A UK-wide health and social care levy based on National Insurance contributions will pay for the biggest catch-up programme in the history of the NHS in England


Boris Johnson has abandoned his pledge not to raise the main rates of tax as he set out plans to overhaul adult social care and deal with the COVID-19 backlog in the NHS.

In a Commons statement, the Prime Minister announced a new, UK-wide, 1.25% health and social care levy based on National Insurance contributions.

He said that the additional revenue would pay for the biggest catch-up programme in the history of the NHS in England, with £12 billion a year to help deal with the backlog of cases built up during the pandemic.

It will also cover the reform of the social care system in England, ending what Downing Street described as ‘unpredictable and catastrophic’ care costs faced by many families.

From October 2023, anyone with assets under £20,000 will have their care costs fully covered by the state, whereas those with between £20,000 and £100,000 will be expected to contribute to their costs—but will also receive state support.

No-one will have to pay more than £86,000 for care costs in their lifetime.

Scotland, Wales, and Northern Ireland will receive an additional £2.2 billion in additional health and social care spending from the levy.

‘Long time coming’ 

Responding to the announcement in a statement, Dr Chaand Nagpaul, British Medical Association (BMA) Chair of Council, said: ‘The effectiveness of our healthcare system is hugely dependent on a safe and functional social care system with sufficient capacity, an issue which has been highlighted starkly by the COVID-19 pandemic.

‘This funding of £12bn, a figure the BMA estimated was needed in our September 2020 paper, will go some way to meet the rising demand of social care and relieving pressure on an already over-stretched NHS.
‘Currently, gaps in the care available to people mean that the most vulnerable patients—often elderly and living with multiple long-term conditions—are more at risk of seeing their health worsening and requiring care in the NHS. These gaps also cause delays in discharging patients back into their communities, disrupting services, while poor care standards increase the likelihood of patients ending up back in hospital and further health problems.
‘While today’s announcement of increased funding has been a long time coming, it’s extremely important that there is also additional funding on top of this to ensure equitable and better access to care, by providing more services free at the point of need. Widening access to care services can reduce the need for costly long-term care services and NHS care.’


Highlights from the healthcare proposals in Mr Johnson’s Build back better document include:

  • additional funds to tackle the backlog posed by the pandemic, including 9 million more checks, scans, and procedures

  • the NHS in England will be able to deliver ‘30% more elective activity’—or pre-planned care—by 2024/25

  • patients with suspected cancer and other urgent conditions may be given the ability to arrange follow-up appointments as and when they need them

  • a focus on ‘prevention’; this includes the possibility that the NHS Health Check—a health MOT for people aged over 40 years—may be changed into a ‘National Prevention Service’.

Hard winter ahead 

Earlier, MPs on the Commons Health and Social Care Committee were told that the NHS should brace itself for a ‘remarkably hard’ winter.

Blood tube shortages may also be having a big impact on the waiting list, the Committee heard.

Dr Andrew Goddard, President of the Royal College of Physicians, said that a difficult winter in the health service may also result in a growing waiting list. ‘During winter, what we’d normally see is that the medical wards get full, we spill over, and the ward becomes a ‘Winter Ward’ [when] it’s normally an orthopaedic ward’, he said.

‘So immediately [surgeons] cannot operate on people who are on the waiting list.

‘I do not see that being any easier this winter and, if anything, I think it’s going to be much worse this winter because of COVID infection prevention, but also we’re expecting a bad flu season this year.

‘So I think that the £5.4 billion funding is fantastic news, but let’s be under no illusions: this winter is going to be remarkably hard, and it’s going to impact waiting lists, probably more than anywhere else.’

On the shortage of blood tubes, he added: ‘Clearly at the moment, you know, getting blood tests, is a real problem.

‘We do 1.7 million blood tests a week in the NHS—that number has been significantly curtailed because of the blood bottle shortage.

‘So it seems likely that there are going to be added complications, which will lead to further delays in diagnosis—you can’t start a treatment and therefore get off the waiting list until you have a diagnosis.’

Emergency medicine specialists have also expressed concern over the forthcoming winter months.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: ‘We’re in a real pinch point at the moment, so we’re equally fearful of winter.

‘We are seeing levels of crowding back in our departments over the summer that are worse than people have ever seen.

‘We were really struggling [before the pandemic] and we’re really struggling again now.’

She added: ‘The last bad flu winter resulted in all elective surgery being cancelled.

‘So how are we going to get through this winter, when we really don’t want to cancel elective surgery, unless we can sweat every bit of the assets, making sure that every bit [of the NHS] is working as effectively as it possibly can.’

MPs heard that many people on the waiting list are concerned over a lack of communication while they are waiting for care.

Dr Goddard added: ‘Many of these problems would be resolved with more people because there would be more people to talk to, so patients can get that reassurance they need.

‘And time and time again, talking to patients, it’s not knowing, it’s not hearing, which are the things that cause the problems and it causes a huge amount of mental stress.’

Dr Henderson added: ‘We understand that people are wanting information, and when they’re finding it difficult to find information, they go to the place where the lights are on.

‘And so, almost inevitably, we will have seen patients who have questions that unfortunately we can’t answer who will come to [A&E].

‘What we need is to be able to make sure that we’ve got the ability to answer those questions in the right place, otherwise it’s a very ineffective system.’

She added: ‘I cannot help a patient about a very specialist drug therapy that they’re getting from some oncologist in my unit.

‘I have not got the knowledge to deal with that. They shouldn’t need to come near the emergency department to get that advice.’

This article contains information from PA Media.

This article originally appeared on Medscape, part of the Medscape Professional Network.