Health and Social Care Levy

Baroness Winterton of Doncaster Excerpts

1st reading
Wednesday 8th September 2021 Commons Chamber

[Carla Lockhart (Upper Bann) (DUP)]

I thank my hon. Friend for giving way and I agree with much of what she has said to date. She may or may not know that in Northern Ireland today a leading gas supplier announced a 35% price increase. That will put significant financial pressure, particularly on the—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I am not sure whether the hon. Lady has been in for much of the debate, but it is important that interventions are very short because there are a lot of people who have put down to speak who may not get in.

[Carla Lockhart]

That will put significant pressure on the low paid and the squeezed middle. Does she agree that the increase in national insurance contributions on top of that will have an impact on them, even making—

[Madam Deputy Speaker]

Order. I have to stop the hon. Lady.

[Catherine West]

Thank you, Madam Deputy Speaker. The hon. Member for Upper Bann (Carla Lockhart) is making a really important point about the unknowables. We do not know by how much our gas and electricity bills will go up in the next year. We do not know whether firms will take fright and stop hiring people. One thing we do know is that council tax will go up, because there was nothing in the announcement for councils. We know a few things are not going to get better. We know a few things could get better and might not get better. It does seem to be a bit of a risky move.

In conclusion, we have had a very strange return to Parliament. Sometimes I get very surprised by the Government. I think sometimes Ministers do, too. I hope there is urgent work between the Ministry of Housing, Communities and Local Government, the Department of Health and Social Care, and the Treasury to really make this work. It is likely to go through. I do not think there are quite enough rebels like the right hon. Member for Rossendale and Darwen—he is shaking his head. Please try to make it work. In taking such a risky decision right now, we can at least get the dividend of people being better cared for, getting through the backlog and helping our constituents to be able to see GPs when they wish to.

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[Ben Everitt]

Absolutely. We need more providers in the market, but the market needs to be functioning for that to take place.

My hon. Friend made a very good point earlier about another aspect of how the money is spent. The £86,000 cap needs to be met and tweaked with a regional house price element to recognise the fact that houses are worth more in some areas than in others.

In conclusion, I will vote for this. Our job in this place is to make good laws, and we need to do that at every stage. This is a tricky problem. The Government are right to grasp the nettle and reform social care. The fundamental problem that we face is that the assumptions that we are basing our entire welfare system on were made in the 1940s when people went into work in their teens, retired when they were 60 and lived until they were about 65. Now, they are living much longer lives and retiring earlier. That is the funding issue that we face.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I must gently point out that colleagues may think that they are helping each other out by making interventions, but at this stage they are going to prevent other colleagues from getting in.

[Mike Wood (Dudley South) (Con)]

My hon. Friend the Member for Bolsover (Mark Fletcher) rightly said that to govern is to choose. One of the reasons for the result of the last general election was that voters knew that this Government were more likely to make the difficult choices that were needed. The choices we have to make are not always between the good and the perfect. Many of them involve choosing the less bad option. As a Conservative, I believe that raising taxes is certainly a bad option. It clearly breaches a manifesto pledge, and it is both economically and morally wrong. It is economically wrong because higher taxes will dampen growth and prosperity in the longer term, and it is morally wrong because it means taking money away from those who have worked hard, to be spent elsewhere. That needs to be kept to a minimum.

However, if raising taxation is a bad option, surely the alternative—not acting—is far, far worse. Not acting would mean allowing the backlogs that have built up in the NHS through the pandemic to continue. That would put people’s early diagnoses at risk and delay treatments further, clearly endangering lives. It would mean not reforming social care, despite there being almost universal agreement that that reform is long overdue. Government after Government have promised to take this on, to reform social care and to put it on a sustainable footing financially. There have been endless reviews, but each time they have ended up in the “too difficult” box.

How many of us can go for a week without getting an email from a constituent about social care, whether it is about the quality of social care, access to social care, top-up fees, their ability to pay or the fear that they will have to sell everything they have worked hard and saved for all their life? That is why something needs to be done. If we agree that action is needed and that we need more money to be spent on the NHS to clear the backlog and reform social care, the only decision we have to take is how we pay for it.

In the long term, borrowing to pay for this is not a sensible option. There are very few taxes that can raise anything like enough money to meet the challenges we face. Of course this could be put on VAT, but that is clearly a much more regressive option that would place a disproportionate burden on the least well off. There have been various fanciful ideas from some Opposition Back Benchers that basically suggested that someone else should pay for it, or that there was a hidden pot of money that could be raided. It is not there! The fairest way is to have a levy on national insurance contributions, sharing the cost between employees, employers, the self-employed and those who get income from dividends, so that those who earn more pay more.

I think the shadow Chancellor suggested that this could be funded by charges on the sale of land, property and shares, but the truth is that combined revenues from all stamp duties on land, property and shares comes to about £15 billion, which is nothing like enough to pay for what is needed. So national insurance is the fairest option. Gordon Brown was right, on this one occasion, that it is the most regressive option—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order.

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[Tom Hunt (Ipswich) (Con)]

One thing that concerns me is that I saw some polling earlier this week showing that only about 25% of the population know that social care has to be paid for. That in itself is something we need to address through a certain level of engagement. If a lot of the people who are dismissing and opposing the national insurance rise truly understood and comprehended the devastating consequences of out-of-control social care costs, they might think differently.

Where are we right now? We are in a situation where we have spent £400 billion since the start of the pandemic. We have waiting lists growing and spiralling out of control as a result of the pandemic. We all have constituents who are waiting in pain for hip and knee replacements and more serious operations. We have constituents, including mine, who are not able to see their GP face to face and all the consequences of that. That needs to be addressed urgently. My constituents should be able to see their GP face to face when they need to do that.

We are in this appalling situation, and I take issue with the dismissive way that Opposition Members have spoken about many of the individuals who could benefit from the social care cap, referring to them all as millionaires in Surrey. The people I know who have been clobbered by social care bills are not millionaires in Surrey; they are people who have worked hard their entire life, paid tax on what they earned and at the end of their life, they have something to show for it. It is not just bricks and mortar; it is a home that they love and that they raised their kids in. Not unreasonably, they want to pass that on to their kids. When their mental and physical health is deteriorating, to see everything they have worked hard for whittled away in a matter of years is utterly depressing and morally wrong. I am proud to support a cap that addresses that, and I make no apology for doing so.

In terms of the manifesto point, I stood on a manifesto—we all did—and there was a pandemic straight after we had the election. This is an extraordinary situation, and probably nothing has happened since the second world war that has had such a dramatic effect on cost and spend. We spent £400 billion. People make this inaccurate comparison with George H.W. Bush and “read my lips”. Over the summer, I had a few days off, and I read a very long book about George H.W. Bush. He did not have a pandemic happen a year after he stood for election. It just simply did not happen. It is like writing a manifesto in 1938 and then realising that thousands of Spitfires have to be built because the second world war is starting. The money has to be raised somehow, and to say, “We cannot possibly do that, because we cannot change the manifesto we stood on a year ago”, would be absolutely absurd.

What are we dealing with right now? We are dealing with a situation where we have a cap of £86,000. We need to know more. We need to know more particularly about those with £20,000 to £100,000 and how their care costs will be subsidised. We understand that the councils will help with that. I need to know more about how that will work in practice. I sympathise with my hon. Friend the Member for Bishop Auckland (Dehenna Davison) and others who represent areas with hard-working constituents where house prices are very different from those in London. We need to know more about that.

Ultimately, we have seen the Prime Minister speak on this issue, and we have seen his passion. He is right to be passionate about this. The easy thing for him to do would be to use the pandemic as an excuse to push this issue into the long grass, but he has not done that. He has done the difficult thing and grasped the nettle. I am proud that he is our leader and our Prime Minister. He is doing that. What else was in the manifesto? Sorting out social care. No one should suggest we push that into the long grass. The Labour party does not want to decrease international aid, it wants us to make the universal credit increase permanent and it wants us to spend £16 billion on this and that. Labour never says no to a pay increase. I know what will be in my manifesto: you voted against—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order.

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[Mark Fletcher]

My hon. Friend is giving an excellent speech. One thing he has touched on, but perhaps not expanded on, is the efficiencies that local government has found. Are there any particular lessons that he thinks are relevant to the NHS as we move forward?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. We really are pushed for time, and this is not fair on those who are winding up.

[David Simmonds]

Concluding rapidly, Madam Deputy Speaker, that is a very important point. We need to recognise, as many constituents are surprised to discover, that as a matter of law very strict eligibility criteria restrict what they can access. We need to ensure, as we reform the sector, that we free up local authorities to use these resources to meet the demographic challenges.

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[Peter Grant]

On the subject of cases being demolished, one of the cases that the right hon. Gentleman’s colleagues have made great deal of play of today is that of the fictional Yusuf in the Government’s own document. According to the Government, Yusuf’s care home costs are £700 a week. They claim that under the current system they would have had to spend £293,000 before they reached the current cap. The Minister will be aware—I hope he can count—that in order to spend £293,000 at £700 a week—

[Madam Deputy Speaker (Dame Rosie Winterton)]

I would like the hon. Gentleman to put his question.

[Peter Grant]

What percentage of people going into a care home have any chance of still being alive in nine years’ time?

Health and Social Care Levy Bill

Baroness Winterton of Doncaster Excerpts

2nd reading
Tuesday 14th September 2021 Commons Chamber

Second Reading

[Madam Deputy Speaker (Dame Rosie Winterton)]

The reasoned amendment in the name of the Leader of the Opposition has been selected.

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[Steve Barclay]

In the public sector pay agreement that we reached, we accepted the recommendations of the independent pay review body. That is why we decided on 3% and why the NHS was treated differently from other areas of the public sector such as the police and teachers. This recognised the importance of those frontline workers and it was why those under the threshold of £24,000 were carved out. This recognises the point that my right hon. Friend has raised.

In conclusion, this levy will enable the Government to tackle the backlog in the NHS. It will provide a new permanent way to pay for the Government’s reforms to social care and it will allow the Government to fund our vision for the future of health and social care in this country over the long term. I commend the Bill to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Before I call the shadow Minister, I should say that there will be a six-minute limit on Back-Bench speeches to start with. If anybody wishes to speak, they should catch my eye, and to do that it is important to keep standing. If colleagues have not put in to speak but wish to do so, it would be helpful to let me know. They will have to have been here from the beginning of the debate, and they will be expected to be here for the wind-ups, which will start at approximately 4.45. Bearing all that in mind, I now call the shadow Minister, James Murray.

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[Craig Mackinlay (South Thanet) (Con)]

The hon. Gentleman is talking about a two-tier system. Is he saying that the millions of people in the public sector and the not-for-profit sector who have auto-enrolled pensions are rather daft to have a sensible pot under their own name, with the flexibility that it brings? Are you calling millions of taxpayers daft?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The hon. Gentleman is experienced enough to know that he should not speak directly to another Member.

[James Murray]

The hon. Member for South Thanet (Craig Mackinlay) knows full well that his question is not relevant to this discussion. We are talking about the NHS and the social care system, and we need reassurance from Ministers that they will not entertain a two-tier healthcare system on the back of comments made by Conservative Members.

We need to transform social care into the service that people want, need and deserve, which is why our plan for social care would include: enshrining the principle of home first; making a fundamental shift in the focus of support towards prevention and early intervention; getting care workers the pay, terms and conditions they deserve—at the very least, a real living wage of £10 an hour—while transforming training to improve the quality of care; and, crucially, making sure that England’s 11 million unpaid family carers get proper information, advice, breaks and the workplace flexibility they need to balance work and caring responsibilities.

Of course, today we are not discussing how to transform social care. We are debating a Bill that introduces a tax rise that may never go towards helping social care, and one that is raised on the backs of working people and businesses that are creating jobs.

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[Alison Thewliss]

The point is that we do not know what we will get out of this. We do not know because it is not clear in the documentation that has been provided. We also do not know what will happen on the other side of that equation—money in other devolved areas could be whipped away from us at our expense. Organisations such as the British Association of Social Workers have pointed out that cuts to local government will fundamentally undermine the social care provision in England. Authorities will not receive anything for three years, which will also have an impact on the money that we have to spend in Scotland.

These moves tax the poorest. They come at the same time as £20 a week is being removed from universal credit. Some 2.5 million people across the UK will be affected by both of those policies at a time when they can least afford it. The tax on jobs will stifle the recovery. Rather than being a Union dividend as Ministers like to try to claim, this is a Union dead end.

[Madam Deputy Speaker (Dame Rosie Winterton)]

In order to try to get everybody in, I will reduce the time limit to five minutes, and I have been able to warn the next speakers of that. If people do not get in, let me remind them that there is a Committee stage to follow and they might like to bear that in mind.

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[Madam Deputy Speaker (Dame Rosie Winterton)]

Obviously we have had one or two interventions along the way, so after the next speaker I shall reduce the time limit to four minutes, but I think that it should be fairly consistent from then on.

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[Andrew Griffith]

My hon. Friend, as ever, makes an important point. We should be on a quest for consensus, and it would be useful to hear more from Opposition Members in the wind-ups.

I pay tribute to the many dedicated workers in care homes across my constituency as well as their residents—from Barlavington Manor in the north to Valerie Manor in the south and from Villa Adastra in the east to Westergate House in the west. They are just four of the 28 care homes in my constituency providing fantastic quality care. It would be lovely to see more resources pumped into them as well as their staff.

Let me conclude broadly where I started. This is a down payment on a process of reform in our healthcare systems, building on the innovation that we have seen. However, a health and social care system cannot be managed permanently on an exceptions basis. We need reorganisation, better data and better decision making to build the high-quality health and social care system that both sides of the House want to see.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. Before we move on, I remind colleagues—I am sure they know—that it is very courteous to listen to a lot of the debate before intervening, because many colleagues have sat here from the beginning and are waiting to speak.