More money for the NHS overdue, but not enough to fix social services | Andy cowper


Boris Johnson today announced the government’s new social protection plan. Entitled Rebuild better, and followed by a massive media information war between the Prime Minister and the Chancellor in recent weeks, this plan makes various financial commitments on the NHS and funding for social care.

It is worth remembering Johnson’s words, as he stood in front of No.10 on his first day as Prime Minister, over two years ago: “My job is to make sure you don’t have to wait three weeks for see your GP, and we’re starting work this week with 20 new hospital upgrades and making sure the NHS money really gets to the front lines.

“My job is to protect you or your parents or grandparents from the fear of having to sell your house to pay for the child care costs, and so I am announcing now – on the steps of Downing Street – that we are going to sort it out. the crisis in social care once and for all with a clear plan that we have prepared to give every elderly person the dignity and security they deserve.

did he deliver? To answer this question, we must first consider its financing plans. From April next year, a 1.25% increase in national insurance contributions for employers and employees, and a 1.25% increase in the tax on stock dividends, will total 12 billions of extra pounds in taxes levied each fiscal year: years of this parliament. This has been called a “health and social care levy” and will eventually show up on payslips as a separate payment from income tax and national insurance contributions.

Of that £ 36bn (which breaks the Tories’ 2019 manifesto pledge not to raise any of the top three taxes), the NHS will receive an additional £ 30.6bn. This follows Monday’s announcement by Health Secretary Sajid Javid of a £ 5.4bn more for the NHS for the remainder of the current fiscal year to meet additional costs related to Covid-19 and the order book.

This points to a serious effort to provide adequate funding for the NHS, as assessed by the independent health think tanks. But we must not get carried away. Between 2010 and 2019, the NHS had the period of weakest financial growth in its history. Even before the Covid, NHS waiting lists have exploded.

One consequence of the funding cuts has been the regular shifting of NHS money from capital and maintenance budgets into day-to-day spending. This led to a huge backlog construction and maintenance work.

Social assistance has long been the “poor relation”. It is also misunderstood. Many people believe that social services are free at the point of use: they are means tested and those with assets over £ 23,000 are billed for their care.

Recently announced financial plans keep social care firmly in the shadows. Of the £ 36bn raised, only £ 5.4bn is earmarked for social assistance. Of that £ 5.4bn, £ 2.5bn is funding the new £ 86,000 lifetime cap on individuals’ contributions to their care costs, leaving just £ 2.9bn out of three years for reform.

Essentially, this reform is about doing what Johnson promised – preventing people from having to sell their homes to pay for their care. As such, it will disproportionately benefit wealthy seniors. It also does not address the fact that half of social care is intended for adults of working age: for these people, the proposals offer very little.

To get an idea of ​​the magnitude of the missed opportunities, the Health Foundation Report – What needs to be done to remedy the social assistance crisis? – points out that restoring access to healthcare services caused by cuts in government grants to local authorities during the austerity era would cost £ 12.5 billion.

And on the delivery of the new government plans, the picture is even weaker. In fact, there are very few actual plans on offer, beyond a few general commitments (one of which is for the NHS to create a new delivery plan).

On the NHS backlog, there is a striking claim: ‘The NHS in England can aim to provide around 30% more elective activity by 2024-25 than it was before the pandemic. “

Yet additional infection control protocols have reduced the NHS ‘ability to treat patients – which is now below the level at the start of the pandemic (when waiting lists had already grown considerably). And the NHS still has no real plan to increase the number of employees by anything like the amount needed to do so.

There is nothing in the document that far resembles a plan to reduce the NHS backlog. Rather, it is a celebration of aspirations, articulated with words such as “may aim at”, “should” and “could” (where “will”, “must” and “must” would be more reassuring). There is nothing substantial about how the quality of current social care delivery will be improved; nor on how salaries and conditions of staff will be improved.

Put simply, the government has provided more funding: probably about enough to get the NHS off to a good start in the backlog, but nothing like it to improve social care. And in terms of his plans to bring the change: they just aren’t there.

This article was last modified on September 9, 2021. It is people with an asset value over £ 23,000 who are billed for their care, not those with assets below £ 23,000 as one version put it. earlier.

  • Andy Cowper has been a journalist who has written on health policy for 22 years. He is a regular columnist for Health Policy Insight, the British Medical Journal and Civil Service World.


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