BUILD BACK BETTER. Our plan for health and social care Building Back Better: Our Plan for Health and Social Care Presented to Parliament by the Prime Minister by Command of Her Majesty September 2021 CP 506 © Crown copyright 2021 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.uk/official-documents. Any enquiries regarding this publication should be sent to us at [email protected]. ISBN 978-1-5286-2857-0 E02669460 09/21 Printed on paper containing 75% recycled fibre content minimum. Printed in the UK by HH Associates Ltd. on behalf of the Controller of Her Majesty’s Stationery Office. 2 CONTENTS Foreword 4 Introduction 6 Our plan for healthcare 9 Tackling the electives backlog 11 Putting the NHS on a sustainable footing 12 Focussing on prevention 13 Our plan for adult social care in England 15 Capping adult social care costs 16 Financial assistance to people without substantial assets 17 Wider support for the social care system 19 Improving the integration of health and social care 20 Our new funding plan 23 A new Health and Social Care Levy 23 Impacts of the Levy 24 Increasing dividend tax rates 25 Delivering for the whole United Kingdom 25 Conclusion 27 Technical Annex: Health and Social Care Levy 28 Summary of impacts 28 Dividend tax increase 31 3 Foreword Prime Minister Rt Hon Boris Johnson, MP The COVID-19 pandemic has been an unprecedented challenge. The worst public health emergency for a century has had a profound impact on the NHS. Staff have treated more than half a million COVID-19 patients over the last 18 months in hospital alone – providing outstanding care for those suffering new, complex and sometimes severely debilitating conditions. The pandemic has illuminated chronic problems in our health and social care system, and made many of them worse. For instance, when COVID-19 broke out, there were thousands of hospital beds filled with people that could have been better cared for elsewhere. These problems are making it much harder to manage the pressures that have inevitably built up elsewhere in the system as a result of the pandemic. The need to treat COVID-19 patients has contributed to worsening wait times for non-COVID-19 care. Before the pandemic, nine out of ten were waiting fewer than 25 weeks in England, but that has now risen to 44 weeks. The number of NHS patients waiting for tests, surgery and routine treatment in England is at a record high of 5.5 million and could potentially reach 13 million over the next few years. Health services in other parts of the UK have faced similar challenges. Around seven million patients in England did not come forward for treatment during the pandemic – and it is right that they should now be seen and given the treatment that they need. So while hard-working NHS staff are doing their best, it has been estimated that it may take the NHS up to a decade to clear treatment backlogs without concerted action. We must also address the challenges in adult social care. The pandemic has placed significant pressure on the sector. But even before the pandemic there were problems in the sector. People in England were required to pay for all of their care needs in full, right down to £23,250, at which point the state would start to provide some support. At an already difficult time in their lives, people suffering medical conditions such as dementia faced losing their life savings. Successive governments have pledged to reform the system but none have brought about long-term change. So we must take the same far-sighted approach as the Government that established the NHS and the modern welfare state after the Second World War. We must pursue the equivalent project of our era, supporting the NHS, reforming adult social care and creating a new integrated system between health and social care focussed on improving outcomes for our people. And that is what this Government will do. 4 We will provide significant new investment – reducing long waits for the tests and treatment that people need. We will bring the health and the social care systems more closely together – so that people are cared for in the most appropriate place for their needs, whether at hospital, in care or at home. We will protect individuals and families against unpredictable and potentially catastrophic care costs – so that from October 2023, no eligible person starting adult social care will have to pay more than £86,000 for personal care over their lifetime. We will recognise the extraordinary contribution that health and social care staff made in helping the country through the pandemic – in part by making sure that they have the support that they need. This is an unprecedented investment in health and social care. It is one that we should all accept some personal responsibility for providing. Both for our own futures and to care for our loved ones. To do otherwise and rely solely on the state to step in through yet more borrowing would be to fray the bonds that hold families and society together. So it is right that we should introduce a Health and Social Care Levy to benefit the whole of the UK, with new funding to support health and social care services in England, Scotland, Wales and Northern Ireland. No government wants to raise taxes, but nor should they neglect their duty of care to their citizens. So we must act to build a health and care system which reflects the brilliance of the staff working within it. The NHS is a source of enormous pride for the nation. We will ensure that it continues to be. Rt Hon Boris Johnson, MP Prime Minister 5 Introduction 1. This Government is committed to the delivery of world leading health and social care across the whole of the UK. The response of the nation’s public services to the COVID-19 pandemic is a source of extraordinary pride. This was recognised by the award of the George Cross to the UK’s national health services. 2. The NHS has led the response to COVID-19 and continues to drive our vaccine rollout. To protect staff and patients, and combat the risk of infection, hospital wards and waiting rooms were reconfigured to reduce transmission of the virus, and the Government provided billions of Personal Protective Equipment (PPE) items. The Government also rapidly expanded hospital bed capacity to treat COVID-19 patients and, together with the devolved administrations, swiftly established ten Nightingale hospitals across the UK. We have also worked with the devolved administrations to deliver the National Testing Programme, with UK-wide daily testing capacity currently standing at more than 600,000 PCR tests per day, supported by seven Lighthouse laboratories across the UK. This programme has provided over 166 million tests to date for UK citizens across 1100 test sites. We have also led the world with our vaccine programme – from AstraZeneca’s initial design, to public volunteers for vaccine trials, to manufacturing in England and bottling in Wales. This incredible effort meant that the UK was one of the first countries in the world to start vaccinating our citizens and, working closely with the devolved administrations, we have now vaccinated more than 48 million people right across the UK. 3. The pressure from the COVID-19 pandemic caused significant disruption to the provision of health and social care in England, Scotland, Wales and Northern Ireland. The immense efforts of those on the front line to respond to the pandemic and roll out the vaccine programme inevitably reduced the capacity to respond to non-COVID-19 related care. For instance, 5.5 million people in England are now waiting for non-emergency treatment, at least 900,000 more than before the pandemic, and average NHS waiting times are over ten weeks, up around 40 per cent since before the pandemic. 4. The impact of the pandemic has also increased pressure on wider NHS funding. Much of that increase was temporary, but underlying pressures are expected to build as a result of demographic changes, the long-term impact of COVID-19, rising care costs and NHS backlogs. The ONS estimate that UK Government spending on health increased by around 25 per cent in 2020, by far the biggest year-on-year increase since the ONS series began in 19971. The NHS must be put on a more sustainable footing so that it can rise to the challenges of the 21st century. 5. Social care is an integral part of our society and economy. Adult social care covers social work, personal care and practical support for younger and older adults over 18 with a physical disability, learning disability, physical or mental illness. It also includes safeguarding for those at risk of harm and abuse, drug or alcohol dependency, as well as support for unpaid carers. Around 950,000 adults in England receive some form of 1 ONS, 2021. Available at: <Healthcare expenditure, UK Health Accounts provisional estimates: 2020> 6 long-term social care support, which is focused on enabling a sustained and independent quality of life. 6. We all share a commitment to ensure that adults that need extra care are well looked after. But it is widely recognised that the social care system could be working better both for people using it and for those caring for others.