Following the Government's recent health and care funding reforms, John Baron warns against future policy being rushed through at a similar pace, expressing concerns over the lack of scrutiny over issues such as the National Insurance rise and the likelihood of these funds ever reaching social care. 

Last July, I wrote on this site about the importance of social care reform, highlighting that it was over 20 years since Tony Blair as Prime Minister told the Labour Party conference "I don't want our children brought up in a country where the only way pensioners can get long-term care is by selling their home." The Prime Minister and the Government therefore deserve the credit for finally grasping the nettle of social care reform and trying to put in place a durable funding settlement.

However, despite the time Ministers and special advisors may have spent discussing these proposals internally, they took them too quickly to Parliament – the plans were announced on the Tuesday, were voted on the following day and the necessary legislation was passed in a single day the following week. If nothing else, it would have been interesting to learn why the Government had rejected other models of social care funding in favour of a re-heated version of the Dilnot proposals of a decade ago.

History shows that legislating in haste often leads to problems further down the line. Parliamentary scrutiny is an essential part of our system, and a few days spent examining legislation is neither here nor there when we have been waiting over 20 years for reform. As it happens, the Commons agreed to raise £36 billion in tax rises – more than in many budgets – in a tiny space of time using procedures usually reserved for emergency legislation.

This is all the more surprising because we do as yet not know the substance of the social care reforms, details of which are to come later. In the short term, the funds arising from these tax increases are to be sent to the NHS to speed its efforts in clearing the pandemic backlog, before these funds are redirected towards social care.

There are good reasons to be sceptical as to whether these funds will ever reach social care, given the NHS' well-known tendency to subsume new resources. It has already emerged that it is in the process of hiring 42 new managers on salaries up to £270,000, and it is revealing that nearly 50 per cent of the NHS workforce is not medically trained.

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From my decade as the Chairman of the All-Party Parliamentary Group on Cancer, I am also all too aware that far too many resources are ploughed into meeting 'process targets', rather than the outcome measures which are of greatest importance to patients and their families. There are nine such process targets applicable to cancer alone, and these can skew priorities and NHS efforts especially when, as is common, financial flows are linked to performance against these targets.

Despite the enormous extra resources allocated to the NHS, and the growth of these process targets and the associated bureaucracy that accompanies them, our cancer survival rates remain stubbornly behind international averages. This is all the more striking because British health spending is now not far behind EU levels – as a percentage of GDP, we are only slightly behind France, Germany and Sweden, all of which have significantly better one-year cancer survival rates. As our survival rates have improved, so have theirs.

Given it is very unlikely that the NHS, and its many cheerleaders, will accept a cut in the NHS budget when the lion's share of these extra funds is switched to social care, it seems clear that, without strong economic growth, further tax rises in several years will be inevitable. For a Conservative it is never attractive when the seeds of the next tax rise are planted in one you are passing.

The Government's method of raising these extra funds is also concerning. The Conservatives have traditionally referred to National Insurance as a 'tax on jobs', and for good reason. The inevitable knock-on effects to the economy, employment and investment do not appear to have weighed heavily on the Government. This is especially pressing as our economy is rebounding from the large pandemic shock; raising taxes at this time risks choking off our nascent recovery.

There is also an unfairness in that that poorer workers pay a higher proportion of their income in National Insurance, and this is compounded by these tax rises being used to, in effect, protect the inheritances of pensioners who are significantly richer. It also seems unfair that people on low wages will be paying this new tax, but not rich non-working pensioners. This is hardly furthering the Conservatives' 'One Nation' agenda. Overall, a general rise in income tax would be much fairer and equitable.

For all these reasons I did not vote for the Health & Social Care Levy Bill at Second and Third Readings. However, the Government did not face any real difficulty getting its plans through the Commons, and this is the wider political lesson for the new post-COVID era.

Having also decisively reshuffled his Cabinet, the Prime Minister appears at the height of his powers and still riding high in the polls. The next General Election is still some way off, and while the Government may have not made the best decisions this month, it still has many opportunities to get it right in the coming years.

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