Politics

More money for the NHS is overdue, but there’s not nearly enough to fix social care | Andy Cowper

Boris Johnson right this moment introduced the authorities’s new plan for social care. Entitled Build Back Better, and trailed by an in depth media briefing struggle between the prime minister and chancellor over the previous few weeks, this plan makes varied monetary commitments on the NHS and social care funding.

It’s value remembering Johnson’s words, as he stood in entrance of No 10 on his first day as prime minister, greater than two years in the past: “My job is to make sure you don’t have to wait three weeks to see your GP, and we start work this week with 20 new hospital upgrades, and ensuring that money for the NHS really does get to the frontline.

“My job is to protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care, 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.”

Has he delivered? To answer this, we must always first think about his funding plans. Starting in April subsequent year, a 1.25% enhance in employers’ and workers’ nationwide insurance coverage contributions, and a 1.25% enhance in share dividend tax, will whole an additional £12bn in taxes raised every monetary year: £36bn over the three remaining monetary years of this parliament. This has been labelled a “health and social care levy”, and can in time seem on payslips as a cost distinct from revenue tax and nationwide insurance coverage contributions.

Of this £36bn (which breaks the Conservatives’ 2019 manifesto dedication not to elevate any of the most important three taxes), the NHS will obtain £30.6bn additional. This follows the well being secretary, Sajid Javid’s, announcement on Monday of an additional £5.4bn for the NHS for the the rest of this present monetary year to handle additional Covid-19 and backlog prices.

This is shifting in direction of a severe effort to present satisfactory funding for the NHS, as assessed by the independent health thinktanks. But we shouldn’t get carried away. Between 2010 and 2019, the NHS had the lowest period of financial growth in its historical past. Even earlier than Covid, NHS waiting lists had shot up.

One consequence of the funding squeeze was the common switch of NHS money allotted for capital and upkeep budgets into day-to-day spending. This led to an enormous backlog of constructing and upkeep work.

Social care has for a very long time been the “poor relation”. It is additionally poorly understood. Many individuals consider social care is free at the level of use: it is means examined and people with property under £23,000 in worth are charged for their care.

The newly introduced monetary plans preserve social care firmly in the shadows. Of the £36bn raised, solely £5.4bn is for social care. Of that £5.4bn, £2.5bn funds the new £86,000 lifetime cap on people’ contributions to their care prices, leaving simply £2.9bn over three years for reform.

This reform is very a lot about doing what Johnson promised: to forestall individuals having to promote their properties to pay for their care. As such, it would disproportionately profit rich older individuals. Nor does it handle the undeniable fact that half of social care is for working-age adults: for these individuals, the proposals supply little or no.

To get a way of the scale of missed alternative, 2019’s Health Foundation report – What must be completed to fix the disaster in social care? – factors out that restoring the entry to care providers brought on by austerity-era cuts to native authorities’ authorities grants would value £12.5bn.

And on delivering the authorities’s new plans, the image is even weaker. In truth, there’s little or no precise plan on supply, past just a few broad commitments (one among which is for the NHS to create a brand new supply plan).

On the NHS backlog, there’s a hanging declare: “The NHS in England can aim to deliver around 30% more elective activity by 2024-25 than it was before the pandemic.”

Yet additional an infection management protocols have lowered the NHS’s capability to deal with sufferers – which is now under the degree at the begin of the pandemic (when ready lists had already grown massively). And the NHS nonetheless doesn’t have an actual plan to enhance the variety of employees by something like the quantity wanted to do that.

There is nothing in the doc that remotely resembles a plan to scale back the NHS backlog. It is as an alternative an aspiration-fest, articulated with phrases resembling “can aim to”, “should” and “could” (the place “will”, “shall and “must” could be extra reassuring). There’s nothing substantial on how the high quality of present social care provision will likely be raised; nor on how pay and circumstances for employees will likely be improved.

Put merely, the authorities has supplied extra funding: most likely nearly enough for the NHS to make an honest begin on the backlog, but nothing like enough to enhance social care. And when it comes to its plans to ship change: they simply aren’t there.

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