Health and Social Care Levy (Repeal) Bill

James Cartlidge Excerpts

2nd reading
Tuesday 11th October 2022 Commons Chamber

[Chris Philp]

I do not think I should trespass into the realm of my right hon. Friend the Secretary of State for Health and Social Care and Deputy Prime Minister. She will make her own views and policy on that issue without intervention from me. We are ensuring that the NHS is well funded so that it can provide the treatment our constituents need. Our commitment to NHS funding is undiminished.

Let me turn to the Bill, which repeals the health and social care levy. Members will recall that the health and social care levy was originally announced in September last year, and the Health and Social Care Levy Act 2021 received Royal Assent on 20 October last year. The levy had two phases: first, a temporary 1.25% increase for employers and employees in the current tax year; and then from April 2023 a formal surcharge of 1.25%, which would have affected not just those of working age but also those of state pension age. The Bill repeals that Act with elegant simplicity. Clause 1 states simply:

“The Health and Social Care Levy Act 2021 is repealed.”

[James Cartlidge (South Suffolk) (Con)]

This is my first opportunity to congratulate the Chief Secretary on his appointment. What he said on the energy support for my constituents and all our constituents is very important, and I very much welcome that. However, on repealing the levy, he is of course aware that one of the most important things that it was going to fund was the welcome cap on care costs introduced by the Government, which had been promised by successive Governments with many a White Paper and many a Green Paper. How will we now pay for that?

[Chris Philp]

I thank my hon. Friend for his kind words. We are long-standing colleagues, and I look forward to working with him for many years to come. To be clear, the funding that was to be provided via the levy for both health and social care, which in the case of social care amounted to £5.4 billion over the three-year spending review period, is completely unaltered. There is no change to that funding at all.

My hon. Friend asked about funding for social care. The funding envelope for all public services will be set out by my right hon. Friend the Chancellor on 31 October via his medium-term fiscal plan. We will ensure that we are responsible custodians of the public finances by sticking to the spending plan set out in spending review 2021. We will be disciplined about doing that. We will ensure that we generally exercise spending restraint, mindful of the fact that we cannot have public spending forever increasing at faster and faster rates. We will be disciplined about how we manage the public finances.

I also point to economic growth. If, or rather when, we are successful in delivering the growth plan’s mission to elevate trend growth from 1.5% to 2.5%, with an extra 1% per annum over a consistent period of time—for example, five years—by the fifth year that additional growth will deliver about £47 billion of extra tax revenue, as set out in the table on page 27 of the Blue Book that accompanied the growth plan. I hope that gives my hon. Friend a hint about our thinking, but really the medium-term financial plan on 31 October will provide the most complete answer.

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[Chris Philp]

I am spoilt for choice; I will start with my hon. Friend the Member for South Suffolk (James Cartlidge).

[James Cartlidge]

I am lucky to have a second intervention already. I know that as a former businessman, the Minister cares passionately about growth, and I respect that. However, as a businessman, he must also know that the single most important factor for business is confidence and stability. When we speak to businesses at the moment, we hear that they are worried about the lack of stability. They want certainty and confidence. He needs to explain the basic question about the £17 billion of revenue from the levy to fund social care and the NHS. If the levy is going, surely that implies that borrowing fills the gap or some other change fiscally. Is it the case that that will be confirmed on the 31st?

[Chris Philp]

Yes, it is. My hon. Friend is asking entirely reasonable questions, but we have to look at this issue in the round across the entirety of public expenditure. The Chancellor will set that out in detail on 31 October to the House, accompanied by the OBR scoring.

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[James Murray (Ealing North) (Lab/Co-op)]

Just over a year ago, Opposition Members stood in this Chamber urging the Government to drop their plans to hike national insurance contributions and to introduce a new levy on working people and their jobs. It was not just my Opposition colleagues and me making the case against this tax rise; the Government were warned by so many others, from the Federation of Small Businesses to the British Chambers of Commerce, the CBI and the TUC. Ministers were warned from all sides of the harm that their approach would cause. The Government were warned by their own Back Benchers. Ministers at the time even warned themselves. The tax information impact note on the tax rise was signed off by the Minister who took the original legislation through Parliament, and that note said:

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

In relation to businesses, it said:

“Behavioural effects are likely to be large, and these will include...business decisions around wage bills and recruitment.”

Yet the Government pressed ahead with the tax rise, supported in the Lobby by the current Prime Minister and the Chancellor. The Government kept supporting it until the then Foreign Secretary became Prime Minister and decided to perform a U-turn.

We welcome this U-turn, as it puts an end to a tax rise that we said was wrong from the very start. It is, of course, not the only U-turn that we have seen under this Prime Minister. Just last week the Government U-turned on their damaging and misguided plan to cut the top rate of tax for the very highest paid, so our current message to the Prime Minister and the Chancellor is to keep on U-turning.

[James Cartlidge (South Suffolk) (Con)]

Will the hon. Gentleman clarify something? Would he keep the social care cap and the spending on the backlog, and if so, given that he supports repeal, how would he fund that?

[James Murray]

The truth is that we are having this debate as part of a wider Government economic strategy that has caused economic chaos, and contains no plan for growth and no plan to fund public services. Even when we were discussing the original Bill last year, there was no plan for social care: there was no guarantee that a penny of the money would go into social care. So I will not take lectures from the hon. Gentleman.

[James Cartlidge]

rose—

[James Murray]

I am going to make some progress. I may let the hon. Gentleman intervene again in a few moments.

As I was saying, right now our message to the Prime Minister and the Chancellor is to keep on U-turning. They need to U-turn on their whole disastrous approach to the economy, which the Chancellor set out just over two weeks ago. That Budget—in all but name—was the most destructive, unfair and irresponsible fiscal announcement in a generation.

The Prime Minister and the Chancellor should now U-turn on their decision to lift the cap on bankers’ bonuses. They should U-turn on their refusal to ask oil and gas giants to put some of their eye-watering excess profits towards helping keep to people’s energy bills down. They need to U-turn on their discredited, dangerous trickle-down approach to the economy. It is time for them to reverse their disastrous kamikaze Budget, which has unleashed an economic crisis that they made in Downing Street, and which working people are paying for through higher mortgages and prices.

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[James Murray]

The Minister must not have been listening carefully enough to the shadow Chancellor setting out Labour’s plans, because we have set out how we would scrap the non-dom status, which it is completely irresponsible to keep in the current context, and to use some of that money to set out our plans for investment in the NHS. The difference between the Government and the Opposition is that the Government make promises and use throwaway comments about how they might fund this with general taxation or through extra borrowing, whereas when we set out our pledges, we set out exactly what we will pay for. They are fully costed, fully funded and paid for through fairer taxation.

[James Cartlidge]

Will the hon. Gentleman give way?

[James Murray]

No, I am going to make some progress.

We have set out that we will not borrow for day-to-day spending and that we will not ask working people who are already struggling to foot the bill. That is what we mean when we say we are the party of economic responsibility and the party of social justice. The Conservatives have shown themselves to be the party of a failed approach to the economy. After six so-called growth plans from the Government that have all failed, the drunken gamblers of Downing Street have rolled the dice one last time, putting their faith in the ideological mantra that if they just slash taxes and regulation, they will unleash business investment and growth. They believe that wealth is created only by a few at the top, when the truth is that it comes from the bottom up and from the middle out.

The trickle-down economics of the Prime Minister and her Chancellor are wrong. Their approach will not work and it is not fair. It will hit working people’s spending power, undermining prospects for growth, and it ignores the need for the Government to be a partner for business to grow—something that is more important than ever with the turbulent, changing, challenging outlook that we face. That is why the next Labour Government would do things differently. We would bring together businesses and trade unions through a national economic council. We would support businesses to grow, through our modern industrial strategy, and we would use a national wealth fund to invest in the new green industries of the future. That is our approach to the British economy: pro-business, pro-worker, pro-growth.

The Government are making the wrong calls again and again. They were wrong last year to introduce the national insurance rise on working people, just as they were wrong last month when they tried to cut tax for some of the highest paid in society and to hide the OBR report on their plans. We welcome the Government finally admitting that they were wrong to raise national insurance on working people and businesses in the middle of a cost of living crisis, but their wider economic approach is one that is characterised by ballooning borrowing and a discredited trickle-down approach to economic growth.

The Prime Minister and her Chancellor are gambling with the livelihoods and wellbeing of people across the UK. Their gamble is dramatically worsening the cost of living crisis, with higher costs and mortgage payments for households across the country. It is shredding any reputation for economic competence the Conservatives might once have claimed to have, and it will fail to deliver the growth we need after 12 years of stagnation.

Throughout the cost of living crisis, Labour has forced the Conservatives to U-turn time and again. By repealing the national insurance rise and levy and by halting their plans to cut the top rate of tax for the very highest paid, the Prime Minister and the Chancellor have shown that they have it within themselves to make a U-turn. Our message to them is clear: do not stop there. The Government must U-turn on their whole economic approach and reverse their disastrous kamikaze Budget. Our message to the British people is also clear: this is a Tory crisis that has been made in Downing Street and is being paid for by working people. Only Labour will fix the damage that the Tories are doing. Only Labour will deliver economic responsibility and social justice. Only Labour will be a Government that are on your side.

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[James Cartlidge (South Suffolk) (Con)]

It is fair to say that it is a bit of a novelty for me to be called so early, and without a time limit, in a debate. I am very grateful, not least because how we pay for healthcare is one of the single most important subjects in British politics. That is essentially what we are debating today, and I feel strongly on this subject. The core principle must be one that I have always held as a Conservative, which is that we are fiscally responsible. As with the environment, we must aim to leave things in a better condition for future generations and, with the public finances, have in mind at all times the impact on those yet to be born—on our grandchildren—so that we are fiscally responsible. That is the fundamental belief of my party, in my view.

With that in mind, there is a lot of excitement about what the OBR will say on Hallowe’en, but it has already pronounced on the matter of health expenditure. In July it published “Fiscal risks and sustainability”, a fascinating bedtime read. The crucial thing is what it says about the OBR’s estimate for the future cost of healthcare in this country. It predicts that the current spend on health and adult social care will go from around 10.3% of GDP to 17.5% of GDP in 50 years’ time. That is an extraordinary increase—almost double—and it would take up so much more of our wealth and public expenditure. The OBR’s track record is very accurate on estimating health spend. It is based on a lot of cautious variables that are obviously difficult to predict, but essentially this is, if you like, cutting the mustard in telling us the future cost we have to face up to.

To put this in context, the OBR estimates that the headline estimate for public debt that we will be passing to our grandchildren will be 100% of GDP in 30 years’ time and that in 50 years’ time it will be 267% of GDP. That is what it says in this document. If we carry on as we are, we will have a national debt of 267% of GDP because of the rising cost of what is called demographics. That is mainly healthcare but also the state pension and other aspects of the pensions system. Overwhelmingly, however, it is healthcare. Adult social care will double as a percentage of GDP as well.

I should declare an interest in the sense that I had an indirect role in the creation of the health and social care levy, and it is fair to say that I have many reservations about what we are doing today. As colleagues know, the former Prime Minister—who deserves great credit for this—was determined that we would not just have another Green Paper or White Paper on social care. He wanted to actually deliver something for the country and he introduced the cap that had been promised by successive Governments, so that although people who have saved hard and have assets have to contribute to their care, they know that there is a limit. It is incredibly important that we brought that forward, and I sincerely hope that in removing the funding mechanism for the cap, the Treasury will resist the temptation to water it down. Local authorities are not yet aware of exactly what the cap will cover, and with the funding stream gone, the Treasury must resist the temptation to water the cap down. That is absolutely paramount.

When the Prime Minister came forward with wanting to pursue the cap, it was the view of the then Chancellor —my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak), who I had the privilege of being Parliamentary Private Secretary to throughout the pandemic—that it must be funded, and that it could not just go on the national credit card. The social care cap on its own is massive rising liability. I have just set out what is going to happen to health costs more generally. So, how to fund social care? The most common suggestion was an increase in national insurance, for the simple reason that it applies to businesses and individuals and so raises the sorts of revenue we can get. It is not easily avoided, and it can give us the money in the bank to pay for these expensive costs that we face.

However, I submitted a paper to the Chancellor at the time and suggested that, rather than having just a narrow national insurance levy—a social care levy, as it were—we should have a full health and social care levy that should be hypothecated and appear as an explicit line on people’s payslips. It will be there on our payslips until November. I accept that we have not made the most of it, and there has been almost no enthusiasm from any quarter—possibly only from the social care sector—but with a transparent, hypothecated statement on payslips, if the NHS came back to us two years into a five-year funding settlement saying, “We need this additional big item,” we could say, “Fine, but it will come out of the levy.” That would be transparent, and it would have provided the discipline that we have terribly lacked in health spending for many years, under successive Governments. I thought it had great potential, but it is being vapourised today. The Prime Minister has a mandate for it and the whole House seems to support that view, as does the Labour party even though it does not have the foggiest idea how it would fill the gap.

[Peter Grant]

The former Prime Minister had a mandate to do what he did last year. The hon. Member for South Suffolk (James Cartlidge) says the new Prime Minister has a mandate to do this. Where did that mandate come from? I do not remember Parliament being dissolved for a general election in the last couple of months.

[James Cartlidge]

The new Prime Minister would rightly say that our manifesto said we would not increase national insurance, so she can draw on the mandate of the general election. We also seem to have vapourised our memory of the pandemic, but I would argue that it changed everything. The enormous borrowing accrued to this Government during the pandemic, which everyone supported—everyone wanted even more spending and even more support for businesses and individuals, as I remember because I was the then Chancellor’s PPS—made it exceptional, and we had to balance the books. I make it clear that this was not my preference, as I would not have wanted a levy to fund the NHS and social care. Given the politics of the time, it was the best way forward.

This is my personal view about how we should move forward. The key point is that the NHS is free at the point of delivery, which means we pay with time. When something is free, people wait and there are massive queues. Of course, those queues have been massively exacerbated by the pandemic, which is why the backlogs are so big, but it is blindingly obvious that the pressure on the NHS is overwhelming. There is almost infinite demand on finite capacity.

Labour Members will say in any election campaign, as we will. “We will do everything possible to increase capacity.” The Deputy Prime Minister and Health Secretary will, of course, do everything possible through her ABCD—ambulances, backlogs, care, doctors and dentists —strategy to improve outcomes in the NHS, but when we talk about funding the NHS, when we talk about the obligation to our grandchildren and the next generation, we have to be more radical, frankly.

In my view, we need a core NHS that is free at the point of delivery, but as a country we need to drive up the use of the independent sector and of private healthcare from all those brilliant companies that are seeing take-up shoot through the roof because of the backlogs. I know some of this territory is difficult to talk about, but I will give three key reasons why we should go down this route. First, every single person who pays to go private is freeing up space on the backlog. They are also boosting NHS capacity.

Secondly, this is standard in comparable countries. The Republic of Ireland, Australia and Germany have tax incentives for people to pay for their healthcare. There is an understanding that people who go to that trouble should have some kind of rebate, because they are doing everyone else a favour.

Thirdly, this is already happening. The post-Beveridge revolution is happening, and it is happening silently. There has been a massive surge in the number of people paying privately for healthcare. The Guardian recently published figures estimating that one in 10 adults in the UK has paid for private healthcare in the past 12 months, primarily because of the backlogs. Use has surged, according to the Independent Healthcare Providers Network. The number of people paying for hip replacements was up 193% in January to March 2022 compared with January to March 2019, and the number of people paying for knee replacements was up 173%. This is a huge surge in the number of people paying privately. It is true that many of them will not have wanted to do so, and I am not suggesting that they will have been delighted. Of course, we all want everyone to be able to use the NHS without long waits—that is clearly the ideal scenario—but it is not deliverable any more, not least with the demographic pressures we face.

We should look at the surging use of the independent sector and embrace it as a policy opportunity. Research from the Independent Healthcare Providers Network shows that 48% of people in this country will consider going private in the next 12 months because they know about the waits. This is about choice, and the most important thing is to have greater tax incentives for people to use the independent sector, so that people think about making a realistic choice. We should not settle for long waits for care any more. This is standard practice in comparable European and Australasian countries.

To be very specific, going back to the OBR document I mentioned, as a country we face a huge liability for health and social care. We should target increasing the percentage of our healthcare spend that goes to the independent sector so that we have a better balance, more like the balance in comparable European countries. If we did that, we would get much better outcomes, we would have more choice and we would finally have a 21st-century healthcare system with diversity of provision, which is the best way forward.

We should recognise that the revolution is happening, and it needs to happen with the Government’s backing and support.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the SNP spokesperson, Richard Thomson.

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[Alison McGovern (Wirral South) (Lab)]

Before I get into the Bill, I want to note some of the remarks made by the Government on their energy package and the speed with which that was brought forward. Given that this is the first opportunity we have to discuss these financial matters, I want to record that it felt during recess as though almost every day in August people were begging the Government to act, and they did not. We waited and waited, while they had an internal debate when they could have acted. For 12 years, in fact, it has seemed that the British economy has had both deep-rooted problems and significant shocks. Given the situation before us and the chaos we face, would not any Government want to act?

That brings us to today’s Bill, which is essentially a U-turn. As colleagues have said, the Government are showing here that they can U-turn, but what we need now is much more significant action. We can say with certainty that the Chancellor has already made a considerable impression on the economy. He inherited a cost of living crisis and for good measure added a cost of borrowing crisis, an interest rate crisis, a mortgage crisis, a sterling crisis, a Government bond crisis and a pension funds crisis.

Inflation was already at its highest rate in 40 years, devouring household wages and savings; Shell, ExxonMobil and Chevron recorded their highest ever profits and household energy bills doubled within a year. Thanks to this Government, the pound has slumped to its lowest value against the dollar since Britain went decimal in 1971, and the Bank of England has been forced to launch an emergency £65 billion bond-buying scheme that, as we saw yesterday, has barely stopped the chaos.

Thanks to this Government, in the blink of an eye the average homeowner now faces a monthly mortgage payment that is £500 more expensive and food bank use has soared to such an extent—[Interruption.] Do not say it is global. The food bank increase is not global; it is a feature of the UK economy, and it has soared to such an extent that volunteers will need either to turn people away or to reduce the size of emergency rations. That is the situation we face, and that is why this Bill must not represent the last U-turn from this Government.

We have heard from various Conservative Members that they are the party of tradition, so let me commend the Government on respecting a long-standing Conservative tradition in their conduct relating to our economy. Just like on 16 September 1992, Conservative Governments always end up sacrificing family finances to pay for their chaos.

This Chancellor, in his airy disregard for experts, produced a Budget so complacent, so unfunded and so unconvincing to the markets that the cost of our long-term borrowing soared. His doubters are now not just the members of the Labour party; they include bond traders, the currency markets, the civil service, the OBR, the Bank of England, the IMF and the British public.

The Conservatives have pierced a hole in the British economy, and the effects are widespread and severe. Pension funds were brought to the edge of collapse and, before the Bank of England intervened, we risked falling into a self-perpetuating spiral,

“threatening severe disruption of core funding markets and consequent widespread financial instability.”

To be so ignorant, so high-handed and so willing to risk impoverishing people is unforgivable.

It is some small comfort that today the Tories are reversing their own rise in national insurance. U-turn follows U-turn and we return to square one. However, this zig-zagging incoherence is not just a waste of parliamentary time and energy, but damaging to our stability and our credibility. No matter whether they raise taxes or lower them, high-quality public services and economic growth will continue to elude the Conservatives. That is because, as has been said so often, economic strength does not come just from the top; it starts in the everyday lives of working people right across our great country. The hon. Member for South Suffolk (James Cartlidge) explained well what is happening right now for people trying to work. Thanks to the Conservatives, record waiting lists see acute conditions becoming chronic and more and more people having to leave the labour market. Do not crow about unemployment being at historically low levels when inactivity—people simply unable to work—is shooting up again, as we found today.

[James Cartlidge]

Just to clarify, what I said was that it was due to the pandemic—not entirely, but everything the Labour party says now is airbrushing out of history the greatest post-war trauma that the country faced, when there was an enormous surge in borrowing, which we all supported, to fund the support for businesses and people in our constituencies. At some point, will Labour recognise the impact that had and the action we had to take, which has led to decisions such as these tax increases?

[Alison McGovern]

The impact of the pandemic on our labour market and our health service has been profound. It should inspire us to see the capabilities of the people within our health service, and it should show us the undeniable truth that there will be no economic health in this country without securing the health of the people of this country. That is what the pandemic shows us. I simply ask that the party in government today, the Conservative party, learns that lesson.

If we look at what is going on with our labour market, we see that part of the growth plan must be to secure our health service, get waiting lists down and get people back to good health. We have heard that funding for health and social care services will be untouched, so let me assure the Government—already so elastic with their commitments—that their promise on the health service will be under heightened surveillance in months to come.

The Government say that they have a growth plan to end their cycle of stagnation and to radically overhaul what has been dragging us down, but that plan simply has no credibility. It is delayed and delayed. Until we see what they truly believe can help this country grow, all we see is the cost of borrowing growing, inflation growing, mortgage payments growing, food bank use growing and child poverty growing, while the true opportunities that this country has—its people and their talents—are left wasted.

Who asked for this? Who nodded happily at higher mortgage repayments? Who wanted public services to be slashed or spiralling inequality? There is no consent for this, as we have seen—not even consent on the Tory Back Benches. The resulting damage to our economy is immediate and sharp, but there is another danger that emerges slower but is just as great: the risk to our relationship with the British people.

I worry that we have short memories in this place. Only three months ago, more than 60 Ministers fled the Government of the right hon. Member for Uxbridge and South Ruislip (Boris Johnson). For some time, that Government were viewed with real anger by the public, who overcame the pandemic through shared sacrifice, only to feel cheated, insulted and taken for fools by their Government. Well, the British people are not fools, Madam Deputy Speaker. They understand that this winter, whether it is due to soaring energy bills, surging inflation or the war in Ukraine, shared sacrifice is needed again. In return, they are owed compassionate, responsible leadership and a Government who can look them in the eye.

This is not a time for economic hobbyism—for testing pet theories like schoolboys in the common room—and ignoring the country. Not even two people in every 1,000 voted for the Prime Minister or her Chancellor. Britain did not choose to be experimented on in this way. When the Chancellor delivered his crazy Budget on 23 September, everyone in this country was united in experiencing that act of economic vandalism. When children are hungry, pensioners colder and families fearful, the Chancellor avoided the profits of energy giants and signed off unfunded tax giveaways for millionaires. In waving through bigger bonuses for bankers, he took a torch to our social contract. Instead of shared sacrifice, this gang of fanatics on the Treasury Bench turned to casino economics and gambled away public trust.

It is an old, old saying that you can judge a person by what they choose to do with power. After 12 years of the Tories in power, the veneer has worn off, revealing the same old ideas that have been tested to destruction in this country: run the country on the cheap, leave public services crumbling and make working people pay the price. The big society—remember that?—has been and gone, one nation conservatism is a painted shell, and the façade of levelling up has been abandoned, as they cut taxes for millionaires and look set to cut benefits for the poor. It does not matter whether it is this Prime Minister or whoever soon replaces her—this is the Conservative project and it has been there all along.

It is the single greatest privilege in this country to sit on the Treasury Bench. Instead of living up to that honour, the Conservative party is hopeless, reckless, callous and weak. There is no consent for this Government’s ideas, and they should be driven out of office. If they really are such a confident group of free thinkers, surely they have nothing to fear from taking their pitch to the country.

Health and Social Care Levy (Repeal) Bill

James Cartlidge Excerpts

Committee stage
Tuesday 11th October 2022 Commons Chamber

[Steve Brine]

I know why Dame Rosie is smiling: she thinks that I have possibly attempted to fit my Second Reading speech into this response to new clause 1. If I go down the road of energy policy, I may test her patience. All I would say to my hon. Friend is that, if the energy price guarantee was a price cap, and people could not pay more than the amount at which the cap was set, there would be some argument for not having a public campaign advising people on their energy use. It is not a cap; it is an energy price guarantee. If people use more energy, they will pay for more energy. It therefore seems logical to me, on lots of levels, to help people save energy—but what do I know?

I was just coming to diabetes. The NHS spends about £10 billion a year—that was about 10% of its budget, when I was in the Department—on diabetes care. That is a phenomenal amount of money, yet type 2 diabetes is preventable and, as we have heard from Members, people can turn it around. Why would we not want to encourage people to manage their weight better, when weight is one of the big drivers of diabetes?

Finally, stoke is a big killer in this country. It costs the NHS billions. During conference recess, I visited a group in my constituency called Say Aphasia—I figured it was a better use of my time. I met a group of 15 men who had had strokes. One was two years younger than me. They had severe communication difficulties. I see my hon. Friend the Member for Bury St Edmunds (Jo Churchill), a former public health Minister, by the Front Bench. She knows what I am going to say. Why would we not want to help the NHS prevent stroke through a proper salt reduction strategy? Given my surname, when I tried to suggest one to the Department, it caused some amusement among officials, but I think it is the right thing to do. If we cannot prevent stroke, I will meet a lot more people like those I met in the Say Aphasia group last week. Their ongoing cost to the NHS is significant.

In conclusion, the point I am trying to make, and maybe I am not making it very well, is that, if we do not believe in prevention—and in my heart I believe that those on the Front Bench do believe in prevention—the costs of the NHS predicted in the OBR book are going to look quite conservative. I think I am right in saying that those projections include this levy being in place, not repealed—

[James Cartlidge]

And corporation tax.

[Steve Brine]

And corporation tax, as my hon. Friend says from a sedentary position. If we believe in prevention—and, as I say, I believe that those on the Front Bench do—we need to have the courage to act on that. That will mean doing unpopular things, but sometimes we have to do unpopular things to do the right things, and that means preventing some of the major killers and some of the major causes of ill health that I have mentioned. If we do not do that, the NHS will continue to cost unsustainable amounts of money and it will become unsustainable. There endeth the lesson of Dr Brine.