Health and Care – the bill arrives.

The cuts in earnings and benefits that have been announced and will be announced are the price we pay for years of neglect of our care system and for our lack of preparation for the pandemic. The two are linked, in the early months of the pandemic, residential care facilities were incubators of the Coronavirus and thousands – mainly elderly – residents, died because our hospitals and care homes couldn’t cope. Funded by private equity, most care homes are run for profit and had no margin for the error of mass migration of dependent hospital patients in Q2 2020.

This may have been the catalyst for this Government finally addressing the conclusions of the Dilnot report.

The reporting of the measures being put in place has been playing catch up with their severity as it was revealed yesterday.

Misconception one – it’s a 2.5% not 1.25% NI hike

This is not a 1.25% rise in national insurance, it is a 2.5% rise. The employer’s bit may not be noticed on your pay-slip but it will be front of mind when salary increases are next considered.

Misconception two – pension income

Pensions in payment will not, contrary to reports in the Daily Mail, be subject to NI -even for those still in work. However those in work after state pension age, will pay the extra NI on their earnings.

It was no surprise to hear that the state pension triple lock would become a double lock for a year. Theresa Coffey slipped this into the mix and debate on it is unlikely to be that great. Nonetheless it represents a second reversal in manifesto pledges. If you were under the misconception that Covid 19 would award you an 8% increase in your state pension, you aren’t now!

Misconception three – this increase will become a third income tax.

This is an extension of NI. In the short term, we will simply see our NI go up on our pay-slip (this starts in April 2022). However, from 2023m, the 2.5% on the NI band of earnings will become a third tax, a healthcare levy that will introduce all kinds of complexity and no doubt a number of tax avoidance measures.

The payroll industry are going to have a busy time of it over the next 19 months.

Misconception four – “no one will have to sell their house for care”.

The 2.5% increase is going to fund a more generous care system. The “floor and ceiling” measures being introduced will mean that more people will pay less and some with limited assets won’t pay at all. But while the increase in payments is in 6 months, we will have to wait another year for the benefits to kick in and when they do, they will still leave many in peril of having to sell their houses.

As the IFS point out (see link below), the initial use of the extra revenues will be to help the NHS get over the waiting lists which we are told still haven’t peaked. There is an excellent analysis of how this will happen but it will be dawning on the nation over the next few days that these payments are in lieu of the £38bn reportedly spent on track and trace.

If the revenues from the taxes are £36bn – as predicted – they are in effect , the price we have paid for our failures in preparedness for a pandemic. While no-one is doubted this money had to be raised, we should be under no misconception that we are paying the price for some poor decision making in 2020.

The floor and ceiling promises will still leave many people at risk of having to sell the family home, these reforms are not as generous as Dilnot recommended and they will not bite for some time. Most importantly, there is a distinction between meeting the cost of care and the residential costs of care homes (sometimes called the hotel costs). The hotel costs often dwarf the care costs.

The IFS’ predictions for the future for inclusive care is not bright, even with these reforms

While the precise path for spending – and hence for the availability and quality of care – is unclear, it is clear that the extra funding will not be sufficient to reverse the cuts in the numbers receiving care seen during the 2010s. Thus, while more people will become entitled to financial support as a result of the reforms planned, many people with care needs not considered severe enough will continue to miss out.

Misconception five – the 1.25% dividend tax will not touch pension funds.

As well as escaping the NI hike on their pensions in payment, those with pension savings look like escaping the 1.25% dividend tax on their pension pot.

Pensions are not threatened by the increase in dividend taxation. The 1.25% levy on dividend income, designed to catch those who live off dividend income , will not be levied on our pension funds.

This appeared as a correction during yesterday. It appears from this FT article that savings within ISAs will also be exempt from this additional tax.

For the detail and the wider picture

For more details on how the benefits will be distributed and who will pay the bulk of the cost, this excellent resume from the IFS is today’s best reference point. The IFS show with charts that the vast bulk of the cost will fall on those in employment (the self-employed will get off lightly). Implications for future employment practice are worrying – who would be an employer if workers can be contracted from self-employment?

And finally

While those with earnings worth taxing , worry about national insurance and healthcare levies, those whose incomes are insufficient for tax to be the major consideration have quite a different worry on their doorstep.

Once again , it appears that those on the lowest rungs of the income ladder will be paying the heaviest price for a national calamity.

About henry tapper

Founder of the Pension PlayPen,, partner of Stella, father of Olly . I am the Pension Plowman
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5 Responses to Health and Care – the bill arrives.

  1. Brian G says:

    So from what I have read I cannot see “the plan”. Instead the government has announced how it is going to raise hypothecated funds, and even then its not going to be immediately available to fund social care. But that aside where is the “plan” that Boris supposedly prorogued Parliament to finish off? Where are the detailed plans for how health care and social care are going to be joined up? Where is the strategy detailing HOW care is going to be provided? Where are the detailed plans for what care is going to be provided? Where is the plan for how to recruit and train the literally tens of thousands of professional care staff needed to give care? I can’t be bothered to look at all the flaws in using NI to raise revenue when the gaping holes in any policy for delivering social care means it does not really matter.

  2. henry tapper says:


    The fundamental problems with residential care for the elderly rest with it being provided mainly through the private sector and mainly through PE funding. One of the themes of yesterday is that the state will not be paying the hotel bills – it is only the care that will be taken care of (within the floor and ceiling limits).

    • Brian G says:

      I agree. I am pointing out that this bill is wholly inadequate. The lack of investment by government of all shades has been going on for years and throughout the last 20 years medical breakthroughs mean that more and more people are now surviving illnesses that would previously kill them. Combined with an ever growing ageing population the need for long term care has escalated at a time when investment has been lacking. The lack of integration between health care and social care means that some people with some conditions have no access to care at all, so that the issue of whether they have to pay for it becomes academic. There is a simply massive gap in the availability of mental health care. You practically have to have committed suicide before it will be posthumously recognised that maybe you weren’t feeling so well. There are 2 per cent less GPS now than there were 2 years ago. There are massive shortages in professional skilled health care individuals and those who exist are vastly underpaid. Social care that does exist is privatised, standards of care are patchy to say the least. So I say again, where is the plan?

  3. Brian G says:


    I think your blog is reporting things very well indeed, I just happen to believe that our society has its priorities all wrong, but of course that is an opinion not a fact. I believe that there is a terrible lack of awareness amongst the British public generally, and that they simply believe that the state will take care of them if they need long term care. We know this is a million miles from the truth. So because the narrative about tax and spend is almost always portraying the expansion of the welfare state as “bad” and that paying less tax is “good”, no major party has grasped the nettle and pointed out the harsh reality. What is clear is that this current policy has been cooked up by a small part of the cabinet, and its development has not sought for or encouraged the views of the rest of their own party, let alone asking for input from across the house. Rishi Sunak and Boris Johnson are not equipped to understand the issues surrounding the catastrophic state of our health and social care services and they do not appear to have sought the views of experts in coming up with their “Plan”.

  4. John Mather says:

    I am only surprised that this comes as a surprise. Britain has for many years promised Northern European social services at US tax rates.

    Productivity is not high enough to meet expectations. Increased borrowing announced today shows that the gap is getting worse and the target slips again.

    You are correct that a radical solution is required

    The have/have not range is incompatible with that radical solution

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