Health and Social Care Levy Bill - Second Reading (and remaining stages)

– in the House of Lords at 3:20 pm on 11th October 2021.

Alert me about debates like this

Lord Agnew of Oulton:

Moved by Lord Agnew of Oulton

That the Bill be now read a second time.

Photo of Lord Agnew of Oulton Lord Agnew of Oulton Minister of State (HM Treasury), Minister of State (Cabinet Office)

My Lords, it is a pleasure to open this Second Reading debate on the Health and Social Care Levy Bill. This is a short but very important Bill that aims to legislate the plan announced by the Prime Minister on 15 September. The plan will 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 substantial difference to the lives of millions of people across this country. It will be funded with a record £36 billion investment in the NHS and social care systems. Noble Lords will be aware that such an ambitious plan requires funding. In order to pay for a significant increase in spending in a responsible and fair way, the Bill before the House today introduces a new 1.25% health and social care levy. 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 or class 3 NICs. It will be introduced from April 2022 and, from April 2023, the levy will also apply to those working over the state pension age.

Noble Lords may be aware that it takes time for HMRC to prepare its systems for such a major shift. That is why, as set out in Clause 5 of the Bill, in 2022-23, the levy will be delivered through a temporary increase in NIC rates of 1.25% for one year only. I would like to make it clear that all net revenues generated by the temporary increase in NIC rates will be ring-fenced and paid to NHS England, NHS Scotland, NHS Wales and the equivalent in Northern Ireland. From April 2023, the temporary rise in NIC rates will be replaced by a formal legal surcharge of 1.25%. Clause 2 of the Bill sets out that this revenue will be ring-fenced for health and social care only.

It is the intention that existing NIC reliefs and allowances will also apply to the levy. That will mean 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. The top 14% of taxpayers will pay around half the revenue raised. Conversely, at least 6.2 million people earning less than the NIC primary threshold will not pay the levy at all.

Let me once more remind Noble Lords today why this levy is so crucial. As the Prime Minister and the Chancellor have said, this levy will enable the Government to properly fund the NHS, so that it can recover from the pandemic. Senior NHS leaders have made clear that without additional financial support we will not properly be able to address the significant backlog in the health service. To get everyone the care they need will take time and will require additional revenue.

In addition, our social care plan aims to create a dramatically expanded safety net for people in their later life. This means that, instead of individuals having to bear the financial risk of catastrophic care costs themselves, we as a country are deciding to share more of that risk collectively. This is a permanent, new role for the Government and a structural increase in the size of the British state. We therefore need a permanent, new way to pay for it. Noble Lords will be aware that the only alternative would be to borrow indefinitely. That would clearly be the wrong course of action when our national debt is already the highest it has ever been in peacetime. Borrowing ever more today just means higher taxes in the future.

We need to fund our vision for the future of health and social care in this country over the longer term. As the Prime Minister said, with proper funding, we can tackle not just the NHS backlog and expand the social care safety net but afford the nurses’ pay rise, invest in the best equipment, prepare for the next pandemic, provide the largest investment ever to upskill social care workers and build the modern, more efficient health service that the public across the UK deserve.

To conclude, this 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 beg to move.

Photo of Lord Eatwell Lord Eatwell Labour 3:26 pm, 11th October 2021

My Lords, I am grateful to the Minister for his brief introduction to the Bill.

The key promise of what he has described as the permanent new role for the Government, as expressed in the Bill and accompanying documentation, can be described as the introduction of the health and social care levy, which will mean that, between 2019 and 2025, the NHS England budget can increase by 3.9% per year in real terms. That is slightly above the long-run average of 3.6% in UK health spending. However, it is well above the 1.2% per year seen in the Conservative austerity years from 2010 to 2019, in which the share of GDP spent on the NHS fell year after year, leaving the NHS severely weakened when the pandemic struck. However, even this new higher rate of investment in the NHS will be well below the average of 6% per year seen under the Governments of Tony Blair and Gordon Brown.

It is useful to start from the fact that the Bill consists of three semi-independent strands woven together. First, there is the introduction of a new hypothecated tax: the health and social care levy. Secondly, there is the predominant alignment of the base on which the new tax is charged with the present tax base of national insurance contributions. I say “predominant” because the levy is also to be funded by the extension of NICs to those over 65 and by the dividend tax promised in the Budget later this month. Therefore the tax base is potentially malleable: it need not be NICs and it is not entirely NICs even at the beginning. Thirdly, there is the transitional arrangement of raising overall taxation in 2022-23 via the one-year increase in NICs—the transitional year.

To assess the true impact of the Bill it will be helpful to deal with these three strands of the Bill in order, beginning with the first strand: the new hypothecated tax. It is well known that hypothecation is a dirty word in the Treasury. National insurance contributions, for example, are not allocated uniquely to national insurance, and the road tax is not used for the upkeep of roads. Yet here we have a substantial increase in taxation that is, we are assured, pre-allocated to health and social care. Given the historic experience with other fictional hypothecation, it is reasonable to ask: for how long will this last? It is noticeable that Clause 4 allows the Treasury to use the levy to make different provision for different purposes, not necessarily the purpose described by the noble Lord. The only conclusion can be that this is a grudging and perhaps temporary hypothecation—a temporary uplift in NHS spending sufficient to buy political time as NHS waiting lists reach all-time highs. Can the Minister make it crystal clear: is this hypothecation here to stay or is it a temporary political expedient?

Once introduced, taxes tend to rise, so does the Minister expect an expanded role for this new hypothecated funding of health and social care? Or does the Minister agree with the assessment of the Institute for Fiscal Studies that

“In the short run, the additional revenues may be spent on boosting spending on health and social care. In the longer-run, the hypothecation is an illusion”?

If for now we accept the Government’s commitment to hypothecation, what is the rationale for the second strand: basing the levy predominantly on the NICs base rather than any other tax base? It is, after all, obvious that this will solely impact individuals whose income is mainly made up of earnings or profits, as opposed to other forms of income such as property income, pension income or savings.

When the Minister replies, will he explain why the levy does not cover income from buy-to-let properties? Why does the levy target the 17% of pensioners who work, while allowing wealthy pensioners receiving income from other sources to escape scot free? And why does the levy fall on low-paid workers?

Given the evident unfairness, I find the Government’s attempts to justify the distributional impact of the levy in the document entitled Illustrative Analysis of the Impact of “Building Back Better: Our Plan for Health and Social Care” a disturbing insight into Tory instincts where the NHS is concerned.

It is customary for the Treasury to accompany fiscal changes with an analysis of the distributional consequences of those changes: the impact on the poorest 10%, the next poorest 10%, and each decile up to the wealthiest 10%. Here, for the first time, the Treasury presents the impact of the levy on individual social groups together with what it believes will be the consequential spending on healthcare from which that social group would benefit. In other words, payment of the levy by a given group and the provision of healthcare to that group are linked. It is but a short step from this approach to the idea that payment for healthcare and receipt of healthcare should be linked—a negation of the fundamental character of our NHS, in which funding and the delivery of care have never, before this document, been linked. I hope that when the Minister sums up, he will disown the document.

I turn to the third strand: the impact of the increase in NICs and the dividend tax from their introduction in April next year. The policy paper published by HMRC on 9 September sketches—the appropriate word for something that is very limited—the various impacts that the Government have considered. For example, HMRC refers to the impact on households:

“There may be an impact on family formation, stability or breakdown as individuals, who are currently just about managing financially, will see their disposable income reduce.”

This is not the Opposition speaking, it is HMRC. On business, the Government tell us:

“This measure is expected to have a significant impact on over 1.6 million employers who will be required to introduce this change.”

On the economy as a whole, HMRC says:

“The measure is anticipated to have a significant macroeconomic impact, with consequences including but not limited to for earnings, inflation and company profits. Behavioural effects are likely to be large, and these will include decisions around whether to incorporate or not, and business decisions around wage bills and recruitment.”

That is all rather serious stuff. Will the Minister tell us what steps are being taken to offset the impact on those who HMRC says are just about managing financially and who will see their disposable income reduced? Is he content to serve in a Government who wilfully introduce extra taxation that they acknowledge will hit those who are just about managing while at the same time cutting universal credit? Is he proud to be doing this to those who are suffering in-work poverty?

What of the impact on those 1.6 million employers—many of whom, as HMRC says, may well be reassessing business decisions on wage bills and recruitment? Will the Minister tell us exactly what the Government anticipate will be the scale of the impact on recruitment? Does he agree with the assessment of the Federation of Small Businesses that the levy will result in 50,000 fewer jobs being created? Does he agree with the Institute of Directors, a well-known left-wing organisation, which argues that:

“This is an extraordinary time to be adding additional burden to business and the cost of employing staff”?

Where are we to find the Government’s assessment of the impact of these measures on earnings, inflation and company profits? We have been offered none. However, the Institute for Fiscal Studies has again commented that:

“Following a rise in income tax of £8 billion and in corporation tax of £17 billion in the March Budget… the Chancellor has announced a further tax rise of £14 billion… which if delivered will raise the tax burden in the UK to the highest-ever sustained level.”

When the economy is struggling to recover from the pandemic, when the furlough scheme has ended, when business support has ended, leaving small and medium-sized companies with debt-laden balance sheets, when output is barely back to pre-pandemic levels and is hampered by serious supply chain problems and fuel shortages, the Government raise the tax burden to the highest-ever sustained level. Does the Minister consider that in this critical recovery period, the introduction of a levy that will have “significant macroeconomic impact” is quite such a good idea?

Finally, we come to the most important question of all: will it work? A fundamental issue must be the division of revenues between the NHS and the social care providers. As has been made clear, spending will be heavily weighted towards the NHS in the first three years, and then perhaps there will be some crumbs for social care. How can the Minister really pretend that this is the plan that the Prime Minister promised two years ago? To quote the Institute for Fiscal Studies once again:

“While the precise path for spending—and hence for the availability and quality of care—is unclear, it is clear that the extra funding will not be sufficient to reverse the cuts in the numbers receiving care seen during the 2010s”— the great austerity period.

“Thus, while more people will become entitled to financial support as a result of the reforms planned”, as the Minister told us,

“many people with care needs not considered severe enough will continue to miss out.”

In fact, the focus of what has been announced is almost entirely on changing who pays for care rather than directly addressing the growing problem that too few people are getting the care they need in the first place.

In his introduction to Build Back Better: Our Plan for Health and Social Care, the Prime Minister writes:

“We will bring the health and the social care systems more closely together”.

Over the weekend, there have been suggestions in the press that the Government are planning to create a national care service, integrated in some way with the NHS. If this is so, will the Minister tell the House what will be the role of the levy? Will it be raised further for what will be an expensive operation? Will hypothecation be extended?

I am afraid that the Bill is a typical example of ill-thought-through legislation, rushed through Parliament to spare the Prime Minister political embarrassment. If this was a plan ready more than two years ago, why the need for fast-track legislation? The explanation given by the Government is, I am afraid, disingenuous:

“The legislation is required to be in place for the 2022-23 tax year, which starts on 6 April 2022. The increase in National Insurance rates for that year will require changes to be made to the systems of employers and HMRC … it is important for both those employers and HMRC to have as much time as possible to implement the changes.”

All this amounts to saying that, even though the Government have announced the policy, with great fanfare, uncertainty about whether it will be put into effect persists, halting action until the relevant legislation is passed. In other words, a Government with a majority of 80 in the House of Commons are uncertain whether they can pass a money Bill. Pull the other one.

The rush was clearly designed to limit the time for proper scrutiny of the Bill and its many implications—scrutiny that your Lordships’ House can provide this afternoon. With that proper scrutiny, it will be evident that the provisions in the Bill are ill-thought-through and unfair, and will have potentially serious macroeconomic consequences.

Photo of Lord Haskel Lord Haskel Deputy Chairman of Committees, Deputy Speaker (Lords)

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

Photo of Baroness Brinton Baroness Brinton Liberal Democrat Lords Spokesperson (Health) 3:42 pm, 11th October 2021

My Lords, I declare my interests as a vice-president of the Local Government Association and a vice-chair of the All-Party Parliamentary Group on Adult Social Care. I also declare that I am disabled as a result of a long-term condition, and that my husband is my unpaid carer.

From these Benches, our focus is to see how this levy Bill will benefit those using social care and those working in it who are trying to provide an essential but frankly invisible service against impossible odds. There is no doubt that they have hoped that this Government will introduce real reforms for the care sector, especially after Ministers’ abject failure to protect people in care homes during the pandemic: from the lack of tests and PPE, to lies about a “protective ring” around care homes while people died in horrifying numbers. The way hospital patients were moved into care homes to free up space without being tested for Covid was equally horrifying for patients, their families and the staff in care homes, too.

The current underlying problems in our care sector were there long before the pandemic. We have an iniquitous funding system, with the general public not understanding that they are more than likely to have to pay for their care, and that the so-called “hotel costs” of living in a care home—accommodation and food—will now be separated out.

Ten years ago, the three major parties all came together to support the proposals of Andrew Dilnot’s review—but, just before we were going to achieve success, the Conservative Party walked away. Over the succeeding decade, the crisis in the sector has worsened considerably, not least because of the draconian cuts to local councils and other local services, especially to those that are there to help keep people out of homes, to keep their independence and their lives going. The current pricing of beds and the cuts to day services mean that independent living, which really would help keep people out of homes, just is not there. Staff in the care sector, unlike in hospitals, are paid at the minimum wage because, shamefully, as a society we regard social care as unskilled, when those of us who know the sector well see the exact opposite.

Worse, the funding rates for residents are based on most staff being on the minimum wage, making it impossible now for employers to compete with retail, hospitality and agriculture, where employers are charging customers more and are then able to pay their staff more. Worse, these dedicated staff, under this proposal, will be paying an increase in national insurance, which will further reduce their income at the exact time that they are facing cuts to universal credit and increases in the cost of energy, food and many other items. The limits on publicly funded costs and the iniquitous position of privately funded beds now cross-funding those in beds funded by the state must stop—and now. But this means that the real rates need to be paid to reflect that cost.

The paper Build Back Better: Our Plan for Health and Social Care, published last month with a foreword by the Prime Minister, is not a plan for health and social care. It is a funding plan for how people pay for their care and for the NHS, and for what element is paid for by the state. The Minister has set out the structure for paying the costs of those who will need support beyond the proposed cap, but not, as many think, for extra front-line funding for our care homes. Even worse, the public do not understand that this cap excludes all of the so-called “hotel costs”, regardless of the resident’s length of stay. That means that those who believe this Conservative Government’s words that they will no longer have to sell their home might find themselves, if they are asset-rich and pension-poor, likely to have to sell their home anyway for a large portion of their weekly care costs. This sleight of hand is breath-taking.

The extra funding referred to by the Minister in the paper for the next three years is first and foremost for the NHS, which is likely to have to absorb the 3% pay rise that the Government have graciously given it, as well as deal with the backlog from the pandemic. Once again, the Government are blunt: social care will get whatever sits behind and is left from that NHS spend. Already, many in the care sector are concerned that there will be nothing left for social care, so I really hope that the Minister will be able to say what funding from the £12 billion announced in the paper is guaranteed for the social care sector. Will any extra be provided if the NHS needs it all?

I echo concerns about what was said in newspapers over the weekend. There were leaks from the Government that local authorities might well be required to fund support for social care increases via council tax increases of 5% per annum for three years. That is another deeply regressive tax that puts a very specific burden on the lowest paid in our society. I echo concerns about the rumours outlined by the noble Lord, Lord Eatwell, about integrated health and care services in the future. Is this not all totally upside-down and back-to-front? Surely the principles of reform should be announced first, before a funding mechanism is agreed by Parliament. Despite the fact that the Commons is already looking at the Health and Care Bill for integrated care structures, the Prime Minister’s proposals for reform of the social care sector remain stubbornly in his mind and behind the closed doors of No. 10. There needs to be honesty about the direction; reforms must be long-term and total. They are missing at the moment, and this is a key element.

How will the delivery of social care itself be reformed and do we know that the funds sought through the levy will be adequate for it? From these Benches, we were clear in our 2019 manifesto that we would raise additional revenue that would be ring-fenced to be spent only on NHS and social care services through income tax. This would be generated from a 1p rise in the basic, higher and additional rates of income tax. We would use this cash to relieve the crisis in social care and urgent workforce issues and to invest in the mental health and prevention services that I outlined earlier. This frankly represents an efficient and effective way of spending these extra resources and ensuring that they will have the greatest impact on the quality of care that people receive.

We from these Benches have been calling on the Government not to delay any longer and to engage urgently in cross-party talks on the wider future of social care. If the Prime Minister has not yet announced his reforms to social care but keeps saying that he is prepared to talk to other parties, why are we not talking now? Perhaps the Minister could remind him.

Two years ago, Boris Johnson pledged from the steps of No. 10 that he would fix the crisis in social care once and for all, as a top priority. But with social care services in crisis, it is time that he sets out how he plans to do it. Instead, people are selling their homes to pay for care and more than 1.5 million people are missing out on the care they need. More and more people are stranded in hospital, unable to leave because the follow-up care just does not exist, and the staffing crisis in the sector worsens daily. This is putting an increased strain on the NHS, which does not have the cash to cope.

The cost of inaction and delay is falling on the shoulders of the over 11 million unpaid carers in the UK, whose contribution to the current social care system is almost completely ignored. The cost of reform to the Government might seem large, but it is a fraction of the true cost to families across the country. Carers UK estimates that unpaid carers already save the Treasury £193 billion a year. Any discussions of funding for social care services need to include discussions on fair pay and support for hard-working carers employed in the sector. This pandemic has reminded everyone that caring for people’s health does not stop at the hospital exit or the GP’s surgery door. We can improve the NHS only if we properly support carers, whether unpaid family carers or dedicated staff working in homes and in patients’ homes.

This Bill does not build back better; it is a building block to start the funding mechanism, but one that uses national insurance, disproportionately affecting those on low incomes, including, critically, those working in the sector. Perhaps that is this Government’s secret plan. After all, the Secretary of State for Health and Social Care told the Conservative conference last week that we did not need the care sector, as families should just look after their own. Of all the comments from Ministers over recent weeks, that was the most chilling. I hope the Minister can reassure us that the Government believe in, and support, our hard-pressed social care sector and recognise the real need for reform beyond the financial levy. From these Benches, we remain prepared to help.

Photo of Lord Forsyth of Drumlean Lord Forsyth of Drumlean Chair, Economic Affairs Committee, Chair, Economic Affairs Committee 3:52 pm, 11th October 2021

My Lords, it is a pleasure to follow the noble Baroness, who speaks with such authority on this subject. I very much welcome the Prime Minister’s determination to fix social care. However, this Bill does not do that. It is a bit like going into a restaurant and being presented with a bill for the meal before you have even seen the menu. I have to say to my noble friend the Minister, whom I admire enormously, that to speak for less than five minutes on a Bill of this importance to the economy and to millions of families—a Bill which has been rushed through for reasons that I still do not quite understand—says something about the relationship between government, the Executive and Parliament itself.

The Bill certainly will not fix social care but it will massively increase the regressive nature of the taxation system, because, as has been made clear, it will place the burden on those who have least, not those who have most. Way back in 2006, when we were in opposition, George Osborne and David Cameron asked me to spend a year of my life with some very able people of all political persuasions to produce a tax reform document. One of the recommendations was to look at merging national insurance with income tax. This is an absolute missed opportunity for those of us who believe we need a simpler, fairer, flatter tax system in our country.

I have a number of questions on the tax aspect. What measures will be in place to prevent people getting round these national insurance increases? I can see even now—well, I cannot actually see it, but I can imagine it—people in the City thinking, “Those bonuses we were going to pay in April, perhaps we had better pay them in March.” How will we avoid the loss of expected revenue? Will measures be brought forward to avoid forestalling?

I will concentrate on social care. The Economic Affairs Committee, which I chair, produced a report more than two years ago called Social Care Funding: Time to End a National Scandal. We set out a series of arguments. Since then, we have had a number of debates in this House on this subject. There has been unanimity across the House on the need to deal with this urgently. Since then, and in the run-up to the publication of that report, demand for social care has grown and grown—and not just among the elderly. One of the really frustrating things about this debate is that everyone seems to focus on the elderly. We are told that it is not fair that young people have to pay for the needs of the elderly, yet half the budget goes on people of working age; the demand from that group is growing as well.

Our report set out a number of questions for the Government. I am very pleased that my noble friend Lord Bethell will speak later in this debate. At each and every debate, he has said that the Government will produce a White Paper but that they want to follow the recommendations of the Economic Affairs Committee and find a solution on an all-party basis, so that it is permanent and so we can move forward. This is certainly not an all-party solution. In case people think I have gone native, I also think it is a bit rich for the Opposition to keep criticising what the Government are doing, without putting forward their own proposals on social care.

In this context of increasing demand, our committee reckoned that it was necessary to spend £8 billion on social care just to get back to the standards of care that existed in 2010. This Bill aims to raise £12 billion, but that will not touch the sides of the problems which face the social care industry and the people who depend on it.

My right honourable friend the Chancellor said that it was a moral duty to ensure that the costs of this were met by an increase in taxation and not by borrowing. Personally, I think we need to think about how as a nation we can generate the wealth to meet our obligations to the elderly. If we are going to talk about moral duties, it is certainly a moral duty to ensure that there is a safety net below which those vulnerable people will not fall. And they are falling.

This Bill, and the Government’s proposals set out in that document, do nothing to address immediate needs. As the noble Lord, Lord Eatwell, said, it is not clear how much of the £12 billion will actually go to social care. Last time we had an emergency payment for the National Health Service, it was £20 billion, and it disappeared into the health service. How much of it went to social care? Almost nothing. The entire cost of social care then was £20 billion. Some people refer to social care as the Cinderella service, but in this case, Cinderella never gets near to going to the ball. That is true of these proposals.

We are told that this will happen in 2023 and we are told that the Dilnot report is the answer. When our committee looked at Dilnot, we were concerned. If you have a cap on spending, the level at which the cap is set is very important, and £86,000 is quite high. Most people will, sadly, spend only three years in nursing care, so you would have to go pretty hard to spend £86,000. Does it apply then only to those who might spend a long period in nursing care? That is okay, but how will the £86,000 cap be calculated? Will we have an army of bureaucrats going through every invoice and every type of care provided in the course of a lifetime? No. I suspect—and the Government’s own publication hints at this—that it will be calculated on the basis of what the local authorities would have paid. But we know, and our report pointed out, that the local authorities’ rates are being subsidised by self-funders, who are sometimes charged as much as 40% more than the going rate for the local authorities. That is not to blame the local authorities; they do not have the money, so they try to squeeze.

What is the solution put forward for this? It is that everyone, even if they are a self-funder, can have their place found by the local authorities. That will not provide the revenue for the people who run the nursing homes. As a result, the nursing homes are going to disappear. Indeed, it is already happening that they favour self-funders because of the differential.

When we started our report on social care, I was attracted to the idea of a cap because the insurers would then be able to come in behind it. It will not work, however, because of the size of the cap and because, on the whole, people will not buy insurance for something they think will not happen to them. It is hard enough to get them to invest in pensions, when they know—or hope—that they are going to get old. They do not hope that they will require care in a nursing home or elsewhere.

The most chilling thing of all—because none of this money will be allocated to social care in the short term—is that it will all be left to local government. Over the weekend we heard the hints that the noble Lord, Lord Eatwell, mentioned: that local government will need to pick up the strain here. It does not have the money. If it goes on the council tax, that will be even more regressive and damaging and will introduce a postcode lottery for care. The sad thing is that some of the local authorities with the broadest tax base have the least demand, and those with the narrowest tax base have the most demand. There would therefore be inequality. Building up? This is building down. A postcode lottery would be the consequence.

What will the Government do to fulfil the Prime Minister’s promise to fix social care? I have been watching the Brown-Blair films, and there is a bit where Gordon Brown is alleged to have said to Tony Blair: “You have stolen my”—expletive deleted—“Budget”. I have a feeling that the Chancellor’s Budget has been stolen a bit here, because we have a commitment in this respect, but where are we on local authority funding? If we are really to fix social care, I assume that the Chancellor will make a very generous settlement to local authorities in order for them to provide the means they need to deal with this problem now. I hear someone saying it is unlikely—have faith.

If the Government really want to fix social care and are committed to the Dilnot solution, why on earth are they not doing it now? The legislation that provided for Dilnot was passed in the Care Act 2014—seven years ago. It is there on the statute book; they could do it now. What we are seeing here is a bit of: “I need money for the health service and I need money for social care. Let’s think of a number that’s not quite big enough, and we’ll say that we’ll do it first for the health service and then social care will get it.” If you believe that, you will believe anything, because the truth is that the National Health Service needs that £12 billion and, three years on, the money will not be available—just like the £20 billion put in before, as I mentioned.

I have a question for my noble friend: is domiciled property to be included in the means test for domiciliary care? At the moment it is not. If it is, it will create a huge incentive for people to go into nursing homes and a real unfairness for people who wish to be cared for in their own homes.

I did a few calculations, in case my noble friend thinks I was being unfair about the regression. If you are an average worker on an average wage and are paying the basic rate of income tax at 20%, and you work that little extra to create that extra £1 of value, 20% of that disappears in income tax, 13.25% disappears in national insurance and your employer has to give up 15.05%. In other words, 48.3% of every £1 disappears—and we wonder why our productivity is low when those are the incentives. I do not believe that national insurance was the right tax to use to achieve the purpose that the Government intend.

Of course, it is too late to say that now. We cannot change it in this House; we have to leave it to the House of Commons. A decision has been taken, but it is for the Government to fulfil the Prime Minister’s promise to fix social care and that means looking at the resources provided to local authorities, which have been absolutely heroic. My bins get emptied once a month now. Almost every service has been cut to the bone in order to try to help those people needing care. We look forward to the Budget at the end of the month and the fulfilment of the promises that have been made.

Photo of The Bishop of Carlisle The Bishop of Carlisle Bishop 4:06 pm, 11th October 2021

My Lords, it is a privilege and a little daunting to follow the noble Lord, Lord Forsyth. I should declare an interest in this debate, given that I share with my brother in caring for our 93 year-old father who has dementia. He lives with each of us for six months at a time.

To be positive for a moment, I should also say how grateful I am that the ongoing nettle of funding social care is being grasped, at least tentatively, by this proposed levy when, for so many years, it has been studiously avoided or ignored. Nor would I wish to quibble with the obvious benefit of this proposal for our hard-pressed NHS, resolving as it will at least some of the backlog of diagnosis and treatment that has built up during the pandemic. Despite the hesitations already expressed about Sir Andrew Dilnot’s proposals, I am glad of signs that some of them—now 10 years old—are being partially implemented. I am also delighted that the question of integration between health and social care is, at least on the surface, being taken seriously at last.

But—and it is quite a significant but—there are several problems with this proposal, in addition to those which have already been raised, which demand our attention. First, we have already referred to the relatively small amount of money raised over the next few years that will actually go into social care when the whole social care system is already on its knees and in danger of breakdown.

Secondly, even after two years, there are real questions about whether the funding allocated will be enough and, indeed, as the noble Lord, Lord Eatwell, has indicated, whether this hypothecation will actually last.

Thirdly, little attention has been given as yet to workforce planning, which goes hand in hand with the developing integration of health and social care and is so crucial for the future. We are promised more of this in the forthcoming White Paper, to which I look forward and which will, I hope, also address issues such as the value and status of paid carers, many of whom will in the near future find themselves even worse off than they already are due to a combination of the levy, the removal of the universal credit uplift and the rising cost of energy and other goods, as mentioned by the noble Baroness, Lady Brinton.

Fourthly, the massive contribution of unpaid carers—really massive—is not yet properly recognised. We need further proposals for funding carers’ breaks; for increasing the carer’s allowance; and for honouring the Government’s manifesto pledge on leave from the workplace. However, I am pleased to know that unpaid carers will be consulted about the White Paper and blueprint for adult social care which we all await with some eagerness.

The fifth point is that people of working age with complex disabilities currently account for about half the total spend on social care, as mentioned by the noble Lord, Lord Forsyth. I hope that they will also be consulted to ensure that any reforms in future meet their needs. Sixthly, while welcoming the money that will be aimed at hospital discharge and rehabilitation—about £500 million—I wonder whether this relatively small sum will be enough for the sort of preventive measures that could make such a huge difference to the current demand for social care.

Finally, whatever the amount raised by the levy and however it is ultimately distributed, the biggest question of all—this has been raised by the noble Baroness, Lady Brinton, and so graphically by the noble Lord, Lord Forsyth—relates to the quality and nature of the care on which this money will be spent. We on these Benches were unsuccessful in proposing a cross-party Select Committee to consider that issue, so instead we have established a commission that has been tasked with reimagining social care in this country. We look forward to sharing our findings in due course with both Her Majesty’s Government and Members of your Lordships’ House.

Photo of Lord Macpherson of Earl's Court Lord Macpherson of Earl's Court Crossbench 4:11 pm, 11th October 2021

My Lords, I draw attention to my declaration of interests in the register, including the ownership of a flat that I rent out.

I have long been in favour of a health and social care levy and, unlike most former Treasury officials, I am in favour of the hypothecation set out in the Bill. It was clear long before we knew about Covid-19 that the country would need to spend more on the national health service and social care. Demographic pressures have been building for some time and are set to increase further over the next three decades. The events of the last year have confirmed that care home provision is simply not good enough. It is a mark of a civilised society how a country treats those in need of the greatest care.

It has also been clear for some time that the Government have lost the will to find offsetting spending savings to pay for demands on our health and social care system, so taxes have to rise. I have no great problem with that. With gilt yields rising, debt interest promises to be the fastest-growing programme in the spending review. Better to finance current spending out of revenue than through borrowing. So I congratulate the Treasury and the Minister on achieving something all too rare: persuading an oversensitive No. 10 to accept a tax rise that breaks a manifesto commitment. This is not a forced tax rise of the sort that followed crises in 1976, 1992 and 2009 but a discretionary one. The Government are choosing to spend more, so they are taxing more.

I am tempted to leave it at that, but I feel duty-bound to take issue with three aspects of the tax. First, there is the issue of fairness. It is a principle of sound taxation that the tax base should be as wide as possible to keep rates as low as possible. Here I fear the Treasury has missed a trick. The health and social care levy should be paid by everyone, old as well as young, and should be payable on all income.

I welcome the Chancellor bringing dividend income into the levy’s coverage, but I am puzzled that rental income is exempt. The fact is that rental income has its own income tax schedule, Schedule A, so it would be easy enough to ensure that such income bore a higher rate of income tax. Indeed, for much of income tax’s 220-year existence, unearned income incurred a higher tax rate than earned income. That has been turned on its head over the past 40 years as Governments have chosen to channel tax increases through national insurance and tax cuts through income tax. However, the issue of rental income is a matter not just of fairness but of economic efficiency. Housing already receives substantial privileges, which further entrenches the bias in favour of property investment over equity investment. Rentiers generally do not need additional privileges—they have enough already.

I am also concerned that the levy further increases the differential in tax between employees and the self-employed. However, having spent 30 years of my life trying to persuade politicians to close this gap, only to see the noble Lord, Lord Hammond of Runnymede, try and fail the year after I left the Treasury, I am sufficiently realistic to accept that there is a zero chance of correcting this anomaly.

My second concern is that Government have decided to apply the levy to employers by increasing the rate of national insurance that they pay. This is sleight of hand, as the incidence of the tax and its economic effect is the same whether it is borne by employees or employers. It would have been much more transparent to introduce a levy of 2.5% payable only by individuals. I fully understand that taxing employers is easier politically—they do not have many votes—but, as always with tax, there is no free lunch. Employers’ national insurance is a tax on jobs. Tax more employment and you get less of it. That is why Margaret Thatcher abolished the national insurance surcharge in the 1980s.

I recognise that this Government have a rather different attitude towards business. The Chancellor has announced over £40 billion of tax increases this year. Nearly two-thirds of these will be borne by business in the form of high corporation tax and national insurance. That may be good politics, but at a time when Brexit has made it more important than ever that the UK is business-friendly, it is almost certainly bad economics. That, in turn, makes me wonder whether the Government will succeed in making the tax increase stick. Over the past 50 years, there has been many a radical tax change. Tax rates have swung wildly, new taxes have been created and old taxes abolished, but throughout this period, the tax take has remained stubbornly stable. No Chancellor has managed to get tax receipts above 34.1% of national income. Many Chancellors have forecast a rising tax take, only to be disappointed. This Bill envisages a tax take not seen since the days of Sir Stafford Cripps. I am sceptical it will deliver it.

My final point relates to where the money will be spent. I can see the case for capping the care costs individuals pay, but I agree with the noble Lord, Lord Forsyth, that it likely to have many unintended consequences. The social care cap is a simple income transfer from those who pay the levy to those who benefit from the cap. Of itself, it does nothing to increase the capacity of the social care sector. Given the travails of the past 18 months, that should surely be the priority at the current time. It would be tempting to rely on increased funding for local authorities, but, again like the noble Lord, Lord Forsyth, I fear that will not be forthcoming. It is not a protected programme, and recent Governments, since 2010, have chosen to squeeze local authorities over and over again. So, as well as looking forward to the increase in the social care levy, we will be looking forward to many an increase in council tax.

To conclude: I support this Bill, but the design of the levy has flaws. I hope that once the levy is in place, the Government will seek to address some of its faults.

Photo of Lord Hunt of Kings Heath Lord Hunt of Kings Heath Labour 4:18 pm, 11th October 2021

My Lords, for decades, social care has proved to be an intractable problem. After numerous reviews and failed reforms, the level of unmet need rises, the pressure on unpaid carers grows, the supply of care providers diminishes and the strain on the undervalued care workforce ever increases. So, it is welcome that at last we have a proposal before us and, as the noble Lord, Lord Macpherson, has said, a recognition that taxes will have to rise to pay for it.

The problem is that these are the wrong proposals. What the Minister has brought to us today, is essentially a tax increase on younger and low-paid workers so the wealthy can retain more of the value of their properties to pass on to their children. As we have heard, it is a tax on employment that will hit businesses. It will not, as yet, solve the underlying pressures in social care.

What a flimsy Bill it is. It is treated—remarkably—as emergency legislation, despite the fact that the Government have had 11 years to bring forward proposals to Parliament. There have been no cross-party talks about this and no consultation, and no Select Committee was allowed to scrutinise the Bill before it was brought before Parliament. Clause 4, as my noble friend Lord Eatwell said, is remarkable in the power it gives to the Treasury to make any change it seems to want to in relation to the proposals before us. If this Bill were to receive proper parliamentary scrutiny, it would be torn to bits. No wonder the Minister spoke for less than five minutes.

My noble friend Lord Eatwell has already referred to the remarkable commentary from HMRC on this tax rise. I will repeat one comment that he made. HMRC said:

“There may be an impact on family formation, stability or breakdown as individuals, who are currently just about managing financially, will see their disposable income reduce.”

As my noble friend said, how can the Minister justify that? What does he say to the CBI, which commented that a national insurance increase

“will directly hurt a business’s ability to hire staff, at a time when businesses have faced a torrid 18 months and are now fighting crippling labour shortages”?

Indeed, having listened to the Prime Minister and Ministers last week, I might ask whether the Government have any interest at all in the future health of our business sector. It seems not.

Unfair as it is, will this levy be sufficient? In his opening remarks the Minister remarkably claimed, without any evidence whatever, that this will put social care on a long-term sustainable footing. But we have already heard that the levy is projected to raise £36 billion over the next three years, that all the money raised in 2022 will go to the NHS and that for the remaining two years £5.4 billion will be invested in social care. This money is not designed to alleviate existing funding pressures on the system, yet these are immense. The committee chaired by the noble Lord, Lord Forsyth, published an excellent report which estimated that an £8 billion yearly increase would be needed to restore care provision to 2010 levels—he has already referred to that. But the £5.4 billion, one assumes, is to be allocated primarily to implementing the cap.

The Health Foundation, following up on the Select Committee report, set out at the beginning of this month what it may cost the Government to fund the NHS and social care system in England, along with workforce requirements, over the next 10 years. It looked at two projections, stabilisation and recovery, and stated that both of them would need much higher growth than in recent years. It said that

“an additional £8.9bn and £14.4bn is needed in 2030/31 over 2019/20 for the stabilisation and recovery scenarios respectively.”

Does the Minister really think that the levy is the answer to that, when most commentators reckon that, in the end, the NHS is going to need almost all of the levy and is likely to get it?

The claim that no one will be forced to sell their own home is surely questionable. My estimate is that on average a person will have to spend at least £160,000 before they get to the £86,000 cap. This takes account of a modest calculation of living costs at about £12,000 per annum, and the fact that the £86,000 cap, as the noble Lord, Lord Forsyth, who is surely right, said, will be calculated on local authority rates—despite the fact that the self-funders subsidise those local authority rates. Even when a person reaches the cap, they will still have to find living costs on an annual basis, and it is quite likely that the local authority will still pay only at the local authority rate, so many people will have to pay top-ups as well. Melissa Lawford in the Sunday Telegraph put the estimate much higher. She thought a self-funder would receive government support only after five years, having spent £296,000. The puzzle to me is that no effort at all has been made to encourage and incentivise the insurance market to provide a more effective way of support for self-funders.

The ABI, in a commentary it set out over the weekend, said that the cap should be viewed as a solution to avoid catastrophic care costs and not as a way to enable a private market to develop. A cap, in itself, would not prompt a market to develop. Why on earth are the Government not seeking to incentivise a private market to develop to help self-funders, allowing the Government to concentrate on the proper provision of social care for those who cannot afford to pay above any insurance prospect?

Why have the Government spent so long dithering about implementing Dilnot when they should have been thinking about a much more concerted approach to dealing with these issues, to encourage as many people as possible to support themselves while shoring up the pitiful state of our social care system at the moment? There is no plan. We are promised a White Paper in December. Does any noble Lord think that this is going to be well thought through in a way that will deliver a good social care system for us going forward?

What about carers? The right reverend Prelate asked what this would mean for carers. I would just say to him, as Carers UK has said, that carers have been propping up a chronically underfunded healthcare system at huge cost to their own personal health, finances and ability to stay in work. It is very telling that nothing, in all the claims the Government have made, has been said about how carers will be helped.

Paul Johnson of the IFS recently described our social care system as the unfinished business of the National Assistance Act 1948. It enshrined, he said, a Poor Law philosophy of both needs-tested and then means-tested moving into the social care system, to be run in parallel with the free at point of use NHS.

This Bill is not the answer to that. It will not transform social care; it will not help care workers get the pay, terms and conditions they deserve; it will not help unpaid family carers. Instead, we have a huge, missed opportunity and a tax on the youngest and lowest-paid workers for the benefit of the better off. This Bill will not do.

Photo of Baroness Tyler of Enfield Baroness Tyler of Enfield Liberal Democrat 4:27 pm, 11th October 2021

My Lords, I declare an interest as a close family member is a long-term care home resident. Before turning to the specifics of the Bill, I will make a few general points about reform of social care, as others have done.

First, as well as looking at how the money is raised to provide a cap on social care costs and a more generous means test—as we are today—we must consider how we can best shore up a fragile and highly fragmented sector reeling from the impact of the pandemic, increased costs and low occupancy rates, with some care homes becoming increasingly financially unviable. Immediate funding is needed to improve the quality of care and introduce minimum standards for care homes.

Secondly, we urgently need a new deal for the care workforce, with action on pay, training development, career progression, professionalisation and recognition. In my view, care staff, who have given so much during the pandemic, deserve to be paid well above the minimum wage. Thirdly, and as the noble Lord, Lord Forsyth, pointed out, half the adult social care budget is spent on working-age adults—often people with learning disabilities—many of whom do not own their own home. So framing this whole social care debate in terms of trying to prevent older people having to sell their homes is only one part of a much bigger picture. Finally, the social care sector is complex and little understood, with both large and small providers providing both domiciliary care and care in care homes—something I hope I can expand on when we have our debate on Thursday.

The Bill takes forward the Government’s decision to introduce a new tax to pay for social care, beginning as a 1.25% rise in national insurance from next year and then becoming a separate tax on earned income from 2023—the levy. It is estimated to raise £12 billion per year.

As others have already said, raising this money primarily from national insurance is regressive, falling disproportionately on the young and low-paid. While I welcome the fact that the levy will be payable on dividends and pension earnings, which is a step forward, there is no getting away from the fact that this tax will impact hardest the lowest earners and youngest, as the noble Lord, Lord Hunt, said, as well as hammering small businesses. The threshold for paying national insurance contributions is lower than the income allowance threshold, so a worker has to earn only £9,560 to start paying NI contributions, as opposed to £12,570 for income tax. The rate paid on national insurance falls as earnings increase, in contrast to the more progressive structure of income tax.

As well as its regressive nature, national insurance is levied only on earnings and not on unearned income, so those in work contribute more. In addition, increasing national insurance increases the tax gap between employees and the self-employed, and the gap between the tax that people pay on their employment income and the tax that they pay on income from renting out property. Those last two points were compellingly covered by the noble Lord, Lord Macpherson.

None of this feels fair to me. As Paul Johnson, director of the Institute for Fiscal Studies—much quoted already in this debate; I hope he is listening—has said previously:

“Funding social care just from national insurance would be very inequitable.”

He pointed out that the levy on employee earnings and employer wage costs, despite applying to working pensioners and running alongside an increase in tax rate dividend—we do not know what that will be yet—remains

“a tax which will be overwhelmingly borne by workers with very little coming from pensioners.”

That is a serious concern.

We already know that the vast majority of the money raised will go to the NHS, including £5 billion for healthcare in the devolved nations, to increase capacity and help with the backlog of treatments built up over the pandemic. Of course that is much needed, but it leaves only £5.3 billion to be allocated to social care, and the bulk of that—£2.5 billion—will fund the cap on lifetime care costs. Ultimately that leaves, by my calculation, some £2.8 billion over three years for social care reform, which is so much lower than many respected commentators, such as the Health Foundation, have said is needed. Indeed, a total reform package which included investment to improve access to social care, paid workers decent wages and enabled providers to deliver higher-quality care is estimated by the Health Foundation to cost about £12 billion, as the noble Lord, Lord Hunt, said. That sounds a lot but, to put it in perspective, it represents about a month’s NHS funding or 0.6% of GDP.

Now that the Government have finally published their proposals for social care, it is time to start the long-overdue cross-party talks that have been promised for years to bring on a proper, long-term, sustainable solution that ensures that everyone gets the quality care they need, which this short-term fix clearly does not. For me, nothing should be off the table in those long-term cross-party talks; they should certainly include looking at other sources of income and wealth. It seems illogical that income from property rental is excluded, so we end up with a situation whereby a relatively low-paid pensioner earning a little extra to help make ends meet will end up paying national insurance, whereas a property owner receiving a good income from rent will pay nothing, a point made by the noble Lord, Lord Eatwell. To throw in another idea, how about taxing the IT giants in the digital economy—the Facebooks and Googles of this world—so that they can start making a proper contribution to health and social care?

I have long believed that we should look for a long-term solution through the prism of intergenerational fairness, in which all generations contribute but no one generation is impacted unfairly. That will be vital to ensure greater buy-in across the generations. Although it may be a bit out of fashion, I have always sympathised with the recommendation of the Barker commission back in 2014 that the over-40s pay an additional national insurance contribution earmarked for adult social care. However, proper cross-party talks involving a wide range of stakeholders are far more likely to come up with a long-term funding solution that sticks, rather than being a political minefield in every general election.

This is a deeply flawed Bill which fails to set out a plan to fix the crisis in social care or improve pay and conditions for social care workers. Only a small proportion of the money raised will go to social care over the next three years, and even that is not guaranteed. It is deeply concerning that there is no commitment that Parliament will get a vote on the social care plan when it is finally published before spending the money it raises.

I end by asking the Minister to explain more convincingly than I have heard so far why the Bill was brought forward before details of the Government’s social care reform plans for England have been published—which is very much the wrong way round, as many other noble Lords have said. Can he also clarify whether the cap on lifetime costs will be available only for those starting care from 2023—that is, it will not apply to those already in the system? If that is the case, it strikes me as very unfair.

Photo of Lord Lansley Lord Lansley Conservative 4:36 pm, 11th October 2021

My Lords, I am very pleased to follow the noble Baroness; I agree with her on one or two items I will come to in a minute. She had some ideas about how these revenues might be otherwise achieved. I will not offer my own ideas, but there is a question here; I wondered whether the noble Lord, Lord Macpherson of Earl’s Court, might have said this. It seems very misplaced to have a fiscal effect of this scale in September when the Chancellor should be on his feet in late October with what ought to be the fiscal event that gives us the OBR’s judgments, which enables us to see the whole panoply of revenue and expenditure, and I am surprised that it was done this way. It is obviously done for political reasons; it has enabled the Treasury to distance itself somewhat from the decision that led to this. I am grateful to my noble friend on the Front Bench for introducing the Bill in this way. He set out the Treasury’s arguments in favour of the Bill; it was therefore necessarily a short speech.

The noble Lord, Lord Eatwell, is not in his place at the moment but I was surprised that he did not refer to Gordon Brown’s hypothecation of a national insurance increase to the NHS. As a subsequent Secretary of State, I can say that this was important only in so far as it made the accounting for the NHS in the departmental accounts more complicated. It had no impact whatever on the decisions made about revenue and expenditure in the Department of Health, as it then was. This will not have an impact either. The NHS will continue to be funded out of general taxation, and the only impact of this increase is that it further reinforces the misplaced belief on the part of the general public that the NHS is funded out of national insurance contributions and it is therefore a contributory tax. It is not like that, has not been like that and will not be like that. The noble Lord, Lord Eatwell, made a point about whether people think that they have access to the NHS because they pay for it. They have free access to the NHS because they pay for it through general taxation, not because they pay for it through national insurance contributions, and the extent of their national insurance contributions has no impact, and should have no impact, on their access to the NHS.

I have two problems with using national insurance contributions in this way for the National Health Service. The first is that it is a tax on jobs. This is happening in the week after the Prime Minister has told the business community that it is going to have to pay higher wages, so it may well say, “If we have to pay higher wages, you might not impose on us additional costs of employing people”, which is exactly the point that the noble Lord, Lord Macpherson, made. There is a gap at the moment between the cost of employing people in this country and the cost of employing people in, for example, continental Europe. However, we cannot be complacent about that, because there is a different gap and a cheaper cost of employing people in many of our other competitor countries. We have to be very aware of the risks associated with continuously increasing the cost of employment.

All that said, increasing national insurance is an inappropriate way of funding social care. Like my noble friend Lord Forsyth of Drumlean, I welcome the fact that the Government are addressing the funding of social care. They have done so in the past, through one or two mechanisms, but at no stage have we seen the increases in resources for social care keep pace with the rising cost. That is where we need to be. The NHS, as I know perfectly well from past experience, needs, broadly speaking, a 4% per annum increase in real terms to keep pace with demand. Social care is getting nothing like that, but the increase in demand for social care is very like that for the NHS.

More of these resources should go to social care than the Government intend—not all of them, but perhaps one-third over the next three years—and that should start now. If you ask people in the NHS whether funding for social care and funding for the NHS are separate, they of course understand the essential link between them. Funding social care now, so that we can remedy some of the lack of access to local authority-funded social care and enable people who have substantial, not just critical, care needs to get access to social care, will do a great deal to reduce the crisis in demand for the NHS.

This is particularly true of accident and emergency units, which are often presented with older, frailer people with comorbidities—incredibly difficult patients with whom to work. The NHS does not want to discharge such patients to their homes with comorbidities and unresolved issues, so the cost to the NHS is very high. But such patients can be managed through the social care system and in primary care—we just need to make sure that they have fewer crises that have not been anticipated and dealt with.

Speaking as the Secretary of State who asked Andrew Dilnot to form his commission and prepare his report, I note that it is now over 10 years since it was presented. We legislated for it in 2014. It is available and it could be implemented now, but in my view it should not be paid for out of the national insurance increase. I proposed, more or less 10 years ago, that it should be paid for by removing the exemption for people’s principal private residence from the means test for domiciliary care. My noble friend Lord Forsyth of Drumlean asked this question. Now, it would, I think, raise something like £1.3 billion a year. If, in addition, higher-rate taxpayers who are pensioners were not to receive the winter fuel allowance, we would have about the amount of money necessary to pay for the cap on care costs and the changes to the means test.

That is how it should be paid for—within the system, essentially by those who will benefit from it, because they have the underlying resources to do so, not least in the properties that they own. So let us not go down the path of unfortunate intergenerational impacts, particularly for younger people, of putting this on to national insurance contributions.

My final point is that a White Paper on social care and healthcare is coming. We already have the Health and Care Bill. The integrated care in that Bill is not integrated care between health and social care. When we talk about integrating health and social care, what we need is not institutional integration but integration around the care user and patient themselves. That is the only integration that will really work: integration around the person themselves. Whether it is done by personalised care or self-directed care, it needs to be supported by pooled budgets and joint commissioning. Fundamentally, it is about giving patients and care users themselves, and their families, much greater control over the nature of the services provided to them by the NHS and social care. I hope that is what we shall see in the autumn.

Photo of Lord Lipsey Lord Lipsey Labour 4:44 pm, 11th October 2021

My Lords, if we did not have a national insurance contribution system, no one would even think of inventing it. This debate has been a succession of hammer blows to the structure of national insurance, which is not paid on unearned income such as rent, is paid at a higher rate by the poor than by the rich, and is not paid by the elderly, who in this case will be the main beneficiaries. It is a nonsense tax, which makes it odd that even this Government should choose it as their preferred way of funding increased spending on health and social care.

This afternoon, I will not go into the social care elements. The cap introduced by the Government is nonsense, but we will debate that on Thursday. I will focus merely on this choice of method. Paul Johnson, the director of the Institute for Fiscal Studies—the Johnson who never lies—has said:

“Funding social care just from national insurance would be very inequitable. It would be a continuation of a long-term policy of hitting those of working age while protecting pensioners”.

The Government know this and go to unbelievable lengths in their attempts to deny the clear facts. Boris Johnson said:

“The top 20% of households by income will pay 40 times what the poorest 20% pay”.—[Official Report, Commons, 8/9/21; col. 296.]

Yes, but that is because the poorest 20% pay virtually nothing because they do not earn the basic minimum for this.

Then there is the Treasury’s document, published with this, called Illustrative Analysis of the Impact of “Building Back Better: Our Plan for Health and Social Care” on Households. In general, I am that rare creature: a supporter of the Treasury—much more so than the ex-Permanent Secretary has shown your Lordships that he is this afternoon. But let me put it as mildly as I can: this document will not go down in the history of the Treasury as one of its finest bits of work. It puts together two completely unrelated bits of government spending—the bit on health and the bit on social care—and calls them “a package”. Of course, money spent on the NHS is reasonably progressive, because a great deal of it goes to poorer people, but money spent subsidising social care mostly goes to the better off. The cap will almost entirely benefit the better off, since half the population are paid for by the state anyway. It will not do to put these two things together.

Anyway, until we get this White Paper—if we ever do get it—we do not know what the Government are actually proposing. This is not just a matter of making a few broad statements that sound good on the telly interview. There is a great deal of detail on all this, and we do not know anything about that detail. There are some pretty weird assumptions in that Treasury paper. If you look down at the footnotes—the sort of thing that only I am geekish enough to do—you will see that the benefit calculation is done without including residential care. What is this whole business about? It is about people in residential care who run out of money, and yet that is excluded from the Government’s analysis. You could not make it up.

I referred favourably to Mr Johnson earlier on. It would be a favourable contribution to public debate if the IFS was to produce a more detailed and objective expert analysis which is not shaped by the instructions of Ministers to deny what clearly is the truth.

Finally, I want to say something about the Government’s procedure on this Bill. It is now more than 20 years—who would believe it—since the Royal Commission on Long-Term Care of the Elderly reported. I signed a minority report. It is a decade since the Dilnot report, which was legislated for by the Government, although the legislation was never brought into effect. Apart from those reports, there has been a non-stop flow of learned and wise contributions on the subject—well, some of them were wise.

Nearly two years ago, Boris said that it was a done deal:

“We will fix the crisis in social care once and for all with a clear plan we have prepared”— tick, tock, tick, tock. After that, we got the September announcement. We might have expected further consultation and discussion to fill the many gaps in it. Indeed, we expected to have a White Paper, but very curiously we do not have a White Paper: we have this Bill before this House’s powerless presence. We are voting for a levy to pay a lot for something, but we really do not know in any detail whatever what it is paying for.

The Government’s excuse—I am amazed that even these Ministers dare utter it—is that it is to give time for employers to prepare for it. What about the 18 months that have passed since their plan was already fully baked, as Johnson told us on the steps of Downing Street? What about those months in the summer when, day after day, there were leaks in the newspapers about the alleged position of various Ministers on the details of this plan? Time did not matter then but, now, when they want to get this legislation through without either House of Parliament having a chance to look at it properly, time has been cut short for political reasons.

Legislating in a day should be done only in circumstances of extreme urgency. To do it for a tax that will not even bite until 2022 and for a policy that will not even be fully in being until 2024 is a travesty of democracy. Legislate first, policy later—it is Alice in Wonderland.

Photo of Lord Bethell Lord Bethell Conservative 4:52 pm, 11th October 2021

My Lords, in the last two years I have become seasoned in these debates on social care. I am completely and utterly persuaded that there are very strong arguments for the fundamental reform of how social care and our health system are provided for, and how it is operationally delivered. In the last 18 months, I have lived a ministerial life with day-to-day meetings where, at first hand, I have seen the pressures on the NHS and the huge and completely unsustainable amounts of money that have been spent to support the response to the pandemic. I have seen for myself the fragility of our social care system, for both the elderly and the vulnerable, the technology we needed to put in place to try to sustain people during the pandemic, the PPE, the support we gave to staff and the financial fragility of many of the providers. I am under no doubt that these matters need to be addressed very fundamentally.

Many noble Lords have spoken very movingly about their strong suggestions for not just the moral and pastoral cases but the fiscal case for why reform is needed, and how the financial issues need to be addressed. But I still stand here pleased to support the Bill because my biggest concern when I was on the Front Bench was that we would not address these issues at all. I was concerned that they would be lost in a political quagmire because I do not see any form of political consensus about any of these ideas. I say that with huge regret; I wish there was a political project and some form of collaborative enterprise where the voices in this Chamber and elsewhere had somehow come together to create some form of consensus, but I just do not see that happening.

Noble Lords, including the noble Lord, Lord Macpherson, and my noble friend Lord Forsyth, have made incredibly persuasive arguments about how to rewrite the tax code and completely rethink the financial arrangements around health and social care. I am strongly persuaded by the intellectual arguments they make, but I do not see us being in any shape to fundamentally rewrite the tax code this year.

Therefore, with that degree of pragmatism and in celebration of simplicity, I support this money Bill, because it addresses the sustainable financing of health and social care in the near term. Coming out of the pandemic, with a huge backlog at the NHS and with the financial fragility of many care providers, it is essential that we find some money as quickly as we can to plug those gaps.

The sequencing of this is incredibly frustrating. I wish there was a White Paper that laid out a clear programme for reform at every level, but that does not exist. The Bill provides some breathing space and a degree of confidence about where the money has come from, so that that work can be done, and that is why I support the Bill, but the Minister would help enormously if he could answer a few questions in his closing remarks about where the money is going—particularly the £500 million earmarked for the training of care providers. The noble Baroness, Lady Tyler, spoke very movingly and quite rightly about care providers, who did so much in the last 18 months and need so much more in terms of visibility of their career prospects, and therefore an idea of how that money will be spent would be extremely valuable.

Respite support for unpaid carers was clearly one of the most acute needs to emerge from the pandemic, and I was very moved to sit through debates on that. It would be very helpful if the Minister could talk about whether there will be resources to contribute to it.

Lastly, on my own particular interest in technology, we can make social care much more productive through better use of digital records and things such as acoustic monitoring and dementia-focused entertainment, and I ask the Minister to reassure us that NHSX will have the resources to address those issues.

Photo of Lord Whitty Lord Whitty Labour 4:57 pm, 11th October 2021

My Lords, it is of course a pleasure to follow the noble Lord, Lord Bethell, but also to underline that what he has bequeathed to his successor is no answer to this problem, and he is now asking the Minister to provide at the end of this debate an answer which he and his many predecessors failed to provide.

I am totally convinced that the social care system has been chronically underfunded for decades and that the NHS itself requires very substantial increases, not just because of coronavirus but because of earlier underfunding and mis-funding. I am therefore at one with the noble Lord, Lord Macpherson, that we do need a significant tax rise, but I strongly object to this Bill. I object to its ill-thought-out basis; its misuse and possible distortion of the national insurance system; its regressive burden and unfairness, in terms of its impact on low-paid workers, jobs and the young; its jobs-threatening impositions on employers; and its ambivalence on whether this is a temporary or permanent structure for our taxation system, with its half-baked and probably temporary hypothecation.

I also object, and here I follow my noble friend Lord Lipsey, to the way in which this House has been asked to consider the Bill. This has been designated a money Bill, but behind it is an enormous political and policy issue: it is not just about our resources; it is about what we are going to do with those resources. The House of Commons was asked in a day to pass the Bill, in both senses, and we are not really allowed to vote on it. This is treating Parliament with contempt. It is also treating the public with contempt, as well as those of us who are supposed to benefit from this increase in resources, and those who are expected to pay for it. I do not think we should be party to that. Unfortunately, given its designation, we have no means of not being party to it.

I take one phrase from the noble Lord, Lord Forsyth, much of whose speech I totally agree with—I also agree with, rather more than I expected, the speech of the noble Lord, Lord Lansley, and with the masterly speech by my noble friend Lord Eatwell—that we cannot agree wholeheartedly to a Bill before we have seen the menu. That is what we are being asked to do today.

Behind all this is the fact that social care has been underfunded, staff are underpaid and service quality is rarely checked. Residential care is paid for in a variety of different—mainly unjust—ways, principally by individuals and their families through self-funding and unpaid care, but also by local government and the NHS regarding the nursing component. It is a mess. Care workers attending the clients’ own homes are subject to intolerable time regimes, their pay is awful, their management is awful and the visit diaries mean that those who really need sustained care rarely get it. The Covid epidemic has made this much worse.

Similarly, the NHS has been subject to severe cuts and constant reorganisations, but it has always been financed by general taxation. The tax proposed in this Bill is termed a “levy”. Normally the term “levy” suggests that we are addressing a temporary problem—it may be a big one such as a war, but nevertheless a temporary problem—but this must be resolved on a long-term basis. The genesis of this proposition is interesting. Originally the proposition was to raise money for social care but somehow it has been hijacked by the absolute necessity to find very substantial sums of money for the NHS. The bulk of the money is, rather peculiarly, to be raised on the basis of national insurance not general taxation, but the proceeds will go into the general fund.

As the noble Lord, Lord Macpherson, said, hypothecation is usually a dirty word in the Treasury, yet the mandarins have somehow been convinced that it is sensible to apply it to this. I am not against that in principle, but I wonder how a complete shift in Treasury ideology, a muddled basis of taxation and a lack of clarity as to how long this will persist give us a proper way of forward planning. I have a theory about why this was done. My noble friend Lord Lipsey pointed out that the Royal Commission on which he notably sat and many think tanks, commissions and inquiries since then, including Andrew Dilnot’s, have looked at this in detail. Some of those proposals have been half-baked, some pretty good, some partly good. Some have raised the issue of basing social care on a national social insurance basis. This is leverage. This is an old idea rethought. My feeling is that part of what the Prime Minister so wildly committed to, in resolving social care once and for all, was some of these ideas, which were floating around in circles in which he moved but were in reports he hardly read, which included a social insurance principle. This was regurgitated, therefore, in this form in this Bill when the Chancellor and the Secretary of State for Health realised that they need an answer to some of these issues. However, instead of it going into social care and making social care part of social security, it was hijacked and used for the very pressing and important needs of the national health service.

This is not a way to operate. The committee of the noble Lord, Lord Forsyth, provided a much sounder basis for proceeding in relation to social care. The issue of the integration of social care and the health service has been with us for a long time. Like the noble Lord, Lord Lansley, I mean integration not necessarily of institutions but of policy. This does not resolve the issue at all; it simply doles out the bulk of the money to one part and a little bit left over to the other.

The Bill is not about a sensible plan for bringing NHS and care services together, nor about putting both on a social insurance basis. It is about avoiding putting up income tax or profits tax contrary to the Conservative Party manifesto. It is about not depriving wealthier families of the inheritance of their parents’ homes to pay for when they have to go into a care home. Frankly, it is about putting the burden on lower-paid workers and small employers, who will disproportionately be paying the cost.

What started out as a vaguely half-decent strategic idea for social care has ended up in a bodge, and one that I think will boomerang on this Government. I plead with the Government that there is time to think again—not much time, but time to devise both a financially viable long-term social care system, which may or may not be based to some degree on social insurance, and to find the undoubtedly much-needed money for the NHS, but in a much less regressive manner. We need a long-term plan for health and social security, not a thin White Paper that just tells us how much it will cost us when we do not know what it is. We need a strategy whose cost is based on everyone contributing according to their means. We can thereby ensure that people get the benefit according to their needs.

Photo of Baroness Fraser of Craigmaddie Baroness Fraser of Craigmaddie Conservative 5:06 pm, 11th October 2021

My Lords, I refer to my interests as set out in the register. I have no illusions about the mountain that health and social care services have to climb as we emerge from the impact of Covid, and I have no illusions that the necessary steps will require significant funding. Like my noble friend Lord Bethell, I welcome the Bill in that at least it grasps the nettle of an issue that needs to be grasped urgently.

I will confine my remarks not to how the extra funding is raised but to how it is to be spent. First, I would welcome funding for improved health and care services in Scotland. In fact, the Scottish Government have a manifesto commitment to establish a national care service over the next 10 years. I am sure they would welcome a union dividend of more than £100 billion, whatever they might say.

I also know that the other place debated and defeated the amendments to Clause 2 to allocate and give the funds from the Bill to the nations of the UK in accordance with the Barnett formula, but is it really in line with our stated intention to treat the devolved Administrations with respect for the Bill to state where the consequential spending is directed? Please let us not give Ms Sturgeon yet more ammunition to aim at Westminster.

Secondly, the levy perpetuates the status quo as regards spending on health and social care, as many noble Lords have stated. Experience, though, has taught us that investment alone will not be enough to fix the challenges faced by health and social care services. The Prime Minister himself, in the introduction to the Building Back Better document, said that

“when COVID-19 broke out, there were thousands of hospital beds filled with people that could have been better cared for elsewhere.”

That was indeed true, and remains true, but our answer to this challenge is always just to create more beds. We saw great efforts going into the building of temporary Nightingale hospitals, but there was no equivalent for social care or community rehabilitation. Why not? Because, as always, social care is seen as secondary to the needs of the organisation that is the NHS.

If the solution is not just more money, it is also not just more people. The people in the current health and social care system are most definitely a crucial part of this answer, but just wishing for more of them is not the solution either—not least because there are worldwide shortages of supply in some specialisms and it would take years to train the additional numbers required.

I turn to the lessons learned during the pandemic, which is why we are here in this urgent debate. Research from the University of Glasgow and the London School of Hygiene & Tropical Medicine found that many disabled people and their families felt abandoned and that existing structural failings and inequalities were starkly exposed and magnified. Their research concluded that it was the third sector that was best able to adapt to this increased need in the community and to deliver the services and care during the pandemic.

I declare an interest as chief executive of a third sector organisation, Cerebral Palsy Scotland. Third sector organisations reimagined their services very early, often in difficult circumstances with huge funding and personnel challenges. They set about tackling isolation; filled gaps after the closure of daycare centres and community services; supported people to become digitally literate, so that they could access online healthcare; and, in effect, became the mechanism that kept people well and enabled the NHS to respond to the challenges of Covid. In fact, the state became reliant on a strong and resilient third sector. The third sector, therefore, plays a key role in the solutions facing health and social care, yet a few organisations seem to be relegated to the back pages in a list of stakeholders.

The justification for this levy is that we are trying to build back better. It is essential that we do indeed build back better because what we had before was not working. What we saw during the pandemic illustrates what happens when we fail to understand the impact of the withdrawal of services on disabled people and those with long-term health issues. It illustrated that, to keep people out of hospitals, we have to support them to remain well at home. It also demonstrated the importance of ensuring a robust third sector.

The key to the successful deployment of the health and social care levy will clearly be in the details of the much awaited White Paper and the Health and Care Bill, which I look forward to coming before this House. International examples of where integration has worked best have required local delegation and local solutions. In Scotland, we have been trying it since 2014 but, as my noble friend Lord Lansley said, it went from being a very person-centred hope to being one where the free at the point of delivery NHS was merged with the paid-for systems of social care. We are still dealing with the problems that trying to put those two large organisations together have created.

The answers that the Government are looking for clearly lie in fundamental reform of the whole system, not just little parts of it. We cannot just keep spending more and more money to fix backlogs. We must be bold, but we have to take those who use health and social care, those who work in health and social care and all cross-sector organisations that provide health and social care with us. If we do not, all we will do is take the taxpayers’ cash and they will see no real benefits from it.

Photo of Lord Hain Lord Hain Labour 5:13 pm, 11th October 2021

My Lords, I declare an interest that may be common to many, if not most, of us in your Lordships’ House. I have a relative living in a care home in England, so when the Prime Minister, with his trademark flourish, announced a new social care policy, I was naturally encouraged. However, as I examined it against the reality facing my relative and most of our citizens needing residential care or 24-hour home care, I became increasingly sceptical. Here is my take on what his policy means from the front line. If the Minister thinks I have got anything wrong, will he please say so when he replies? Specifically, will he write to me in response to what I have said?

The Government said that the reforms would address the problem of people having to sell their homes to pay for the cost of care. From October 2023, they plan to introduce a new £86,000 cap on the amount anyone in England will have to spend on their personal care over their lifetime. The cap will be applied irrespective of a person’s age or income—so far, so good.

However, Boris Johnson’s reforms do not live up to their marketing, and the cap will help relatively few who need care. It would be a surprise to most people to know that only care costs will be covered by the lifetime cap and that these do not include the so-called hotel costs, which may be very, very high. Under the Prime Minister’s framework, only money spent on meeting a person’s personal care needs counts towards the cap. The Government’s position is that a person would have to pay for living costs even if they did not need residential care but depended on care—maybe continuous care—at home. Spending on daily living costs, or what the Government refer to as hotel costs in a care home, does not count. There is therefore no help under the policy towards accommodation and food, as these are designated by Ministers as part of hotel costs.

The care costs would cover the nursing and care staff and possibly the costs of ancillary staff and medical supplies, but not the other costs of providing a residential care service. These include, for example, any mortgage on the residential home, insurance and legal fees, audit and professional fees, council tax, utility bills—such as rocketing heating costs—waste disposal, registration fees, transport costs, maintenance, marketing, office services and so on. These are categorised as counting towards the hotel costs and not covered by the lifetime cap.

I have looked at the current fees breakdown in a large care home in England with 50 beds running at 92% capacity. The current social service rate—the rate the local authority may contribute—does not even cover the care and nursing staffing costs; nor will the new plan. Yet the Prime Minister has given the impression that people entering residential care will benefit from the reforms to the social care charging framework with the introduction of the £86,000 lifetime cap on the amount anyone will spend on their care. In reality, only a small percentage, perhaps a measly 5%, will be protected from “catastrophic care costs”. Therefore, contrary to what the Prime Minister claimed, many, if not most, people will still have to sell their homes to pay for care.

Although the reforms are meant to solve the current catastrophic crisis in social care, it appears from paragraph 60 of the Government’s much-vaunted new policy, that there will be nothing for adult social care until April 2023. There is no funding in the levy to address the current problems facing social care and no plans to tackle the current gaps in the social care workforce, with over 100,000 vacancies. Although the Government’s plan discusses greater professional development and career support for social care workers, backed by a £500 million investment and a workforce White Paper, it contains no credible plans to tackle the current chronic shortage of social care staff.

Stakeholders in social care have highlighted challenges associated with transferring revenue raised by the new levy from the NHS to social care in future years, pointing out that there is absolutely no precedent for this, especially with many parts of the NHS on life-support, facing massive funding gaps, and serious shortages—running into tens of thousands—of doctors and nurses. The new funding will probably stay in the NHS and care home employers will be left with an additional burden: having to bear the payroll burden of the national insurance hike provided for in this Bill. That means that they will have to pass that on to their residents, many of them dementia patients and therefore oblivious, even if their families most certainly will not be.

The Government have said they will ensure that local authorities have access to sustainable funding for core budgets at the spending review, but local authority leaders across the party divide do not believe this. They have suffered budget cuts of around 30% these past 11 years, and it is not honest to dump the problem back on local councils. That means that people needing care will have to sell their homes whatever the Prime Minister claims. People on very modest incomes or pensions living in modest homes will lose them to finance costs of around £5,000 monthly for residential and nursing care. The new levy is simply totally inadequate to fund plans necessary to reform adult social care if Britain is to claim to be a civilised society.

It is troubling that the Government’s solution to addressing social care’s core pressures appears to be the use of council tax, a social care precept and long-term efficiencies. To describe this as totally unrealistic is overly polite. The Prime Minister might better recognise it as sheer balderdash.

His reforms will instead create confusion and frustration among the public. On the one hand, people are told that the levy will fund adult social care and, on the other, that “hotel costs” are not covered. Hotel costs is a handy label for Ministers, because it implies to the public some super-duper state of luxury when actually it is a massive slice of providing care.

The £86,000 cap will benefit very few people, leaving most to continue paying high care home fees. Rather than create a simpler system of funding, the plan also paves the way for entrenching the complexity of funding that has beset social care for so long. This has left many families in a state of misery as they grapple with care costs of £1,300 per week in residential care homes, with staff on poverty wages and businesses struggling to survive. Sadly, this is no care plan; it is a care con.

Photo of Lord Shipley Lord Shipley Chair, Youth Unemployment Committee, Chair, Youth Unemployment Committee 5:21 pm, 11th October 2021

My Lords, I remind the House that I am a vice-president of the Local Government Association. Like others, I was very surprised by the speed with which the Bill passed through the House of Commons. I was even more surprised by the lack of challenge to it. As we have heard from right across the House this afternoon, national insurance is the wrong tax to use. Calling this a levy makes no difference. It is a tax. It is a change to the tax system worth £12 billion a year for three years—indeed, inevitably, longer than that.

It is a tax on work and it is more regressive than income tax because the rate charged reduces at higher earning levels. Those earning under £967 per week pay national insurance contributions of 12%, but those earning over that level pay only 2% on earnings. If speed is needed, using income tax would be fairer, because the threshold for paying national insurance is lower than it is for income tax. Thus, this levy hits the lower-paid more. As we have heard, those paying income tax have a personal allowance of £12,570, but the national insurance threshold is £9,568 for employees and £6,515 for the self-employed. Most of the revenue for the new levy will come from workers earning under £50,000. That is particularly unfair to younger workers.

Reference has been made to the briefing note from HMRC. I repeat this point, because it is important. The briefing note says that the Financial Secretary to the Treasury has agreed that:

“There may be an impact on family formation, stability or breakdown as individuals, who are currently just about managing financially, will see their disposable income reduce.”

It is astonishing that the Government find this acceptable. They have declared that they are pursuing a policy of levelling up. You cannot level up places without levelling up people, but you cannot level up people on low incomes by increasing the amount of tax they pay.

The context of the Bill is a tax burden which will be the highest in 70 years. At the same time, inflation is rising to over 4%, energy costs are spiralling and there is now talk of council tax rises of over 5% each year for several years. I submit that we cannot go on imposing high council tax rises year after year to help meet the cost of adult social care. The Government introduced the social care precept in 2016 at up to 3%, yet council tax is regressive. Council tax rises impact disproportionately on poorer people.

Yet the demand for social care is rising. Councils need an extra £2.6 billion a year simply to maintain current levels of social care, but they will get only £5.4 billion from the new levy over three years. Will there be enough money for social care? What is the spending profile for social care over those three years? How much will go to the NHS and how much will come to social care?

It could be argued that national insurance is easier for the Treasury to impose since it is relatively easier to administer. However, it hits the lower-paid and younger people most. A 1p increase in income tax, as my noble friend Lady Brinton has suggested, would at least raise contributions from better-off pensioners.

Council tax is being used to support adult social care based on property values of 30 years ago. It is, as I said, a regressive tax: those in lower tax bands pay higher effective tax rates than those in higher bands. One policy suggestion made recently by the Housing, Communities and Local Government Committee in the House of Commons is for a proportional property tax to replace council tax and business rates. I hope the Minister will agree that the time has come to look very closely at that suggestion.

This is an inadequate Bill, rushed through and ill thought-through, which will not solve the care crisis. I hope the Government will take note of the fact that most speakers today have found the Bill wanting.

Photo of Lord Hannan of Kingsclere Lord Hannan of Kingsclere Conservative 5:26 pm, 11th October 2021

My Lords, that is one way of putting it. This Bill has been so hacked about from every Bench, so lacerated, that it seems an act of almost wanton cruelty to take out my own cleaver and join the mob. In the spirit of balance—at least, of karmic balance—let me therefore at least preface my remarks by saying that this is a good problem to have, in one sense, because we are talking about a problem caused by improvements in medical care and increased longevity, and we are looking at ways in which the wealth of an increasingly well-off society can spill over into the social care sector.

In the end, wrote Goethe, in what has always struck me as the single most depressing line in the whole corpus of European literature, we are all King Lear. Of course it was not quite true in his day and it is not true today, but we have a challenge, like every developed country, in ensuring that we are not stretched out upon the rack of this tough life any longer than necessary.

I wanted to agree with what I thought was a devastating takedown of the proposals by the noble Lord, Lord Eatwell, but I am going to disagree with one aspect of his remarks where he spoke about the reduced proportion of GDP going on health and social care. That strikes me as not a great measure. A more useful metric is what is the absolute amount. If you can grow an economy very quickly then a smaller proportion of that economy can be a much larger sum. It therefore seems to me that the question, if we are looking at how to fund this or indeed any other aspect of our welfare system, is where we strike the balance between getting instant revenue now by raising taxes and ensuring that that growth continues, thereby generating future surpluses. If, as in this case, we are looking at the prospect of increasing costs—because I think we can reasonably expect that longevity will continue to increase and that there will continue to be medical advances—how do we ensure that it is funded sustainably and that we do not, in removing money from the productive bit of the economy now, reduce the overall size of the economy and so damage future revenue?

However, I agreed very much with what the noble Lord said about the craziness, as we come out of the worst downturn that we have had—worse than anything we saw in either war or in the recession—of taxing jobs. Of all the ways that we could be raising revenue, this seems to me the most misconceived. On the contrary, we should be finding ways to reduce taxes on employment and investment so that, as furlough ends, we encourage people and firms to be investing and hiring more, thereby of course generating more economic activity and, in the medium term, more government revenue.

I would be very happy to see national insurance scrapped. If we consider the case made against it by the noble Lord, Lord Lipsey, and my noble friend Lord Lansley, it is quite difficult to see why anyone—I agree with what the noble Lord, Lord Lipsey, said—would invent it today. I very much support my noble friend Lord Forsyth of Drumlean’s idea that we should be honest and merge it with income tax and stop the pretence that it is somehow a hypothecated tax paying for social care. Of course, Governments will never do that, because they will never admit the amount they are actually taking in income tax—so they pursue the strategy of having lots of little taxes to add up to one big one as a way of disguising the overall tax burden.

I also agree with the noble Lord on the absurdity of hypothecation. It is not that it is a bad idea, but that it is impractical. It did not work for Gordon Brown and has not worked for any other leader. It is impossible to devise a system where a Chancellor cannot simply substitute a different budget. It has defeated every attempt at doing so.

Finally, I agreed with the noble Lord, Lord Eatwell, when he spoke very truly and said that it is in the nature of taxes to go up. That has been true of almost every tax, going right back to the introduction of income tax as a temporary measure to pay for the Napoleonic Wars. Governments find that they do not have the revenue they need and have to widen and deepen the tax. So let us be clear what we are talking about; it is going to be a ratchet, where there is constant pressure for higher budgets, higher caps and so on.

Why are we doing this? Why have we picked this tax and this method? And why, as every other Bench has asked, are we doing it in such a hurry? I was very struck by how few people in the other place on the Conservative Benches voted against it. My right honourable friend the Minister, with commendable honesty, described it as a

“permanent … increase in the size of the … state”.—[Official Report, Commons, 14/9/21; col. 844.]

That is absolutely right. How many people on Conservative Benches in either House went into politics in order to pursue a permanent increase in the size of the British state? Yet there were only something like five Conservatives in another place who voted against it.

I suspect that that is because, when asked in isolation, this measure polled very well. It always does. If ever you phrase an opinion poll question as “Should we raise taxes to pay for”—insert desirable thing—you always get a very large yes, because people have been conditioned by our political discourse to hear the question as “Are you a nice person? Are you selfless or are you greedy?” They cannot tick a box in that opinion poll that says “Well, only if it is accompanied by efficiency gains”, or “Yes, I will happily fund more clinicians, but I don’t want to fund more NHS diversity officers”, or “What has happened to the £20 billion that has already been spent?”, or “Could it be done with the following priorities?” So they say yes because they do not want to look ungrateful.

My noble friend Lord Tebbit, when he was the Conservative chairman, once said that the only opinion poll on tax that matters, the only question that elicits a valid response, is “Do you feel that the amount of tax you personally are paying is too low, too high, or just about right?” I suspect that, when people see the implications, not least the second-order implications, of there being fewer jobs and therefore less overall revenue and slower growth, there will be a very different attitude.

Of course, your Lordships do not need to worry about opinion polls. The function of this House is precisely that it can take a longer view and bring perspective to these questions. It is clear, if you look at the long view and take a proper perspective, that the way to have growth and an economy that can then more easily accommodate increases in healthcare, social care and all the rest of it, is by pursuing the formula that has always and everywhere increased economic performance: freer trade, lighter regulation and lower, flatter and simpler taxes.

Photo of Lord Griffiths of Burry Port Lord Griffiths of Burry Port Labour 5:34 pm, 11th October 2021

My Lords, it is with some trepidation that I add my voice to those who have spoken already on this matter. Some of the speeches will live with me for a very long time, in the way that the case has been put and the evidence put forward, and it seems almost recondite for someone like me to add to the detail. I want to come at it from the point of view of social care but also, perhaps existentially, from my experience with MHAMethodist Homes for the Aged—the largest charity care provider in the country, which has been doing it for 75 years. It has 70 residential homes scattered across the country, looking after 4,400 people. Three thousand people are being helped to live in their communities, with staffing and support people to do that, and 11,000 in their own homes. MHA has 7,000 staff and 3,750 volunteers. As the cream on top of the milk, it is one of the leading exponents, in such institutions, of music therapy—just to indicate that all is not simply bread and butter.

It has to be said that seeking some guidance from MHA on what it has felt about what has been happening on the ground in the communities that it cares for is what gives me a sense of wanting to contribute to this debate. Things have been dire. Let us look, first of all, at the last 18 months—or whatever it is—since Covid started and see how it has affected the care system in general. If all goes well and things are better than we think and expect, we are talking about waiting two years before a certain amount of money might come into the system and be addressed to social care. The last 18 months have taken so much out of those providing social care that any talk of sustainability begs the question: sustaining what? Things have been dire. A 95% increase in insurance has had to be borne as a result of the pandemic, £2 million per year was needed to purchase PPE, there has been staff sickness, overtime, bank agency staff, restricted movement between care homes and so and so forth. Care homes have barely managed to hold the show together under the pressures that they have been feeling in these last 18 months. So when the Prime Minister got up and made the announcement he did—and we all hope there will be however many millions it is in two years’ time—we have to ask ourselves, “What about now? What about repairing the damage that has just been done and is still being suffered?”

The thought that the mandatory vaccination status for care home staff which is not required in the health service could see a labour shift from care homes to hospitals seems really rather perverse. We simply have to recognise that many of the care institutions that we are talking about are in a dire, dire state. There is a dependency and a relationship between them and the local authorities that are being looked to, to anchor the proposals that are being made. MHA has contacted local authorities to see how to take advantage of the £3.2 billion that was given to local authorities to respond to Covid-19 pressures. Of the 188 local authorities that it works with, only 5% gave a 10% increase, there was a smaller uplift from 35% of local authorities, and 60% gave no uplift at all. You just wonder how much of this money that was supposed, through local authorities, to improve the situation financially for social care got to the front line. The conclusion from MHA is that almost none at all got there.

We also have the whole question of recruiting and retention. On this workforce business, perhaps if there are any HGV drivers who are surplus to requirement now that we are training them all ourselves and producing them for supply chains and all the rest of it, we could get them qualified to work in our care homes, because there is a desperate need. Across social care, so many years of low pay have been compounded by valued staff leaving, due—as I say—to Brexit and exhaustion from the pandemic, and now some staff leaving and moving to the NHS, as I have suggested.

The last 18 months have left the social care sector in dire straits. The next two years—until whatever, if anything, filters through from the latest arrangements—will have to be survived. Clearly, from the evidence I have been adducing, local authorities are not in a position to play their part. Frankly, to talk about the future of the social care sector seems redundant; survival is the very first thing, as well as a carefully thought-through policy. We have heard so many hints of good ideas that have been in circulation in cross-party committees which have worked on these issues. Therefore, this little piece of legislation seems tawdry.

I hope the Minister will recognise that, lovely man as he is, we want him to be the channel through whom we declare our displeasure to the Government he serves.

Photo of Baroness Altmann Baroness Altmann Conservative 5:41 pm, 11th October 2021

I regret being unable to support this Bill and will try to articulate some of my reasons. There are so many, and I will not detail them all. I associate myself with every word of my noble friend Lord Forsyth’s remarks.

While we debate this Bill, the care sector is marching ever closer to disaster. The measures we are debating—but of course are unable to amend—are nowhere near what is needed to fulfil the 2019 commitment to sort out the social care crisis. No help is guaranteed at all, near-term. The claims that these reforms demonstrate the courage to tackle the difficult issues that other Governments have ducked simply do not stand up to scrutiny. I wish they did, and I wish I could stand here and support a bold initiative to get to grips with a situation that is, frankly, a monumental national and social failure that has already, and will continue to, cost the lives of many vulnerable British citizens.

The challenges of social care are significant. This Bill simply fails to address them. It merely repeats the Dilnot-style measures already legislated for by the Care Act 2014, with a cap that still does not cover all the care costs and still leaves vital funding elements to cash-poor local authorities, which will keep having to ration, reduce or deny care for those in need.

Even the funding promised in this Bill is not ring-fenced to pay for care. It will first prop up the NHS, which already receives the lion’s share of taxpayer money and has itself worsened pressures on social care through the pandemic and proved, yet again, the second-class treatment—for example, by discharging Covid-positive patients, refusing to admit elderly people to hospital and cutting the previous regular visits by GPs to care homes.

This Bill does little or nothing to address so many of the basic fundamental social care sector failings and will still leave ordinary families facing massive costs to subsidise local authorities, which underpay for council-funded residents. There is nothing to address the artificial distinction between free at the point of need NHS care for, for example, cancer, and the hugely expensive social care for, for example, dementia patients.

It does nothing to help reduce staff shortages, which are real and rising right now. In that context, I ask my noble friend to reconsider the proposal for mandatory vaccination. This measure will make the situation worse. There are currently more than 150,000 vacancies in this sector in England. Care staffing shortages have already been compounded by post-Brexit migration rules, as carers from overseas do not reach the new higher income threshold to be eligible to work in the UK. The Government themselves estimate that at least 40,000 CQC-registered care home staff will refuse the vaccine and risk being forced out on 11 November if mandatory vaccination is introduced.

Without staff, how can homes look after people needing care? Many care homes are on the brink of bankruptcy after pandemic costs, with high staff turnover and competition from the NHS and hospitality sectors, as the noble Lord, Lord Griffiths, just outlined. They do not demand vaccination. Care workers may therefore just move to different or better jobs, but the staff shortages run risks with people’s lives. People have a right to refuse the vaccine. After all, even when vaccinated, they can catch and transmit Covid. I ask my noble friend the Minister to consider the case of a Ms Waite from Preston, who was dismissed from her care home job for gross misconduct for refusing the vaccine, despite having documented medical reasons for doing so.

This Bill will not reduce unmet needs or the financial fragility of care home operators. It will not end the current rationing of care, nor the ongoing reduction of preventive measures. The national economic model of social care relies on councils’ public funding paying below costs of delivery. I am afraid this is simply not a meaningful commitment to social care. It encourages short-term use of this money, supposedly designed to improve social care for the NHS. This obviously needs to be facilitated—reducing the backlog in the NHS is important—but social care underfunding is equally serious for the health and lives of our nation.

I cannot agree that national insurance is an appropriate mechanism for care funding. There will be no contribution from pensioners’ pensions, buy-to-let landlords or capital gains. This hardly spreads the burden widely or fairly across society. It may be rather better than the current costs falling entirely on those who are so frail or unwell that they cannot look after themselves and do not qualify for NHS help until they have used up most of their savings or assets to get public funding, but it will not stop people selling homes to pay for care. Indeed, if domiciliary care takes home value into account, it will increase the numbers of those who need to pay for care by selling their homes, although I do not believe that is an important yardstick in this debate.

This national insurance change is a regressive tax, which breaks a manifesto commitment and penalises the lowest earners and businesses already struggling to recover from the pandemic. Of course, as we emerge from Covid-19 disruptions, additional funding for both NHS and social care is needed, but the care crisis predates this period. Why should businesses pay for this?

I am disappointed to hear some on the Benches opposite turning this into a political issue. This is a social policy issue of the utmost importance, which has been neglected by successive Governments for decades. Worthy words, reviews, royal commissions and more have made recommendations for urgent change, but action on the ground was ducked. Even legislation has lain unimplemented, despite rising need and the financial collapse of major operators. Funding the NHS is still being prioritised over funding social care.

I have a few important questions for my noble friend. How much of the money raised by this levy is guaranteed for social care? Will the Government commit to abandoning their plans for mandatory vaccination for care staff? Can my noble friend give the House the estimated numbers of people requiring care over the coming years, as baby boomers now just starting to enter their 70s reach their 80s and demographic pressures mean a sharp increase in need relative to today’s rather small cohort of more elderly people, with which this country is currently not even coping?

Have the Government considered introducing incentives for families to save for future care needs? I do not mean just insurance but actual savings, a tax incentive for those with pensions, such as tax-free withdrawals to keep money earmarked for their later life, in case they need care, and incentives for people to earmark their ISAs for care—for example, a maximum amount of ISA that could be passed on free of inheritance tax if set aside for care. More than 8 million over-60s hold a total £300 of billion, an average of £35,000 to £40,000 each, in ISAs, and those are 2018 figures which have probably increased since then. These are not necessarily earmarked for any purpose, and before the money is spent on cars, cruises or other goods, introducing an incentive not to spend it could benefit both families and the financial services industry.

As the care cap will start accruing only when needs are substantial, there is nothing to help those with moderate needs, and the cap will cover only local authority-approved rates. Many families will want to have some money to help them before the care cap even starts counting, and as more people have used their pensions or ISAs while relatively young, future taxpayer costs will be higher, because people will have exhausted their savings before they need care and will have no opportunity themselves to help support preventive measures, higher standards of care or care earlier than is otherwise the case.

This is a national policy issue. It is not about politics. I hope that my noble friend responds to cross-party offers of co-operation on this important issue.

Photo of Lord Sikka Lord Sikka Labour 5:51 pm, 11th October 2021

My Lords, I declare my interests as set out in the register. I am an unpaid senior adviser to Tax Justice Network and will be referring to some taxation issues.

I cannot support this bad and cruel Bill. It does not address the Government’s failures on social care or the NHS. Local councils, which are responsible for social care, have seen their budgets plummet by up to 38% in real terms, and the Bill still does not provide the funding needed to reduce the NHS queues or improve social care. It does not create an integrated healthcare system in which social care is free at the point of delivery. It does not challenge profiteering by private equity, hedge funds and corporations from their involvement in social care and the NHS.

The 1.25 percentage point hike in national insurance, which I would like to popularise as “the Johnson tax”, as that is what we should be calling it, hits the poorest the hardest. Following the Bill, people’s wage packets will show deductions for three direct taxes: income tax, national insurance contributions and, from 2022-23, the newly invented health and social care levy, better known as the Johnson tax in many circles. This is from a Government who promised that there would be no increase in income tax or national insurance contributions.

Before the pandemic, the poorest 10% of UK households paid 47.6% of their income in direct and indirect taxes, compared to 33.5% by the richest 10% of the households. This regressive Bill does not provide any relief for the people at the bottom of the pile. People on the minimum wage will pay the additional national insurance. An employee on a £20,000 wage would pay £130.40 more each year, an effective increase of 10% in the amount of national insurance. This is in addition to the higher income tax which they will need to pay because the Government have frozen the personal allowances, while, at the same time, universal credit is cut by £1,040 for 5.5 million people. Did the Government ever wonder how people will survive? What will happen to social stability?

Many retirees are already struggling on the average state pension of around £8,100 a year and have sought to supplement this meagre pension through part-time jobs. This Bill will force retirees to pay more national insurance on their earned income. The national insurance hike will reduce people’s spending power and have a negative impact on the local economy and household budgets. Levelling up it is not; kicking down it certainly is.

The Government’s PR machine has made much of the 1.25% increase in dividend tax from April 2022. After the increase, dividends will be taxed at marginal rates of 8.75%, 33.75% and 39.35%, compared to marginal rates on earned income of 20%, 40% and 45%. So the tax privileges of the rich continue. At the same time, those receiving unearned income in the form of capital gains and dividends will pay zero national insurance, because it is not charged on unearned income.

Earlier in the debate, the noble Lord, Lord Eatwell, referred to the HMRC policy paper Health and Social Care Levy, which states:

“There may be an impact on family formation, stability or breakdown as individuals, who are currently just about managing financially, will see their disposable income reduce.”

Why are the Government hell-bent on hitting the poorest when they will also be facing higher inflation, including higher food and energy prices?

The Government claim that the national insurance hike will raise an additional £11.4 billion a year over the next three years. This could easily have been done without hitting the less well off, and in ways that reduced inequalities and unfairness. Earlier, the Minister said that there is no alternative other than borrowing. He is 100% wrong. For example, by taxing capital gains at the same rates as earned income, the Government could have raised an additional £17 billion a year, plus national insurance contributions of £8 billion. This reform alone would have generated more than double the amount generated by the Johnson tax. The capital gains tax regime benefits only 265,000 taxpayers, mostly resident in London and the south-east of England, so that reform would also have reduced regional inequalities. Again, the Government do not really wish to address that.

By taxing dividends in the same way as earned income, another £5 billion a year in revenue could have been raised, plus the increase in national insurance contributions possibly hitting between £600 million and £1 billion.

I ask the Minister to explain why billions of pounds in unearned income from the sale of second homes, speculation on stock markets and dealings in foreign exchange, commodities, artworks, land and other markets are not subject to national insurance. Does he agree that those tax perks for the rich are unfair and should be eliminated altogether?

Currently, employees generally pay 12% in national insurance on incomes up to £50,270. As other noble Lords have pointed out, the rate on incomes above that is only 2%. This means that high earners pay a lower proportion of their income in national insurance compared to the less well off. By extending the 12% rate to all earned income—just earned income, not including what could be collected from unearned income—an additional £14 billion a year could be raised. Again, the Government do not wish to do that.

I ask the Minister once again to explain why he is content with such a regressive system of national insurance, and why the Government have chosen to hit the less well off rather than inconvenience the rich.

Let us look at the tax relief on pension contributions. Around £41 billion a year is given; most of it goes to people on 40% or 45% marginal rates. Some 1.5 million people get zero tax relief on their pension contributions because their income is less than the personal allowance. Simply ensuring that everybody gets just 20% credit—equivalent to the basic rate of income tax—would leave the Government £10 billion spare.

I have referred to only four ways of raising tax revenues to fund social welfare without adding anything to the basic rate of income tax, the 40% rate of income tax or national insurance contributions for the masses. There are dozens of other ways and if I had more time I would be delighted to go through them. Hurting the less well off is a deliberate choice by the Government, because they have numerous other options available. I cannot really support the Bill as it is very cruel and bad.

Photo of Lord Naseby Lord Naseby Conservative 6:01 pm, 11th October 2021

My Lords, it is clear that there is an understanding across the House that there is a crisis in social care. We all know that. We all campaigned in recent elections and we know that it is a real crisis. However, it does not help to come up with all sorts of wizard new taxes, as the noble Lord did just now. If I may say so to the noble Lord, Lord Eatwell, who I respect as an economist from the college next door to mine, he can analyse and criticise, but equally it behoves the spokesman from the Opposition Benches to put forward the alternative. The noble Lord knows that there is a crisis but there was not a word from him about what the answer is to meet it. It was, of course, a Labour Government who put up national insurance in 2003 for matters they considered at that point to be absolutely vital. I have been a leader of a local authority and I understand social care. My view is that, at a time of real emergency in social care, which this is, we have to find something simple that can be done quickly. That is why I support the Bill.

My noble friend Lord Forsyth, in what I thought was a really good speech, made it clear that there is a crisis. The question to my noble friend on the Front Bench is, if I read this Bill correctly, that it is the Treasury that will determine the share of the extra money that will go to social care. I find that profoundly unsatisfactory. If social care is the one key element of the problem, which we all recognise it is, surely Her Majesty’s Government should decide, whatever money is raised—it will be a huge sum once it is up and running—that social care will get a ring-fenced proportion of that budget that shall not be leached away to something else in the National Health Service. That is fundamental.

I declare an interest: I am married, for 61 years now, to somebody who trained as a medical student across the road when I was courting her. She became a doctor. She did her house jobs in Calcutta. She set up her practice in Biggleswade when somebody died. She ran the biggest practice in that part of Bedfordshire, had three children and was a wife to a politician. She worked full-time. I have a son who is not dissimilar: he is a doctor and now a deputy coroner.

The other element of the problem lies principally with our general practice today. It is a shambles. Just to take my particular practice where I am a patient—which I obviously know in some depth—there are six doctors, one full-time and five part-time, four of which are ladies and one a gentleman. You cannot run any medical practice anywhere in the world—and I have worked in India, Canada and Sri Lanka—on the basis of part-time medical practitioners. The system does not work that way: people do not get ill on a part-time basis; people get ill and want attention. It has been made worse—and I can understand why, as my noble friend Lord Bethell set out. With the challenges they faced in the pandemic we had to have the triage. That I accept. It worked to a degree, but that is gone now. It did not work for the elderly or the infirm and it does not work for them now. The general practice in this country has got to the stage where it is no longer fit for purpose.

I do not know for how many years there have been no home visits, but it must be at least a decade. That is social care as much as anything because a home visit from a general practitioner helps prevent someone going into more extensive social care. There are no home visits even now: even people who have come out of hospital having had terrible Covid have no visit from the general practitioner to check whether they are recovering properly. I know that because actually—and I do not want to get too emotional about it—my wife nearly did not come back. There was no visit.

What, therefore, are the answers? I will suggest a few simple ones because this is not a broad debate on healthcare, but it is so important that it must get a little bit on the record. We need more doctors, which means more students going into medical college, and it has to comprise roughly 50% men and 50% women. If we look at the countries that are successful in retaining doctors, we should look at the case history of Singapore. If you are a medical trainee in Singapore, you are required to work for five years in the national health service there or pay back the cost. That is not new to this country: my elder son happened to be sponsored by the Army. He had to sign on for five years as a medical doctor in Her Majesty’s forces, or else pay back the grant. I think we should have a long, hard look at that.

We now have a situation where, while pre-pandemic, 80% of consultations were in the surgery, today that figure is, sadly, 58%. That does not work. We now have the Royal College of General Practitioners stating that the model of the full-time GP is probably something that we will never see again. That is absolute utter rubbish; I find it totally unacceptable and if he feels that way, I suggest that it is time he stood down and let somebody else lead the general practitioners of this country back to full-time practices.

Photo of Baroness Bennett of Manor Castle Baroness Bennett of Manor Castle Green 6:09 pm, 11th October 2021

My Lords, in following the noble Lord, Lord Naseby, I wish to entirely dissociate myself from anything he said about general practitioners. That was an unacceptable attack on people who have given so much to our society under the extreme pressures of pandemics. The gendered nature of his remarks was particularly disturbing. I do not know if it is something that the House authorities will look at, but I certainly think that they should.

To go back to what I was going to say, it is a great pleasure to take part in this mostly extraordinarily high-quality debate, and its fine level of forensic scrutiny—most notably the tour de force from the noble Lord, Lord Forsyth of Drumlean, who is not currently in his place. I also applaud the contribution of the noble Lord, Lord Sikka, who rightly labelled this as a Johnson tax, with the poorest hit hardest. I will circle back at the end to the reasons why I think that is a particularly accurate label.

We must look at what is happening here in this debate: we have a huge democratic deficit. We in your Lordships’ House have torn this plan to shreds, but we cannot do anything. Such is the state of our antique, dysfunctional political system, Boris Johnson won 44% of the vote in 2019 and now he can do what he likes on anything at all, including taxation. The phrase “no taxation without representation” comes to mind, because the strange thing is that your Lordships’ House is more representative of the country than is the other place. If we had a vote in your Lordships’ House, it would be the Cross-Benchers—the non-party people—who would have the deciding votes.

It is worth thinking about what the words “social care” actual mean. Nobody that I have heard has really defined this or looked in detail at what it means; we tend to talk in the abstract. So I decided to look at Scotland’s definition, where, of course, social care—in a far more democratic political system—is free.

A noble Lord:

Not entirely.

Photo of Baroness Bennett of Manor Castle Baroness Bennett of Manor Castle Green

It is a lot freer than it is here. What does it cover? Personal hygiene, assistance at mealtimes, immobility problems, medication and general well-being. In Wales—also more democratic—there is a cap on how much can be charged weekly for such provision, similarly defined. Just imagine for a second being in the position of not being able to get or afford such care—to eat, to bathe, to take your medication with confidence you are taking the right pills at the right time. It is really stressful to need that care, and to not be certain that it is available to you is very distressing and, indeed, unconscionable.

In the course of this debate, I also find myself unable to resist challenging a statement made by the noble Lord, Lord Hannan of Kingsclere, that this is taking money from the productive bit of the economy. I challenge the noble Lord’s definition of “productive”. A carer ensuring that a frail elderly person is able to feed themselves; an assistant enabling a profoundly disabled young person to live a full life—that surely is the definition of a productive use of the resources of our society. We come back to a really fundamental question: is the economy there to serve us, or are we slaves to the economy? This is where I disagree with the noble Baroness, Lady Altmann—not currently in her place—who suggested that social care should not be a political issue. This is absolutely political; it is about the way people, particularly our most vulnerable, are able to live in society.

I want to address one crucial issue before I get to three points about the structure of the Bill and the way it works. Here I echo the words of the noble Baroness, Lady Brinton, who asked the Minister to disavow the claim from the Health Secretary that social care should be provided by families. I very much hope the Minister will directly address this point and will disavow that comment, because it suggests that the Government indeed regard this, as many have suggested from different angles, as a temporary measure; that they plan for the state to eventually step back from any kind of provision for social care at all.

We heard from the right reverend Prelate that he takes a share, entirely commendably, of the care for his 93 year-old father. But how many families are in a situation to do that? The pension age is rising; many people who might have provided care for elderly relatives are now in paid employment—they have to be to meet their costs. It is a standard assumption that both members of a couple, where people are in couples, will work. Also, sadly, we are seeing the level of disability among middle-aged people rising. There is also the question of space: 1.5 million people who live in social housing are already in overcrowded conditions, which means circumstances such as children sleeping in the living room. Where are you going to put an elderly relative you are caring for—in the bathroom? I very much hope that in addressing this issue, the Minister will answer the questions at greater length than when he introduced the Bill.

We have heard some noble Lords refer to the idea of funding social care through individuals paying insurance, although most have accepted that is unviable. However, we should regard being a member of what we would hope is a decent, caring society as an insurance against hard times, illness and disability. That is why social care should be available without challenge at the point of use to all who need it.

I will address three specific points about the structure of this proposed Johnson tax: who is paying, how the money will be raised and where it is going. The noble Lord, Lord Eatwell, referred to how costs fall particularly on low-paid workers. He made some further interesting and disturbing points about the way the Government’s illustrative analysis seems to put the idea of paying for healthcare linked directly to payment.

I want to pick up a couple of groups to see what that actually means. I credit the Liberal Democrats in the other place for uncovering the fact that NHS and social care workers will be paying 12% of the £7.4 billion expected to be raised from employees through the tax—£900 million. That does not include self-employed healthcare workers and social care workers, so the real figure is even higher—call it £1 billion. These are often low-paid workers, carers and nurses, far too many of whom we regularly hear are dependent on food banks to feed themselves. They are having money taken from them so that possibly a little more money goes into the system. I will quote an unusual source for me, Fraser Nelson in the Spectator:

“How can you justify increasing taxes on the working poor to safeguard the assets of the stonkingly rich?”

What we are seeing—I think the public is often not well aware of this, because for many it is an academic point which will never come into view—is the fact that the national insurance employee contribution falls from currently 12% of income to 2% of earnings over £50,270 a year, so that high-earners pay a lower proportion of their earnings in national insurance contributions than low earners.

Of course, national insurance contributions also kick in around £9,500, which means that even some people too poor to pay income tax are paying into the system. When we think about our broadly-speaking young people—the graduates paying back student loans—they will be taxed at 50% on any increase in salary above £27,288.

So, those are the people who are paying. How is it being arranged? I refer back to the excellent speech by the noble Lord, Lord Forsyth of Drumlean, who spoke about the need to combine income tax and national insurance and the missed opportunity for a simpler, fairer, flatter tax system. The noble Lord, Lord Naseby, was looking for an alternative solution. I can point him to the Green Party manifesto of 2019, which goes even further than the noble Lord, Lord Forsyth. It merges employee national insurance, capital gains tax, inheritance tax, dividend tax and income tax into a single consolidated income tax. All income is treated the same way for tax purposes. This ends the injustice of people who work for their income being taxed more lightly than those whose income is derived from wealth, frequently arrived at by accident of birth or blind luck. I also note that our manifesto provides free social care to the over-65s.

Finally, I get to the point about where the money is going, and this picks up points made by the noble Lord, Lord Sikka. A large amount of this money is going into a privatised, financialised sector—large chains of care homes with hedge fund owners taking returns of 12% or more a year out of the provision of care for our most vulnerable citizens. I very much enjoyed and commend the contribution of the noble Lord, Lord Griffiths of Burry Port, who talked about the commendable work of MHA and gave us an insight into just how difficult that work has been, particularly in the last couple of years. We also heard about the excellent work MHA is doing through music therapy. All the funds it gets go towards providing care. Think about what would happen if you scooped out 12% or more in financial returns and then still tried to meet the basic needs of residents—that is certainly all you would be able to do.

Of course, that is academic because, as many noble Lords have said, while this is talked about as being for social care, the money, for the next foreseeable time, will go into the NHS. With one more executive power grab, from 2025 the Chancellor will decide what happens then.

It is often suggested that there should be a “truth in advertising” rule for government policy. If we were to see that, we might see a total gridlock of government—one to rival the chaos in our supply chains—as opposed to the tangle of unpublished strategies, undeliverable targets and fantasy announcements that we have now. Were trading standards and the Advertising Standards Authority asked to cover the announcements of government, I think their websites would do down in seconds.

This is billed as a health and social care levy; it is clearly nothing of the sort. It does nothing to fix the enormous financial and structural issues in our care system. It leaves underpaid, overstressed workers seeking to care for underserved, neglected patients while private profits are scooped out of the system. It does not even do more than apply sticking plasters across some of the gaping gaps in our NHS.

I conclude by referring back to that term, “Johnson tax”. It is misleading in its claims, it is fragile in its structure and it does not create any kind of solid framework for the future. I cannot help thinking of the London garden bridge, the Irish Sea bridge, the “Boris buses” and the so-called Emirates Air Line. It is misbegotten, unreliable and fundamentally unsound.

Photo of Baroness McIntosh of Pickering Baroness McIntosh of Pickering Conservative 6:22 pm, 11th October 2021

My Lords, I congratulate the Government on at least tackling what is a very vexatious part of government policy. I refer to my interests: the work I do with the Dispensing Doctors’ Association and the fact that I was a dispensing doctor’s daughter and a dispensing doctor’s sister.

There has been very little focus today on the delivery of care in people’s own homes, as opposed to care homes. Through dispensing doctors and rural practitioners generally, and indeed those delivering care in people’s own homes, I am very familiar with the fact that delivering NHS and social care in rural areas is more challenging and therefore costs more than in more urban settings. How do my noble friend the Minister and the Treasury expect that to be addressed through both the raising and the spending of the money raised through the levy? There used to be a sparsity and rurality factor in NHS funding, and it would be very welcome to return to that if we can. How will funding apply to and be highlighted for the delivery of care to the elderly in their own homes in rural settings?

I come to the points raised by my noble friend Lord Lansley about those who are elderly with comorbidities, who are often taken into hospital as an emergency and then find it difficult to be released from that setting into their own homes. I regret the fact that many of the community hospitals and wards that used to take them as a step-up, step-down halfway house before they were deemed safe to return home have disappeared. It is important that the release of these patients and their discharge from hospitals to their own homes is highlighted in the way the levy can be used.

Therefore, I would particularly like to ask my noble friend what proportion of the extra money raised in the earlier years will be allocated to the health service especially. How will that money be distributed between primary and secondary care? At the moment, we are seeing that, where primary care does not have the resources to deliver, people of whatever age—but particularly the elderly, with comorbidities—are turning up and being treated as an emergency in hospitals.

I would also like to ask, because the Bill does not set this out, at what point my noble friend will address the urgent problem of staff shortages, which a number of noble Lords have addressed this afternoon. There is clearly a shortage of nurses, and I saw that as recently as last week, when a family member was treated, excellently, by the NHS; there is clearly a shortage of nurses and doctors, and, I may add, carers too. When will my noble friend address that and when will the Government come forward with proposals for our consideration?

Finally, I would like to say how regrettable it is that this regressive form of tax is being chosen. There are alternatives. The least favourable option for me would be an insurance scheme, which I know operates in many parts of continental Europe, such as Denmark. I find it quite alarming that, when a member of my family in Denmark calls an ambulance, they have to produce the payment and show they have the coverage before they are whisked off to hospital. For me, that is probably the least favourable option. But I regret that the form that has been chosen in this Bill is the most regressive. As the noble Lord, Lord Shipley, pointed out in the Government’s own tax information and impact note, it will impact on those who are just about managing at the moment.

I would like to point out something that the Government do not seem to have any recognition or cognisance of at all. By raising the levy on national insurance, the Government are taking money out of care and hospital care. Who are the largest employers in the country at the present time? The NHS and local authorities, and many noble Lords have referred to the fact that council budgets have already come under severe restraint. They are our two largest employers at the moment. The same tax information and impact note refers to the fact that:

“This measure is expected to have a significant impact on over 1.6 million employers who will be required to introduce this change.”

What the note and the Bill fail to reflect is that both the NHS and local authorities will have to find this money.

My final question to my noble friend is this: what estimate have the Government made of the cost to the NHS, local authorities and other employers of this additional 1.25%? How are the Government going to make good that money to make sure that patient care is not depleted in the same degree?

Photo of Lord Desai Lord Desai Non-affiliated 6:28 pm, 11th October 2021

My Lords, an advantage of being the last speaker is that everybody has to come back into the Chamber to listen to you, because that is part of the rules of the game.

Let me say first that this has been a good debate. I mean, it is pointless, because we cannot amend a money Bill. The Commons has passed it, and the Government want to rush it through. Whatever we say, no notice is going to be taken, so we can be completely disinterested and make good suggestions—nothing partisan.

This is a bad Bill and a bad proposal. It is bad not so much from the point of view of the people who are going to bear the burden but from the point of view of the Government proposing it, because it is not very elastic in terms of raising revenue. It is procyclical, so the collections will fall any time life is hard and there is unemployment. Then we will have to do what Pitt the Younger set a good tradition for and raise the rates, so 1.25% is not the end of it. It is just the beginning and it will happen steadily if this tax stays on the books—and I am sorry to say that it will.

It is not to finance social care. Let us get it absolutely straight: social care is in the title of the Bill but this is not to finance it. It is to make up the NHS gaps, but they can never be filled. That is very clever, because people have this folk memory that the Beveridge plan created national insurance to finance the National Health Service when it was set up. That is the folk memory I was brought up on. So, everybody will say, “This is quite a nice tax because we will finance our NHS” and even poorer people will say, “I am willing to pay a little bit more to finance the NHS because it is very close to me.” As the noble Lord, Lord Hannan, said, people will be asked, “Will you pay extra tax?” They will say, “Of course I will pay extra tax for the NHS” because, as people have said, we only have one religion in this country and that is the NHS.

Financing social care will have to be done later on and I will come on to that. We have this tax, and lately there has been a flurry of excitement in the newspapers that the Tories are becoming a high-tax party and people are asking what will happen. Do not worry, I say to these Benches; you are not being taxed—the poor are being taxed. That is what the Conservative Party came into power for, so relax, you are all safe. The question of how we will finance social care will remain. How will we organise social care is for another day, but how are we going to fund it?

Before I get into those sorts of things, I have a technical question for the Minister, and I would like a reply. I have been working hard. Will the carried interest of private equity firms be subject to the levy or not? I would like an answer to that because that may bring in a bit more money. The noble Lord, Lord Sikka, shakes his head. I can see that he knows the answer. I do as well, but I will not go into it. He suggested various schemes in which money can be raised. I have always thought that I have a very clever device to raise money. I do not think anybody would like it and I have a record on this; I was sacked twice from the Opposition Front Bench for proposing new taxes nobody liked. Here goes, as I am no longer on the Front Bench.

The original problem is this: the better-off middle classes have property, and they do not want to sell the property to finance old-age care. I think the noble Lord, Lord Hunt, pointed this out. Instead of tackling that problem, the thinking is, “Oh, the poor better-off people want to hang on to their house and pass it on to their children. How can we save them from the terrible problem of having to sell a house?” Fine—let us respect that wish. People do not want to sell their house. The house is the one asset more widely owned in this country—not by the majority but more than any other asset. Quite rightly, people want to hang on to their house. Houses are a very good investment because you have an unrealised capital gain. My question is: how do you tax unrealised capital gains? That is the essence of the problem: making sure that people do not have to sell their house but pay part of its unrealised capital gain. Your Lordships can see where this is going and no one is going to like it, but it is very lucrative for raising money.

I shall take my own example because that is a very simple thing to do; I am not making up the numbers too much but I will not give your Lordships the true numbers. I have a house, which I have had for 17 years, and it has quadrupled in price. No other asset that I know of would give me that high a return, and every middle-class family knows this. However, I have paid the same council tax based on the original price at which I bought the house so I have pocketed all of its unrealised capital gain. The poor council has not got anything out of it, even though it has higher expenditure for collecting my garbage and so on.

How can we release that unrealised capital gain to councils? The answer is very simple. You do not have to raise a council rate; you have only to raise the value of the base on which the tax falls. Since I am a very ambitious person when it comes to imposing tax, I would do this annually but you could do it quinquennially: we could have a national commission for valuing property that valued all properties across the country by different types—one bedroom or two, garden or no garden, SW1 or NE17 or wherever—and it would announce a number for each type of house where the price had gone up by X per cent.

The base of the council tax for those kinds of houses would go up. I would not be taxed fully for the quadrupling of my house price but I might be taxed for its doubling, so I would pay more council tax while I was living in the property. When I came to sell, I would make a capital gain. I would not lose money. My children, or whoever I wanted to pass my property on to, would get the property. The property would not be gone, it would stay with its owner, but we would milk a little bit of the capital gain that accrues every year because of inflation and growth. People think that is impossible but it is not. Anyway, I am not running the country.

I believe that some sort of flexible, elastic tax like that is required. To take care of the problem of the postcode lottery which the noble Lord, Lord Forsyth, mentioned, where a poorer council would not get it but a richer council would, one could equalise because the increase in the base rate would be national. There would be some partial exchange. I cannot solve all problems in this short speech but I can solve some.

I urge the Government to consider this, although not now because they do not have the opportunity. In fact, if not the Government then perhaps, as the noble Lord, Lord Forsyth, said, we in the House of Lords ought to form a committee to solve this problem. Members down the Corridor are not going to solve it because they do not have the time, but we do, and being elderly is our problem so we have a stake in this. We ought to genuinely look for elastic, high-yielding ways of taxing property without, as far as possible, affecting people’s desire to hang on to their property while they live. If we could do that—and only the House of Lords could; no one else can—that would be a very good thing. I urge the Government to make room to implement that proposal and then take our propositions seriously.

Photo of Baroness Kramer Baroness Kramer Liberal Democrat Lords Spokesperson (Treasury and Economy) 6:40 pm, 11th October 2021

My Lords, I am the first of the winding speakers. I have listened to many debates in this House, but it is very rare to hear speech after speech of the quality that we have had today. Frankly, it makes it even more galling that the other place dealt with this Bill so quickly, when there was so much that needed to be said and changed. It is galling that we cannot in any way directly impact the shape of the Bill, other than by hoping that we have persuaded the Government to reconsider an issue here or there, but that is the world in which we function. At least we can make sure that we are heard. I hope the Government will read today’s speeches because they have been quite extraordinary.

I come from a party that has been talking about a hypothecated tax to increase the funding of health and social care for years. We always assumed that that would be based essentially on income tax, as the broadest-based tax and the most progressive of the taxes available. Lots of other ideas have come from the Floor today, including a much more regular re-rating of property. There are many ideas to consider, but the essential principle that the increased funding for the NHS and social care should be funded by a very broadly based, progressive tax is to me fundamental and sensible.

One of the reasons we as a party have gone in the direction of a hypothecated tax is to keep the Treasury’s sticky fingers off the additional money. It will be important to hear an answer from the Minister on the question that the noble Lord, Lord Eatwell, raised about how long this levy will be hypothecated. We need some assurance and a fuller understanding of that issue.

When I first heard that the Government were going to consider a levy, never in my wildest dreams did I consider that it would be put on national insurance. It would be hard to find a more unsuitable basis for raising this kind of funding. Many people have made the fundamental point that the threshold for paying national insurance is much lower than that for income tax, so this falls on the poorest in our society. The levy has a rate step-down for people earning higher incomes and of course it does not touch unearned income. We understand that there will be some sort of dividend tax but, as others have said, unearned income, whether on property, pensions or savings, is not captured. The Government talk constantly about levelling up, but they plan to put a tax on those with the lowest incomes, while excluding the sources of income of many of those with the highest incomes. How on earth does this contribute to levelling up?

It is normal for us to see a distributional analysis—this was raised by the noble Lord, Lord Eatwell, and others—to show where the costs fall. I would be very interested to see an analysis which separates out where the costs and the benefits fall. That information will be critical. As many have pointed out, those who will be able to benefit from the cap will be some of the biggest winners in all this, rather than people who are currently struggling because the social care on offer to them is completely inadequate and needs to be better funded. We need that distributional analysis, broken out in an appropriate way.

Context matters when we consider increasing something such as national insurance. Context always matters. The context in this case is a rapidly rising cost of living. I read today that inflation is now anticipated to reach 6% by the spring and to fall back only to about 3% for the remaining decade. That will be an incredible hit for individuals, and much of that inflation will be embedded in essentials such as food and energy. Bitterest of all for almost everybody on low incomes is the £20-a-week cut in universal credit, coming as part of this overall package. It is described by the Resolution Foundation as a “toxic” combination, and that is perhaps the most accurate phrase.

If we look back at the work done by the House of Commons Library just to give people a sense of exactly how that works, we see that a typical NHS worker is on something like £19,330 a year, and many such workers rely on universal credit. They are about to see their income fall by almost £80 a month at this time of rising prices. That is despite the 3% pay increase that they have been awarded, because the increase in national insurance and the cut in universal credit are dwarfing the pay increase. The Government must have known that when they agreed to the 3% pay increase, and frankly, it makes me absolutely furious that we did not have full honesty, transparency and openness at that time.

I have a particular question to ask the Minister because I would like some clarity on this. The Government intend to reimburse government departments for the increase in national insurance contributions for those whom they employ directly. But many departments, and far more especially local government, contract out services, and indeed, the Conservative Government have pressured them to keep contracting out services for a long period. What happens when that increase in national insurance hits the cost of outsourced services? Will the Government pick up that added bill? As many others have said, we now see local authorities considering a 5% increase in council tax just to cover the underfunded cost of social care, and I do not think that includes the additional impact of the national insurance contribution on the cost of outsourced services. We absolutely have to get some sense of an answer.

We all know—we have heard again today from speaker after speaker—that this levy is far from adequate to solve the problem, not just of social care but even of the NHS, especially with its post-Covid backlog. Social care is again pushed into the Cinderella role. We know also that over the next three years, of the £36 billion raised, it is anticipated that at best only £5.4 billion will go to social care. That is a drop in the ocean in many ways, particularly listening to the numbers that the noble Lord, Lord Forsyth, quoted on the need for an £8 billion-a-year increase; others updated those figures to something closer to between £9 billion and £14 billion. Like many others, I am absolutely convinced that we will not see the NHS claim this money just for a short two or three-year period. When I talk to people in the NHS, they are very clear that they will need to claim the lion’s share of all that money for more than a decade to be able to bring the National Health Service to the level that will enable it to deal with its current and anticipated burdens.

Demographics are moving against us as well. Many people talked about the fact that half of those using social care presently are adults with various forms of disability. They will be moving into old age. The demographics mean that we will see an ever-increasing social care burden, so we need a comprehensive plan, as many said—a proper framework to be able to deliver social care. I would love to know what is in that famous White Paper which was apparently in the Prime Minister’s back pocket, but we have not even seen that at this time. I also agree with so many of those who say that when you look at this package, it is clear that not only does it not fund the social care reforms that we need to deal with the desperate staffing shortages—now well over 120,000 people—but those who think that their costs will be covered will find that they are not covered for “hotel costs”. May I say what an appalling term that is? These are costs of living, not costs of luxury holidays. They are not hotel costs in the sense that anybody would ever anticipate. In addition, that the cap will be tied to costs defined by local authorities’ assessment of cost rather than the real cost puts us in an absolutely extraordinary situation.

I know that I should finish very quickly. From all the voices that I have heard today, I have taken that there is a huge amount of common ground across parties, Benches and ideologies. We are not all absolutely in agreement on every single point. However, it is clear that it is possible to pull all parties together and establish an underlying policy and principle that everyone can sign up to and that then guarantees that both the schemes and the funding do not become political footballs in ensuing elections. It also means that we can have in place the kind of long-term planning that is fundamental to the answers that we are searching for. Could the Minister take back or even give us confirmation today that he will be genuinely pulling together all the various voices to both establish the framework and think through the funding? We all completely admired the statement made by the noble Lord, Lord Forsyth of Drumlean, right at the beginning. We are being asked in the Bill to pay a bill but have no idea what on earth is on the menu and what services will be provided. If we do not do this on an all-party basis, we will be doing something that, frankly, has very little future.

Photo of Baroness Thornton Baroness Thornton Shadow Spokesperson (Equalities and Women's Issues), Shadow Spokesperson (Health) 6:51 pm, 11th October 2021

My Lords, I first thank all noble Lords for their contributions. After 23 years in your Lordships House, this is the first time I have been on the Front Bench during a money Bill. I am used to, of course, at Second Reading, thinking about the legislation that might be amended and how we might amend it and put it under greater scrutiny—so more is the pity today.

During the 2019 general election, Boris Johnson said,

“Read my lips, we will not be raising taxes on income or VAT or national insurance”.

The Chancellor of the Exchequer has gone further and solemnly said,

“Our plans are to cut taxes for the lowest paid through cutting national insurance”.

After the general election, on the steps of Downing Street in December 2019 and on his return from Buckingham Palace, the new Prime Minister said,

“and so I am announcing now—on the steps of Downing Street—that we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve”.

Almost two years later we can see that there was no plan prepared or even in existence, and that it was an untruth when Boris Johnson promised that national insurance would not be raised. These two facts cannot be excused by the intervention of Covid-19. As my honourable friend Rachel Reeves, the Shadow Chancellor, said,

“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”.—[Official Report, Commons, 8/9/2021; col. 327.]

After the devastating critique of the Bill and its effects by my noble friend Lord Eatwell at the opening of the debate, combined with the Adam Smith Institute condemning the Prime Minister’s speech to his own conference as “vacuous and economically illiterate”, I think it is safe to say that we are all in trouble.

At the end of the remarkable debate today, I take a moment to pay tribute to the extraordinary work and commitment of social care staff over the last year, in the independent sector and local authorities. They have been on the front line of this pandemic, going beyond the call of duty in helping hundreds of thousands of people through an extremely difficult time. I want to recognise that the vast majority of care and love provided to our vulnerable fellow citizens is from their families—unpaid and unsupported carers—and who in this Chamber has not been fulfilling that role in some way or other over the last year or so? I pay tribute to the volunteers and community activists who stepped up during the pandemic to ensure the well-being of millions of the most vulnerable in our communities.

Throughout the pandemic we saw that social care was still not funded or treated as equally important as the NHS: front-line care workers are chronically undervalued and underpaid; families, who provide the vast majority of care, get too little support in return; and an already fragile care market has been made even more susceptible to failure, with all the human consequences that that will bring.

At least we now know the Government’s underlying philosophy on social care. Sajid Javid, in his Conservative Party conference speech, said that health and social care “begins at home” and that people should turn to:

“Family first, then community, then the state.”

That tells us a great deal. Not only is it disrespectful to the millions of unpaid family carers, whom this levy does nothing to help or support—4 million of whom are children—but it is deeply ignorant to imply that people

“always go first to the state” when family and friends do so much, increasingly during the pandemic, and so many have been pushed into poverty, even having to give up work to care for relatives in many cases.

The truth is that many people are unable to cope with their relatives’ caring demands because of other caring commitments; perhaps they do not live near enough, or are elderly, disabled and have care needs themselves; or they simply cannot cope with complex needs. It is also worth noting that unpaid social care falls disproportionately on women—72% of carer’s allowance recipients are women—so it also perpetuates gender inequality. The levy we are debating also does not address how to meet unmet care needs, which highlights the wider issue and need for reform. The Secretary of State’s “family first” line exposes the Government’s lack of policy and ambition for reform, in sharp contrast to Labour’s policy of “home first”—enabling people to receive the care they need, with dignity, in their own home.

I have come to the conclusion, sad and frightening as it is, that this Government do not understand who the cared for are and who does the caring in our society. Is the Minister aware that one-third of the users of social care—and half the social care budget goes to them—are working-age adults with disabilities? Build Back Better hardly mentions them at all; it just assumes and addresses our ageing population. Is he aware that more people get care and support in their own home than in care homes? Is he aware that one in three unpaid family carers has to give up work or reduce their hours because they cannot get the help they need to look after their loved ones? They lose their income, employers lose their skills and the Government lose their taxes.

Yet, despite social care being vital to so many people, over the last decade the Government have repeatedly failed to tackle the underlying problems in the system—a fact brutally exposed by Covid-19. It is quite reasonable for the noble Lord, Lord Forsyth, to ask what Labour would do instead. Our goal is to transform the situation for older and disabled people, as part of a much wider ambition to make Britain the best country in which to grow old. In this century of ageing, we understand that social care is as much a part of our infrastructure as our roads and railways. If you neglect your country’s physical infrastructure, you get roads full of potholes and buckling bridges, which prevent your economy functioning properly. The same is true if you fail to invest in your social infrastructure. Without a properly paid and trained care workforce, vacancy and turnover rates soar, fewer people get the support they need and families end up taking the strain.

We have been calling for a 10-year plan of investment and reform, empowering users and families to live the life they choose, ensuring their views and experiences drive change throughout the system, with a guiding principle of “home first”. We will always need residential and nursing homes, but the vast majority of people want to stay in their own home for as long as possible. Yet too many struggle to get even the basic support or home adaptations that make this possible. Greater use of technology can also help people live independently for longer, as can expanding the housing options between care at home and a care home.

Delivering on the “home first” principles requires a fundamental shift in the focus of support towards prevention and early intervention. Some 1.5 million older people need help with the basics of getting up, washed, dressed and fed but do not get any support at all. That is not good for them, or for taxpayers if they end up needing more expensive care or end up in hospital as a result.

None of these improvements will be possible without transforming the pay and conditions of the workforce. This pandemic has shown, more than ever, that front-line carers are essential to a properly functioning society and economy, yet two-thirds do not earn the real living wage and a quarter are on zero-hours contracts. So it is time for a new deal for care workers to back the aspirations of staff, tackle high vacancy rates and deliver at least 500,000 extra staff, whom we will need over the next decade just to meet growing demand.

As a starting point, Labour has called on the Government to guarantee that all care workers are paid at least a real living wage of £10 an hour in their plans for social care reform. Alongside this, families need decent support to help care for their loved ones, so that they do not put their own health and livelihoods at risk. We back a new partnership with unpaid carers, so that they get proper information, advice, breaks, and more flexibility in the workplace to help them balance their work and caring responsibilities. Our vision is for social care services to be fully joined up with, but not run by, the NHS. We have learned from the media that, as many noble Lords have said, there is likely to be a comprehensive plan for a new national care service, under which health and social care could be delivered by the same organisation, and that it is being actively considered for inclusion in a White Paper next month. Well, we have been waiting for a White Paper for two or three years, so who can say when that will happen?

I hope that the noble Lord, Lord Bethell, is enjoying his non-governmental role. At no point over the past two years have he or the Government attempted to have cross-party discussions about the future of social care—not once. I am totally puzzled as to why he did not take up the good ideas in the paper led by the noble Lord, Lord Forsyth, for instance.

So we have a half-baked Bill before us today which says that national insurance contributions will rise by 1.25 percentage points from next April, to raise £12 billion a year for the NHS and social care, but social care will not get any of the funding for two or three years, if at all. The Minister must have picked up the scepticism across the House about how that will roll out. At the same time, launching the Bill before us today, Downing Street remained unclear about how an integrated system would work best. In addition, we have a huge NHS Bill in play in the Commons which says that its aim is to create integrated care systems—well, who would have thought?—for providers and commissioners of NHS services, together with local authorities and other local partners to collectively plan health and social care services. Can the Minister describe what the final outcome of all this might be, and in what kind of timetable?

My noble friend Lord Eatwell posed many questions that the Minister must address in his closing speech. My noble friends Lord Hunt, Lord Lipsey, Lord Whitty, Lord Hain, Lord Griffiths and Lord Sikka have added many important and pertinent questions, and I have added one or two of my own. The Minister now has an opportunity to persuade the House that this Bill solves at least some of the problems that face social care.

Photo of Lord Agnew of Oulton Lord Agnew of Oulton Minister of State (HM Treasury), Minister of State (Cabinet Office) 7:03 pm, 11th October 2021

My Lords, this has been an interesting debate. The quality of speakers has been very high, and I am aware that most of them know far more about these issues than I do—so it is with a certain humility that I attempt to reply. Also, as someone who does not appear that often, even I have noticed that I do not necessarily have the mood of the House with me on this Bill. However, I will spend longer in summing up than I spent in opening, to try to address some of the concerns and at least put the Government’s point of view on the many challenges that have been raised.

I will start with my noble friend Lord Forsyth, the noble Lords, Lord Eatwell and Lord Shipley, and the noble Baronesses, Lady Tyler and Lady Kramer, on the fundamental issue of the use of national insurance as the linchpin for this tax raising. We need a broad-based tax, such as income tax, VAT or national insurance, to raise the sums needed for such a significant investment. There is a precedent here. In 2003, the Labour Government increased the same NIC rates by 1%, specifically to increase funding for the NHS. There is an existing NIC ring-fence for the NHS. The NIC system already directs a ring-fenced proportion of receipts to the NHS. This ring-fence was established in 1948 and expanded by the Labour Government in 2003. I cannot provide the noble Lord, Lord Eatwell, with a cast-iron guarantee that the hypothecation will remain in perpetuity, but we see the principles here and, as my noble friend Lord Hannan said earlier, rarely do these taxes, once created, go away—so I hope to give some reassurance on that.

This also ensures that businesses contribute to the NHS. That is fair and reasonable, because they need a workforce that benefits from the NHS. Lastly, NICs apply on a UK-wide basis.

The noble Lords, Lord Macpherson and Lord Sikka, asked why we have not included rental income in the widening of the net. We have included dividends while excluding modest amounts of dividend, up to £2,000 a year. With regard to income from property, tax is currently levied at the same rates as income tax on earned income. Divergence in these rates would add complexity and create opportunities for avoidance. Those who earn their income from property have made a contribution to public finances. The property allowance has been frozen, as have the personal allowance higher rate and additional rate thresholds.

The Government are making sure that landlords continue to make a contribution. For example, we have restricted tax reliefs available to landlords. Over the past four years we have restricted relief for finance costs: it can now be claimed only at the basic rate, not at 40% or 45%. That has raised more than £1 billion. The higher rate of stamp duty for additional residential dwellings means that landlords now pay between 3% and 15% extra tax on those properties.

The noble Baroness, Lady Tyler, raised the issue of people over the state pension age, and noble Lords asked about the whole issue of intergenerational fairness. If we were to raise the sums required just for those over 40, the levy would need to be 60% higher, at around 2%. This would be a much larger burden on working people. Furthermore, around half of all the funding raised by the levy will go towards health and social care services that benefit working-age people, such as general NHS funding and vaccines. Working-age people will also benefit from limits on what they would need to pay if they themselves needed care in later life, and they will gain the peace of mind that comes from protecting their family members from substantial costs.

The noble Lords, Lord Eatwell and Lord Sikka, my noble friend Lord Forsyth and the noble Baroness, Lady Tyler, asked about the impact on the lowest paid. In relation to individuals, NICs are a progressive way to raise money: the highest-earning 14% will pay about half the revenues raised, while 6.2 million people who earn less than the NIC threshold of £9,500 will be kept out of the levy. I accept the points raised by two noble Lords about the cliff-edge nature of NIC contributions for higher earners, but the brutal reality is that, in the round, that top 14% will be paying around half of the total. That goes to the crux of this whole debate: we have tried very hard to ensure that this is a broad-based tax—as broad as possible.

Lower-income households will be large net beneficiaries from the package, with the poorest households gaining the most as a proportion of income. As was noted by one noble Lord, the highest 20% of households by income will contribute 40 times as much as the poorest 20%. One can make arguments about how much the bottom and top earn; nevertheless this is a highly redistributive approach to a difficult tax and an issue that all parties have dodged for 20 years. It is a genuinely progressive policy, and the distributional analysis published by the Treasury makes that clear.

Going beyond that, since 2010, Conservative Governments have consistently kept lower-paid people out of tax and kept the cost of living down. The income tax personal allowance threshold has increased by over 90%, meaning that a typical basic rate taxpayer now pays £1,200 a year less than they would have done otherwise. We also increased the NIC primary threshold by over £800, in April of last year, with a typical employee saving just over £100. In April of this year, we increased the national living wage to £8.91—an annual pay rise of £350 for someone working full time on the national living wage. Taken together, our changes to national insurance mean that someone working full-time on the minimum wage is currently £5,400 better off than in 2010.

The noble Lords, Lord Eatwell and Lord Macpherson, asked about the impact on employers. Some 70% of the money raised from businesses will come from the largest 1% of employers, and some 640,000 employers are excluded through the assistance at the bottom end. Again, as a Conservative Minister myself, I do not like raising taxes for anybody, but we have tried to broaden this tax as much as possible. Around 40% of businesses will not be affected by the levy. The noble Lord, Lord Macpherson, and my noble friend Lord Hannan, are not happy about a tax on jobs. The OBR will consider the economic effects of the levy in the light of its updated economic and fiscal forecasts, which will be published in the next couple of weeks alongside the Budget.

The noble Lord, Lord Eatwell, asked about the tax bill on the UK. We have had to take these difficult decisions because, as I said in my opening comments, this is a permanent increase in taxation for a permanent challenge that we face in a country with aging demographics. Our tax system remains competitive, with our tax take as a share of GDP lower than major international competitors, and broadly in the middle of the G7.

My noble friend Lord Forsyth asked about anti-avoidance rules, which is a very important question. I suspect, pragmatically, that there will be some fiddling around at the edges in the March/April threshold, but this whole piece of legislation will be subject to the full anti-avoidance rules that apply to NICs. Indeed, the recent work on IR35 would probably have been the biggest area of weakness had we not engaged in those reforms. The noble Lord might be interested to hear that even government departments are being threatened with fines by HMRC for non-compliance with IR35, so HMRC is out there already.

The noble Lord, Lord Eatwell, and the noble Baronesses, Lady Brinton and Lady Kramer, asked about hypothecation. I touched on this earlier. In 2022-23, all revenue from the health and social care levy will be directed to NHS England and equivalent bodies in Scotland, Wales and Northern Ireland through the existing NHS allocation. From 2023-24 onwards, levy revenue will be ring-fenced in law for health and social care. HMRC will pay the proceeds to those responsible for health and social care in all four parts of the UK, including NHS Scotland, NHS Wales and the equivalent in Northern Ireland.

The noble Baroness, Lady Fraser, asked about devolution and our way of handling that. This is absolutely a UK-wide problem. We have taken the decision to act on a UK-wide basis for the benefit of citizens across the UK. Scotland, Wales and Northern Ireland will receive Barnett consequentials on the additional health and social care funding in the usual way, with exact totals to be confirmed in the SR. Early indications are that, pro rata, the populations of the devolved authorities will receive more money from this approach.

The noble Baroness, Lady Brinton, asked about the funding specifically for social care. The Government are committed to spending £5.4 billion across three years on adult social care from this levy. This funding will end unpredictable care costs and include over £0.5 billion to support the adult social care workforce, in recognition of their efforts over this terrible pandemic. It includes funding to enable all local authorities to move towards paying providers a fair rate for care, which should drive up the quality of adult social care services, improve workforce conditions and increase investments.

Several noble Lords asked about funding for local authorities. We are committed to ensuring that local authorities have access to sustainable funding for core budgets at the spending review. We will ensure that every council has the resources they need to deliver these reforms.

The noble Lord, Lord Griffiths, spoke movingly and clearly understands this sector very well. I would like to reassure him that substantial support has been provided to the social care sector through the pandemic—for example, billions of items of free PPE prioritised to care workers, residents and unpaid carers for vaccination. We have made available £2.4 billion in specific funding for adult social care. This is made up of £1.75 billion for infection prevention and control, £522 million for testing, and £120 million to support workforce capacity. This funding is additional to the £6.1 billion for local authorities to deal with the impact of the pandemic on their services, including adult social care.

I turn to some specific questions on social care spending. First, on the size of the cap, the new £86,000 cap will end unpredictable care costs so that more people can preserve their savings and assets. Andrew Dilnot’s report was published 10 years ago and reflected the circumstances in 2011. Clearly, levels of wealth and asset prices have increased since then. We think that we have set the cap broadly at the right balance of achieving personal responsibility for planning for old age but putting in place a safety net where exceptional costs or periods of care are needed.

On domiciliary care, I think my noble friend—

Photo of Lord Hunt of Kings Heath Lord Hunt of Kings Heath Labour

Would the noble Lord give the House an estimate of how much a person would really have to spend before they reach the £86,000 cap? Does he agree that it will be at least double?

Photo of Lord Agnew of Oulton Lord Agnew of Oulton Minister of State (HM Treasury), Minister of State (Cabinet Office)

My Lords, more detail will be set out in the Budget and spending review in the next two or three weeks to address the noble Lord’s question.

The noble Lord, Lord Hunt, my noble friend Lord Bethell and the right reverend Prelate asked about help for carers specifically.

Photo of Lord Forsyth of Drumlean Lord Forsyth of Drumlean Chair, Economic Affairs Committee, Chair, Economic Affairs Committee

I apologise. My noble friend was about to answer the question on domiciliary care.

Photo of Lord Agnew of Oulton Lord Agnew of Oulton Minister of State (HM Treasury), Minister of State (Cabinet Office)

Yes, sorry. I lost my thread. There will be no changes to existing procedures.

Noble Lords asked about support for unpaid carers. Of course, they play a vital role in the care system. I suspect that there is hardly anyone here in the Chamber who has not been involved in the care of their parents at the end of their lives on an unpaid basis. I certainly had to—but luckily I am one of seven siblings and we all live in the same county. None the less, it is a considerable burden.

The Care Act encourages local authorities to support unpaid carers and to provide preventive care to stop people’s early care needs escalating. A new cap on care costs will offer greater certainty to unpaid carers and support informed decision-making and planning for the overall costs of care.

The Government will take steps to ensure that the 5.4 million unpaid carers have the support, advice and respite they need, fulfilling the goals of the Care Act. We will work with the sector, including unpaid carers, to co-develop more detail in our plans and will publish further detail in the White Paper for reform later this year—and on the matter of the White Paper, I say to noble Lords that it is not long now. It is only a couple of months; it has been promised before the end of the year, and I am perhaps a little more optimistic than some Members of the House.

Photo of Baroness Kramer Baroness Kramer Liberal Democrat Lords Spokesperson (Treasury and Economy)

Before the Minister leaves this area of exploration, does he have an answer to my question on whether the Government will pick up the costs of the additional national insurance to be paid by those to whom local government outsources services? I believe it is a yes or no answer.

Photo of Lord Agnew of Oulton Lord Agnew of Oulton Minister of State (HM Treasury), Minister of State (Cabinet Office)

I cannot give the noble Baroness a clear answer on that now. More detail will be available in the Budget and the spending review. If it does not transpire in those documents in the next couple of weeks, the noble Baroness can write to me and I will investigate further.

On the adult social care workforce, our investment is at least £500 million across the three years to deliver new qualifications, progression pathways and mental health support. This workforce package is unprecedented investment: it is something like a fivefold increase in public spending on skills and training for this sector.

The noble Lord, Lord Griffiths, asked about vaccines for NHS staff. He is correct that at the moment there is no requirement for NHS staff to be vaccinated. However, we have a consultation under way to try to find the best way through on that sensitive issue.

I have probably answered the noble Baroness, Lady Kramer, as much as I can on the compensating of NICs. Just to confirm, I say that the Government will compensate public sector bodies such as the NHS for the increased cost of employer NICs. If they did not, they would simply reduce the amount available. The Chancellor will set out more details in his spending review.

My noble friend Lord Bethell asked about NHSX funding. We remain absolutely committed to all aspects of technological improvement. Again, I am more optimistic over the long term because I believe we will find new ways of treating this sector more efficiently, and NHSX will play a part in that.

My noble friend Lord Naseby made a point about the structure of GPs’ surgeries. We will have to see some dramatic changes in that area. In my view, we cannot sustain surgeries in which five-sixths of the doctors are working only part-time, but again I think this will throw up opportunities. The two sectors will have to work much more closely together—

Photo of Baroness Thornton Baroness Thornton Shadow Spokesperson (Equalities and Women's Issues), Shadow Spokesperson (Health)

The Minister is straying into territory that I think is probably unwise. The noble Lord, Lord Naseby, made various assertions, but there is no proof that part-time doctors and GPs are less efficient or that this is a less efficient way of working. We know that this absolutely is not the case in lots of other places, and there is no proof that it is in this case. The Minister might be wise not to go there.

Photo of Lord Agnew of Oulton Lord Agnew of Oulton Minister of State (HM Treasury), Minister of State (Cabinet Office)

I respectfully disagree with the noble Baroness on that. Your Lordships are having a much more detailed debate on health reform very shortly, so I am sure that will be teased out in those discussions.

The noble Lord, Lord Lipsey, asked about the White Paper. As I said, we certainly hope to see that out in the next few weeks.

The noble Lord, Lord Desai, asked about the taxation of carried interest and private equity firms, but I suspect he was being slightly disingenuous as he knows we are not extending this to capital gains tax, only to dividends. No doubt there is a separate debate to be had on that, but at the moment it is a capital gain.

The essence of this debate is the fairness of the way the tax is being structured—

Photo of Lord Eatwell Lord Eatwell Labour

It is fortunate that the Minister just brought up once again the issue of fairness and the discussion of it in the House. At the beginning of his speech, he referred to the proportion of the total raised from—I think he said—the top 14% of payers. This is a completely bogus statistic and has nothing to do with fairness. Let me give him an example. Let us suppose that someone earns £1 million and there is a 10% levy. They pay £100,000 on the levy and have £900,000 left. Then let us suppose that someone earns £10,000 a year—they would still be caught by this levy, by the way—and, to keep the numbers easy, that they still pay 10%. Their income has gone down from £10,000 to £9,000 and, as Marcus Rashford has said, they are choosing whether to eat or to stay warm. To understand fairness is to understand the impact on individuals of the measures taken. Using these absolutely bogus numbers, which are not at all representative of fairness, simply distorts and degrades the debate.

Photo of Lord Agnew of Oulton Lord Agnew of Oulton Minister of State (HM Treasury), Minister of State (Cabinet Office)

I take on board the noble Lord’s points, but the reality is that the highest-paid in this country are paying the largest contribution to this tax and indeed PAYE itself. I accept entirely what he says about the impact being disproportionately greater on poorer people, but that is why we have designed the structure to protect as many people as possible. As I mentioned in my opening comments, some 6 million people will not be subject to this at all, and we have kept 40% of smaller businesses out of it. Those on higher earnings will pay a lot more, and that is an important principle, but I absolutely accept the point he made.

I am grateful for the opportunity to explain the Bill and address the issues that have arisen today, and I now commend the Bill to the House.

Bill read a second time. Committee negatived. Standing Order 44 having been dispensed with, the Bill was read a third time and passed.

House adjourned at 7.26 pm.