Health and Social Care Levy

Kieran Mullan Excerpts

1st reading
Wednesday 8th September 2021 Commons Chamber

[Dr Kieran Mullan (Crewe and Nantwich) (Con)]

I begin by joining others in applauding this Government for finally tackling the social injustice of catastrophic care costs. Yet again, a Conservative Government are taking the difficult decisions that others have avoided. My remarks today will focus on fairness and the nature of health and social care demand.

First, on fairness, somehow the political debate in this country—fuelled by those on the Opposition Benches—focuses on fairness as only one thing: the need for the better off to pay more. That is definitely an important element of fairness in society, and we see that with these proposals, with the top 14% of earners paying half of this new levy. It is not the only measure of fairness, however. The other important way to decide whether a society is fair is to think about what someone gets back compared with what they put in. We do not talk enough about the fact that a small number of people pay many, many times over what they get back and that some people pay almost nothing and get everything paid for by others. Hon. Members on both sides of the House have talked about the challenge for those on low incomes and the proportion that will be taken from their income by a tax rise, but it works both ways. Those same people, relative to what they put in, get a lot back when they seek health and social care services.

A person from a middle-income family could pay significant amounts in tax over many decades and buy their home but then see that home and nearly every penny of what they saved taken off them to pay for social care. They could live next door to someone who has paid perhaps no tax or a low rate of tax and gets everything paid for them. They end up in exactly the same boat, with nothing to show for what they saved, despite the huge difference in what they put in through taxes. That is simply not fair. In this case, people on lower incomes will continue to benefit from essentially free social care; they are just being asked to contribute a little bit more, and inevitably a little bit more will be spent on them. That is fairness, too.

I turn to demand for health and social care, and a point that perhaps will not be popular on my side of the House. I am a Conservative and do not want the Government to pay for everything on behalf of everybody, but the facts of health and social care spending are fundamentally different from those of other areas of spending. In real terms, what it costs to run an education system, prison service or public transport should be broadly stable—if anything, it might go down—but every time we treat someone successfully in the NHS, one of two things happens. Either the condition becomes chronic or comes back and we have to treat them again or, if it does not come back, they live longer and become ill with another condition. That is an unalterable reality, and it will happen more and more as we improve our healthcare services.

A heart attack is a good example. We have improved enormously the number of lives we save when someone has a heart attack, but that means more people live with chronic heart conditions that result from their heart attack, or they may live longer and end up with another condition—perhaps cancer or dementia—and we have to pay for that on top. [Interruption.] I join Opposition Members in saying that that is not a bad thing. We have not failed because we have spent more money on people’s health and social care. It is not a negative—we are providing a greater public benefit—but ultimately, over time, even if we tackle all the inefficiencies and challenges in healthcare spending we see in the NHS and get all those things right, we will still need to spend more on health and social care. That is why I welcome the proposal.

We need to start separating the discussion on tax and spend for health and social care from that on other areas of public spending, and the step we are taking to create some hypothecation, which is similar to that seen in other countries through insurance, does that. People can therefore understand that we have not failed because we have spent more and that we all need to spend more to ensure that we get the continued public benefit of living longer, with health and social care supporting us to do that, so that we can spend more time with our friends and families.

I will support the motion and encourage Members on both sides of the House to engage more thoroughly with the challenges of rising costs in health and social care. This is not just about waste, efficiency and all these other things; it is actually in the nature of delivering better health and social care for a population.