© 2021 Toate drepturile rezervate. Anunturi, Reclame Gratuite in Romania
A n announcement on social care funding is imminent, with a national insurance rise the probable outcome. But what ought to be unambiguously good news, after years of delay, is not. Far from being the best solution to a problem regarded as intractable only because governments do not want to pay for it, the proposal to raise up to £10bn a year from extra NI contributions is closer to the worst.
The current impasse is untenable, not least because of the burden it places on the NHS. The difficulties created for hospitals by the lack of suitable social care arrangements have been documented for years. With the health service facing unprecedented pent-up demand as another autumn-winter season of Covid and its knock-on effects approaches, ministers know they have to do something if they are not to risk a wave of public wrath.
Among many uncertainties are details of how the funds raised might be distributed between the NHS and social care. The expectation is that the NHS would receive the bulk of any new money upfront, with the costs to the public purse of social care expected to rise as more people qualify for support (which will depend on the level of any cap). The idea is that cash could be diverted from the NHS to social care in due course.
With ministers arguing over the size of an NI increase, and the health select committee chair, Jeremy Hunt, pushing for an income tax rise instead, much remains uncertain. But several principles are clear. The first is that Mr Hunt is right: it is insupportable that young working adults should contribute to increased health and care spending while anyone over the state pension age is exempt – since they do not pay NI, even if they are still employed and whatever their earnings and wealth. NI is, additionally, charged at a higher rate on lower earners and so is less progressive than income tax.
The second is that an attempt by Boris Johnson’s government to kill two birds with one stone, by folding a boost to NHS England’s budget into a half-baked plan for social care, could be disastrous. Currently, while the health secretary is nominally responsible for social care, he has limited power to deliver it. This duty falls to councils. The future of social care in the UK (which is not fully devolved, though the government’s decisions will have the greatest bearing on England) is an opportunity to review this division between national and local. This should logically form part of any health service reform, along with chronic staffing and care quality issues.
But voters remain in the dark over what Mr Johnson plans for social care. The prime minister is facing a backlash from MPs and cabinet ministers elected on a manifesto pledge not to raise income tax, VAT or NI. Such is the price of electoral sops. Social care is a contract between generations (as well as between the able and disabled, with half of all current care spending on working-age adults).
With wealth and assets, above all residential property, disproportionately concentrated among older people, the last thing any government should be doing is placing further demands on the young while exempting the rich. The state should be more generous because we are all living longer, with a higher demand for long-term care needs. The key to unlocking the debate over social care entitlements – and answering the question of who should meet the cost of looking after us when we are unable to look after ourselves – must be fairness.