The Prime Minister ()
Mr Speaker, with permission I will make a statement on the
Government’s plans for health and social care. Our national
health service is the pride of our whole United Kingdom, and all
the more so after it has been there for us during the worst
pandemic in a century, treating almost half a million patients,
administering more than 88 million vaccines and saving countless
lives. The inevitable consequence of this necessary and
extraordinary action is that covid has placed massive pressures
on our NHS. As we stayed at home to protect the NHS, thousands of
people did not come forward for the treatment they needed. Like
those who suffered from covid, these are all people we know: your
aunt who needs a new hip, your neighbour who has problems with
their heart and needs a pacemaker, or your friend at work who
thinks that they should get that lump or cough checked out. So we
must now help the NHS to recover, to be able to provide this much
needed care to our constituents and the people we love, and we
must provide the funding to do so now.
We not only have to pay for the operations and treatments that
people decided not to have during the pandemic; we need to pay
good wages for the 50,000 nurses who will enable that treatment
and who can help us to tackle waiting lists that could otherwise
expand to 13 million over the next few years. We now need to go
beyond the record funding we have already provided, and we need
to go further than the 48 hospitals and 50 million more GP
appointments that are already in our plan. So today we are
beginning the biggest catch-up programme in NHS history, tackling
the covid backlogs by increasing hospital capacity to 110% and
enabling 9 million more appointments, scans and operations. As a
result, while waiting lists will get worse before they get
better, the NHS will aim to be treating around 30% more elective
patients by 2024-25 than it was before covid.
We will also fix the long-term problems of health and social care
that have been so cruelly exposed by covid. [Interruption.] The
Labour party certainly failed to tackle them. But having spent
£407 billion or more to support lives and livelihoods throughout
the pandemic—from furlough to vaccines—it would be wrong for me
to say that we can pay for this recovery without taking the
difficult but responsible decisions about how we finance it. It
would be irresponsible to meet the costs of this permanent
additional investment in health and social care from higher
borrowing and higher debt.
So from next April we will create a new UK-wide 1.25% health and
social care levy on earned income, hypothecated in law to health
and social care, with dividends rates increasing by the same
amount. This will raise almost £36 billion over the next three
years, with money from the levy going directly to health and
social care across the whole of our United Kingdom. This will not
pay for pay awards for middle management; it will go straight to
the frontline at a time when we need to get more out of our
health and social care system than ever before. It will enable
radical innovation to improve the speed and quality of care,
including better screening equipment to diagnose serious diseases
such as cancer more quickly; designated surgical facilities so
that non-urgent patients are no longer competing with A&E;
faster GP access to specialists, so people do not have to wait
months to see someone in hospital to find out whether something
is wrong; and new digital technology so that doctors can monitor
patients remotely in their homes.
We will do all this in a way that is right, reasonable and fair.
Some will ask why we do not increase income tax or capital gains
tax instead, but income tax is not paid by businesses, so the
whole burden would fall on individuals, roughly doubling the
amount that a basic rate taxpayer could expect to pay, and the
total revenue from capital gains tax amounts to less than £9
billion this year. Instead, our new levy will share the cost
between individuals and businesses, and everyone will contribute
according to their means, including those above state pension
age. So those who earn more will pay more, and because we are
also increasing dividends tax rates, we will be asking better-off
business owners and investors to make a fair contribution too. In
fact, the highest-earning 14% will pay around half the revenues.
No one earning less than £9,568 will pay a penny, and the
majority of small businesses will be protected, with 40% of all
businesses paying nothing at all.
Although Scotland, Wales and Northern Ireland have their own
systems, we will direct money raised through the levy to their
health and social care services. In total, Scotland, Wales and
Northern Ireland will benefit from an extra £2.2 billion a year
and, as this is about 15% more than they will contribute through
the levy, it will create a Union dividend worth £300 million.
However, we cannot just put more money in; we need reform and
change. We need to build back better from covid. When the covid
storm broke last year, 30,000 hospital beds in England were
occupied by people who could have been better cared for elsewhere
and who wanted to be better cared for elsewhere. That is 30,000
out of 100,000 hospital beds in our NHS, costing billions. Those
beds cannot be used by people needing cancer care or hip
operations, making it harder than ever to deal with the growing
backlog in our NHS.
Too often, people were in hospital beds because they or their
relatives were worried about the cost of care in a residential
home, and that same fear kept many others at home without any
care at all. This anxiety affects millions of people up and down
the country: the fear that a condition such as dementia, one of
nature’s bolts from the blue, could lead to the total liquidation
of their assets, their lifetime savings and their home—the loss
of everything, however great or small, they might otherwise pass
on to their children—while sufferers from other diseases, who
have to be in hospital for the majority of their treatment, have
their care paid for in full by the NHS.
Governments have ducked this problem for decades. Parliament even
voted to fix it, yet that 30,000 figure is an indictment of the
failure to do so. There can be no more dither and delay. We know
we cannot rely solely on private insurance because demand would
be too low for insurers to offer an affordable price, and a
universal system of free care for all would be needlessly
expensive when those who can afford to contribute to their care
should do so.
Instead, the state should target its help at protecting people
against the catastrophic fear of losing everything to pay for the
cost of their care, and that is what this Government will do. We
are setting a limit on what people can be asked to pay, and we
will be working with the financial services industry to innovate
and to help people insure themselves against expenditure up to
that limit.
Wherever you live, whatever your age, your income or your
condition, from October 2023 no one starting care will pay more
than £86,000 over their lifetime, and no one with assets of less
than £20,000 will have to make any contribution from their
savings or housing wealth—up from £14,000 today. Meanwhile,
anyone with assets between £20,000 and £100,000 will be eligible
for some means-tested support. This new upper capital limit of
£100,000 is more than four times the current limit, helping many
more people with modest assets.
As we fix this long-term, long-standing problem in social care,
we will also address the fears that many have about how their
loved ones will be looked after by investing in the quality of
care, in carers themselves, and by integrating health and care in
England so that older people and disabled people are cared for
better, with dignity and in the right setting. My right hon.
Friend the Secretary of State for Health and Social Care will be
bringing forward a White Paper on integration later this year.
You can’t fix the covid backlogs without giving the NHS the money
it needs; you can’t fix the NHS without fixing social care; you
can’t fix social care without removing the fear of losing
everything to pay for social care; and you can’t fix health and
social care without long-term reform. The plan that this
Government are setting out today—the plan I am setting out
today—will fix all of those problems together. Of course, no
Conservative government ever want to raise taxes, and I will be
honest with the House: I accept that this breaks a manifesto
commitment, which is not something I do lightly, but a global
pandemic was in no one’s manifesto. I think that the people of
this country understand that in their bones and can see the
enormous steps this Government and the Treasury have taken.
After all the extraordinary actions that have been taken to
protect lives and livelihoods over the last 18 months, this is
the right, reasonable and fair approach, enabling our amazing NHS
to come back strongly from the crisis; tackling the covid
backlogs; funding our nurses; making sure that people get the
care and treatment they need, in the right place, at the right
time; and ending a chronic and unfair anxiety for millions of
people and their families up and down this country. I commend
this statement to the House.
12:46:00
(Holborn and St Pancras) (Lab)
I thank the Prime Minister for advance sight of his statement—I
think I had almost as much notice as the Cabinet. May I also
thank everybody who works in the NHS and social care? During the
darkest days of the pandemic they kept our health service from
collapsing, they looked after the elderly when others could not
and they rolled out the vaccine, which has finally provided the
light at the end of the tunnel. Despite their efforts, we are
facing the toughest winter in the history of our health service.
Not only do we have the threat of another covid surge, but
waiting lists for diagnosis and treatment have reached record
levels, we risk cancer survival rates going backwards for the
first time ever, and social care remains neglected and strained.
It is a crisis, but how did we get here?
The pandemic has undoubtedly placed the NHS under huge strain,
but that is only part of the story. A decade of Conservative
neglect weakened the NHS. Waiting lists had spiralled—up 2
million before the pandemic. Targets were missed, on cancer, on
accident and emergency, and on mental health, before the
pandemic. The same is true on social care, with £8 billion cut,
despite growing demand, before the pandemic. Carers were on
poverty wages, without secure contracts, before the pandemic.
There were 100,000 vacancies before the pandemic. And the Prime
Minister has just referenced the 30,000 hospital beds occupied by
those who should go into the community—this is before the
pandemic—and he called that an “indictment of failure”. Who had
been in government for 10 years at that stage? Just remind me.
Prime Minister, an “indictment of failure” is an accurate
description of the situation in our health service and social
care before the pandemic, so the pretence that he is “only here”
because of the pandemic is not going to wash. He is putting a
sticking plaster over gaping wounds that his party inflicted. He
made that commitment on social care before the pandemic, and he
said he would pay for it without raising taxes before the
pandemic.
Yes, the NHS urgently needs more investment, but the backlog will
not be cleared unless the Government hit the 18-week target set
out in the NHS constitution—the Prime Minister did not mention
that. It was set and it was met by the last Labour Government.
Let me ask a direct question: if there is to be improvement,
Prime Minister, can you commit today to hitting the target and
clearing the backlog by the end of this Parliament—yes or no? I
know he likes to avoid these questions, but if he cannot answer
that basic question, it is clear he has not got a plan.
Let me turn to social care. Under these proposals, people will
still face substantial costs. I heard what the Prime Minister
said, so I have another direct question for him: can the Prime
Minister guarantee that under his plan no one will have to sell
their home to fund their own care—yes or no? [Hon. Members: “He
just told you.”] Well, let us hear him make the commitment, at
the Dispatch Box, that under his plan no one will have to sell
their own home to fund their own care, and then we will come back
to it.
Social care is about so much more than this. The blunt and
uncomfortable truth is that under the Prime Minister’s plans the
quality of care received will not improve—there is no plan for
that. People will still go without the care that they need—there
is no plan for that. Unpaid family carers will still be pushed to
breaking point—there is no plan for that. Working-age adults with
disabilities will have no more control over their lives—there is
no plan for that. Pay and conditions will not improve for care
workers—there is no plan for that. Let me spell it out: a poorly
paid care worker will pay more tax for the care that they are
providing without a penny more in their pay packet and without a
secure contract.
The Prime Minister
indicated dissent.
The Prime Minister shakes his head; my sister is a poorly paid
care worker, Prime Minister, so I know this at first hand.
This is a tax rise that breaks a promise that the Prime Minister
made at the last election, a promise that all Conservative
Members made—every single one of them. It is a tax rise on young
people, supermarket workers and nurses; a tax rise that means
that a landlord renting out dozens of properties will not pay a
penny more, but the tenants working in full-time jobs will; and a
tax rise that places another burden on businesses just as they
are trying to get back on their feet. Read my lips: the Tories
can never again claim to be the party of low tax.
The alternative is obvious: a timetable and plan to clear waiting
lists, just as we did under the last Labour Government, and a
comprehensive reform plan for social care that deals with the
inadequacies that I just pointed out and drives up the quality of
provision—not just tinkering with the funding model. We do need
to ask those with the broadest shoulders to pay more, and that
includes asking much more of wealthier people, including in
respect of income from stocks, shares, dividends and property.
[Interruption.] Chancellor, I was listening. The Chancellor knows
the numbers just as well as I do—he will have done the sums and
we have done them. Tinkering and fiddling with dividends will not
do it. The Government are placing the primary burden on working
people and businesses struggling to get by.
As I have said to the Prime Minister, if the Government come
forward with a plan to genuinely fix the crisis in social care
and they have a fair funding model, yes, we will work together.
Thousands of families who are struggling with the current system
and only want the best for their loved ones deserve nothing less.
The Prime Minister
Now we know why over decades the Labour Government totally
refused to deal with this problem, and now we know why both Blair
and Brown failed to do it: the right hon. and learned Gentleman
has absolutely no plan. I was waiting, and I am amazed that he
sat down. What is his answer to the backlogs in the NHS? What is
his answer to the problems in social care? The Opposition have
absolutely no plan. They have no idea how they would raise the
money.
Let me answer some of the right hon. and learned Gentleman’s
questions. We will of course be investing in social care. I thank
his sister for what she is doing in social care, but we have
lifted people’s wages across the country with record increases in
the living wage; we are investing in 700,000 training places for
people in social care; and we are making sure that we invest £500
million—that is in the plan I announced today—in the social care
workforce.
What this plan will also do is enable us to get our wonderful NHS
back on its feet and enable it to deal with the backlogs. The
right hon. and learned Gentleman totally failed to explain how a
Labour Government would do that. One year of capital gains tax
would not even begin to deal with this problem. He has not got a
solution and it is deeply irresponsible of him to come to this
place without having any kind of alternative.
Let us be in no doubt: if we did what we have heard from the
Labour party over the past few weeks, we would still be in
lockdown, because the right hon. and learned Gentleman opposed
coming out of stage 4; we would have absolutely nothing by way of
dealing with the NHS backlogs; and after decades of inertia from
the Labour party we would have absolutely no way of dealing with
the anxiety of millions of families across this country who face
the prospect of catastrophic social care costs.
This Government are dealing with those things—we are dealing with
all of them. We are getting on with it. We are taking the
decisive action. We are doing it all together. This is the
Government who get on and deal with the people’s priorities; this
is the Government who tackle social care; and, indeed, this is
the party of the NHS.
(South West Surrey) (Con)
Raising taxes is an incredibly difficult thing for any
Conservative Government to do, so I thank the Prime Minister for
biting the bullet on this intractable issue that I and many
former Health Secretaries have wrestled with.
Does the Prime Minister agree that the demographic
challenge—which I know he is personally trying to address with a
bit of population growth in Downing Street—means that whether
someone pays insurance in America, social insurance in Germany or
taxes in the UK, everyone is going to pay more for their health
and care? Any Government have a responsibility to make sure that
resources are allocated where the electorate’s priorities are,
and in this country that is health and social care.
The Prime Minister
I thank my right hon. Friend not only for his support but for all
the campaigning and hard work that he did when he was Secretary
of State—the first Secretary of State for both health and social
care because he sees that the two things go together, unlike the
Labour party. What he said is entirely correct.
(Ross, Skye and Lochaber) (SNP)
I thank the Prime Minister for an advance copy of his statement.
Let me quote from it:
“Although Scotland, Wales and Northern Ireland have their own
systems, we will direct money raised through the levy to their
health and social care services.”
Let me tell the Prime Minister that health is devolved to the
Scottish Government. The Prime Minister can get his mitts off our
health system, because the people in Scotland trust the Scottish
Parliament and the Scottish Government to run health and they
certainly do not trust the Prime Minister—[Interruption.]
Mr Speaker
Order. Quite rightly, we heard the Prime Minister and the Leader
of the Opposition; I expect everybody to listen to the leader of
the SNP.
Thank you, Mr Speaker. When we have an attack on devolution, we
have the baying mob of the Tories trying to shout down the voices
from Scotland.
Government briefings in advance of the statement on social care
told us that this was supposedly a key part of securing the Prime
Minister’s legacy in office. Well, the Prime Minister is
certainly creating a legacy, but it is definitely not the one in
his vivid imagination. The real legacy of this Government is now
well defined: a Tory Government who blatantly break manifesto
promises and blatantly break international law.
It is telling that as we hopefully emerge from the covid crisis,
the first act of this Prime Minister is to impose this regressive
tax. The scandal of the tax hike is that it will fall hardest on
the young and the lowest paid—the two groups that have suffered
the worst economic consequences of the pandemic. Pre-covid and
post covid, the pattern is the same, and this Government have
learned nothing. Westminster keeps adding to the growing burden
that young people face while stripping them of the benefits that
previous generations enjoyed.
The unfairness of this tax hike will be especially felt in
Scotland. The Scottish Government are responsible for social care
and already funds provision—including SNP policies such as free
personal and nursing care—from existing budgets and tax receipts.
We have done it. As the Prime Minister well knows, by raising
this levy across the UK, the Tories are taxing Scottish workers
twice and forcing them to pay the bill for social care in England
as well as at home in Scotland. This is the Prime Minister’s poll
tax on Scottish workers to pay for English social care. Scottish
people remember that it is this Prime Minister who said that
“a pound spent in Croydon was of far more value to the country
than a pound spent in Strathclyde.”
Can the Prime Minister explain to the people of Strathclyde and
across Scotland why he is now going after the pounds in their
pockets to solve a social care problem in Westminster, which has
failed to fix problems in Croydon and right across England? If
their pound is really of less value, as the Prime Minister
claims, why are we paying the price? Is he willing to stand up
and explain to the families in Scotland why we are being hit by
another Tory poll tax?
The Prime Minister
The NHS is a UK institution and we are all proud of it, and we
are proud of what NHS Scotland does as well. The right hon.
Gentleman is completely wrong in what he says about those who pay
this tax. The burden falls most heavily on those who have the
broadest shoulders, as it should, and it is the richest 14% who
pay at least half the taxation. As I have just explained to the
House, there is a massive Union dividend of £300 million across
the whole of the United Kingdom, and the whole of the UK will
find that there is more money for health and social care, which
is, I think, what the people of Scotland will understand.
Dame (South Northamptonshire) (Con)
There will be millions of people right across the country who are
so relieved today that, at last, the matter of health and social
care will be resolved, with fairness to everyone. Can the Prime
Minister reassure the many people who are concerned about
prevention? We need early intervention, providing support for
families with the very youngest children in our society, so that
they too can have healthy and fulfilled lives throughout the
United Kingdom.
The Prime Minister
I thank my right hon. Friend for everything that she does on this
issue of early years. She and I have campaigned on this together.
I have listened to her attentively over many years and I know
that my right hon. Friend the Chancellor is determined to ensure
that we get the proper funding for early years because the
investment that we make in those first three years repays society
and families massively.
(Barking) (Lab)
Let us set aside for a moment the Prime Minister’s unbridled
record on reneging on his promises, because, today, he has chosen
what I consider to be the least progressive option to fix both
our health and social care system. It is unfair between
generations, unfair between individuals and unfair between those
who derive their income from assets or from work. He is ignoring
a raft of better alternatives: raising income tax; and making
dividend tax equivalent to income tax or capital gains tax. Why?
The Prime Minister
The simple reason that I gave earlier is that none of those
measures raise anything like the funding that we need. I have
explained that very clearly, and I think that colleagues
understand it and I think the country understands it. People are
very suspicious. They know that this country has been through an
enormous fiscal impact from the pandemic. They know that the
Government have put their arms round people and spent £407
billion. They would be very suspicious of a Government who
pretend that they can get the NHS back on its feet without some
kind of serious, responsible, fair, fiscal effort and that is
what we are doing.
(Winchester) (Con)
I pay tribute to my right hon. Friend for gripping this issue. We
are not in Government to be afraid of doing anything for fear of
offending anyone. I will study the plans that the PM has promised
to set out and I thank him for them. On behalf of my constituents
and their families trapped right now in the spiral of rising care
costs and fast disappearing resources, may I urge him and the
Health Secretary, as we develop the new system that he has
promised, to consider those for whom this is an issue in the
present and not just many years into the future.
The Prime Minister
I absolutely agree with what my hon. Friend has said. The tragedy
of decades of failure to tackle this matter is that people are
now facing these costs. What we are doing is investing—as we have
done throughout the pandemic—about £6 billion, I think, in
dealing with the immediate costs of social care to try to help
people through this very difficult time. What this package offers
is a way of developing a long-term solution, enabling, we hope,
the private sector to come in and give people a long-term plan to
fix the costs of their own social care, knowing that the
Government will remove the risk of those catastrophic costs. That
is the advantage of what we are doing today.
(Hemsworth) (Lab)
Putting aside the unfairness of the national insurance tax rise
that the Prime Minister is proposing, is it not the case that the
expenditure cap will be his poll tax? In his Uxbridge
constituency, the average price of a house is £500,000; in parts
of mine it is £130,000. That would leave people in his
constituency with an inheritance of more than £410,000 per
family, and in mine £44,000 per family. That is unjust and
unfair. It is not about levelling up, is it, Prime Minister? It
is about doubling down on everything that is wrong, and yet again
the poorest will pay the most.
The Prime Minister
This is a massively progressive measure that increases the floor
on people’s liabilities four times. It protects people up and
down the country from catastrophic costs, which anybody can face.
Everybody across the country will benefit not only in the
investment in social care and in care workers, but in making sure
that we deal now and deal properly with the NHS backlogs and
their effect on our NHS, which is what this country wants to see.
Mr Speaker
Let me just say to Members that we will be running this statement
for around an hour, so, please, let us try to rush on and get
through.
(Cities of London and Westminster) (Con)
During the summer recess, I spent a week looking after my father
who has advanced Alzheimer’s as my mother had a respite holiday.
I pay tribute to all those who look after their loved ones in
similar circumstances and all those who work in the care service.
I certainly welcome the Prime Minister’s statement today. May I
seek assurances that, through the health and social care levy,
money raised will go to fund local authorities that do so much
brilliant work in this area as well as the NHS?
The Prime Minister
My hon. Friend asks the question that everybody wants to be
certain of. Absolutely, this is a legally hypothecated levy, but
we will ensure that the funds that are fixed for social care go
to social care so that we deal with the problem of the
catastrophic costs. This will not be dispensed by the NHS, but by
the Treasury in the normal course of Government spending.
(Kingston and Surbiton) (LD)
I am a carer and I have been a carer for most of my life. Like
millions of others caring for their elderly, ill or disabled
family members, I have desperately wanted a plan to fix the
country’s social care crisis after the Conservatives failed to
implement the Lib-Dem plan legislated for in 2014, but this is
not that plan. Where is the plan for the care staff to fill the
120,000 vacancies so that there are people to provide the care?
Where is the plan for working-age adult care—care for physically
and learning-disabled adults, which is the fastest growing care
challenge? Where is the plan for the crisis facing millions of
unpaid family carers whom the Prime Minister always forgets, and
what is his message to the low-paid, the young and the small
business owners hit by covid who now face his unfair tax? This
Prime Minister has not a clue about fairness and he just does not
care.
The Prime Minister
After a long career of listening to Liberal Democrat opportunism,
I do not think that I have heard anything quite so absurd. The
right hon. Gentleman calls for more funding and then attacks the
Government for providing the wherewithal to do exactly what he
wants. We will be spending half a billion pounds supporting
carers, and there will be 700,000 more training places. The plan
supports adult care. It supports everybody who needs care up and
down the country; it is not just care for the elderly.
(West Suffolk) (Con)
The reform of social care has been ducked for decades because
successive Governments have put it in the too difficult box. I
congratulate the Prime Minister on delivering on our commitments
and his commitment. May I ask him to ensure that, as well as the
money, we integrate properly the NHS with social care so that
people can get the dignity that they deserve?
The Prime Minister
I thank my right hon. Friend, because he played a major part in
the gestation of these policies and knows them intimately. He is
completely right and has been massively encouraging to the
Government over the last few weeks.
We will be bringing forward a White Paper on the integration. Of
course this is going to be difficult, but it has to be done. We
must have a system whereby people can work across both the health
sector and the care sector in an integrated way. We have to have
single budget holders and we have to ensure that, for instance,
we have single electronic records in both health and social care.
These are things that need to be fixed. We need to make sure that
people are cared for appropriately and in the right setting, and
that is why we are bringing forward the White Paper.
(Vauxhall)
(Lab/Co-op)
The Prime Minister will know that a number of young people are
carers for their elderly relatives and family members. I was a
carer for my late mother, who suffered from complex needs,
including sickle cell anaemia and renal failure. Without those
carers, our local government would have to pick up more issues.
What assessment has the Prime Minister made of the high vacancy
rates in the care sector, and will he be honest and say that this
social care plan announcement has no impact on addressing those
rates?
The Prime Minister
No, this plan does address the problems in the care sector. In
addition to the £6 billion that we have put into supporting local
government with social care during the pandemic, we are putting
another £0.5 billion into supporting the care workforce. I have
mentioned the 700,000 training places that we are investing in.
We are also trying to ensure that people who become carers—they
are wonderful people; I thank the hon. Member for what she has
done—get the progression and career structure that they need, and
understand how valued and respected they are.
(Thurrock) (Con)
The public will welcome the certainty in my right hon. Friend’s
announcement today, particularly with regard to the cap and the
floor, but does he agree that it is time that we had a real and
informed debate about the nature of old age, now that we are all
living longer? The longer that we can live independently, the
better it is for everyone’s wellbeing, and we can all make
lifestyle choices to encourage that. Does he agree that we need a
fair debate about new models of care and housing models to
encourage exactly that discussion?
The Prime Minister
My hon. Friend is completely right. One of the things that we are
bringing in today is the housing and innovation fund, to ensure
that we care for people in the right settings. She is completely
right that there is no point in having residential care when a
domiciliary option would be better, more effective and perhaps
less expensive. That is exactly the right approach. The patterns
of care and way we do things will change and improve—very
rapidly, I believe.
(East Antrim) (DUP)
Prime Minister, most people recognise that if we want more
services, we have to pay more. But if we are going to pay, it
should at least be fair. Despite your claim that this is a
progressive tax, it is not. It is a flat-rate tax, the benefit of
which will go mostly to better-off people. Those who are less
well off will therefore be subsidising those who are better off.
At a time when we are trying to create more jobs, young people
and employers are going to feel the impact. Could I ask you—
Mr Speaker
Order. Can I just say that the right hon. Gentleman has been here
a long time and knows that I am not responsible—I certainly do
not want to be responsible for this—so could he not use “you”? I
call the Prime Minister to respond.
Will the Prime Minister—
Mr Speaker
Sammy, sit down; come on, son.
The Prime Minister
The right hon. Gentleman is a formidable campaigner for his
constituents, but I believe that these measures do serve them.
This plan is progressive; the burden falls most heavily on those
who can most afford to pay. It will, above all, help to deal with
the current waiting lists in Northern Ireland, which are
excessive and need to come down.
(Sleaford and North Hykeham) (Con)
The NHS has been outstanding during the pandemic. However, as the
Prime Minister has said, there is now a large waiting list of
people needing treatment. As a hospital doctor, I am delighted to
hear about the increased investment in the national health
service that we are getting today, but as well as money we will
need medical and nursing staff hours to reduce the waiting list.
What are the Government doing to increase the numbers of those
medical and nursing staff?
The Prime Minister
We are massively recruiting NHS staff. I think I am right in
saying that, as I stand here today, there are 11,600 more nurses
in the NHS than there were this time last year, and we will go on
to deliver on our manifesto commitment to recruit 50,000 more
nurses.
(Luton North) (Lab)
Having been a care worker, I know that it is a hard and skilled
job that deserves decent pay and recognition, not a Tory tax
hike. Does the Prime Minister really believe that his tax hike,
which will fall on the shoulders of care workers, is any way to
reward the heroes who have got us over the last 18 months?
The Prime Minister
Yes, because the burdens fall overwhelmingly on those who can
best afford to pay, and the benefit for care workers is not only
the increase in the living wage, but the colossal investment that
we are making in care. That is something that will benefit not
just care workers, but their charges: their patients, and the
families who desperately need care up and down the country.
(Bournemouth West) (Con)
A decade on from Dilnot and with the demographic challenges
becoming more intense, my right hon. Friend is to be commended as
the first occupant of Downing Street to grapple with this immense
challenge. Some of the most distressing cases that we encounter
as constituency MPs are families who are caught in that tension
between those who are in hospital ready for discharge and the
local authorities. We see distressed and anxious
families—confused, bewildered and vulnerable people. The greatest
reform that we can make to the system is to put those who need
the care at the very centre of our reforms.
The Prime Minister
I thank my right hon. Friend deeply; in that intervention, he has
summed up the heart of the issue that I was trying to explain in
my statement. It is the anxiety of millions of families up and
down the country who face this uncertainty—about the finance, but
also the proper setting for their relatives—that we are
addressing today.
(Birmingham, Erdington) (Lab)
The backbone of the social care system is an army of underpaid
and hard-working home carers and carers. How does the Prime
Minister begin to justify to them a tax rise that not only breaks
a promise, but hits them hard in their pockets?
The Prime Minister
Because we are investing massively in the sector. We are putting
half a billion pounds into supporting care workers and investing
in 700,000 training places. We are lifting the living wage by
record amounts. Above all, we are valuing care workers and
showing the respect to them and their careers that I do not
believe has been properly shown before, by any Government.
(Harlow) (Con)
I welcome that paying for this proposal is going to fall
predominantly on the well off and those with the broadest
shoulders. My right hon. Friend has pointed out that those who
are earning less than £9,500 a year will not have to pay for the
proposal, but what other mitigating factors can he put in place
to help those on lower incomes to pay for it? Once the financial
conditions allow, will he look at continuing to raise the living
wage and at cutting taxes for lower earners?
The Prime Minister
My right hon. Friend is right consistently to campaign in the way
in which he does for low earners. We are increasing the threshold
for which people can be liable for paying anything at all from
£14,000 to £20,000, which is a benefit that has not really come
out properly in the conversation. People need to understand that
we are lifting the minimum assets for which people can be liable
from £14,000 to £20,000; that helps people on low incomes. As my
right hon. Friend knows, we are also increasing the living wage.
I am pleased to see that one of the effects of the current
rebound in the economy, which I know he will be studying, is that
wages are now starting to rise again—in exactly the way that some
of us who campaigned for Brexit wanted to see.
(Eltham) (Lab)
When I was first elected to this place in 1997, one of the first
people who came to see me in my surgery was the wife of a man who
had been waiting two years for open heart surgery, and we are
back there again with the waiting lists. There was no righteous
indignation from the Tories when the list reached 2 million
before the pandemic hit. Will the Prime Minister commit today to
hitting the 18-week target for waiting lists, and to clearing the
backlog by the end of this Parliament?
The Prime Minister
I think what the Labour party needs to do is come up with any
type of plan at all. Every day in this country, plan beats no
plan. We are putting record investment into the NHS. We have a
plan to clear the backlogs—to reduce the backlogs as fast as we
possibly can with this levy. What would Labour Members do? Answer
comes there none: they have no plan.
Neil O’Brien (Harborough) (Con)
For years, people have come to my surgery with horror stories
about the difficulties of accessing care and the frankly squalid
conditions that their loved ones have to be in in residential
care. Can the Prime Minister reassure me that, as well as
protecting the things people have worked hard for all their
lives, we will also protect people from having to put their loved
ones into conditions that not one person in this House would ever
want for their loved ones?
The Prime Minister
Yes, because in addition to the caps and the floors that we are
introducing to protect people from catastrophic costs, we are
also introducing a fair cost of care.
(Paisley and Renfrewshire North) (SNP)
Paul Johnson of the Institute for Fiscal Studies said that there
were really no good arguments for using national insurance to
raise these moneys, and having been briefed on the Government’s
plans, care leaders are extremely disappointed, furious and
depressed at the Government’s meagre plans on social care. But
the question is: why is it necessary at all? This will raise
about £12 billion a year, but the Prime Minister’s Brexit bonus
of £350 million a week would aggregate to £18 billion a year. So
where is this money, or did it never exist?
The Prime Minister
I think the whole country understands that we have been through a
pandemic that obliged the Treasury to spend £407 billion on
protecting people, jobs and livelihoods by furlough and other
measures across Scotland. That was the right thing to do. I think
people also understand that it is the reasonable and responsible
thing to do now to put the NHS back on its feet with the funding
it needs, and to sort out social care at the same time. That is
what we are doing.
(Kenilworth
and Southam) (Con)
Is not the starting point in this discussion that greater demand
for social care is bound to require greater money to pay for it,
and anyone who does not like these proposals needs to explain
what the alternative is, which is unlikely to be clear, simple
and popular? Is it not the case that, in order to create an
insurance market to give people even greater reassurance about
their future care costs, we need to put a cap on and that is why
the cap is most welcome? Will the Prime Minister do all he can to
make sure that that insurance market is stimulated? Finally, will
he confirm that that cap applies to those who have care needs
regardless of their age?
The Prime Minister
Yes, I can certainly confirm that my right hon. and learned
Friend is right on the last point—that the cap applies regardless
of age. He is completely right in what he says about the logical
necessity for the cap if we are to have any hope of the private
sector coming in with the financial instruments that will help
people to protect themselves against the cost up to the limit.
That is the virtue of what we are setting out today. And what do
we hear from the Labour party? Deafening silence.
(Oldham East and Saddleworth) (Lab)
People living with dementia and their families have been
particularly affected by the social care crisis. They represent
40% of care home residents and they pay a dementia premium of
15%. On average, they spend £30,000 a year on their care.
Dementia is an outcome of different diseases, which are
increasing; we are going to see more and more people living with
dementia. Therefore, can I ask the Prime Minister whether he will
also fulfil his commitment in the general election manifesto for
a dementia research moonshot? We know that we can, in the same
way that we have developed a vaccination programme, develop cures
and treatments for dementia.
The Prime Minister
The hon. Member is right to focus on the issue in the way that
she does. It is a very cruel lottery that one in seven face these
catastrophic costs as a result of dementia, while those who have
other conditions are funded in full by the NHS. I can certainly
confirm that the moonshot programme that was begun by my right
hon. Friend the former Secretary of State for Health—one of his
many moonshots—continues.
(Guildford) (Con)
Can the Prime Minister confirm that this funding injection will
go directly into frontline NHS services, not middle management,
and that patients will be able to see the tangible benefits from
it?
The Prime Minister
Yes. Not only will it go to frontline services and to beating
waiting lists, but we will make sure that this money—this
massive, unprecedented investment—is accompanied by the reform,
change and productivity gain that the NHS needs to see.
(Nottingham East) (Lab)
My former colleagues where I used to work as a care worker
sacrificed so much during the pandemic and now, under the Prime
Minister’s plans, their pockets will be raided with a tax that
will hit hardest those who are older, young and less well-off.
Does he agree that it is now time for a national care service and
a wealth tax to fund it?
The Prime Minister
The funding that we need on the scale that we need simply could
not be raised in the way that the hon. Member describes or in the
way that the Leader of the Opposition has vaguely indicated
today; I do not think I heard a clear description of what he
actually intends to do. But of course we want to make sure that
people in the caring profession get the support and the
investment that they need. That is why we are putting money into
their training and into supporting carers, but also lifting their
wages with the biggest ever increase in the national living wage.
We will continue to support that.
(Heywood and Middleton) (Con)
I declare an interest as chair of the all-party parliamentary
group on local government, in thanking my right hon. Friend for
making the tough choices that he has today, rather than kicking
the can down the road, as the Labour party did for 13 years when
it had the opportunity to do something. As welcome as this
injection of cash is, can I ask for an assurance that it is going
to be met with the same rigorous reform that is necessary to make
the system viable for years to come?
The Prime Minister
Yes. I thank my hon. Friend for everything he does for local
government. Of course we will make sure that we bring forward the
White Paper, which will show how we intend to join up healthcare
and local government in a way that they have not been since the
foundation of the NHS more than 70 years ago.
(Gower) (Lab)
The Prime Minister is behaving like Father Christmas; he does not
know what he has not delivered in government for the last 11
years. In this House last night, we had cross-party consensus on
covering the costs of medicinal cannabis. So while Father
Christmas is at the Dispatch Box, can he deliver on a Government
promise to immediately set up a fund to pay for prescriptions for
medical cannabis for children with intractable epilepsy?
The Prime Minister
I thank the hon. Lady. The prescriptions that she asks for are
actually already provided for on the basis of clinical advice.
(Ashford)
(Con)
There has been much debate about how the money is being raised,
but of more concern is how the money is going to be spent. My
fear is that, once you start spending on perfectly proper things
like the NHS backlog, there will never come a point where there
is enough money in the new fund to transfer to social care, which
needs it now. You cannot spend the same pound twice. So can my
right hon. Friend guarantee that the social care sector will
itself see a significant uplift in its support in the immediate
future?
The Prime Minister
My right hon. Friend has done great work on this subject and I am
indebted to him for some of the advice that he has given to me
personally about how to proceed in this. He is right in what he
says. The issue is making sure that the funding goes where it is
needed and that it is specifically ring-fenced. The investments
in social care will be protected by the Government and by the
Treasury.
(Exeter) (Lab)
There are better ways of doing this than to take money from the
less well off in work and the young to give to better off
pensioners. Can I commend to the Prime Minister and my own Front
Benchers the work of the Health and Social Care and Housing,
Communities and Local Government Committees in their joint report
of 2018, agreed unanimously by all Members of all parties in this
House, which would deliver a system that is sustainable and
equitable, address poor quality and low pay, and allow the proper
integration of health and social care—none of which, from what I
have heard today, his proposals would deliver?
The Prime Minister
Time and again, Labour Members have stood up and said that there
is a better way to do this, without offering a single idea. A
plan beats no plan.
(Clwyd West) (Con)
Can my right hon. Friend confirm that the sums passed to Wales
under his proposals will not only be ring-fenced for health and
social care, but that the Welsh Government will be required to
apply the same £86,000 cap as will be applied in England? It
would be grossly unfair if care users in one part of the country
were to be worse off than those in another.
The Prime Minister
My right hon. Friend makes a very important point. Members across
the House will know that the lower limit in Scotland is £12,500
at the moment. Lifting that to £20,000, as we are now, is
something that people in Scotland may want to address. I
certainly think that the cap of £86,000 is something that people
in Wales will want to see, too. There is a strong benefit to the
whole of the UK proceeding as one.
(East Kilbride, Strathaven and Lesmahagow) (SNP)
As chair of the all-party parliamentary health group, I have been
hearing concerns from older adults across the United Kingdom who
are in social care or in the community and have experienced
loneliness, anxiety, isolation from loved ones, illness,
bereavement and loss. The British Journal of Psychiatry has today
documented a significant rise in depression in this group. Will
the Prime Minister commit to ensuring that older adults in social
care and the community have access to adequate mental health
services and that those services are fully funded?
The Prime Minister
The hon. Lady is completely right to draw attention to the
suffering of people throughout the pandemic, particularly in care
homes, including the mental stress they have suffered as a result
of not being able to see or hold loved ones in the normal way. It
has been one of the most appalling features of this pandemic, and
we are certainly investing record sums in mental health to deal
with that issue and many others.
(Vale of
Glamorgan) (Con)
Does the Prime Minister share my disbelief at the Leader of the
Opposition’s response to his statement, considering that waiting
times for treatment and discharge for my constituents in Wales
are much longer than they are in England? Can he confirm that
Wales, Northern Ireland and Scotland will be net gainers out of
the social care levy? Will he further guarantee that the
additional sums available will be spent on health and social care
in the nations?
The Prime Minister
I can certainly confirm that Wales, Scotland and Northern Ireland
will be getting an increment. There will be a Union dividend in
the way that I described, but clearly it is up to those parts of
the country to ensure that that money is spent on the people’s
priorities, and I believe that the people’s priorities are health
and social care.
(Bristol South) (Lab)
As well as the 30,000 beds that the Prime Minister talked about,
we know there has been a 36% increase in people dying at home
through the pandemic in circumstances that we know not much
about. The mental, physical and financial torture and cost born
by families is unknown and will shock many of us when we hear
from our constituents. He may be flying a kite today, but I do
think he is breaching a dam, and that is something that we all
need to grasp. Targeted help is not a long-term solution. My
right hon. Friend the Member for Exeter (Mr Bradshaw) highlights
what that solution could be, but there is some certainty offered
today. Can the Prime Minister clarify whether he is going to
bring forward a White Paper? Will he bring forward different
forms of legislation? How are we going to understand the impact?
The Prime Minister
I thank the hon. Lady very much. We are setting out the plan
today on the caps and floors and how to deal with social care. We
are setting out the plan on nurses’ pay and dealing with the
backlogs. What we will also be doing is setting out the finer
detail of the integration between health and social care in the
ways that I have described: everybody should have electronic
records for both health and social care; there should be movement
between the two services; community nurses and adult social
carers should not be doing these radically different professions
with different pay spines—there should be an integration; people
should be having care in the appropriate setting; and there
should be a single budget holder. Those are some of the things
that we will be discussing in the White Paper.
(West Bromwich West) (Con)
Additional investment is welcome, but that has to come with
assurance. My constituents in Tipton, because of the Labour
party, are getting turfed out of their care home, despite a £2
million underspend by Sandwell Council on adult social care. Can
my right hon. Friend assure my constituents in Tipton that their
campaign to save Walker Grange care home is not in vain? Will he
ensure that assurance comes with the investment to stop the
Labour party turfing out some of the most vulnerable people in my
community?
The Prime Minister
Yes, Mr Speaker, and I think my hon. Friend speaks to the
profound indifference of the Labour party to this issue for
decades. That is why we are taking the decisive action that we
are to address the problems in the whole social care system, to
support care homes and to support those who must face the cost of
social care.
(Huddersfield) (Lab/Co-op)
Does the Prime Minister agree that any new money must go
alongside reform of our NHS? Does he agree that, as we have a
system where most people’s entry into the health system is
through a GP, it surely cannot be right that in many of the most
deprived communities in our country, people cannot get a GP for
love nor money? There must be something wrong in many parts of
our country that in this day and age, people cannot get a GP and
cannot even get a dentist. When can we do something to change
that?
The Prime Minister
The hon. Gentleman is entirely right in what he says, in the
sense that we are doing 50 million more GP appointments. That is
part of our manifesto pledge. What we are also going to do as
part of these reforms—I do not think anyone wants to see money
just funnelled into the NHS without reform—is look at GP
contracts to make sure that GPs see the right patients at the
right time.
(Gloucester) (Con)
If there was an easy solution to the problem of social care, it
would have happened years, if not decades ago. I believe that
everybody in this House, but particularly those from parties
offering no alternatives, should welcome how the Prime Minister
is tackling health and social care together with a hypothecated
tax, which means that this health and social care levy is
ring-fenced for all our constituents’ benefit. On the issue of
intergenerational fairness, my right hon. Friend said that the
recently retired would contribute and the lowest earning would
not contribute, so will he encourage the Health Secretary to lay
out the details of the tapers as soon as possible, so that
everyone can see that this is a progressive levy?
The Prime Minister
My right hon. Friend the Health Secretary will certainly be
laying that out. What everybody in the country understands is
that there is no intergenerational issue here, because in the end
all families are affected by this. Everybody has older relatives
whom we love, and the cost of whose care makes us anxious.
Everybody understands that families across the country are liable
for this and we must take steps to fix it, and that is what we
are doing.
(Hornsey and
Wood Green) (Lab)
Confidence in job creation is crucial right now in our economy.
What assessment has the Prime Minister made of the number of jobs
where employers will look at the extra national insurance
contributions and say, “No, I do not think I will take on those
extra staff”?
The Prime Minister
The hon. Lady should remember that 40% of companies will not be
affected at all by this. I am sure she also knows that the labour
market is so buoyant that not only are there huge numbers of
vacancies, but wages are rising, and that is a good thing.
(Rutland and Melton) (Con)
During the pandemic, the Government stepped in to save lives and
jobs. In Rutland and Melton, 47% of jobs would have been lost
without those efforts. Does the Prime Minister agree that it
would be wrong to meet the cost with higher borrowing and debt,
which would be carried by our children? Will he commit to look at
those councils that are worse funded, specifically Leicestershire
and Rutland, which need real help with social care above and
beyond a generic formula across the country?
The Prime Minister
Yes, Mr Speaker. I thank my hon. Friend for what she says about
Rutland and Melton, and we will certainly make sure the councils
get the funding they need. She has hit on the fundamental point:
borrowing more is no answer. We are borrowing a lot, and in the
end borrowing is just future tax rises for younger people or even
people unborn. That is not what this Government are going to do.
(Leeds East) (Lab)
Health and social care do need massive investment, especially
after Tory austerity has so undermined our national health
service over the past 11 years. A 10% tax on the wealth of those
with over £100 million would raise £69 billion. Surely a wealth
tax is how we should be funding these vital services. Is the
truth not that despite the rhetoric and the promises, the Tories
do not have the guts to take on the super-rich who fund their
party, and that is why they will not back a wealth tax?
The Prime Minister
I thank the hon. Gentleman for his contribution. At least he has
the guts, unlike the leader of his party, to say that he would
tax people in this country to the tune of £12 billion or £13
billion a year to pay for this. This is a wealth tax on that
scale. We believe that this is the right way. What we have not
heard from those on the Labour Front Bench is any credible
alternative.
(West Aberdeenshire and Kincardine) (Con)
Will my right hon. Friend confirm that as a result of this
announcement today, the Scottish national health service will
receive billions of extra pounds in funding? Does he share my
astonishment—and, I am sure, the astonishment of the people of
Scotland—at the remarkable reaction of the SNP today? It seems
that because the SNP has not asked for it, it does not want
Scotland’s NHS to get this extra funding.
The Prime Minister
That was brilliantly and succinctly put. Does the SNP want the
money or not? Do the people of Scotland want investment in their
healthcare and social care or not? There is more money coming for
Scotland; let us hope that the SNP spends it wisely.
(Twickenham) (LD)
A little over two years ago, the Prime Minister stood on the
steps of Downing Street and promised the nation an oven-ready
deal on social care, yet the announcement of a tax on jobs only
promises a plan later this year. Crucially, the detail in the
statement says that only people starting care after October 2023
will be helped with these catastrophic costs. What does the Prime
Minister say to the 1.5 million people missing out on care and to
the millions of hard-working families facing crippling costs
between now and September 2023 but paying for it from April next
year?
The Prime Minister
What I say to the hon. Member is that, frankly, she should take
that up with the former leaders of the Labour party, and , and all the
former Ministers responsible who did absolutely nothing to fix
the problem when they were in office. It is this Government
dealing with it now.
(Forest of Dean) (Con)
The Prime Minister was absolutely right to focus on the
importance of the social care workforce. Unfortunately, the
Government’s own estimate is that due to our compulsory
vaccination measures, 40,000 people in that workforce will leave
the sector by November. Are there urgent measures in his plan
that the Government will take to replace those missing care
workers so that we can deliver the high-quality care that I think
everyone in the House wants to see?
The Prime Minister
My right hon. Friend makes an important point about compulsory
vaccination. I believe it is the right thing, and, in the ways
that I have described, we are making sure that we encourage more
people to join the social care workforce, with the £500 million
of investment and the training places. We must also understand
that many of those social care workers are leaving to join the
NHS, where vaccination is not currently compulsory. Almost 10% of
NHS frontline workers are not vaccinated. That is something on
which we need to reflect, and that is why we are having a
consultation on the way forward for the NHS. I do not think it is
right that almost one in 10 frontline NHS workers should be
unvaccinated against covid.
(Dulwich and West Norwood) (Lab)
It is telling that, in the Prime Minister’s statement, there was
not a single word of tribute to our extraordinary social care
workforce or any mention of the pay increase that they so
desperately need. Many of those social care workers are on low
pay and will face a £1,000 cut in their income as a consequence
of the Prime Minister’s cut to universal credit, on top of the
national insurance increase they face. What has the Prime
Minister got to say to our dedicated social care workforce who
spend their time caring for our precious loved ones every single
day?
The Prime Minister
Let me say again what I have said repeatedly: the social care
workforce of this country have done an amazing job and continue
to do so. They did an amazing job throughout the pandemic as well
as before it and beyond. I met more of them today. What they are
getting from this package of measures is not only investment in
their careers and progression but the long-term structure and
respect that they need as a profession and the prospect of
integration between what they do and what the NHS provides. That
is a massive prize.
(South West
Wiltshire) (Con)
I congratulate my right hon. Friend on grasping an issue that his
predecessors have been ducking for decades. Does he agree that
what has been announced restores some equity to a system that
relies on pooling our risk and that, in particular, people who
have been excluded with dementia, neurodegenerative disease,
Parkinson’s disease and the general frailty of old age, and their
relatives, can look forward with some confidence to the system
that has been there for others also applying to them?
The Prime Minister
My right hon. Friend knows exactly what he is talking about,
because he is a former GP who has seen these issues at the
frontline. With this measure, we are not only investing in care
and in the NHS but bringing the magic of averages to the rescue
of millions.
(Sheffield South
East) (Lab)
Before the pandemic, the Conservative-led Local Government
Association said that there was a gap in social care funding and
local authority funding of about £5 billion. It has got worse
since. Will the Prime Minister therefore state clearly, of the
£36 billion to be raised through this addition to national
insurance contributions in the next three years, how much will go
to local authorities to fund social care? When, in 2023, he
brings in the cap and floor system, that will mean less money
coming in from people’s own funding, so what will the net
addition be for local authorities from the increase in national
insurance payments and the reduction in payments from the cap and
floor system?
The Prime Minister
The hon. Member makes an exceptionally important point. In
addition to the £6 billion that we put into supporting local
government throughout the pandemic, we are putting more in
precisely to support social care. That will ramp up over time as
the system kicks in. The distribution will be set out in due
course by my right hon. Friend the Secretary of State for Health
and Social Care.
(Wellingborough)
(Con)
Nobody in this House, and I doubt anyone in the country, will be
surprised that the Prime Minister has the guts to take on
reforming social care when none of his predecessors did. I was
amazed that in the statement he pointed out that roughly one in
three hospital beds are occupied by people who could be better
treated and cared for elsewhere. It seems to me from my surgeries
that the problem is largely due to local government and the
health service not working together. When can we see some
improvement in that?
The Prime Minister
My hon. Friend is completely right, and I am sure he speaks for
Members across the House who have experienced this problem in
their surgeries for years. There is a mismatch between health and
social care and there is not a proper system for deciding where
people should be treated for their own benefit, and the result is
that we get these huge pressures of delayed discharge that make
it more difficult to deal with the elective surgery that people
need—particularly now. That is why we must do both things at
once, and that is why we are doing what we are doing.
Dame (Hackney South and Shoreditch) (Lab/Co-op)
The right hon. Member for Ashford (), the hon.
Member for Cities of London and Westminster () and my hon. Friend the Member for Sheffield South East
(Mr Betts) have hit the nail on the head: there is no plan for
social care. What the Prime Minister has listed is money to go
into the NHS. Will he tell us now when the money will go to local
authorities so that it can go to those domiciliary and
residential social care providers who actually need it?
The Prime Minister
It is all in the plan. The overwhelming bulk of the funding
begins with support for frontline NHS electives, for nurses’ pay
and for vaccines; then, as the social care plan ramps up, the
ratio changes. It will be set out by my right hon. Friend the
Secretary of State for Health and Social Care.
(Thirsk and Malton) (Con)
May I quote from a recent report from a joint inquiry by the
Health and Social Care Committee and the Housing, Communities and
Local Government Committee on the future funding of social care,
on which I sat together with 12 Opposition Members? It says:
“We therefore recommend that an earmarked contribution, described
as a ‘Social Care Premium’, should be introduced, to which
individuals and employers should contribute. This can either be
as an addition to National Insurance, or through a separate
mechanism”.
Does that not show that there is cross-party support for such a
proposal and that the Opposition’s objections are simply
political opportunism?
The Prime Minister
I thank my hon. Friend for making that elegant but telling point
about the cross-party support that there should be. We are trying
to create the conditions by decisive Government action for
exactly the kind of insurance systems that I know he wants to
see.
(Ealing
Central and Acton) (Lab)
It has been a long time coming, but this announcement is too
little, too late for the 34,000 people who have died of covid
with dementia. Will the Prime Minister tell us when he will
honour his manifesto pledge to double research spending into this
cruel disease that took my mum—it was isolating before covid—or
is this just another one going the same way as the money for the
NHS promised on the side of the bus?
The Prime Minister
I am very sorry to hear about the suffering of the hon. Member’s
mother. Dementia is a very cruel affliction, and it is because of
the cruelty of that lottery about who gets it and who does not
that we are putting in the measures that we are. But we are also
funding extra research into dementia, and my right hon. Friend
the Health Secretary is determined to ensure that we continue
with the moonshot that I was referring to earlier.
(Bexhill and Battle) (Con)
May I ask the Prime Minister why he decided to reject other forms
of insurance as a model? The Germans brought in an insurance
model back in the 1980s, facing the same problems that we had,
and it relies on the private insurance sector. The noble
from the other
place has brought forward a Bill that would see the Government
set up a state insurer. Those retired householders would then pay
a premium, which would be fixed as a charge, and then that charge
would only be paid upon the death of that individual. Do not
those models do a little more to intergenerational fairness?
The Prime Minister
I thank my hon. Friend for his thoughtful question. We looked at
all those models of course, Mr Speaker, as you can imagine. I
think that the problem is that we need to go for an insurance
system that works and has a genuine chance of being set up, and
the only way of encouraging the financial services industry to
come in and offer products, whether they are insurance or
annuities or whatever, is to take away that risk of catastrophic
cost. That is a very substantial risk for too many people and it
means that the insurance market has not been able to develop. We
believe that this is the best way forward for the country.
(Inverness, Nairn, Badenoch and Strathspey) (SNP)
My hon. Friend the Member for Paisley and Renfrewshire North
() referred to comments by IFS director Paul Johnson
earlier, but Paul Johnson has also said he is
“bemused as to why such a bad tax policy instrument has to be
used”,
and pointed out that the under-50s would pay two thirds of the
costs of social care if they paid through NI. Prime Minister,
that means young people and the lowest-paid bearing the brunt.
Many of these are also working with universal credit—people in
Scotland paying that and elsewhere. Does he think it is fair to
progress this while also cutting the £20 a week from hard-pressed
families on universal credit?
The Prime Minister
No, because obviously older people continue to pay the levy and
the richest 14% pay half the cost of this transformation, and
that is entirely the right thing to do.
(Christchurch) (Con)
If there had not been a pandemic, how would we have funded this
reform of social care without having to raise taxes?
The Prime Minister
The pandemic and the cost of the pandemic have impacted both our
health and our social care systems. As I have tried to explain to
the House today, they are intimately related. The best way to put
them on a sound footing—both of them on a sound footing—for the
future is to treat them together and to put in the levy in the
way that we are.
(Stockton North) (Lab)
We all know that the Prime Minister’s promises are a wee bit
dodgy. Today, he promised that his extra taxes will go to the
frontline, so by how much will he increase the pay for people in
the social care profession or is it just going to be another
round of applause?
The Prime Minister
People in the social care profession, overwhelmingly, are not
paid by the Government as the hon. Member knows, but they are the
beneficiaries of the living wage, which the Government have
increased by record amounts. What we are doing is investing in
their training, investing in their careers and making sure that
they get the respect and the progression that they need.
(Central Devon) (Con)
The devil, as ever, will be in the detail. However, may I
initially broadly welcome these proposals, particularly compared
with what we were expecting, which was a rise across national
insurance as it stands at the moment? This is a much
broader-based levy: it includes those who have retired and those
who are receiving dividends. It seems to me that that has a very
welcome consequence; the broadest shoulders will pay the most.
But can my right hon. Friend also address one of the criticisms
of what we feared might have been brought forward today, which
was the impact on the young in particular and this issue of
intergenerational fairness, and how he feels that this approach
is going to be useful in that respect?
The Prime Minister
I thank my right hon. Friend very much for his support, because
it is extremely important, and I think he is completely right. We
are trying to make sure that those who can pay the most do pay
the most. We are trying to make sure that we address the issue of
intergenerational fairness. But there is a bigger point, which I
have made repeatedly. This is not something that simply affects
one generation, the elderly. There are huge numbers of younger
people in care who will benefit from what we are doing and every
person in this country has relatives who face the problems that
we are trying now to allay or to defeat.
(Sheffield Central) (Lab)
The Prime Minister today was supposed to be announcing a social
care plan, but there was no vision, no detail and no real sense
of understanding the complex web of issues that create the social
care crisis. In particular, he made no mention of the millions of
unpaid carers, whose commitment to their loved ones props up the
failing system. So will he now say very specifically what is in
his plan to identify and support unpaid carers, and particularly
young carers, and what resources will he commit to them?
The Prime Minister
I thank unpaid carers for everything that they do, and the hon.
Member is quite right to point out the huge contribution that
they make. What unpaid carers have now is the certainty that if
they need to pay for the cost of care in some way or other, there
will be a limit and they will not have to continue with their
unpaid exertions, their care and love forever, because the
Government are coming in to help them.
(Stoke-on-Trent North) (Con)
I welcome my right hon. Friend’s investment into the NHS,
particularly into the beds, which have obviously clogged up. We
see this in Stoke-on-Trent, where the Royal Stoke University
Hospital was built under the last Labour Government, with a
disastrous PFI debt that steals £20 million a year from the
frontline. It also has 200 fewer beds than the previous hospital.
So can my right hon. Friend ensure that previously forgotten
areas such as Stoke-on-Trent will get their fair share of
funding?
The Prime Minister
With the PFI contracts and the endless borrowing that Labour
instituted, hospitals up and down the country are paying the
price for the approach advocated by the last Labour
Government—the completely financially reckless and incompetent
approach. That is the opposite of what this Government are doing.
We are taking the fiscally responsible, reasonable and right
approach to fixing this problem.
(Wirral South) (Lab)
The Prime Minister said at the Dispatch Box, though it is not in
the printed copy of his speech, that the NHS backlog that we face
will get worse before it gets better. How much worse?
The Prime Minister
It would be a great thing if the Labour party would support what
we are doing. With the package we have brought forward, we will
be able to fix that backlog even faster. If the hon. Member or
the right hon. and learned Member for Holborn and St Pancras
(), the leader of the Labour party—[Interruption.] By
the way, we did not hear from him whether he is going to vote for
these proposals or not: as usual, a great vacuum at the heart of
the Labour party. Does he actually support these proposals—yes or
no? That is what I would like to know.
(Preseli
Pembrokeshire) (Con)
I think the Prime Minister, the Chancellor and the Health
Secretary deserve enormous credit for coming together and working
out a plan for this incredibly difficult problem, and I think
people outside this place will recognise that. But does the Prime
Minister agree with me that one of the most difficult parts of
this challenge is ensuring that we bring out the very best now in
our NHS—that we bear down on unnecessary costs and increase
quality output from the NHS? Does he agree that that is the key
to freeing up that extra resource to get to the frontline of
social care?
The Prime Minister
Yes, we cannot simply continue to funnel huge sums into the NHS
without getting the productivity gains that I know that everybody
wants to see around the country. Of course, we want to value our
frontline NHS workers. That is why we have put up the wages of
nurses. It is why we are increasing salaries and recruiting many
more. But we must see the gains in efficiency that go with the
investment we are making. We are investing record sums, and we
also need to see improvements in the NHS service as well.
(Motherwell and Wishaw) (SNP)
Cabinet Ministers, Tory Back Benchers and Lords, and businesses
large and small are all opposed to this proposal. There is
universal criticism of how it will affect young people and those
who are less well-off who are working, and, to top it all, the
Prime Minister cannot resist interfering in the devolved
settlement, even though Scotland voted for a majority of
independence supporting MSPs. How long—how long—does this Prime
Minister think he can carry on like this before he follows in the
footsteps of the right hon. Member for Maidenhead (Mrs May) and
loses his majority due to a botched plan?
The Prime Minister
I leave it to the hon. Lady to speculate on that time, but it is
very bizarre that yet again the Scottish nationalists—I think she
is a Scottish nationalist—seem to be rejecting the Union dividend
that this produces. I hope, and the people of Scotland deserve,
that this money is spent on health and social care in Scotland;
let us hope it is so spent.
(Beaconsfield) (Con)
Many in this House have discussed the burden placed on councils,
and I echo the concern that this money must be ring-fenced for
the local authorities, who take the lion’s share of the burden
for adult social care. Can the Government give greater assurances
as to how the funding streams will be safeguarded and directed
towards local authorities?
The Prime Minister
My hon. Friend is spot on, and the Secretary of State for Health
and Social Care will set out later how we will ensure local
councils get the support that they need.
(York Central) (Lab/Co-op)
The Prime Minister failed to say a word about the broken private
care market that fleeces the frail and suppresses the wages of
the workers. Why has he failed to lay out plans to end this
broken market and introduce a public national care system?
The Prime Minister
I know that the Labour party wants to nationalise everything,
which would be typically insane since the vast majority of care
is provided by the private sector. What we are doing is lifting
people’s wages with the national living wage, investing in
training and putting half a billion pounds into progression of
the caring workforce, and we will also make sure that local
councils get the funding they need to support a fair cost of
care.
(Dudley
South) (Con)
When people cannot get an appointment with their GP they often
turn to hospital A&E departments, or miss out on early
intervention which places greater pressure on our health system
further down the line. As part of his plan for the NHS to
recover, will the Prime Minister make sure that everybody can get
face-to-face appointments with their GP without further delay?
The Prime Minister
My hon. Friend is completely right and speaks for colleagues
across the House: we need to reform the system so that GPs see
the right people at the right time and in the right numbers.
(Glasgow Central) (SNP)
Mike Cherry of the Federation of Small Businesses has said that
these plans unquestionably mean fewer jobs and economic damage
and that they are “devastating” for businesses trying to
“get back on their feet”.
Why is the Prime Minister intent on damaging the very fragile
recovery we have had for the past year?
The Prime Minister
I disagree vehemently with what the hon. Lady says because the
economy is coming back much more strongly than many predicted,
including the Office for Budget Responsibility, which is a good
thing. If we had followed the advice from the Labour party we
would still be in lockdown, but we are seeing growth returning
and jobs being created, and I do not believe anything in this
plan will do anything to dent that confidence. On the contrary,
businesses want to know that their workforce have the security of
a good health and social care plan to back them up, and that is
what this Government are providing.
(South Dorset)
(Con)
As Conservatives, broken pledges and tax rises should concern us.
Our finances are in a perilous state; surely a radical review of
the NHS is needed if this money is not going to disappear into
another black hole. Does my right hon. Friend agree that the
Conservative way to raise revenue is to lower taxes, not raise
them?
The Prime Minister
I do agree with that general proposition, but in the current
circumstances, after 18 months in which it has been necessary for
the Government to perform the most enormous fiscal exertions to
put their arms around the country at a very difficult and
dangerous time, it is right that we take these steps to put the
NHS back on a sustainable footing and to deal with the problems
of social care which make long-term solutions for the NHS—the
very reform that my hon. Friend and I want to see—so difficult to
achieve.
(Denton
and Reddish) (Lab)
Words I never thought I would say: the Prime Minister is right,
we cannot fix the NHS without fixing social care. But we cannot
fix social care without fixing local government, and of course in
the lifetime of this Government £15 billion has been taken out of
council budgets, disproportionately hitting some of the least
affluent parts of England and impacting on social care outcomes.
Councils need assurances now that funding will follow and clarity
on when they will get it and how much it will be; does he
understand that?
The Prime Minister
Actually in the last few years we have seen record increases in
local council spending power, and we have continued to support
councils throughout the pandemic. My right hon. Friend the
Secretary of State for Health and Social Care will be setting out
how we propose to support local government going forward with the
fair cost of care, but in the meantime may I thank the hon.
Gentleman for his unprecedented support for these measures?
(Morecambe and Lunesdale) (Con)
I can probably say that in the last 18 months during lockdown I
have seen more of the NHS than most people—I have had a neck
operation, my baby was born, my back exploded, for want of a
better word, and I was paralysed—and I would like to go on record
and thank the Royal Lancaster Infirmary for getting me walking
again and looking after me and my family.
I say the following in a collegiate sense to everybody. What the
Prime Minister has done here is what wanted to do 10 years ago but never brought it
through when he was the last Labour Health Secretary and the
shadow Secretary. What the Prime Minister is doing is brave, but
I have been saying for years when knocking on doors in my
constituency, “Put an extra penny on taxation for the NHS,” and
everyone has agreed with me. So, whatever these tax rises are
going to be, so be it: we have to protect the NHS—it is our moral
duty.
The Prime Minister
It is wonderful to see my hon. Friend looking so well, and I echo
his thanks to our healthcare professionals for everything they
do. I believe it is the fixed view of the British people that
after a very difficult time it is fiscally right and responsible
to protect frontline healthcare and support the NHS but also at
the same time to fix the underlying problems, of which social
care is just one.
(Strangford) (DUP)
I thank the Prime Minister for introducing this long overdue
measure to address the NHS and social care. Across the United
Kingdom, and in my constituency of Strangford, small and
medium-sized businesses are critically important in providing
jobs and boosting the economy. Can the Prime Minister assure this
House that across the United Kingdom of Great Britain and
Northern Ireland SMEs will not shoulder the burden, as they can
little afford it?
The Prime Minister
I am a fervent admirer of the businesses of Northern Ireland and
their ingenuity and ability to innovate, which I have seen many
times at first hand. I know they are capable of a very dynamic
recovery, and indeed believe that is going on right now. I have
every confidence in my right hon. Friend the Chancellor to keep
bringing forward those business-friendly, supply-side measures
which will drive a very strong economic recovery.
(North
Somerset) (Con)
I welcome my right hon. Friend’s commitment to improve and raise
NHS capacity. For decades bed occupancy rates in the NHS have
been kept too high in the name of efficiency but at the expense
of resilience. When it comes to reforming long-term care we need
a clear set of principles to be followed: we need to encourage
and make it worthwhile for people to save for a rainy day; we
need to support families to look after their loved ones; and we
must allow enough money to pass down the generations to make it
worthwhile to save in the first place. Can my right hon. Friend
reassure us that his proposed reforms will meet these tests?
The Prime Minister
Yes, and I thank my right hon. Friend for his support; he knows a
great deal about this subject from many points of view. It is
certainly right to bring in the measures that will help to create
a private sector market for support in the way I have described,
but also more fundamentally from our point of view—my right hon.
Friend’s and my point of view—these are measures that support
thrift, that support people who save, and that support people who
do the right thing: who pay off their mortgage and work hard all
their lives to build up something for their families and
descendants. So I think these measures are profoundly in the
interests of the people of this country.
(Aberdeen South) (SNP)
Let us be clear: Scottish taxpayers are being asked to bail out
England’s failing social care system from a mess created by the
UK Government. I ask the Prime Minister, in all good sincerity:
does he believe that his new poll tax will help or hinder the
cause of Scottish independence?
The Prime Minister
Good luck with that one. That is all I can say to the hon.
Gentleman. What the people of Scotland and the whole of the UK
are getting is £2.2 billion more across the whole of the devolved
Administrations and a £300 million Union dividend. If they do not
want to spend it on health and social care, or if they do not
want to spend it at all—if he is handing the money back—then let
us hear it from the Scottish nationalist party. Do they want it
or do they not?
(Yeovil) (Con)
Will my right hon. Friend work with me to examine ways that I can
see of getting the finance, technology and political sectors
together to do this in a way that can be less of a burden on the
taxpayer?
The Prime Minister
Yes. I thank my hon. Friend. I have been reading some of his
brilliant contributions on WhatsApp groups about this issue, and
I share his idealism about the ways in which the private
sector—the financial services industry—can take advantage of what
we are doing to help ordinary people up and down the country to
protect themselves in exactly the way that he describes. I know
that my right hon. Friend the Secretary of State for Health and
Social Care would very much welcome his help as we work towards
the White Paper.
(Gordon) (SNP)
I thank the Prime Minister for at least providing clarity that
any reference to a “Union dividend” simply refers to devolved
nations getting back the taxes that they pay and having the
balance filled up with UK borrowing. In his belated attempts to
tackle England’s social care crisis, with hedge fund owners to
the left of him and millionaire property owners to the right, can
the Prime Minister explain what it was that persuaded him to
embed the advantages of inherited wealth and privilege, and
instead shift the burden for paying for this policy on to the
lowest earning and the youngest in society—those with the least
assets?
The Prime Minister
I do not think there is anything much inherited on the left, the
right or the middle of this particular trio. Again, I find it
extraordinary that the Scottish nationalist party would rather
not have the Union dividend that this programme produces. The
people of Scotland need to look at what is now being offered in
terms of raising the thresholds for protection and helping people
across the UK, and I hope that we can all move forward together.
(Wimbledon) (Con)
I commend my right hon. Friend for keeping a promise that he made
on the first day of his premiership and for his frankness about
the difficulties of funding the challenges. There will be
millions of hard-working families today looking at his proposals
for the cap and floor and welcoming them. Can he confirm that the
cap will cover all types of care—residential and domiciliary—and
that, given that there is likely to be a need for more care
workers, there will be up to £500 million as a training fund
within the levy?
The Prime Minister
I thank my hon. Friend, who knows a great deal about this issue
and the pressures that the sector faces. I can tell him that,
yes, of course it covers both residential and domiciliary, and
yes, there is a £500 million fund to help the caring profession,
and we will provide 700,000 training places as a direct result of
what we are doing today.
