutiny that improves legislation. Because of the Government’s woeful mishandling of the pandemic, allowing the NHS and care workers to face the biggest crisis in their history, with the NHS in the depleted state to which it was reduced after successive Tory Governments stripped £8 billion from the service, much more money is now needed for health and social care.
With waiting lists predicted to reach 13 million, even with this money it will take the health service years to catch up. The working public are now expected to stump up more money for Tory mismanagement of health and social care, and working-class and middle-class workers will bear the 10% national insurance tax hike. The Prime Minister’s plan boils down to this: using the taxes of young and low-paid workers without assets to protect the assets of wealthy people. Raising regressive national insurance, which takes money from the pockets of the lowest-paid workers, many of whom have been on the frontline of the pandemic, is not the way to fix our social care system. I hope that the Prime Minister will listen to the many rational voices in business and industry, including the British Chambers of Commerce, which said that his plan will be
“a drag anchor on jobs growth” as firms emerge from the pandemic and furlough winds down.
We need a national and fair effort to deal with the crisis in social care, and a plan that goes far wider than just looking at funding. We need to address the recruitment and retention crisis in health and social care, which is the most urgent issue at present. It is vital that any long-term plans are included alongside immediate measures. We must properly value those in our health and social care workforce, not tax them to the hilt.
I thank the Prime Minister, the Chancellor and the Secretary of State for Health and Social Care for bringing forward this proposal. It is a bold decision—a difficult decision—but it is the right decision at the right time.
Initially, I really struggled with this concept. When the Prime Minister stood up to deliver his statement yesterday, I did not expect to feel able to support it, but by the time he sat down, I could. That is not just because the PM has excellent rhetorical skills; it is down to the simple and obvious fact that most people want better health and care provision. Most people understand the challenges created by covid and the devastating impact on the NHS. Most people want to see money spent on the NHS, and they expect everybody to make a contribution—and so they should. Covid has brutally exposed what a fragile and struggling health and social care system we have, and yes, the enormous backlog of cases that has arisen must be tackled. Therefore, of course more cash is needed.
I fundamentally believe in incentivising and rewarding hard work, in allowing people to keep more of the money they earn, and that people know better than the state how to spend their own money. A low-tax economy is a buoyant economy, and I hope that when this is all over, we can revert to proper Conservative economic policy. Any MP would say that healthcare features uppermost in their inbox. The struggles to access a GP, the waiting lists, the cancelled operations, the waiting times in A&E and the quality of care are all raised with us day in, day out, and they have very human consequences.
It may be that this is more of an issue in Telford than elsewhere. We have a particularly challenged hospital trust and clinical commissioning group, and some very serious problems have arisen during my time as MP. The trust is now in special measures, it is facing a police investigation into maternity deaths, and there has been a constant revolving door of highly paid senior managers who do not seem to be able to grasp some of the challenges. We have a GP super-surgery with 60,000 patients that has long operated telephone triage. Even pre-covid, people could not get the phone answered, so they have no option but to go to A&E and face huge waits. It is fair to say that it is completely understandable that Telford residents will always put the NHS as their No. 1 concern. We have also had grand transformational schemes devised by hospital management to spend £600 million of Government money. They have had seven years of thinking about it, and they still have not been able to put a shovel in the ground.
I have never been one to believe that throwing cash at a problem will provide a solution. We have a duty to ensure that taxpayers’ money is spent wisely, and that waste and bureaucracy are stripped out. We need to make clear that what we are approving today is no blank cheque and that we expect trusts, CCGs and their management to work to put patient care and the patient experience first. That has been lacking. I know that from my experience and my constituents’ experience. They are so often treated as a nuisance or with contempt. That must stop, and this money will help that to happen. I want my constituents to have far, far better patient care than they currently receive and I know they want to see extra cash spent. They will expect improvements, and I caution that this is not the time to be removing the A&E or other local services from Telford.
The motion before us today is a much-needed first step that I welcome fully. I congratulate my right hon. Friends the Prime Minister, the Chancellor and the Health Secretary for being bold, for being ambitious for our future and for being willing to embrace the big challenges that others have failed to seize. They have my full support, and I hope that all Members on the Government Benches will also be able to support our leaders.
When I first heard that the Prime Minister was going to come forward with a plan for social care, to tell the truth I am so desperate for any improvement in social care that I even considered voting for it. Even until yesterday I would have considered voting for it. As the details came out, however, I was not only disappointed but completely devastated, as will be many of my constituents. Not only does the plan fail to deal with any of the real issues in social care, which I will come on to in a second, but it is actually just a tax hike pretending to deal with health and social care. In reality, at the beginning it is not even linked to that, and later on there is some vague promise that it might trickle down to social care if we are lucky.
This is a tax rise that will hit the youngest, the poorest and the hardest working in our communities the hardest. It exacerbates the crisis in intergenerational justice that we have in our society at the moment. Far too many young people feel that the ladder is being whipped up behind them by an older political generation that is currently in power. I think that is sometimes unfair, because actually the issue is class-based and wealth-based, but this will exacerbate that feeling. A young graduate with student loans will be paying a marginal tax rate of almost 50%, which is more than many people on £90,000 and vastly more than someone whose earnings are from property, shares or other forms of wealth.
There are other options. The Government had other options. They could, of course, have lifted the lower rate of national insurance into the higher rate. Most people do not realise—most hard-working people, of course, do not earn £50,000 or more—that those earning more than £50,000 pay only 2% national insurance. That could easily have been made 12%, or now included the additional for everyone. That would have provided £14 billion in one stroke and not affected any hard-working person in our country. It would have already raised more than this non-existent plan. They could have looked at a wealth tax for people who have wealth higher than £5 million, an amendment that I and other colleagues tabled for today; capital gains reform to bring it in line with income tax, for example; or making inheritance tax fair so it is based on what you receive, not necessarily on what you give, so that those in large families can receive a fair amount while ensuring that everyone pays their contribution.
None of those options were considered. Why? Because this Conservative party is paid for by developers, landlords and the very people this tax will not touch. It is a party not of capitalism, but of extraction: extracting the wealth from hard-working people and small and medium-sized businesses, and redistributing it to landlords and capitalists who work in the stock market and in the City, not in the factories that run our country.
I always listen very carefully to what the hon. Gentleman has to say. Why, then, does he think that Gordon Brown did something remarkably similar to what my right hon. and hon. Friends are proposing—on that occasion, in 2003—for exactly the same reason: to raise the spend on our national health service and care services? Was he wrong?
Because then, wages were growing and the economy and working people were doing better, and now they are not. We are coming out of a pandemic. Everyone has suffered and suddenly putting a tax on small and medium-sized businesses and on working people is the very last thing we need to do.
This is also about the lack of a plan for social care. There is no plan for social care. In fact, we have been asked for a begging bowl, but we have not really been told how the money is going to be spent. How are we going to recruit social care workers, who are currently paid miserable wages for 15-minute appointments and no travel time? How are we going to reform the sector so that is not fragmented between people? How is this going to improve someone’s grandmother’s care home or someone’s brother’s care worker? It is not, because this does not deal with that fragmentation, it does not integrate social care into the NHS, which we desperately need, and it does not relieve the burden on councils. At the moment, the truth is that council tax has to subsidise social care time and again. People complain about the roads, their parks or youth services being shut, but the reality is that it is because the Government have not dealt with funding social care properly. They have put the burden on councils and council tax, which was never designed for social care, and this does not deal with that fundamental problem. When people complain about their bins or potholes, I say to them, “It is not your council’s fault. It is the fault of this Government, failing to deal with that drain on your council.”
This levy will not aid us one bit to close the gap that has been growing. That gap will continue to grow under this Government. So holding my nose and desperately sad, I will unfortunately be voting against this, not because I think that we need no action, but because this action is the worst of all worlds.
I want to begin by thinking through what Labour would do if it were in power. [Interruption.] I am very grateful that Lloyd Russell-Moyle has just outlined some of the things that he might do. If I understand the Labour Front Benchers correctly, I think they suggested that they would use stamp duty or various transaction taxes on assets. I am grateful that Ministers are here, because I think that they know, as I know, that there is no way that the money needed would be raised—[Interruption.] I am grateful that the Minister says, “Correct”. It says in the document that not enough money would be raised from stamp duty and transaction taxes on assets. It is fanciful, and the hon. Gentleman’s proposals are likewise, I am afraid.
We would need to change one of the big taxes. Would Labour Members put up VAT from 20%? Of course they would not because it is regressive. It is a bad idea. It is already too high and it already hits everyone, so they would not put up VAT. Would they put up income tax? I think they would get the same advice that these Ministers have had from the same officials. I think they might be advised that we are already in a position where income tax is rather too dependent on the decisions of a small number of top earners. This is the sort of evidence we have had at the Treasury Committee for a very long time, so I think that we would find that, actually, they were not able to put up income tax.
So where would that leave Labour? That would leave it with the big tax that has always, as the document points out, been used to fund health and social care: national insurance contributions. I think that Ministers, if they were from Labour, would be presented with a distributional analysis like the one I have here, which our Ministers have. Labour Ministers would look at it and see that actually, distributionally, it is really only the top two deciles who are net losers. Deciles from the bottom through to No. 8 are either gaining or, in the case of the eighth decile, right there in net overall, neither gaining nor losing. I think that what Labour would do if it was in power is what it did last time it was in power and needed money for the NHS: it would put up national insurance contributions.
My constituents in Wycombe are very reasonable people. While knocking on doors in Marlow Bottom just last Saturday, I discovered constituents who recognise that we have suffered an enormous pandemic that has done so much to damage the public finances and people’s lives, as other hon. Members have said. But where are we going? That is the second point that I want to touch on. This is what I think Labour would do in power, and that is the problem—sorry, Ministers.
If we look, as I am sure colleagues have done, at the future debt trajectory for the United Kingdom produced by the Office for Budget Responsibility, we can see that our public finances are in an unsustainable state. I could easily give quotations—they are in my pocket—but if I recall correctly, the OBR’s 2018 report describes debt getting to about 260% by about 2057 and says something like, “Of course, policy would have to change by then.” I have always taken that to be a euphemism for “Of course, we would have to default on our age-related spending promises.” That is the consistent finding of the Office for Budget Responsibility on our long-term public finances. Sooner or later—in all our lifetimes, hopefully—we will find that the state cannot afford the promises that it has made to older people.
That is the problem that we face today. It is not about the national insurance contribution rise planned today, which I believe is a levy that the Labour party would adopt if it were in power; the problem is that we have no better ideas than putting up taxes to raise more money for public services.
My hon. Friend makes the powerful point that this is what Labour would do in power. Why are we doing it as Conservatives?
That is the fundamental problem that I face today, because I believe that this is just the beginning of the generational crisis of our inability to fund the promises that have been made progressively for more than 100 years, since the National Insurance Act 1911. I have talked about it ad nauseam, particularly in relation to a Bank for International Settlements paper that sets out charts showing that all western welfare states, and indeed Japan, are in the same boat. Some of the cuts to age-related spending that would need to be made to balance the books are just implausible.
We are in a dreadful position. Historically, when this country has been in a dreadful position economically and socially and on a trajectory towards ruin, there has proven to be only one party capable of rescuing the situation, and of course it is the Conservative party. At some stage in our lifetime, the Conservative party will have to rediscover what it stands for, because I have to say that at the moment we keep doing things we hate because we feel that we must.
My hon. Friend the Minister for Covid Vaccine Deployment stood at the Dispatch Box today and explained that vaccine passports go against his instincts and those of my right hon. Friend the Prime Minister; at one point I think he said that they went against everything that he stood for. We have heard hon. Members say—there are quotes on the internet from former Ministers and Cabinet members—that they hate raising taxes, but do not see how they cannot vote for it. Tonight, colleagues will say, with a good heart, “I just must,” because we all know that we cannot let NHS waiting lists get to where they are going as a result of the pandemic. Well, I know that too, but this I also know: we are going to have to do things differently.
We have to rediscover our confidence as free market Conservatives and the radical reforming zeal of the 2010 Parliament and the big society. We have to show people that we can secure a bright, prosperous and free future that provides for their needs in their old age, but without coming back to higher taxes every time there is a squeeze on the public finances. Down that road is ruin. We all know that eventually socialists run out of other people’s money.
I am sorry, Ministers, but I cannot vote with the Government tonight. Some of us have to be seen to stand for another path.
Order. Peter Grant is next, and then the time limit will be reduced to four minutes.
I am pleased to contribute to this debate. As I listened to Mr Baker just now, the words that kept going through my mind were “Union dividend, Union dividend”—we are tied to a nation whose public finances are in a mess, unsustainable and in a dreadful state.
Before I come on to the regressive nature of the Government’s proposal, I want to touch on just how far it falls short of the promises that the Prime Minister and others made in order to get elected. They have claimed that they have a plan to reform social care in England. It is obviously not for me to dictate what that plan should be, but if they have one, perhaps the Minister will tell us what changes, if any, there will be in the balance of resources between the NHS and social care. What changes, if any, will there be to the arrangements to manage each individual’s needs as they make the transition from health to social care? What changes, if any, will there be to the balance in the provision of care for the elderly between residential and non-residential? What changes, if any, are planned to the balance of responsibility between the state and the family?
There are no easy or right or wrong answers to any of those questions, but although I do not have the answers, I know that there are questions. The Prime Minister does not. I do not believe the Prime Minister even recognises that any one of those questions must be faced up to before he can claim to have a plan, or even the first hint of a plan, to deal with the position that we have, or some of us have, in social care.
The second major problem is that, even if the crisis in social care in England could be fixed with money alone, this proposal would not deliver anywhere near enough, and most of the “not enough” is not going to social care. A lot of it will go to benefit the families of some care recipients—some, but not all; and guess which some?—leaving precious little to actually improve the service. To claim that anyone voting against this tax hike today is voting against meaningful improvements to social care is simply untrue, and those who are preparing to make those claims on their Twitter accounts know that what they are about to tweet is not true.
I am in favour of increased funding for our health and social care services. If necessary, I will support fair and progressive tax increases to fund them, and I will pay my share of those taxes quite happily. However, I will not support this proposal, because it is not fair and it is not progressive. It discriminates against younger people with average incomes in favour of older people with much higher incomes. It discriminates against people who earn their money through their own hard work in favour of people who earn their money through the simple fact of having had plenty of it to begin with. It discriminates against my constituents in Glenrothes and Central Fife and in favour of those in places such as the Prime Minister's constituency, where, according to the Government’s own statistics, the average income per person is nearly £10,000 a year higher than what my constituents have to get by on.
The Government have claimed—we have heard this in a number of Conservative contributions—that they already know which of the UK’s nations will contribute most to this tax hike, and which will benefit most. They have claimed to have conducted an analysis which shows that it is not regressive in terms of different income groups. Although our SNP amendment was not selected, I expect to see the Government honour the spirit of that amendment, not by the end of the year but by the end of the week. I expect them to publish the analysis that we have asked for—or is this another case of their claiming to have all the information until they are asked for it, when we suddenly discover that it does not exist?
The final substantial objection to the Government's proposal is that it is designed to grab powers away from the democratically elected Governments of three of the partners in this Union, and place them in the hands of a Prime Minister who has no mandate to do this even in England. I have no issue with anyone allocating additional resources to Scotland, but I have a big issue with signing up to a regressive tax hike with no guarantee whatsoever that the Barnett consequentials will not be siphoned off as a result of some later Budget decision. Any guarantees that we get from the Government today will be as worthless as the promises that they made in their manifesto in 2019.
Let me be clear: the SNP will continue to honour its manifesto commitments. Any Barnett consequentials coming to Scotland as a result of increased spending on health or social care in England will be passed on in full to health and social care services in Scotland. But within that overarching guarantee, who do the Government think has the mandate to decide exactly how Scotland’s health and social care funding is allocated? I doubt that there is a single person, even on the Tory Benches, who honestly thinks it is right to assume that, because a particular way of allocating funding might be right in England, it is automatically right in the other three UK nations, where health and social care are organised in a completely different way. There is all the difference in the world between allocating funding to be used in a way that honours the Scottish Government’s manifesto promises, and decisions being foisted on us in a failed attempt to cover up the fact that the British Government do not keep their promises, to the electorate or to anyone else.
If one of the Prime Minister’s heroes had been here today, he might well have observed that never had so many promises been broken in such a short time to the detriment of so many and to the benefit of so few.
This area of social care has not had a happy history in respect of political point scoring, and, unfortunately, we have seen plenty of that today on the Opposition Benches. However, it is unacceptable for us to play Russian roulette with people’s life savings when it comes to social care. One in seven people are going to be affected by this. Just because their loved one died of dementia rather than cancer, their life savings are being entirely wiped out. That is not right, but it is right that we are doing something about it, and I am glad that we are seeing some element of cross-party consensus on the model. It is the Dilnot model, and the Health and Social Committee, of which I am a member, put it forward as a proposal. It was supported by the Liberal Democrats when we were in government with them, and to a degree, I think, by the Labour party. So at least we are moving forward slightly in that regard. The real question now is how we pay for this. There has been a lot of confected indignation on the other side of the House to cover up a lack of a plan. National insurance is imperfect in many ways, but, as Tony Blair said:
“If we want sustained investment in the NHS over a period of time, we are going to have to pay for it.”
He suggested that national insurance was the fairest and best way to do it. I agree with him, even if members of his own party do not seem to. Paul Johnson from the Institute for Fiscal Studies says that
“overall much needed reforms to social care are being introduced and unavoidable pressures on the NHS are being funded through a broad based and broadly progressive tax increase. That is better than doing nothing.”
It is incumbent on Opposition Members to really look at themselves and to understand whether they think real change is needed. If it is, they need to come up with a better alternative. Otherwise, they need to walk through the Lobby with Members on this side of the House who are taking difficult decisions on behalf of our constituents. These are not easy decisions. They are not decisions that can be explained away by saying that we are not doing this in a broad-based way when we are, or by making things up about this not being progressive when it is. We are taking these difficult decisions because that is what the Conservatives do in a moment of crisis.
My colleague on the Select Committee, my hon. Friend Paul Bristow, was right to say that reform was needed. This is an awful lot of money that we are putting into a system that is very broken. A third of social care staff leave every year and there are 120,000 vacancies in the sector. We will need to up the quality of provision and to inspect it properly. We will need to ensure that the integrated care services that are being put in place are assessed by the Care Quality Commission. We will also need to ensure that local government is held to account on the standards of care that it provides. These are all important reforms. We need to ensure that social care is truly part of the NHS, so that a nurse can take a year to go and work in the care service and then come back into a hospital. These reforms will all be necessary to ensure that we deliver on our high ambitions for change. We are taking steps to make that change. We will ensure that the options available to families are of high quality and that they will not take away their life savings. We are taking difficult decisions, and the Opposition need to look at themselves and decide whether they are doing the same.
For too long, successive Governments of all stripes have failed to grasp the nettle on social care reform. In fact, we have mostly failed to acknowledge that there was a nettle at all. That is largely because this burden overwhelmingly falls on women, and our voices have been silent. I will not rehearse all the debates that we have had, but this is this time to start something better.
When he came into office, the Prime Minister promised that he had “a plan” to fix social care in England. It is now clear that he did not. But—I say this with all sincerity—he has since started one, and he has brought it to this place at some political risk. This is worthy of a sliver of credit in itself. But having brought these plans forward, we now need an honest and thorough debate here and across the country about their merits and deficiencies. Yesterday I said that the Prime Minister may have broken the dam, and he looked slightly confused. That is because he thinks he has now fixed the problem. The trio of the Prime Minister, the Chancellor and the Health Secretary looked very comfortable with themselves yesterday. They are very wealthy men. They seem to have heard something, but this has not fixed it. They need to understand that behind the dam there is a torrent of questions, costings and aspirations, none of which the Government seem prepared to acknowledge.
This motion does not represent a sustainable plan. Instead, what we have is a shoddy push to nod through these changes without even paying lip service to the scrutiny that they need. Millions of families are hoping for something else, and we must not give them false hope. That would be cruel and unnecessary. There is only one longer-term solution that we will need to inch our way towards in the coming months and years, and that is a universal system based on the same NHS principles of fair taxation based on the ability to pay and according to need. Crucially, like the last Labour Government, we need to start moving people with us on the journey to that solution. Pitting people and generations against each other and talking solely about tax rises is a narrative that is now infecting our debate. It needs to stop.
Today is my birthday—[Hon. Members: “Hear, hear!”] Very kind. I was once in my 20s, and my message to young people is that they will get older. A young woman talked movingly on the BBC yesterday about her struggles with social care, and she said that everyone is one accident away from social care. We have to remake the social contract for a new generation.
Reform is too late for my mother, who is in her 80s, and it is too late for me in my mid-ish 50s. It cannot be too late for my children, which is what I need to explain to them, rather than talking of generational warfare.
On the smoke and mirrors around the NHS settlement, I spent most of my career in NHS management and I was part of the great improvement in health services under the last Labour Government. If we are really going to start delivering on this, it will require a massive clinical and managerial effort to transform the legacy of the pandemic and austerity in the health service, and to change those waiting lists.
Politicians like to talk nicely to managers in private conferences and then take pot shots at them the rest of the time, but clearing the waiting lists is a massive managerial and clinical challenge. The clerical and clinical validation of that list to help people move through the care system will be a massive task, and they need support.
The Prime Minister has a majority of 80 MPs. It is in his gift to deliver a policy that could truly stand the test of time. Having bitten the bullet and picked the fight, he seems determined to squander the opportunity with the solution before us today. I urge him and the Government to think again. He should seek to build the consensus that could exist in this House on doing something truly lasting after the terrible pandemic we have all been through.
The question of how to deal with the worsening social care problem has been put off for too long. Indeed, the Labour party shunned its responsibility when in government and refused to make the difficult decisions to put social care on a sustainable footing.
Peter from Loughborough said in an email to me that it is
“long overdue to try and fix the social care problem. Governments of both parties have pushed this into the long grass time after time and it cannot be put off forever.”
The Conservative manifesto pledged to build cross-party consensus on an answer to solve the problem. Clearly, this has not been possible. It has therefore been left to this Government to make the tough decisions, which I know the Prime Minister has not made lightly as the Conservatives are the party of low tax.
I welcome the hon. Lady’s reference to the aim to create cross-party consensus. We have heard that said repeatedly. I am the health and social care spokesperson for the SNP, and the Labour spokesperson and I did not receive so much as an email. To say that consensus could not have been built is wrong. It could have been built, and we could have had discussions before yesterday.
That is not my understanding. Maybe it is the case, I am not sure. [Interruption.] Forgive me if it is the case.
The Government have made proposals to raise much-needed funds to deliver on important commitments such as upskilling the social care workforce, strengthening the adult social care system, tackling the elective backlog in the NHS as it recovers from covid-19, funding a 3% pay rise for our fantastic nurses and implementing a cap on adult social care costs. These aims all have widespread support across the country.
I could mention many cases that have been referred to me over the years of elderly people who are afraid to come out of hospital because they know they are not well enough to live independently but are afraid to move into the care system because of the cost.
In yesterday’s speech on social care costs, the Prime Minister said:
“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.”—[Official Report,
The Office for National Statistics states that between 2014 and 2016, the most up-to-date figures I can find, the average inheritance was £11,000 per person, which fits in well with what we are trying to develop so that people are enabled to leave something for their family.
Finally, alongside this additional funding, we need to look at the overall finances and management of the NHS to identify where savings can be made, so that money is put where it is needed most—frontline services. That is particularly true in respect of waste generally. For example, GP statistics show that 173,165 people did not attend their appointment last year, costing £5.1 billion. Those are some of the things we need to look at. However, I will support this measure tonight, for the reasons I have set out.
It is a standard trope from Conservative Members that public services in general, or the performance of the Scottish Government in particular, in some way fall short of what happens at Westminster. We heard earlier from John Lamont, who seemed to spend more time complaining about the Scottish National party than he did talking about the NHS and social care.
Despite some of the Damascene conversions that have clearly taken place among Conservative Members overnight, a number of truths and realities in this debate should make for deeply uncomfortable feelings among Conservative Members. By levying this tax, they are not only breaking a manifesto pledge not to increase NI and increasing the tax burden disproportionately on the youngest and least well-off, but doing so in order to play catch-up with the health and social care landscape in Scotland.
I listened carefully to yesterday’s statement and intently to Conservative Members talking earnestly about the need for health and social care integration. I even listened carefully to that call when it came from Members who had, in ministerial office, been in a position to do something to drive that integration agenda forwards. What was startling for me was the gradual revelation throughout the course of the statement that there was no plan. There was no planned assessment of impact or plan for how the moneys raised would make their way through the NHS and ultimately to social care. Leaving aside the unfairness of the means by which these moneys are to be raised and the Prime Minister’s utterly bogus rhetoric about “Union dividends”, we are being asked to applaud the scale of the inputs without any thought having been given to the nature of the outputs. Clearly, in their desperation to do something about this, the Government have decided that a tax is the best form of defence.
It is also clear that in England at least this debate is not even in the foothills of where it needs to be about its health and social care integration. In Scotland, we embarked on that journey several years ago. There is some irony in the fact that on the day the UK Government finally announced their plan to lace up their running shoes on this, the Scottish Government in Edinburgh were announcing in their “Programme for Government” plans to go beyond health and social care integration and forge ahead with a national care service.
What this measure reveals most of all is the mismatch between policy and resources, and the shortcomings of the fiscal settlement for devolution. We saw that through the pandemic. We still do not know whether this is to be Barnettised or hypothecated. We do not know how much is to come to health and social care, and by what means. The answers to those questions matter, because if the devolved settlement is to be respected, the spending decisions should be taken by the Government who are directly elected and directly accountable to Scottish voters. The suspicion has to be, given the lack of detail on that, that this is yet another power grab, with the UK borrowing and claiming that borrowing as the so-called “Union dividend”.
In the time I have left, let me say that the most iniquitous aspect of all is the impact that this move has on the lowest earners in society, the youngest in society and those who have least in the way of assets of their own. They are being asked to forgo their earnings, for an objective with which few can quibble, in order to protect the assets of those who already have the most. This Government have removed the freedom of movement for young people across Europe, are seeking to disenfranchise them at the ballot box and now expect them to pay for a social settlement that few have the means to do and few can expect to benefit from. This is no country for young people at the moment.
It is an honour to follow Richard Thomson, although I did not always agree with what he said.
I have spoken in this place on multiple occasions about the need for a long-term plan that addresses social care in this country, so I welcome the Government’s solution. I have direct experience of the problem of social care funding: prior to being elected to this place, I was the finance leader of a large upper-tier authority and we spent more than two thirds of our budget on social care provision, so I am all too aware of local government upper-tier authorities’ issues with funding social care and the challenge that the Government have faced in addressing the issue.
As we continue the recovery from the covid-19 pandemic and learn its lessons, it is clear that we can no longer ignore social care. By introducing this reform to social care after decades of inaction, we will change the lives of thousands of families who are struggling to afford quality care and having to make difficult decisions in the most vulnerable of circumstances. In finally addressing this long-standing issue, we will improve the quality and availability of social care for those who most need it, while ensuring that it is most affordable and helping to relieve the continuous pressure on the NHS.
We now cannot ignore the backlog created by the heroic work of our NHS in rightly prioritising the treatment of covid-19 patients. I welcome the Government’s plan to address the backlog immediately through the new health and social care levy, which will allow us to increase hospital capacity to 110% and create 9 million new appointments. I am sure I am not alone when I say that many of my constituents have contacted me to express concerns about hospital waiting times, and I know that colleagues from all parties will have constituents who are pleased to hear about the Government’s commitment to solving this problem through the levy.
Fundamentally, I am a low-tax Conservative, but as the Chairman of the Treasury Committee, my right hon. Friend Mel Stride, said earlier in the debate, the Government have few levers with which to address this issue. As the Prime Minister said yesterday, a global pandemic was in nobody’s plans. The £407 billion that the Government have spent to support businesses and families has been vital to keep people safe and the economy afloat during these really difficult times.
We should focus on the impact, not just on the additional resources. The necessity of our response to the global pandemic has brought many changes in the way things are done in this country. I hope that, along with the increased resources, there will be increased ambition to do things bigger, better, quicker and more efficiently, rather than just continually chucking money at things. The extensive support schemes offered by my Government were never intended to continue indefinitely. As we emerge from the pandemic, it is right that we look at real-world funding options for the reforms that are so clearly necessary.
Like, I am sure, many people on both sides of the House, I came here today desperate to support a plan that would see investment in a system that has been set up to provide care not just for us and all our loved ones but for everyone in this country. This is a problem that we all want to see fixed for the 1.5 million people who are not receiving the care they deserve; for the staff who work long hours, underpaid, with 120,000 jobs left unfilled; for the unpaid carers; for those caught in the backlog of NHS waiting lists that threatens every day to deny them life-saving treatment in time; and for all of us who might one day need the system that we were brought up to believe was there from cradle to grave. It is therefore a huge disappointment that this so-called plan does not do any of that.
What we have is not a strategy that will fix our NHS and social care—the long-awaited oven-ready plan that the Prime Minister promised us on the steps of Downing Street. Perhaps it would now be more appropriate to talk about the naughty step and to consider what this so-called plan will mean for the young people, the lowest-paid and the small businesses that will be hit hardest, because this is a tax hike for the low-paid and young people, which the Government promised there would not be.
Where is the carefully costed, detailed plan of what will be spent on the NHS backlog and invested in our social care system? One must not be funded at the cost of the other. There is a better way to deliver for a social care system that was already in crisis before the pandemic—and that is not an excuse for the broken manifesto promises of 2019. This is a system that was already in crisis and already in need of investment.
Liberal Democrats have repeatedly called on the Government to hold cross-party talks to find some consensus on the best plan to fix social care. The Government have had plenty of time. We know that it can be done. When the Liberal Democrats were in government, we built a cross-party agreement through the Dilnot commission, as mentioned by Sir Edward Leigh, and the Care Act 2014, based on the values of the NHS. We legislated for it, but after the 2015 election, the Conservatives ripped it up. Instead, they are now pressing ahead with a scheme that places a huge burden on low earners and small businesses. Has it completely escaped their notice that many of those who will be hit hardest by this tax hike are the frontline NHS and social care workers?
Then there are the other public sector workers—police and fire officers. As for business, this comes at the worst possible time. When, as the Federation of Small Businesses points out, firms are still struggling, trying to recover from the impact of the pandemic, what do the Government do? They end support, stop furlough and then hit them with another bill, while many of them are struggling to get out from under the debt that the pandemic has created. Added to that, so many families are now facing a cut in universal credit.
It is abundantly clear to me and to the Liberal Democrats that this Government, this Prime Minister and this Chancellor are out of touch with ordinary families, small businesses, frontline health and care staff and what they face on a daily basis. As I have said, the pandemic is no excuse for breaking promises. This is a moment in our history when the people in this country most need a Government on whom they can depend and who are as good as their word.
What about the people whom this so-called plan is supposed to help? Where is the respect, beyond that for a certain proportion of the population? We will all start paying for this new arrangement in April 2022, but it will not come into effect until October 2023. What about the people who are in care now or who will enter care in the intervening 18 months? As for the cap, £86,000 is still a lot of money. This country deserves better.
I welcome the Government’s commitment to this investment to speed through the backlog that we have had since the pandemic and to invest in social care. For too long, social care has been left in the “too difficult to solve” box. Well, we come here to do the hard things as well as the easier, and that is what this Government are doing.
In spite of the warm words that have been spoken by Opposition Members, it is absolutely clear to anyone listening today or yesterday that, whatever is proposed, they will oppose it to the extent of even voting against people getting urgent NHS treatment or care.
The proposal of additional money comes on top of unprecedented investment in the NHS, approaching £40 billion by 2023-24, but today’s welcome further boost for the backlog and social care does need paying for. No one on the Conservative Benches likes tax rises, and I certainly do not. It is essential to look at the burden of taxes overall and to commit to reducing that over time. None the less, I recognise and accept that, if we fail to take the tough decisions now, the longer-term economic consequences will be even greater in the future.
Along with these changes, I hope that my right hon. Friends on the Front Bench will consider how we can move away from the burden on council tax with a social care precept and make sure that we continue to modernise and make every pound and penny count on the frontline.
I would like to take a moment to reflect on what that NHS investment through successive Conservative Governments has meant for the people of Dover and Deal. It has meant that we have: a brand new state of the art hospital, the Buckland Hospital; a groundbreaking Harmonia dementia village, the first of its type in the entire country, which has been delayed by the pandemic but is now expected to be open in the spring next year; a pilot centre for a new approach to wounds at the Queen Victoria Memorial Hospital at Deal; a new training centre for GPs and nurses in east Kent, serving our entire area; and even a new dentist provision. The market is also responding to this investment and commitment to healthcare and to the people of our country, with older people’s housing being built by McCarthy Stone in the centre of Dover at this very time. However, the pandemic backlog is causing real distress, as is the failure to grasp the nettle of social care. I see that in my inbox, as we all do. I therefore strongly welcome this funding, this new approach and this commitment to tackle the issue.
Rachel Reeves asked about election leaflets. Well, in mine I committed to better healthcare, and I know that it is this Government who are funding and delivering that for the people of Dover and Deal.
We have heard—mainly from Opposition Members—about the grave issues with and concerns about this NHS tax, which will be detrimental and cause more hardship, especially to young people and poorer people in our society. We have heard about the cuts to local authorities and universal credit, and now the increase in national insurance, which will hit poorer people in our society. How can that be right?
Let me turn my focus to the Government’s progressing efforts to privatise the NHS. NHS privatisation has been a creeping threat for the past decade. The Government make a song and dance about valuing the NHS every election time. This includes their broken promises to build 40 new hospitals and to spend £350 million on the NHS every week if we left the European Union. The Prime Minister has consistently pulled the wool over the trusting public’s eyes, abusing their loyalty to the country’s most beloved asset. He is fixated on the pandemic, yet somehow the Government seem to have amnesia. There were extensive waiting lists at record high levels even before the pandemic. Those levels are even higher now. The Tories cut 17,000 beds from the NHS before the pandemic struck. The way that the Government are betraying and misleading the nation is astonishing.
Two constituents recently wrote to me about their dismay at the way in which the Government are dismantling the health service, and I have to agree. The Government have exploited the chaos of the pandemic to advance their agenda of privatisation with minimal public knowledge. There has been more outsourcing of NHS services to private companies. Public money is spent on contracts, rather than being spent directly on the NHS.
Should the Health and Care Bill pass as written, in April we will enter a new phase, where the NHS will be broken down into dozens of smaller units that will have private companies on their boards, including American health insurance companies seeking only profit. The deputy chair of the British Medical Association wrote last year:
“rather than finding a moment of clarity in this crisis to reinvest in a publicly provided health service and build for a better future, the Government has doubled down on its failures, choosing to throw huge amounts of money at scores of private firms…rather than rebuilding the health and care system and empowering those with the greatest expertise.”
What we are left with is a fragmented healthcare system that is a skeleton of what it once was, with workers underpaid and exhausted, and social care neglected.
Now the Prime Minister wants all taxpayers, including the most financially insecure, to pay for his mistakes—this Government’s mistakes. It is shameful. It is a betrayal of the NHS and a betrayal of the British people, and it is something that the Opposition will certainly not accept.
I welcome the extra funding that is going into tackling the backlog of cases in the NHS. Dartford has been particularly badly hit, with Darent Valley Hospital this week having perhaps its busiest week in many years as it tries to deal with the backlog. I ask the Treasury team, working with their colleagues in the Department of Health, to ensure that the extra money that will be invested in the national health service gets through the treacle of bureaucracy that can quite often affect extra funding for the national health service, so that it can reach the frontline without being siphoned off in various directions on its way through. I welcome the fact that the Government have had the courage to deal with this issue. We can argue about whether the plans are the correct plans, and whether we are funding them in the right way or the wrong way, but it would not be a very wise argument to say that we should carry on kicking this can down the road. It is very welcome that we are confronting this problem head on and dealing with the issue.
It is slightly surprising that we have not seen much support from Labour. I could help my hon. Friend Mr Baker in understanding what the Labour party’s plan would have been had they been in power for the past 11 years. The Labour party had a plan for how to deal with social care in its 2015 manifesto, which says that extra public funds were needed, which I think we all accept, that a cap on contributions to social care should be imposed, and, crucially, that it could be funded by a social care levy. That was the position the Labour party took in 2015. It was so happy with that policy that it had it again for its manifesto in the 2017 general election. So that is exactly how the Labour party would have approached this situation: with a social care levy. That is what is proposed by the Government, and it is therefore slightly surprising that we have not seen more support. As my hon. Friend said, we saw Gordon Brown come to the Dispatch Box in a Budget and increase national insurance by 1%. He did not mention it in his Budget speech—we all found out about it in the Red Book afterwards—but that was his approach then.
We have consistently seen the Labour party supporting exactly what the Government are proposing to do today, but instead of Labour Members supporting it, we have received the class attacks referenced by my right hon. Friend Sir Mike Penning. That shows that they have learned nothing from the last few general elections. They have learned nothing from their experiences of dealing with working-class people. They do not understand that working-class people actually have aspirations—aspirations to own their own house and to save some money where they can, and not to have that house, and everything else, pretty much, that they own taken away from them if they happen to need social care at the end of their lives. It is trying to ensure that those aspirations are met that has ensured that the Conservative party has made far more progress with working-class people than the Labour party, which has simply lost contact and lost connection with the people that it used to serve. I am therefore surprised that Labour Members are not supporting this, and they should perhaps reflect on that decision. I again pay tribute to the Government for having the courage to deal with one of the most difficult issues that faces British politics today.
I am pleased to follow Gareth Johnson, because I do welcome the fact that this debate is happening and that there is an attempt to find a solution to something that absolutely has been kicked down the road. However, I am very disappointed that despite the rhetoric there was no attempt at cross-party contact or to achieve consensus and agree a long-term solution.
I also feel that this proposal is regressive. It will hit lower-paid people, including the key workers we were clapping for just 18 months ago. It will hit the younger generation, who have been hit from multiple directions and will not have the benefits that we have been lucky enough to have in our lifetimes. It will stifle recovery because it is simply a tax on jobs. Like previous social security cuts driven by Tory austerity, it will take money out of local economies and remove spending power. That means increasing poverty—the single biggest driver of ill-health.
In Scotland, that will impact on our aim to have a wellbeing recovery from covid. That is why we object to this measure and why we object to the Prime Minister saying that he will direct how the spending is used. Income tax would have been a fairer method. It is paid by wealthy pensioners, as I will probably be in a few years’ time. It is paid more by people who earn more. It does not hit wealth, but there other taxes that could have been used to do that. The Scottish Government already took action in 2018 by adding a penny to all our tax bands so that we had more money for health and social care. We do not just provide free prescriptions; we are the only UK nation that provides free personal care, and in 2019, that was extended to those in need below the age of 65. That is something to which other nations within the UK should be aspiring. It allows people to stay at home and to have greater independence, and that is how we should be looking on it. The Feeley review, which the Scottish Government commissioned, asks us to turn it around, to stop seeing social care as a burden and instead to see it as a way of allowing the people affected, whether due to disability or age, to still be part of our society.
We object to the undermining of devolution, because it is the Scottish Parliament that has responsibility for the strategy of health and social care. Our health and social care landscape is quite different. Not only do we have free personal care; we also still have a unified, public NHS. We have been integrating with social care since 2013, so to say that suddenly we will hand that control over to the Prime Minister—I am sorry, but that will not wash. The national care service proposal from the Feeley review recognises that we already pay the living wage and we pay for overnight sleepovers. What we actually need for social care in all four nations is to develop social care as a career, so that people stay there and commit to it. It is not just a job that someone does until they can get on the checkout at Tesco. It is a simple fact that above all other careers, care is delivered by people, for people. That is where any plan should start. If there is focus on the workforce, we may end up with a care service that we can be proud of and that will deliver for all constituents.
Political parties in this country set out with manifestos at general elections with a general intent to try to implement them. There is usually a number of rules. If a party thinks it will win, it has the shortest manifesto possible, and if a party is in opposition, it will usually have an endless manifesto with lots of promises to try to attract people. The truth of the matter is that what comes along is events, and a pragmatic, sensible Government have to respond to events.
We have had one big event, the pandemic. Nobody said, “You didn’t have the furlough in the manifesto”, because how could we have foreseen that? The jobs of 7 million, 8 million, 9 million people were protected to get through the pandemic. Nobody said, “You cannot give grants”, or, “You cannot spend £400 billion.” We live in a funny country where the Prime Minister can spend £400 billion getting us through a pandemic, but God forbid he try to put wallpaper up in his flat in Downing Street, which of course the Cabinet Office would not pay for.
The reality is that the Government have been pragmatic and sensible, and the consequence of the pandemic is that we have a higher debt level, and that changes the parameters of what the party that is governing can do. We want to implement our manifesto promises dealing with care. We need to get the backlog of the NHS down. Many people in my constituency have been quiet, waiting for their operation and their opportunity to get back to normal, and we need to give them support. That is what we are trying to do.
The simple truth is that we are in a different world from the one we had in 2019. This Government are treating the world as it is, and that means tough decisions and unpopular decisions. I would not be surprised if we fell behind in the opinion polls, but the reality is that we are doing what the British people expect us to do, which is to govern and deal with the problems we face. I support this Government, not because I agree with everything that they do, but because I am proud of the fact that they take tough decisions. That is what Governments are meant to do. They are meant to take challenges head on.
We are dealing with the NHS backlog. Who can tell how quickly we will get it shifted? Of course we need more staff, but we are seeing in figures out recently that the backlog is already starting to fall. Let us hope it is cleared quickly. We are starting to deal with some of the care issues. Is this proposal a silver bullet for dealing with them all? No, it is not. Is it enough money? I wonder, because there is a list of Government priorities that may mean some funds may be diverted before they get to care. The Government are trying their best to deal with people’s concerns.
We all have constituents whose parents have worked hard all their life to buy a home; we see the unlucky ones when mum or dad has Alzheimer’s and goes into a home and they see the proceeds of a life’s work disappear. If that person is in a home next to someone fully funded by a local authority, it is quite right and proper that we should pay at least some regard to their hard work and recognise the things they did not have—perhaps holidays or horseracing or gambling—because they wanted to buy a home.
The Government are roughly on the right track. I hope that we will get back to a more tax-cutting agenda as the years roll by. I am very hopeful for the deficit this year because we are growing quite rapidly, we seem to be getting control of spending and we have had to take some tough decisions with tax. I am confident that when we come to face the British people, I will hold my head up high because we are tackling the issues that my constituents care about.
We are all aware that the NHS is the pride of the UK, and we are similarly aware that there is a grim possibility that it may become our biggest loss. I am therefore very much focused on health issues. That loss would be because of historical underfunding as well as the unseen pressures that covid has placed on every facet of the NHS, from dentists, physios and surgeons to waiting lists, assessments and operations.
I will not take the path of some others and seek to score political points because that is not what I am about. I am will think of the constituent who, at the age of 53, came to my office almost immobilised having waited four years for a hip replacement. I will think of the parents desperate to get respite for their disabled children. I will think of the mums watching their daughters—and increasingly their sons—who are killing themselves with eating disorders and cannot get the help that is needed. I do not want to score points, but I do want to get it right.
There are rightful questions about who will bear the brunt of what is undoubtedly a necessary evil. My real fear is that for small businesses who in recent years have taken on the burden of paying statutory sick pay to staff, increased wages under the minimum wage and are paying more to ship their products to Northern Ireland due to the disgraceful Northern Ireland protocol, what seems like a small increase may put them off hiring that new staff member. That is a real concern, and when that is weighed along with fact that big businesses with their expensive accountants can find a loophole to prevent them from paying what they can well afford, it seems that the middle class will again be the ones feeling the squeeze. I therefore share the concerns of my right hon. Friend Sammy Wilson, who highlighted the unfair nature of this blanket tax.
Whatever method is used to raise money—I need this to be heard clearly—this money cannot be diverted by way of the Barnett consequential to any other Department, as moneys have been in the past. We need to reform our health and social care or we will lose the NHS, but, in Northern Ireland, the funding make-up means that funding cannot be ring-fenced. As my right hon. Friend said:
“Northern Ireland will benefit by about £420 million per year by this increase in National Insurance but there is no indication that the Executive”— the Northern Ireland Executive—
“will be required to spend it on the purpose for which it was raised since the Government cannot ringfence money”.
Before the debate, I spoke to the Minister for Care to seek assurances, and she will seek those assurances from the Treasury. Since the relevant Minister is not here at the moment, I put these questions to the acting Ministers on the Front Bench. Can that money for Northern Ireland be ring-fenced? Will all future moneys that come to Northern Ireland for this purpose also be ring-fenced? That is what we need to know. We cannot have a system whereby—as has happened on multiple occasions—this salvation funding for the NHS is used for putting, for instance, an Irish language or Ulster Scots sign up on a street. How do we ensure that the money goes on reform and is not used by others to promote their political goals and aspirations?
We undoubtedly need to take the bull by the horns and swallow the pill for the increase. However, we will never be forgiven if in five years’ time we are still in the same position. What guarantees do we have that the sacrifice of every single employed person, every single pensioner and every single business owner will bring about the necessary change and not be lost in the ether of politics at Stormont? Many are willing to make the sacrifice for care—not anything else—and we need binding legislation in place for us to believe that any guarantee given will not be waylaid by political machinations.
The future of the NHS is worth the change to legislation. Let us get it done. I want to see something happen from which we can all benefit across the whole United Kingdom, and I need that to happen for us in Northern Ireland.
May I congratulate the Government on dealing with unfinished business? Since 1948, we have pooled our risk for the management of the consequences of poor health except for things such as dementia and the general frailty that for some of us attends old age. This could be a historic moment in which we sort that out, and I will most certainly be enthusiastically supporting the Government tonight. It is grossly unfair that certain conditions should be excluded from our provision, and I am so hopeful that this will finally, after 70 years, complete the job begun by our predecessors.
I am disappointed that Labour Members should have taken the line they have, because I recall their doing something really rather similar in 2003 with national insurance contributions, presumably because Gordon Brown and Tony Blair at that time decided this broad-based tax was the fairest and most equitable way of dealing with this and, crucially, of raising significant amounts of money. We can debate whether the money was then well spent, and the statistics and figures suggest that that was not the case at least for the rest of that decade, and productivity in the NHS only started picking up in the following decade. Nevertheless, in raising sufficient funds for spending on something we all agree is vital, Gordon Brown and Tony Blair made the right call in 2003, and I find it dispiriting, saddening and disheartening that Opposition Front Benchers should on this occasion decide, for their own purposes, not to support it.
I notice from the right hon. Member’s entry in the Register of Members’ Financial Interests that he makes income via rentals, as many people in this House do. Does he think it is fair that, in what has been presented to us today, rental income for landlords is completely not within the remit of any take for this levy, so there will be care workers in South West Wiltshire who are paying this on the income they make being care workers while it will not be paid by landlords with rental income?
I am grateful for that intervention, because additional rate taxpayers, who I think make up about 2% of taxpayers in this country, will be paying a fifth of the whole receipts for this measure and 14% of taxpayers will be providing half of it. That is progressive, which is presumably why Gordon Brown and Tony Blair, all those years ago, decided to levy this on national insurance. I am extremely grateful to the hon. Member for raising and underscoring that point.
However, I do have some concerns, as Ministers would expect me to have. One of those concerns was expressed by our right hon. Friend Jake Berry, which is that this is a one-way tax, because there is no way that in the future we are ever going to attack a tax hypothecated to health and social care. In some eyes it represents a flawed tax, since as Conservatives we of course always want to remove as little money as possible from the pockets of all of our constituents.
There is also a traditional disconnect in healthcare between money in and services out. We found that in 2003, and the challenge for the Government today, which I am fully confident they are up for, is to turn the money they have announced yesterday and today into the output we so badly need, and which indeed is vital if we are to turn this around in two years’ time and use this money for social care.
There is some concern about the extent to which the money that has been announced for this will distort the social care market, and I would be interested in Ministers’ views on that. Will the industry load hotel costs, and will it front-load charges up to the £86,000 cap? How will that incentivise the domiciliary care market, which could turn out to be extremely positive? How will it affect the current 40% cross-subsidy from fee payers to local government-funded customers? How can it grow a vibrant insurance product market that will cover the delta—the £20,000 to £100,000 difference—and what will be done with actuaries and underwriters to that end?
Can I finish by saying that all of this depends on improving productivity in the national health service? It is a challenge that has evaded many over seven decades, but one that must be grasped if we are to complete this and ensure that we do indeed set the foundations—and I am confident we will—for proper social care. We need, for example, to drive down sickness absence, which is very high in the national health service. We need more service work to be done by professions allied to medicine. We need more artificial intelligence, data analysis and robotics. We need to crack down on variations in healthcare and to have zero tolerance for practitioners who diverge from it. We need to cut treatments and procedures of marginal benefit. We need early switching to generics. We must stop the revolving door between social care and the acute sector—something I am afraid the industry exploits to its advantage. Over time we must revisit the disastrous doctors’ contracts that I am afraid have meant, over the past several years, that people like me at the peak of our powers are retiring early or going part time, grossly reducing productivity in our national health service.
Over the course of the pandemic the UK has amassed a record number of billionaires—171. Their wealth has rocketed by more than £106 billion and in total now stands just shy of £600 billion, up nearly 25% since May 2020. It is safe to say that the super-rich class has not had financial worries over the past 18 months. Unlike millions of people across the country, they do not have to worry about putting food on the table, paying the rent, or the cost of caring for elderly relatives. One might think that instead of hitting the living standards of our heroic key workers, that super-rich class would be asked to pay more when the NHS and social care system is in desperate need of funding, but that is not how it is under a Conservative Government.
This national insurance hike will hit low-paid and young workers the hardest, while doing absolutely nothing to tax the wealth of the super-rich. It will cost a band 5 nurse in Coventry more than £250, and the marginal tax rate of a recent graduate, once student loan repayments are included, will now be close to 50%. That is another attack on the living standards of the working class and the young, from a party that for 11 years has let the rents of my generation soar, as student debt rockets and wages stagnate. That does not come in isolation. Next month the Conservative party plans to cut universal credit by £20 a week—the biggest overnight social security cut in the history of the welfare state. That move will push 500,000 working-class people into poverty.
Yesterday, the Conservative party announced that it would break the triple lock on pensions, robbing retirees of nearly £350 a year at a time when pensioner poverty is already at a 15-year high. This Government are hammering working-class people, raising taxes on workers while cutting their safety net, and doing nothing to rein in the vast wealth of the super-rich. They pretend they are one nation, but today they show that they only represent one class—that of billionaire donors, super-rich property developers, big landlords and fossil fuel barons. Yes, the NHS and the social care system desperately need more funding. Our care system needs to be transformed into a national care service, modelled on our amazing NHS and free at the point of use for all, but that must be funded by a wealth tax on the super-rich, not by an income tax on the poor.
There is, without doubt, agreement across the House that funding is necessary for health and social care. The challenge is in how we fund that, how we spend it, and how we ensure that the Government are held accountable for their promises. I will not repeat the powerful words of my right hon. Friend Jake Berry and my hon. Friend Mr Baker. They spoke truth to power, and I hope the Government were listening. They raised a second issue—indeed, this has been raised by others: is there a proper plan? We have a document; it is called “the plan”. For me, a plan is something that sets out clearly not just ambition—that is there aplenty—but specifically what will be done, when it will be done by, who will be doing it, and how the Government in this case, and the NHS, will be held accountable. What will be the reporting mechanism? I fear I see none of that. If I am asking taxpayers to pay a very substantial sum, I think that is the least we owe them.
Under this proposal, 80% of the pot will go to the NHS backlog and 20% to social care, which will be split between sorting out the woeful provision that we have now and the cap. I suggest that our priorities here are wrong. Yes, there is a backlog, but social care should not be second class. It should not be dealt with second, after the backlog is fixed; it needs fixing now. To be honest, to talk about fixing the mechanism by which we share the cost between state and individual as the priority seems wrong. If we do not have a social care system that actually delivers, there is nothing to pay for, and there is nothing to debate about how we fund it. I believe that the Government must change that priority.
What, then, could the Government do? With regard to the backlog, they could look not just at longer-term plans—we do not have time for that when it comes to recruitment—but at how we are going to get retired doctors and overseas-qualified doctors back. The Government could do that; they could change the bureaucracy that stopped that happening during the pandemic. They could look at how we can change the way we work flexibly across the different specialisms. That can be done, it has to be done, and it should be the focus.
The Government will not like this, but we also need to look at the immigration rules. I know that there are already exemptions for highly skilled doctors and nurses, but we need more than that across the whole health sector, and that help will come only through immigration. What about targets? Constituents deserve to have specific targets set. We need to know how those are going to be triaged according to need, as I assume they will be, and how they will be reported on.
Then we have social care—what are we going to do there? Can we really afford to wait for a White Paper? No, I do not think we can, but what could we do? We could legislate now. We could mandate proper pay—pay that is fair for the quality of work and the professionalism provided. We could develop a proper, professional system. We could fund local government properly. We could police the quality of the commissioning, as we might under the new Health and Care Bill, which is going through Parliament. Again, we could change the immigration rules, and we could also look at properly supporting carers who are looking after relatives at home, removing extra burden on the NHS.
All this is possible, but without a plan and without accountability, how can we look the taxpayer in the eye and say, “If you pay, we will deliver”?
There were many elements of the speech by Anne Marie Morris that I wholeheartedly agreed with, on the definition of good social care and in particular the reporting mechanism for the money that is raised as a result of our decision tonight. She made some very important points.
I want briefly to say what an unusual first week back it has been. Yesterday, we debated the Elections Bill and basically voted on compulsory ID cards. I feel that is very much against the grain of who we are. It has always been nice to know that we can pop out to the shops or down to the polling station without photo ID, and I think that some of the things we debated yesterday about photo ID go against that very liberal notion of who we are.
Likewise, we had the debate about compulsory vaccinations. Again, I feel that there is something very illiberal in that, particularly in forcing certain people, in certain workplace conditions, to do it. I feel that that is another essential debate about who we are. I am the daughter of complete Anglophiles; I grew up with “This is England” on the coffee table at home. Sometimes I feel that we have forgotten who we are.
In 2009, the satisfaction rate for the NHS was 80%, the overall best figure ever since the measure was introduced in 1983. When this Government came in in 2010, that started to drop, and it has now dropped by more than 16%. We know that the waiting list is up to 13 million, but as the hon. Member for Newton Abbot said, we have no recording mechanism and no mechanism for knowing exactly what the money will go on. That point was very well made.
We also know that the Federation of Small Businesses has real concerns that the measure might stifle recruitment right now. The TUC is very worried about young people and their employment prospects, questioning whether this is the right moment, when we do not know whether the recovery is sustainable. I am bitterly disappointed as a vice-chair of the Local Government Association and a former council leader—I know there is one on the Government Benches—that nothing has been spelled out on how we are going to help struggling councils. All of this could very well go straight into a waiting list. There are no targets and there is no promise, so I worry that local government will be ripped off and that the £3.9 billion gap will never be filled.
The measure is coming forward at a time when we know the people who will feel its impact the most, as Jake Berry said, happen to be in that care system. The irony is that they will have to pay even more to work in a failing system, where many are not paid the living wage. Many councils cannot afford to pay the extra living wage, which makes such a huge difference to that workforce. I am sure those on the Treasury Front Bench will make those deliberations when they have a chance. I am sure they have been working on this all summer, but it does feel a bit rushed—
I thank my hon. Friend for giving way and I agree with much of what she has said to date. She may or may not know that in Northern Ireland today a leading gas supplier announced a 35% price increase. That will put significant financial pressure, particularly on the—
Order. I am not sure whether the hon. Lady has been in for much of the debate, but it is important that interventions are very short because there are a lot of people who have put down to speak who may not get in.
That will put significant pressure on the low paid and the squeezed middle. Does she agree that the increase in national insurance contributions on top of that will have an impact on them, even making—
Order. I have to stop the hon. Lady.
Thank you, Madam Deputy Speaker. Carla Lockhart is making a really important point about the unknowables. We do not know by how much our gas and electricity bills will go up in the next year. We do not know whether firms will take fright and stop hiring people. One thing we do know is that council tax will go up, because there was nothing in the announcement for councils. We know a few things are not going to get better. We know a few things could get better and might not get better. It does seem to be a bit of a risky move.
In conclusion, we have had a very strange return to Parliament. Sometimes I get very surprised by the Government. I think sometimes Ministers do, too. I hope there is urgent work between the Ministry of Housing, Communities and Local Government, the Department of Health and Social Care, and the Treasury to really make this work. It is likely to go through. I do not think there are quite enough rebels like the right hon. Member for Rossendale and Darwen—he is shaking his head. Please try to make it work. In taking such a risky decision right now, we can at least get the dividend of people being better cared for, getting through the backlog and helping our constituents to be able to see GPs when they wish to.
I know there have been partisan words flying across the Chamber today, but one thing that unites everyone across the House is a commitment to try to tackle the issue of social care so that our children are still not having to deal with it in generations to come. I would like to start by thanking all our NHS workers who have been a part of tackling the really difficult challenge over the past 18 months. Their dedication to fighting covid, keeping us safe and keeping the NHS working at this difficult time must be commended by us all. I also want to thank our care workers. I have to mention my cousin Natalie and my great aunt Elaine, who have been fantastic, working throughout the pandemic. I have said it now. They will be watching at home.
I am really proud that, after years of it being kicked down the road, it is the Conservative party that is finally grasping this issue and saying that we are going to tackle social care. To some extent it has been disappointing to hear Labour criticise with no viable alternative. I want to try to be more constructive. One of my concerns is about the speed at which these proposals have been presented to us. We know that urgency is needed to tackle this issue. In a sense, it is fantastic that the Government want to act swiftly, but having seen these proposals only yesterday, we have had limited time to scrutinise them effectively and to consult our constituents and find out what their concerns are about these proposals, and to feed that into Government. I really hope that Government will engage with us as this passes through to the next legislative stages.
The speech that really struck me today was from my right hon. Friend Jake Berry. I kind of wish I could copy and paste his speech and turn it into my own, because it really did address many of the points that I wanted to make. The first one I want to touch on is the relativity of house prices and how the maximum floor for care will have an impact. My hon. Friend Bim Afolami made a decent point about needing a simple system, but unfortunately, when looking at that limit and relative house prices in areas such as my Bishop Auckland constituency, where the average house price is about £120,000, seeing constituents potentially lose a huge percentage of their only asset—an asset that they have worked their entire lives for to pass on to their children—is something that I am finding incredibly hard to justify, when people in other areas of the country who have worked equally hard would lose a much smaller percentage of that asset.
It is good, however, to see the floor lifted from £23,000 to £100,000. That is to be commended, but still, there is an issue about the ultra-wealthy who will also have the cost of their care capped, and who can afford to pay more than the £86,000. I hope that that will be addressed. I also have concerns about national insurance being used as the tool for this, like many other colleagues who have spoken today.
My main concern is the fact that we have not had a great deal of time to consider these proposals and to consider alternatives, as my right hon. Friend the Member for Gainsborough (Sir Edward Leigh) said. The article by Peter Lilley proposing a state-backed optional insurance system not only is a free market approach to tackling this, backed up by the state, which is well needed, but goes to the Conservative principle of personal responsibility that I think every Government Member supports.
A quote by Mike DeWine, the former Governor of Ohio and a US Senator, struck me:
“Governing is about making tough decisions, but it’s also about figuring out a better way to do things.”
I am so proud that the Government are making this tough decision. I hope that by working together, we can find that better way of delivering on our social care pledge, but unfortunately, for the reasons I have highlighted today, I will be abstaining on this today. However, I will work alongside colleagues to try to make it the best it can be for all our constituents, for the country and to ensure that our economy can bounce back in the best possible way.
I find it incredibly ironic that the Government scrapped the chance today to debate the removal of the universal credit uplift—perhaps because they did not want to be exposed for taking money away from the some of the poorest in society—to instead offer up a debate about disproportionately hitting some of the lowest-paid people in our country.
The double whammy of a national insurance hike and a universal credit cut shows the complete disdain that the Government have for the working population. Far from being the supposed party of aspiration, they seem to be nothing more than they have always been— the party of the 1%—and they are not even trying to hide it with this regressive tax grab. Instead of sitting in front of the House today to front up this disastrous decision, the Chancellor seems to have gone AWOL. Maybe he spent the day in Sherwood forest as a reverse Robin Hood, robbing the poor to give money to the rich.
As we have repeatedly heard from so many people in the House today, a staggering 2.5 million families across the country will be hit by this huge national insurance tax rise as well as the £20-a-week cut to universal credit. In constituencies such as mine, which has people who are among the lowest paid in the country, this devastating news will mean that in many cases, people will be pushed further below the poverty line. What do the Government have to say to those people or to the struggling small and medium-sized enterprises and businesses that have battled through the pandemic? What am I supposed to say to the people in my constituency—the public sector workers—who have been hit by wave after wave of pay freezes, and now the Government want to hit them again with a national insurance increase? What about those families who are already stretched to breaking point, who will now be forced to sell their homes and plunder their life savings to pay for the £86,000 of social care? The silence from the Government on that point in particular today has been deafening.
This week, the TUC made it crystal clear that it is completely unacceptable to hit the young and low-paid workers while leaving the wealthy untouched. It cannot be right that 95% of this tax bombshell comes from those in employment. Let us be absolutely clear: this is, unfortunately, a tax on jobs and on our economic recovery from the pandemic.
It is incredible how ruthless the ideology of the Conservatives can be, yet when the facts are staring them in the face and it makes financial sense, the Tories simply cannot countenance taxing their own. It is very simple and I will spell it out very clearly: those with the broadest shoulders should bear the greatest responsibility. Even the ultra free marketeers on the Government Benches have voiced concerns about the policy.
We need to consider more progressive taxation measures, such as a wealth tax to ensure that the wealthiest pay their fair share. Let us be really clear about what has happened in the past 18 months: Britain has created a record number of millionaires and billionaires during the coronavirus pandemic. Their wealth has surged—the combined wealth of billionaires in this country grew more than 20%. Instead of raiding the pockets of the lowest paid and of small and medium-sized enterprises, who may struggle to afford it, why are the Government not closing the tax loopholes and targeting the tax havens?
We also need an assessment of the impact on jobs, but we have not heard about it from the Government today and so far they have resolutely refused to do one. We need jobs to get out of this crisis into growth and get more tax coming in. We also need a full, comprehensive social care plan that is properly and fairly funded and integrated with the NHS; a system that looks after everyone in our country from cradle to grave; and, most importantly, a proposal that does not pit one generation against another that is less wealthy. The plan is unjust and badly timed, and it will not fix the social care crisis.
It is a pleasure to follow Sam Tarry, if only because he asked what we would say to the people in his constituency who have been struggling. It seems a strange time to ask that question when the Government have just spent £400 billion helping individuals and businesses through a tremendous crisis, keeping the show on the road and making sure that our economy can recover, that jobs grow and that we have a way of life we can continue with. I feel that the timing of his points was somewhat ill-judged.
It has been interesting to be in the Chamber today, because we seem to have covered all the reasons that we should not do something. It seems that all the ways in which we are doing something are imperfect. I feel we have captured the political paralysis that has surrounded social care over the past couple of decades. It is incredibly difficult to do anything in this area, because it requires tough choices and a punt into the dark that may or may not work—we can never be sure.
We often speak in this Chamber as if we are certain, as if we are positive and as if we know where things will go, but sometimes we have to say, “We think this is the best way forward and we hope it works.” To acknowledge that the Prime Minister and the Government are doing something today on the NHS backlog and on social care is to admire their bravery. To govern is to choose, and that is what the Prime Minister is doing.
We have heard some tremendous speeches about the alternatives to taxation or to systems, but we have been having this debate for so long. When I look my suffering constituents in the eye or when they come to our surgeries and say that the system does not work, we cannot sit there and say, “Okay, but I’m going to engage in an academic exercise for another decade until we find perfection.” Sometimes we have to acknowledge that the best way forward is to take a chance.
Today is a massive step in the right direction. We are investing £12 billion per year over the next three years to try to ensure that any damage done by the global pandemic to our NHS is no longer a problem and that we can reach 110% capacity. We are also grasping the nettle of social care reform. However, there is an intriguing paragraph in the health and social care plan: paragraph 9, which states that
“the Government will ensure this money is well spent and goes to frontline care in England, increasing efficiencies and using reforms to drive up productivity.”
I think that there is an acknowledgment, particularly among Conservative Members, that NHS funding cannot go on becoming a black hole. There is a need to ensure that outcomes and productivity are improved. Look at the lessons of the pandemic, particularly from the Nightingale hospitals, which went up in 10 days through the combination of logistical support from the Ministry of Defence and the NHS—it was unprecedented.
We saw in the vaccine roll-out that when we bring additional expertise into the NHS, we can achieve amazing things.
My “nudge” today is that I do not think we can continue to assume that more and more money will solve the problems that we have. Equally, however, I will not look my constituents in the eye and say, “I did not try.” However tough some of the decisions are that we have to take, I will back our Prime Minister and I will back our Government, because our constituents need to see our country get better, and that is what we are trying to achieve.
It is a pleasure to follow my hon. Friend Mark Fletcher, who made a typically thoughtful and energetic contribution. There was much to agree with there.
My hon. Friend Dehenna Davison quoted the words, “To lead is to choose”, and here we have no easy choices. Indeed, in our job we often have tough days in the office, and nights when we lose sleep thinking about a vote, a decision, the options and the choices that we have in front of us. However, in this speech I am going to look on the bright side. I am going to try to be optimistic, and pull out the good things from the situation and the hard choices that we face. One good thing is that owing to the timing of this, I only lost one night’s sleep, but I am going to be very positive about the policy itself as well. I am going to choose three things that I want to improve, and I am glad that the Chief Secretary to the Treasury is here to listen. Those three things are how the revenue is raised, the quantum and the period over which it is spent, and how it is spent.
There are never any good options for raising taxes, but I happen to think that raising taxes on having a job should possibly be at the bottom of the list when we look at new areas of income. We have spent billions on furlough, keeping people in jobs. That has been borrowed from future generations, and will be paid back. We have kept people in jobs. We have kept the economy going. We have kept the show on the road. We have avoided the economic death spiral of mass unemployment while we have all these additional rising pressures on spending on public services, including, of course, social care—the very problem that we are here to fix. There are, I think, other less bad options. My right hon. Friend Jake Berry suggested a cocktail of taxes and levies. Normally, I instinctively avoid complexity in taxation—
We have to recognise that the simple option is not always the right one, and I look forward to the debates that will follow as this policy evolves.
As for the quantum and the period over which the revenue is spent, I must ask whether it is enough to fix the care sector. Mr Betts, the Chairman of the Housing, Communities and Local Government Committee, referred to the previous report of the Health and Social Care Committee, which required an additional £3.6 billion for the sector. Are we going to get that, and is it going to go through at the right time? We need to solve the broken economics of running a care home, which mean that providers must fund the services off the back of private clients to subsidise the clients who are referred by local authorities. I think we need a big conversation about that as well.
Let us turn to how the money is spent. The additional funding must be supported by meaningful reform. We must address the issue of funding allocation, and the allocation of responsibility within the sector. Currently, the system is set up to incentivise referrals. The system is split between local authorities, care providers and the NHS.
Does my hon. Friend agree that we need a wide spread of provision to ensure that we have the best possible outcomes for social care patients?
Absolutely. We need more providers in the market, but the market needs to be functioning for that to take place.
My hon. Friend made a very good point earlier about another aspect of how the money is spent. The £86,000 cap needs to be met and tweaked with a regional house price element to recognise the fact that houses are worth more in some areas than in others.
In conclusion, I will vote for this. Our job in this place is to make good laws, and we need to do that at every stage. This is a tricky problem. The Government are right to grasp the nettle and reform social care. The fundamental problem that we face is that the assumptions that we are basing our entire welfare system on were made in the 1940s when people went into work in their teens, retired when they were 60 and lived until they were about 65. Now, they are living much longer lives and retiring earlier. That is the funding issue that we face.
I must gently point out that colleagues may think that they are helping each other out by making interventions, but at this stage they are going to prevent other colleagues from getting in.
My hon. Friend Mark Fletcher rightly said that to govern is to choose. One of the reasons for the result of the last general election was that voters knew that this Government were more likely to make the difficult choices that were needed. The choices we have to make are not always between the good and the perfect. Many of them involve choosing the less bad option. As a Conservative, I believe that raising taxes is certainly a bad option. It clearly breaches a manifesto pledge, and it is both economically and morally wrong. It is economically wrong because higher taxes will dampen growth and prosperity in the longer term, and it is morally wrong because it means taking money away from those who have worked hard, to be spent elsewhere. That needs to be kept to a minimum.
However, if raising taxation is a bad option, surely the alternative—not acting—is far, far worse. Not acting would mean allowing the backlogs that have built up in the NHS through the pandemic to continue. That would put people’s early diagnoses at risk and delay treatments further, clearly endangering lives. It would mean not reforming social care, despite there being almost universal agreement that that reform is long overdue. Government after Government have promised to take this on, to reform social care and to put it on a sustainable footing financially. There have been endless reviews, but each time they have ended up in the “too difficult” box.
How many of us can go for a week without getting an email from a constituent about social care, whether it is about the quality of social care, access to social care, top-up fees, their ability to pay or the fear that they will have to sell everything they have worked hard and saved for all their life? That is why something needs to be done. If we agree that action is needed and that we need more money to be spent on the NHS to clear the backlog and reform social care, the only decision we have to take is how we pay for it.
In the long term, borrowing to pay for this is not a sensible option. There are very few taxes that can raise anything like enough money to meet the challenges we face. Of course this could be put on VAT, but that is clearly a much more regressive option that would place a disproportionate burden on the least well off. There have been various fanciful ideas from some Opposition Back Benchers that basically suggested that someone else should pay for it, or that there was a hidden pot of money that could be raided. It is not there! The fairest way is to have a levy on national insurance contributions, sharing the cost between employees, employers, the self-employed and those who get income from dividends, so that those who earn more pay more.
I think the shadow Chancellor suggested that this could be funded by charges on the sale of land, property and shares, but the truth is that combined revenues from all stamp duties on land, property and shares comes to about £15 billion, which is nothing like enough to pay for what is needed. So national insurance is the fairest option. Gordon Brown was right, on this one occasion, that it is the most regressive option—
It has been a pleasure for us to sit here for the past four hours and exercise by seeking to catch your eye, Madam Deputy Speaker, no doubt contributing towards alleviating our future social care needs.
In the next 20 years the population of England alone will increase by 10%. The number of over-75s in England will increase by 60%, which is an extra 2.7 million people. In 2020-21 there were 1.9 million inquiries for social care in England. The system is creaking. A third of my constituents are over the age of 65.
This tells us that we need to act now, and I applaud the Government for taking decisive action now. I have concerns about the action we are taking, but we need to act now and the Government are acting now.
I have three concerns about this particular measure. First, we have a health and social care levy that will, in its initial existence, go towards health. I am concerned about when we take that money out of the NHS and put it into social care. We know how difficult it was to convince people that a temporary lift to universal credit was just temporary. How on earth are we going to challenge the equivalents of Marcus Rashford when it comes to the NHS and persuade people that it is not a cut but was always the plan for a period of time before moving the money into social care? There does not seem to be any guarantee on that, and I am concerned that it will be politically difficult for any Government to do so.
Secondly, I am concerned about the intergenerational unfairness that could be seen in this measure. Along with others here in the Chamber, I have advocated a measure that looks for retired people who have a nest egg to pay more for the service they use, rather than expecting the younger cohort, through national insurance, to have to pay for it when they do not have a home of their own.
The German model was built because of the regional imbalances of reunification, and the Germans considered this model and made a provision that everybody would pay in, workers and employers—the retired had to pay both parts—and no one would have to pay more than €138 a month. That took the political heat out of the system, and it uses the private insurance market for delivery. People are incentivised to look after their parents in their own home, and they can take money from the insurance fund to do so. I would like to look further at that model.
If that does not work for the more catastrophic situations, what about the noble Lord Lilley’s proposal of taking a charge against the property, so that a premium is paid out—he estimated about £16,000—and on death the charge is released from the sale of the property?
Both plans look more towards the people using the service having to pay into it. Those who are older would see the fairness of that, because it is their children and grandchildren who have to pay the national insurance.
Thirdly, I am concerned about the overall tax take. We will have to rein in public spending, as this has to stop. We need to allocate money towards the NHS with strict criteria on where it will be spent, because it cannot be right that a 27-year-old graduate who is paying back their tuition fees is seeing 42% of their pay go towards tax. That is not what Conservatives set out to do; we set out to give people the opportunity to build dreams.
That said, we need to act now and I recognise that the health service needs an injection of funding. I will be supporting the Government, but I want to see my three proposals developed before it is too late.
Like my hon. Friend Huw Merriman, the Chair of the Select Committee on Transport, I will be supporting the Government on this measure. In so doing, I will be breaking a pledge in the Conservative party manifesto at the last general election. That is not done lightly, and I do it for two mean reasons.
First, the £400 billion cost of covid has created a gap in the country’s balance sheet that cannot be ignored or wished away. It has to be dealt with, and it is fiscally responsible for the Government to produce today’s measures. Secondly, as hon. Members have said, we have deliberated on the reform of social care for more than a decade, with every day of delay creating more risks for families. I want reform, and it is best done by this Government at this time.
However, there will be consequences from these increases in tax rates—they will hold the economy back. Public services require a thriving economy to fund them. In turn, a thriving economy requires people to be inspired to create, take risks, invest capital, make profits and grow their businesses, skills and talent. As Conservatives, this is something we understand. It is capitalism and competitive markets that deliver. I would like to hear a little more from our Government about how good the power of free markets is and a little less boasting about the latest ways in which they are spending taxpayers’ money.
With taxation rates already at highs for the past 60 years, for Conservative Members to describe themselves as “low-tax Conservatives” means that they need to be supporting efforts to reduce public expenditure. Every departmental Minister should right now, ahead of the Budget, be raising the bar for investment decisions and casting out those projects that fall short. Each Minister should be taking an axe not just to obvious waste and inefficiency, but to meaningful slices of expenditure that reflect an over-bloated state rather than an essential public need. That applies to all Departments, including the Department of Health and Social Care.
The NHS is a great hallmark of British society, but it is not a religion. It is an organisation of people to achieve a social purpose. As an MP, my role—our role—is not to deify the NHS but to hold it to account for its effectiveness in achieving that social purpose. It is so dispiriting when taxpayer funding for healthcare is increased and the immediate response of those in positions of knowledge or responsibility in our health services is to say that the funding is not enough. It is dispiriting and it is irresponsible to the taxpayer. It is not acceptable that the leadership of the NHS shies away from even the most modest of productivity targets. It is not right that, by the British Medical Association’s own calculations, more than half—70,000—of the 134,000 people involved in general practice are non-clinical administrators, and yet so many of my constituents find it so hard to get an appointment.
I wish to see reform of social care that eliminates the excessive cost risk for families. I recognise that a private insurance market for these risks cannot exist without significant state intervention and that, for a period at least, taxpayer support is required as care services are reformed. As of today, we have promises but not guarantees for reform. I am placing considerable faith in these reforms being implemented by 2023. The Government and the NHS must deliver.
Increasing taxes is not something I take lightly, and it goes against much of my belief, and of many Conservative Members, in the need for a low-tax, high-wage economy. But the realities we now face of increased pressures on our health and care system mean we cannot stand still; we must invest more in these services. Hundreds in Stoke-on-Trent South have contacted me previously about the need for more investment in social care and the challenges they face in accessing healthcare and medical treatment. I am not willing to go on ignoring these calls. For far too long—decades—social care has been starved of the real investment it needs.
No decision to invest more to the scale required is going to be easy, and money must come from somewhere. What we have arrived at is probably the least-worst option. The approach taken will ensure that this burden is spread as broadly as possible, so that all those with earned income streams must contribute, and protections are in place to protect those on lowest incomes. I also welcome the suggestions in the guidance that health services, local authorities and other public services will be compensated for these additional costs, as I know there was significant concern about the potential implications for these services of those additional costs.
If we are to put this huge investment into improving health and social care, we must also see reforms that are needed to ensure that money goes directly to the frontline of improving services in Stoke-on-Trent. We must see a further integration of services so that patients are truly put first, with all local health and care partners fully committed to delivering the improvements needed, supporting one another to reduce pressures and ensuring that people receive the right healthcare at the right time. We must also see the money spent better, cutting out waste and outdated practices where they exist.
I hope that the Health and Care Bill passes through Parliament as swiftly as possible to bring about vital reforms. Investment must be about the creation of a better funding model for social care that improves quality and reduces the burden on families. I also want Ministers to focus on ensuring that we develop the insurance market to help to protect those whose property values are on the lower end of the scale, such as people in Stoke-on-Trent, because we need to make sure that people in such properties receive the same protection as those in other parts of the country.
We must also address the huge issues we are seeing in access to health treatments and GP services, which have dramatically worsened during the pandemic. It is not good enough that my constituents in Stoke-on-Trent South have to wait inordinately long times for the treatment they need and cannot get GP appointments. We must tackle the backlog at the Royal Stoke and get primary care fully back to pre-pandemic levels. But we need to go further. Social care is a key part of addressing the pressures, but so is primary care, which must be properly invested in. We must see the development of new integrated healthcare hubs in north Staffordshire, including the development of the second phase of the new Longton health centre in my constituency, the first phase of which will open in the next few weeks.
The improvement of both social care and primary care will mean that secondary care is better supported, ending the scenes of services overwhelmed that we see frequently today at our local hospitals. In north Staffordshire, our health services face wider challenges because of the legacies of the burdens caused by Labour’s PFI disaster, and the hospital was not built to the capacity needed. Many such pressures continue, and although much progress has been made, we must continue to see the level of investment that we need in health services in Stoke-on-Trent.
It is a pleasure to follow my hon. Friend Jack Brereton. I absolutely agree with him that the Government’s proposal is probably the least worst option.
When it comes to this debate, I feel saddest for the many constituents who have come up to me in recent years and said, “When it comes to the big issues—the issues of national interest—why is it that you lot can’t work together and come up with a solution?” Clearly, this issue is of huge national interest and has been debated in this House many times over recent decades. I have been involved in debates dozens of times in the six years I have been here. I blame colleagues from either side of the House—from both the Labour and Conservative parties. Whether it is the “death tax” or the “dementia tax”, people have come forward with proposals only to be rubbished by the other side for political purposes.
The reality is that this issue is one of many challenges that we are going to face over the next few decades. According to the Office for Budget Responsibility, if we do not change our tax system, our debt-to-GDP ratio will be 400% of GDP by 2060, because of pension, healthcare and social care costs. We must sort out this issue on a cross-party basis so that we have a long-term solution.
The reality is that we have had cross-party consensus. As I have said several times in the past couple of days, I have taken part in two Select Committee inquiries on the issue, the most recent a joint inquiry by the Health and Social Care Committee and the Housing, Communities and Local Government Committee. There were 24 Members on those two Select Committees, 12 of whom were from the Opposition Benches, and we strongly recommended a solution based on national insurance. We can of course argue about some of the detail of the national insurance proposal, which has been changed in some positive ways over recent days, but simply to dismiss it out of hand for political purposes is irresponsible. I understand that the shadow Minister for social care, Liz Kendall, has also proposed a solution based on national insurance. It does not make sense simply to say for political purposes that the proposal is wrong—
The shadow Minister on the Front Bench can shake her head, but that is the reality behind the proposal. The Chair of the Housing, Communities and Local Government Committee, Mr Betts, said clearly that he still supported a solution based on national insurance.
I agree with my hon. Friend the Member for Stoke-on-Trent South that this solution is the least worst option, but we can develop better solutions down the line. I agree with my hon. Friend Huw Merriman that the German solution is better. In Germany, they came together across party lines, based on the national interest, to solve this issue. It was very similar in respect of employer and employee. The key benefit of the German solution is that when a person comes to be defined as in need of care, instead of the local authority allocating care, they can choose to take a monthly cash payment, so they can pay a relative, a neighbour or whoever to care for them. A person can be cared for by the people who know them the best, who understand them the best and love them the most, which must be better than some of the stories that we hear about care providers who give a pretty poor service, with a 15-minute package now and then.
This must be a better solution, but I have one concern. I understand why the scheme has been brought forward like this, using national insurance. It is because it is quick and easy, and we need the money today, but the concern is about hypothecation, which many Members have mentioned. This was a social care levy, but already some of it is going to the health service. That is our understanding at the start. Hypothecated taxes simply do not work, and we see that time and again. It would be better to develop this into a proper social insurance system with not-for-profit providers, so that it does not go into the private sector, but instead the money could be paid in on a proper hypothecated basis to deal with the long-term problem of social care.
It is a pleasure to follow a typically well-informed speech from my hon. Friend Kevin Hollinrake.
I stood for election to be a Member of this Parliament because I want to be part of a party and Government who strive to improve the lives of all of our constituents. I am Conservative because I believe in being pragmatic and realistic, not stuck in ideological thinking, but willing to find solutions to seemingly intractable problems and, more importantly, making sure that those solutions are fit for the times in which we find ourselves. As other hon. Friends have mentioned, I will not shy away from making difficult decisions, which our constituents elect us to take.
When Labour was in power, it failed to fix the roof when the sun was shining. Now the pandemic has clouded our bright skies, but we are determined to grip this issue and to fix the social care crisis once and for all, as we promised. What are we promising to do with the NHS and social care levy? This £12 billion average annual investment over the next three years means that we will invest the largest amount of any Government to upskill the social care workforce, strengthen the adult social care system, tackle the elective backlog in the NHS as it recovers from coronavirus, fund nurses a 3% pay rise as the independent pay review body recommended, build resilience for future pandemics, ensure that the NHS has the resources it needs throughout this Parliament, and, finally, implement a Dilnot solution to cap social care costs.
In addition, we promised to deliver 50,000 more nurses, 50 million more GP appointments and build 40 new hospitals. The Conservatives are the party of the NHS and it is frankly unbelievable that the Labour party will not vote this evening to give the NHS the funding that it needs.
This £36 billion investment to reform the NHS and social care is a responsible, fair and necessary plan. Many of my constituents in Guildford, Cranleigh and our villages will be feeling a sense of relief today for the genuine anxiety they feel. We know that the pandemic has created an enormous backlog in the NHS, with more than 300,000 now having waited over a year for non-urgent care. We know that our constituents have wanted a plan for social care for decades, as many colleagues have mentioned today. Importantly, we know that our constituents understand fairness, which is why I will be supporting the Government today.
It is a great pleasure to follow my hon. Friend Angela Richardson, who set out her position very clearly.
I have to say that this is the first time in all my time in Parliament that a Ways and Means motion has been debated all day. It seems to me that this has been more like a general debate on the NHS and social care. I remind the House that Parliament says:
“A ways and means resolution is needed to authorise the creation, extension or increase of taxes or other charges…Ways and means motions are most commonly put to the House for agreement immediately after second reading”.
In other words, there is a Bill that we discuss; it is laid out there. There should have been a social care Bill. We should have had that Bill and been able to debate the principle of it and then immediately afterwards voted on the Ways and Means, but we have got this mixed up with giving more money to the national health service.
A Ways and Means motion to increase a tax in order to pay more money to the health service is quite acceptable. I mean, we are creating a new tax. The motion today does not refer to 1.5% or to how much will be spent on social care. It just says that we are bringing in a new tax. We are doing that, though, without having the detail. If this was a Budget, the Chancellor would stand up and make a powerful speech, and there would be an immense amount of applause on that day for what he said. People would then read the Red Book, for five days they would unpick the Budget, and then we would vote on the Ways and Means motion.
I am very unhappy with today’s procedure. Although I support the idea of more money for the NHS and I have no objection to it being done through national insurance, I absolutely object to saying that this has anything to do with the Health and Care Bill, because that has not been through the House. Social care should be paid for separately. We should have the Bill and debate it, it should go through Committee stage and through the Lords, and then it should be paid for. I have no idea which clever-clogs in No. 10 thought it was a great idea to mix these two things up. Social care is one of the most important things—if not the most important—that this House will have to decide on. It should be done separately and properly.
The Opposition should be working with us. They have scored so many political points today. My hon. Friend Ben Everitt said it: last night was one of those nights when we do not sleep because we are worrying about how to vote. Should I vote for this because I want to support the Prime Minister? Should I vote against it because I do not agree with the principle? Or should I do nothing because I think it is a good idea and a bad idea at the same time, because the Government have mixed the two things up? I will make my decision after having listened to the shadow Minister and the Minister; as of now, I have no idea what I am going to do tonight.
It is an honour to follow my hon. Friend Mr Bone.
I am in absolutely no doubt that we need to raise the money to enable the NHS to recover from the pandemic. It would be wrong to raise this money through more borrowing. We should not expect our children and grandchildren to settle the debt at some time in the future; we need a plan to pay for it now.
The criticisms of this motion come not so much from the fact that the Government are choosing to raise the money, but more from the way in which it is being raised. Those criticisms centre around one concept: the idea of fairness. As we have heard in this debate, fairness is extremely important for Conservatives. If the Government are to be the force for good that they should be, we need to ensure that our policies are as fair as possible—that benefits and costs fall in a fair and equitable way across the population. I accept that there is some unfairness around using national insurance to raise the levy, but in order to raise the cash required, we must use a broad-based tax. A VAT rise would have a disproportionate impact on those with low incomes and using income tax would not incur a contribution from businesses. Of course, businesses very much benefit from health and social care, as huge numbers of people would have to leave the workforce if those services did not exist.
On reflection, I think that using national insurance to raise this levy is a fair way to proceed, especially given that my right hon. Friend the Chancellor has made sure that dividends and working people of pensionable age are included. I support the motion today because we have to acknowledge that politics is not about striving for perfect solutions. It is about finding the best solutions possible within the financial, practical and moral constraints that bind us all. However, although the money raised through this motion will be a start, it will not be enough.
We have to accept that health and care costs are many times higher now than they once were. I echo the comments of my hon. Friends the Members for Wycombe (Mr Baker) and for Milton Keynes North (Ben Everitt) on this point. When the welfare state was born, life expectancy was about 65. Many people left school in their early teens and entered the workplace. In the 1940s, an individual might well spend fewer than 20 years of their lives not working. Now people can spend more than 40 years of their life not working. Simply put, during our working lives we must now pay a lot more —double, or perhaps more—in taxation, pension contributions and insurance to fund our decades of economic inactivity. We cannot escape that fact.
So in raising any additional money in future we must be far-sighted, inventive, creative and look to other countries, as other hon. Members have said. In addition to taxation, we could look to build on the success of our automatic enrolment model for workplace pensions or consider some form of contributory insurance scheme. But we must also be clear that there are alternatives to ever-increasing bills for health and social care, so I hope to see extensive consideration of local, community and capability approaches in the White Paper. We must not forget the crucial role of the family. How can we help families to look after their own relatives’ wealth for longer and with appropriate support?
I acknowledge and understand that there are criticisms of this motion, but doing nothing is not an option. When it comes to finding a pragmatic solution to such a difficult and urgent issue, I am convinced that this is a fair approach for now.
I totally sympathise with those on the Front Bench and I have huge respect for the Treasury Minister who is in his place, but I am concerned, as a Conservative, at the direction of travel. As we have heard, taxes are at their highest for 60 or 70 years—and this under a Conservative Government. For me, and I think for many of us and people around the country too, the alarm bells are ringing. I do not like being bounced into this decision. I think someone mentioned sleepless nights. Well, we will not have any because the decision is being made tonight, having been told about it only 48 hours earlier, and we still need to hear a lot more from the Government about how this is all going to work.
My hon. Friend Mr Baker talked about the lack of money as our population gets older and the continual demands on the public sector increase. He is absolutely right. We cannot go on just spending the taxpayer’s money willy-nilly. This is not our money. It is money earned by people working their socks off to provide for their family, their friends, their employees and for the health and prosperity of this country, and we cannot abuse that.
I entirely support what my right hon. Friend Jake Berry said, in a superb speech, when he referred to a Trojan horse. If I can paraphrase, we, as Conservatives, are introducing a new tax that will never, ever be withdrawn because, come election time, we would have to say, “Okay, remember everybody—that was a one-off tax, so it is now going and billions of pounds are being withdrawn from the national health service.” I think I can see where the Opposition will go with that and what will appear on their literature in 2024.
With regard to promises made in manifestos, can we not think just a little more carefully about what we say? No one could have predicted the pandemic—I am deeply sympathetic to the Government on that point, because of course we could not. But perhaps we should say that we aim to do something rather than that we promise to do something, because circumstances change, and when one Government take over from another they change the whole thing anyway, and then, if we win again, we have to change it once more.
Throwing money into the national health service black hole is not the solution. The sad fact is that parties of all colours over many years have failed to tackle the NHS issue. We need radical reform both of the NHS and, of course, social care. I am not saying that we should change the care free at the point of delivery—not at all; I am saying that there is plenty of room for reform. Most of those I have spoken to who work in it absolutely agree. It is a matter of political courage to actually get on and do it.
We are Conservatives. A pandemic, appalling though it is, creates opportunities. Where is the vision of the Singapore-style, low-tax economy attracting the world’s best to this country to generate the wealth and prosperity that we need? To generate the revenue we need, we lower taxes—that is proven. We do not raise them, because if we do, all we do is damage our economy and have less money to spend on the things we need, like social care and the NHS.
One thing that concerns me is that I saw some polling earlier this week showing that only about 25% of the population know that social care has to be paid for. That in itself is something we need to address through a certain level of engagement. If a lot of the people who are dismissing and opposing the national insurance rise truly understood and comprehended the devastating consequences of out-of-control social care costs, they might think differently.
Where are we right now? We are in a situation where we have spent £400 billion since the start of the pandemic. We have waiting lists growing and spiralling out of control as a result of the pandemic. We all have constituents who are waiting in pain for hip and knee replacements and more serious operations. We have constituents, including mine, who are not able to see their GP face to face and all the consequences of that. That needs to be addressed urgently. My constituents should be able to see their GP face to face when they need to do that.
We are in this appalling situation, and I take issue with the dismissive way that Opposition Members have spoken about many of the individuals who could benefit from the social care cap, referring to them all as millionaires in Surrey. The people I know who have been clobbered by social care bills are not millionaires in Surrey; they are people who have worked hard their entire life, paid tax on what they earned and at the end of their life, they have something to show for it. It is not just bricks and mortar; it is a home that they love and that they raised their kids in. Not unreasonably, they want to pass that on to their kids. When their mental and physical health is deteriorating, to see everything they have worked hard for whittled away in a matter of years is utterly depressing and morally wrong. I am proud to support a cap that addresses that, and I make no apology for doing so.
In terms of the manifesto point, I stood on a manifesto—we all did—and there was a pandemic straight after we had the election. This is an extraordinary situation, and probably nothing has happened since the second world war that has had such a dramatic effect on cost and spend. We spent £400 billion. People make this inaccurate comparison with George H.W. Bush and “read my lips”. Over the summer, I had a few days off, and I read a very long book about George H.W. Bush. He did not have a pandemic happen a year after he stood for election. It just simply did not happen. It is like writing a manifesto in 1938 and then realising that thousands of Spitfires have to be built because the second world war is starting. The money has to be raised somehow, and to say, “We cannot possibly do that, because we cannot change the manifesto we stood on a year ago”, would be absolutely absurd.
What are we dealing with right now? We are dealing with a situation where we have a cap of £86,000. We need to know more. We need to know more particularly about those with £20,000 to £100,000 and how their care costs will be subsidised. We understand that the councils will help with that. I need to know more about how that will work in practice. I sympathise with my hon. Friend Dehenna Davison and others who represent areas with hard-working constituents where house prices are very different from those in London. We need to know more about that.
Ultimately, we have seen the Prime Minister speak on this issue, and we have seen his passion. He is right to be passionate about this. The easy thing for him to do would be to use the pandemic as an excuse to push this issue into the long grass, but he has not done that. He has done the difficult thing and grasped the nettle. I am proud that he is our leader and our Prime Minister. He is doing that. What else was in the manifesto? Sorting out social care. No one should suggest we push that into the long grass. The Labour party does not want to decrease international aid, it wants us to make the universal credit increase permanent and it wants us to spend £16 billion on this and that. Labour never says no to a pay increase. I know what will be in my manifesto: you voted against—
I begin by joining others in applauding this Government for finally tackling the social injustice of catastrophic care costs. Yet again, a Conservative Government are taking the difficult decisions that others have avoided. My remarks today will focus on fairness and the nature of health and social care demand.
First, on fairness, somehow the political debate in this country—fuelled by those on the Opposition Benches—focuses on fairness as only one thing: the need for the better off to pay more. That is definitely an important element of fairness in society, and we see that with these proposals, with the top 14% of earners paying half of this new levy. It is not the only measure of fairness, however. The other important way to decide whether a society is fair is to think about what someone gets back compared with what they put in. We do not talk enough about the fact that a small number of people pay many, many times over what they get back and that some people pay almost nothing and get everything paid for by others. Hon. Members on both sides of the House have talked about the challenge for those on low incomes and the proportion that will be taken from their income by a tax rise, but it works both ways. Those same people, relative to what they put in, get a lot back when they seek health and social care services.
A person from a middle-income family could pay significant amounts in tax over many decades and buy their home but then see that home and nearly every penny of what they saved taken off them to pay for social care. They could live next door to someone who has paid perhaps no tax or a low rate of tax and gets everything paid for them. They end up in exactly the same boat, with nothing to show for what they saved, despite the huge difference in what they put in through taxes. That is simply not fair. In this case, people on lower incomes will continue to benefit from essentially free social care; they are just being asked to contribute a little bit more, and inevitably a little bit more will be spent on them. That is fairness, too.
I turn to demand for health and social care, and a point that perhaps will not be popular on my side of the House. I am a Conservative and do not want the Government to pay for everything on behalf of everybody, but the facts of health and social care spending are fundamentally different from those of other areas of spending. In real terms, what it costs to run an education system, prison service or public transport should be broadly stable—if anything, it might go down—but every time we treat someone successfully in the NHS, one of two things happens. Either the condition becomes chronic or comes back and we have to treat them again or, if it does not come back, they live longer and become ill with another condition. That is an unalterable reality, and it will happen more and more as we improve our healthcare services.
A heart attack is a good example. We have improved enormously the number of lives we save when someone has a heart attack, but that means more people live with chronic heart conditions that result from their heart attack, or they may live longer and end up with another condition—perhaps cancer or dementia—and we have to pay for that on top. [Interruption.] I join Opposition Members in saying that that is not a bad thing. We have not failed because we have spent more money on people’s health and social care. It is not a negative—we are providing a greater public benefit—but ultimately, over time, even if we tackle all the inefficiencies and challenges in healthcare spending we see in the NHS and get all those things right, we will still need to spend more on health and social care. That is why I welcome the proposal.
We need to start separating the discussion on tax and spend for health and social care from that on other areas of public spending, and the step we are taking to create some hypothecation, which is similar to that seen in other countries through insurance, does that. People can therefore understand that we have not failed because we have spent more and that we all need to spend more to ensure that we get the continued public benefit of living longer, with health and social care supporting us to do that, so that we can spend more time with our friends and families.
I will support the motion and encourage Members on both sides of the House to engage more thoroughly with the challenges of rising costs in health and social care. This is not just about waste, efficiency and all these other things; it is actually in the nature of delivering better health and social care for a population.
The key issue for me is not so much with raising the funds—there are no perfect solutions for that—but with the spending of them. I am more than happy to look my constituents in the eye and say “I voted to raise taxes” if I can demonstrate that we have something to show for it. Those of us with a local government background will know that the social care sector has been crying out for a sustainable financial settlement for at least two decades.
The fair access criteria that were implemented by a Labour Government in 2003 precipitated a financial crisis in a sector that was already under pressure by removing local authority discretion over services and failing to provide the funding for the new model, and charging policies and council tax precepts have proved unable to bridge that gap. As a chairman of a social services committee in those days, I looked my local residents in the eye while imposing Labour’s charging policy for social care on them, so I welcome the Government’s courage in bringing forward a proposal that looks both realistic and workable.
Does my hon. Friend, with his local government background, think that this policy will fit within a wider local government finance reform agenda?
My hon. Friend is absolutely correct to highlight that wider reform agenda. I know we are anticipating more detailed proposals from the Government in due course, but it is clear, as he will know from his local government experience, that if we in this House are serious about fixing social care—much of which is not about the elderly, but about working with adults and children with disabilities—we must learn the lessons from the sector of several decades of change.
First, we must reflect on the lessons of the better care fund, which taught us that councils have been the efficient delivery partner. Even when the sole focus has been to relieve pressure on the NHS, councils have been much more efficient on the whole in using those funds. We must avoid, as many Members have said, that convenient political mistake of allowing all the money to disappear into an NHS black hole with nothing to show for it. However, having learned the lessons of the better care fund, we have to ensure that those additional national insurance costs do not consume the extra funding. I have heard Ministers’ assurances about this, but the care sector has heard many times of new funding that has been cancelled out by deductions from other budgets, so we need absolute clarity that this will find its way to the frontline.
The second point I would like to highlight is that this does not just affect the elderly. About two thirds of social care costs are for working age adults and children, and the NHS is barely involved in many of those cases. However, the costs can be eye-wateringly high, so we need to make sure that as we direct those funds, as my hon. Friends have highlighted, they are getting to where they are required.
The third lesson, which has been mentioned by a couple of Members, is about how the market responds. We have a thriving market for social care in this country, including charities, the private sector and local authorities. We know many of those organisations will see the £86,000 as a very tempting target: the sooner someone spends their £86,000, the sooner the state steps in. We need to ensure that we have learned the lessons of what has happened with the involvement of some businesses, particularly in the children’s social care sector, and make sure this is not seen as simply an opportunity to rip off the taxpayer.
Finally, may I urge Ministers to review the operation of the fair access criteria and the rules that underpin them? The rule of provide for one and provide for all, which was clarified by a subsequent judicial review for the London Borough of Harrow, forced the retrenchment of local authorities in adult social care towards serving only the most critical needs of people in our constituencies.
My hon. Friend is giving an excellent speech. One thing he has touched on, but perhaps not expanded on, is the efficiencies that local government has found. Are there any particular lessons that he thinks are relevant to the NHS as we move forward?
Order. We really are pushed for time, and this is not fair on those who are winding up.
Concluding rapidly, Madam Deputy Speaker, that is a very important point. We need to recognise, as many constituents are surprised to discover, that as a matter of law very strict eligibility criteria restrict what they can access. We need to ensure, as we reform the sector, that we free up local authorities to use these resources to meet the demographic challenges.
It is customary when closing a debate to say that we have had a good debate, and indeed we have, but what has been most striking is how inadequate a basis it has been for a change of this magnitude to the tax system of our country. I intend to come back to that point.
We have heard a number of extremely sharp and insightful contributions, including from my hon. Friends the Members for Wallasey (Dame Angela Eagle) and for Nottingham East (Nadia Whittome), who talked very powerfully about how what has been set out does nothing to improve the working conditions facing social care workers, many of whom will now themselves be facing a tax rise. I would just like to say that it is wonderful to see my hon. Friend the Member for Nottingham East back in her place in this House.
We have heard contributions from the Chair of the Public Accounts Committee, my hon. Friend Dame Meg Hillier, and the Chair of the Housing, Communities and Local Government Committee, my hon. Friend Mr Betts, who asked very important questions of Ministers. We did not get answers to those questions, and I hope the Chief Secretary will address the really important points that were raised. I will touch on those a little later.
We also heard from my hon. Friends the Members for Birmingham, Selly Oak (Steve McCabe), for Eltham (Clive Efford), for Bedford (Mohammad Yasin), for Brighton, Kemptown (Lloyd Russell-Moyle), for Bristol South (Karin Smyth), for Lewisham East (Janet Daby) and for Hornsey and Wood Green (Catherine West). They covered a range of different points, but they were all clear that this does not represent a proper plan for the NHS or for social care. It is, instead, a broken promise. Two and a half million working households will be hit by the Tory double whammy of cuts to universal credit and an increase in national insurance.
Understandably, I have focused on contributions from Labour Members, and I am sad that, except for a few Conservative Members—notably Jake Berry—many of those who bravely stated their reservations over the weekend to the Sunday newspapers have been strangely silent this evening. I hoped we might have heard from whichever Tory MP said that putting up national insurance would be “morally and economically wrong”, and that:
“It kicks in at a low level…If you get all your income from investments and property you don’t pay a penny, but if you work your guts out for minimum wage you get clobbered.”
I could not agree more.
That point about rental income has been made on a number of occasions. If someone holds their properties in a limited company and they take their profits through dividends, those dividends are taxed to include the social care levy. Will the hon. Lady put the record straight and accept that that is the case?
It is ludicrous that a landlord will be paying not a single penny more, but their tenants—many of them perhaps working in the NHS or social care—are about to be clobbered by a tax rise. Some 95% of what is to be raised from this measure will come from working people and businesses. What the hon. Gentleman says is simply not right. I understand that one former Cabinet Minister used perhaps more colourful language this afternoon, and I will not test your patience, Madam Deputy Speaker, by repeating exactly what they said. Safe to say, however, that he or she is not a fan of this Tory tax hike.
It is usual for major fiscal events in the House to be timetabled in advance. Indeed, this week the Chancellor put us all on notice of a comprehensive spending review and an autumn Budget at the end of next month. It is also usual for major fiscal events to be accompanied by independent and thorough scrutiny by the Office for Budget Responsibility. It is usual for those forecasts to be published alongside the Government’s plans, so that all Members of the House can understand, in detail, what they are voting for and how it will affect the public finances, the livelihoods of our constituents and the success of the economy.
The OBR’s typically thorough work back in March produced a report with more than 130 charts and tables, but the flimsy document produced by the Government yesterday had just three. I recall when some Government Members were sticklers for the rights of this House, and sticklers for procedure and proper time to debate and consider changes that will have a huge impact on our society and the shape of our economy. It seems that those days are long gone. The change we are being asked to vote through tonight is not being introduced in this extraordinary form because that is right for the country. The House knows that. It is because it is the right approach for the Prime Minister: announcement on Tuesday, vote on Wednesday, and perhaps a reshuffle later this week—Back-Bench rebellion averted. That is no way to run a country.
Let us be clear about what is happening. This House is being asked to approve, with almost no notice, an extra £11.4 billion of taxation on workers and businesses, and an extra £600 million of dividend taxes—95% of the new revenue is to come from taxing jobs and earnings. When this Government need income, they do not turn first to those with assets, stocks and shares and property, or to those with the broadest shoulders who can afford a little more. No, they turn to working people: to those who work hard to earn their income, and their employers. They break a solemn promise that every Government Member made to the people of this country. That is a choice, and it is not a choice that the Labour party would make.
Two other major questions emerge from the contributions today. Where is the Government’s actual plan? We need a real plan for social care, not a few numbered paragraphs and a handful of case studies. Labour’s priority would be to give older and disabled people the chance to live the life they choose, shifting the focus of support towards prevention and early help. Let us not forget in this place that around half of the social care budget supports working-age adults with disabilities. They are far too often overlooked in discussions about social care, and the Government’s announcement does nothing for them.
Alongside a strong and skilled social care workforce, Labour would deliver a new deal for care workers to create a well-motivated and properly rewarded workforce, with clear support for unpaid carers—the very people who got us through the last 18 months, whom we clapped and claimed to care about. There is absolutely no sign of that plan here today or in the documents published yesterday. The document that the Government published yesterday is strikingly poor on the practicalities of delivery, not just for social care but for our NHS too.
Our national health service was chronically overstretched long before the pandemic hit. We entered the pandemic with over 100,000 vacancies. By March this year, there were 5 million people on waiting lists for NHS treatment—waiting longer for cancer care, longer for vital surgery, longer for mental health support. What we have been given today is not a plan; it is the promise—another promise—of a plan to follow. The Minister could not even tell us what the impact would be on waiting times. He could not tell us what it meant for local authorities on the frontline. He could not give us details of how public sector bodies are expected to meet the cost. It is not a plan; it is just a tax rise.
Much of today’s debate has focused on whether it is the right sort of tax rise. Sometimes it is easy to focus on the fiscal aspects and forget the economic aspects. Our recovery is still fragile. Businesses are under enormous pressure. We all know it; many are yet to fully reopen, and many are not yet operating at full capacity. Yet the Chancellor has been putting up council tax, he is slashing universal credit, he is freezing income tax thresholds—he is sucking demand out of our economy at the worst possible time.
The shadow Chancellor, my hon. Friend Rachel Reeves, set out powerfully what these measures mean for working people, but this is a series of hammer blows for firms, too. Small businesses, struggling to get back on track after a terrible 18 months, have been clear, in the words of the Federation of Small Businesses, that this is “precisely the wrong moment” to be putting up the cost of taking on and retaining staff. The FSB estimates that these changes could mean an extra 50,000 people out of work.
This is the wrong process to agree the wrong tax at the wrong time. It will not deliver what is promised for our health and social care sectors. The Health Secretary cannot even tell us whether it will clear the NHS backlog in this Parliament. It will not give social care the resources it needs in the next three years. There is not a plan for reform of social care. This tax rise will not create more and better-paid jobs in the wider economy, it is not fair across the regions, it will not end people having to sell their homes to fund their care, and it will not help our economic recovery. The Prime Minister cannot even guarantee that it is the last unfair tax rise of this Parliament. Tonight, we are not voting for a plan to fix social care. There isn’t one. We are voting on the third Tory tax rise on working people, and we will oppose it.
Let me first thank hon. and right hon. Members for their thoughtful and constructive contributions to today’s debate.
Yesterday, the Prime Minister set out a series of necessary steps to tackle the covid backlogs, reform adult social care and bring the health and social care system closer together on a long-term, sustainable footing. As the House well knows, the pandemic has put unprecedented pressure on the NHS. The number of patients waiting for elective surgery and routine treatment in England is now at a record high of 5.5 million. If left unchecked, that could reach 13 million, an issue of concern across the House. At the same time, this country is facing a long-standing challenge to the social care system. Typically, around one in seven must pay over £100,000 for care, with bills falling indiscriminately on some of the sickest and most vulnerable in society.
The Government’s response, the plan we have debated today, means an investment of £36 billion in the health and social care system over the next three years. Patients across the country will benefit from the biggest catch-up programme in the history of the NHS. The social care system will finally be reformed, ending unpredictable and catastrophic care costs faced by thousands and making the system fairer for all. I gently say to the shadow Chief Secretary to the Treasury, Bridget Phillipson, who said a moment ago that this is not the right time, that many times in this House people have highlighted the urgency of acting both on the covid backlog and on social care.
My right hon. Friend has helpfully said that one in seven—I believe that is what he said—people currently in the care system pay over £100,000. Could he just say in absolute numbers how many that is, in any given year or period he chooses? If he does not have the information with him tonight or cannot get it from the Box, can he write to me with that information and put a copy in the House of Commons Library before we have our next debate?
I am glad my right hon. Friend highlights that point. Let me address it in two ways, because it goes to the crux of his remarks in the debate. We have set out, as was referred to even by critics of the Government, the illustrative analysis of the impact of this from a distributional point of view, with lower-income households being the largest net beneficiaries. We have also said that we will say more on that, because it will evolve by 2023, when those of state age who are working come within scope. Obviously, the distributional analysis will change.
Let me take head on my right hon. Friend’s central concern, which was that his constituents in Rossendale and Darwen, because of lower housing costs, will be disproportionately impacted. First, if one looks at London, the Evening Standard, for example, is concerned that 14% will pay the lion’s share of the cost because that is where the highest concentration of higher tax payers are. For his constituents, one key aspect of the reform is that, through the cap, it ends the unpredictability of costs. If I look at the north-east of England, the Resolution Foundation found that only 29% of individuals aged over 70 have sufficient eligible assets that they will not receive any state support. The point is that the uplifting in the means test, which my right hon. Friend the Chancellor set out, again benefits those parts of the country he was championing.
I have just given way and addressed my right hon. Friend’s points head on. Let me, in turn, address head on the points raised by the shadow Chancellor, Rachel Reeves.
In the shadow Chancellor’s speech, she said that she opposed the levy despite, as a number of Members pointed out, the previous Labour Government taking a similar approach in 2002-03, because she supports taxing wealth. The problem with that is that only a broad-based tax base, such as income tax, VAT or national insurance contributions, can raise the sums needed for such a significant investment. Again, that was a point made by critics of the Government, including my good friend, my hon. Friend Mr Baker. It could not be raised by taxes on wealth. Currently £6 billion is raised from inheritance tax, £8.7 billion from capital gains tax and £12.3 billion from property transaction tax. Indeed, that case was demolished by the Chair of the Treasury Committee, my right hon. Friend Mel Stride, as well as by my hon. Friends the Members for Dudley South (Mike Wood) and for Thirsk and Malton (Kevin Hollinrake), who highlighted that to raise the revenue required requires a broad-based approach.
On the subject of cases being demolished, one of the cases that the right hon. Gentleman’s colleagues have made great deal of play of today is that of the fictional Yusuf in the Government’s own document. According to the Government, Yusuf’s care home costs are £700 a week. They claim that under the current system they would have had to spend £293,000 before they reached the current cap. The Minister will be aware—I hope he can count—that in order to spend £293,000 at £700 a week—
I would like the hon. Gentleman to put his question.
What percentage of people going into a care home have any chance of still being alive in nine years’ time?
One of the features of the Dilnot proposals—Dilnot has been very frank about this—is that his costs ramp up over time. That is why the initial funding is £5.4 billion, but obviously, the social care element will increase. I will come to the case put forward by SNP Members, who seem bizarrely not to want the Union dividend that is offered and to not be seeking that additional funding. Let me finish on the Opposition amendment—
I will come to the points on devolution and happily give way at that stage, but let me just deal with the Opposition amendment, which requests a distributional impact assessment. As we have covered, that has been set out today. The Government have already published a document on the impact of our health and social care plan on households, looking at the impact of the new spending and the levy, with a full distributional analysis being published at the Budget and spending review.
As for the impact on businesses, businesses will play their part in funding this plan. However, existing national insurance contribution reliefs and allowances will also apply to the levy. This means that 40% of all businesses will not be affected due to the employment allowance, and it allows eligible employees to reduce their national insurance liability by up to £4,000. Again, that point was brought out by my right hon. Friend the Member for South West Wiltshire (Dr Murrison), who highlighted the impact on business and the fact that businesses, with 1% of the highest turnover, will cover 70% of the cost.
I think the right hon. Gentleman probably knows which point I am going to raise. I am very interested in the impact on local authorities. Out of the £36 billion that will be raised over three years, how much extra money will go to local authorities after the costs of the “cap and floor” system have been taken into account? How much extra money over three years will go to local authorities out of the £36 billion?
I listened very closely to the hon. Gentleman’s speech, because he is a very informed and knowledgeable commentator on these issues. He rightly pointed to paragraph 36, where we are being very clear about the role in terms of demographic and unit pressure. As he well knows, part of the discussion at a spending review is to look at local government pressures in the round. That is in the context that local authorities are getting an additional £2.2 billion of funding. I remind the House, in terms of the adult social care flexibility that was allowed for councils this year, that out of the 152 local authorities, less than two thirds actually used that flexibility. That is part of looking at these issues in context.
Let me come to the central point put forward by the Scottish National party, which was very well demolished by my hon. Friend John Lamont. All parts of the United Kingdom need a long-term solution to fund health and social care. The Scottish Government’s independent review of adult social care recently noted—[Interruption.] I am quoting from their own review. I thought they would want to hear that. It stated that
“Scotland’s ageing demography means that more money will need to be spent on adult social care over the long term”— and its recommendations to the Scottish Government are that this would
“require a long-term and substantial uplift in adult social care funding.”
In fact, in 2002, John Swinney said that a 1% increase was
“progressive taxation…required to invest in the health service in Scotland”.—[Scottish Parliament Official Report,
Does the right hon. Gentleman accept that that was 18 years ago and that things have changed? Since that time, national insurance has not been reformed in any way to protect the poorest, as income tax has been.
Obviously, what SNP Members regard as progressive has changed. The point is that if they disagree with this, they can adjust their Barnett consequentials, spend that and reprioritise their spending accordingly. Indeed, likewise, Jonathan Edwards—I hold him in great affection and he speaks very powerfully in the Chamber—said that these are “English priorities”. Clearing the covid backlog and addressing the challenges of social care are not English priorities. They are United Kingdom priorities, they are this Government’s priorities, and they are the people’s priorities.
This levy will enable the biggest catch-up initiative in the history of the NHS, a comprehensive long-term solution to the social care challenge and a significant long-term investment that will directly improve people’s lives.
Those are things that I think my hon. Friend Mr Bone values, and I hope he will support them.
The Prime Minister said yesterday:
“You can’t fi