PARLIAMENTARY DEBATE
Health and Social Care - 7 September 2021 (Commons/Commons Chamber)

Mr Speaker, with permission I will make a statement on the Government’s plans for health and social care. Our national health service is the pride of our whole United Kingdom, and all the more so after it has been there for us during the worst pandemic in a century, treating almost half a million patients, administering more than 88 million vaccines and saving countless lives. The inevitable consequence of this necessary and extraordinary action is that covid has placed massive pressures on our NHS. As we stayed at home to protect the NHS, thousands of people did not come forward for the treatment they needed. Like those who suffered from covid, these are all people we know: your aunt who needs a new hip, your neighbour who has problems with their heart and needs a pacemaker, or your friend at work who thinks that they should get that lump or cough checked out. So we must now help the NHS to recover, to be able to provide this much needed care to our constituents and the people we love, and we must provide the funding to do so now.

We not only have to pay for the operations and treatments that people decided not to have during the pandemic; we need to pay good wages for the 50,000 nurses who will enable that treatment and who can help us to tackle waiting lists that could otherwise expand to 13 million over the next few years. We now need to go beyond the record funding we have already provided, and we need to go further than the 48 hospitals and 50 million more GP appointments that are already in our plan. So today we are beginning the biggest catch-up programme in NHS history, tackling the covid backlogs by increasing hospital capacity to 110% and enabling 9 million more appointments, scans and operations. As a result, while waiting lists will get worse before they get better, the NHS will aim to be treating around 30% more elective patients by 2024-25 than it was before covid.

We will also fix the long-term problems of health and social care that have been so cruelly exposed by covid. [Interruption.] The Labour party certainly failed to tackle them. But having spent £407 billion or more to support lives and livelihoods throughout the pandemic—from furlough to vaccines—it would be wrong for me to say that we can pay for this recovery without taking the difficult but responsible decisions about how we finance it. It would be irresponsible to meet the costs of this permanent additional investment in health and social care from higher borrowing and higher debt.

So from next April we will create a new UK-wide 1.25% health and social care levy on earned income, hypothecated in law to health and social care, with dividends rates increasing by the same amount. This will raise almost £36 billion over the next three years, with money from the levy going directly to health and social care across the whole of our United Kingdom. This will not pay for pay awards for middle management; it will go straight to the frontline at a time when we need to get more out of our health and social care system than ever before. It will enable radical innovation to improve the speed and quality of care, including better screening equipment to diagnose serious diseases such as cancer more quickly; designated surgical facilities so that non-urgent patients are no longer competing with A&E; faster GP access to specialists, so people do not have to wait months to see someone in hospital to find out whether something is wrong; and new digital technology so that doctors can monitor patients remotely in their homes.

We will do all this in a way that is right, reasonable and fair. Some will ask why we do not increase income tax or capital gains tax instead, but income tax is not paid by businesses, so the whole burden would fall on individuals, roughly doubling the amount that a basic rate taxpayer could expect to pay, and the total revenue from capital gains tax amounts to less than £9 billion this year. Instead, our new levy will share the cost between individuals and businesses, and everyone will contribute according to their means, including those above state pension age. So those who earn more will pay more, and because we are also increasing dividends tax rates, we will be asking better-off business owners and investors to make a fair contribution too. In fact, the highest-earning 14% will pay around half the revenues. No one earning less than £9,568 will pay a penny, and the majority of small businesses will be protected, with 40% of all businesses paying nothing at all.

Although Scotland, Wales and Northern Ireland have their own systems, we will direct money raised through the levy to their health and social care services. In total, Scotland, Wales and Northern Ireland will benefit from an extra £2.2 billion a year and, as this is about 15% more than they will contribute through the levy, it will create a Union dividend worth £300 million.

However, we cannot just put more money in; we need reform and change. We need to build back better from covid. When the covid storm broke last year, 30,000 hospital beds in England were occupied by people who could have been better cared for elsewhere and who wanted to be better cared for elsewhere. That is 30,000 out of 100,000 hospital beds in our NHS, costing billions. Those beds cannot be used by people needing cancer care or hip operations, making it harder than ever to deal with the growing backlog in our NHS.

Too often, people were in hospital beds because they or their relatives were worried about the cost of care in a residential home, and that same fear kept many others at home without any care at all. This anxiety affects millions of people up and down the country: the fear that a condition such as dementia, one of nature’s bolts from the blue, could lead to the total liquidation of their assets, their lifetime savings and their home—the loss of everything, however great or small, they might otherwise pass on to their children—while sufferers from other diseases, who have to be in hospital for the majority of their treatment, have their care paid for in full by the NHS.

Governments have ducked this problem for decades. Parliament even voted to fix it, yet that 30,000 figure is an indictment of the failure to do so. There can be no more dither and delay. We know we cannot rely solely on private insurance because demand would be too low for insurers to offer an affordable price, and a universal system of free care for all would be needlessly expensive when those who can afford to contribute to their care should do so.

Instead, the state should target its help at protecting people against the catastrophic fear of losing everything to pay for the cost of their care, and that is what this Government will do. We are setting a limit on what people can be asked to pay, and we will be working with the financial services industry to innovate and to help people insure themselves against expenditure up to that limit.

Wherever you live, whatever your age, your income or your condition, from October 2023 no one starting care will pay more than £86,000 over their lifetime, and no one with assets of less than £20,000 will have to make any contribution from their savings or housing wealth—up from £14,000 today. Meanwhile, anyone with assets between £20,000 and £100,000 will be eligible for some means-tested support. This new upper capital limit of £100,000 is more than four times the current limit, helping many more people with modest assets.

As we fix this long-term, long-standing problem in social care, we will also address the fears that many have about how their loved ones will be looked after by investing in the quality of care, in carers themselves, and by integrating health and care in England so that older people and disabled people are cared for better, with dignity and in the right setting. My right hon. Friend the Secretary of State for Health and Social Care will be bringing forward a White Paper on integration later this year.

You can’t fix the covid backlogs without giving the NHS the money it needs; you can’t fix the NHS without fixing social care; you can’t fix social care without removing the fear of losing everything to pay for social care; and you can’t fix health and social care without long-term reform. The plan that this Government are setting out today—the plan I am setting out today—will fix all of those problems together. Of course, no Conservative government ever want to raise taxes, and I will be honest with the House: I accept that this breaks a manifesto commitment, which is not something I do lightly, but a global pandemic was in no one’s manifesto. I think that the people of this country understand that in their bones and can see the enormous steps this Government and the Treasury have taken.

After all the extraordinary actions that have been taken to protect lives and livelihoods over the last 18 months, this is the right, reasonable and fair approach, enabling our amazing NHS to come back strongly from the crisis; tackling the covid backlogs; funding our nurses; making sure that people get the care and treatment they need, in the right place, at the right time; and ending a chronic and unfair anxiety for millions of people and their families up and down this country. I commend this statement to the House.

I thank the Prime Minister for advance sight of his statement—I think I had almost as much notice as the Cabinet. May I also thank everybody who works in the NHS and social care? During the darkest days of the pandemic they kept our health service from collapsing, they looked after the elderly when others could not and they rolled out the vaccine, which has finally provided the light at the end of the tunnel. Despite their efforts, we are facing the toughest winter in the history of our health service. Not only do we have the threat of another covid surge, but waiting lists for diagnosis and treatment have reached record levels, we risk cancer survival rates going backwards for the first time ever, and social care remains neglected and strained. It is a crisis, but how did we get here?

The pandemic has undoubtedly placed the NHS under huge strain, but that is only part of the story. A decade of Conservative neglect weakened the NHS. Waiting lists had spiralled—up 2 million before the pandemic. Targets were missed, on cancer, on accident and emergency, and on mental health, before the pandemic. The same is true on social care, with £8 billion cut, despite growing demand, before the pandemic. Carers were on poverty wages, without secure contracts, before the pandemic. There were 100,000 vacancies before the pandemic. And the Prime Minister has just referenced the 30,000 hospital beds occupied by those who should go into the community—this is before the pandemic—and he called that an “indictment of failure”. Who had been in government for 10 years at that stage? Just remind me. Prime Minister, an “indictment of failure” is an accurate description of the situation in our health service and social care before the pandemic, so the pretence that he is “only here” because of the pandemic is not going to wash. He is putting a sticking plaster over gaping wounds that his party inflicted. He made that commitment on social care before the pandemic, and he said he would pay for it without raising taxes before the pandemic.

Yes, the NHS urgently needs more investment, but the backlog will not be cleared unless the Government hit the 18-week target set out in the NHS constitution—the Prime Minister did not mention that. It was set and it was met by the last Labour Government. Let me ask a direct question: if there is to be improvement, Prime Minister, can you commit today to hitting the target and clearing the backlog by the end of this Parliament—yes or no? I know he likes to avoid these questions, but if he cannot answer that basic question, it is clear he has not got a plan.

Let me turn to social care. Under these proposals, people will still face substantial costs. I heard what the Prime Minister said, so I have another direct question for him: can the Prime Minister guarantee that under his plan no one will have to sell their home to fund their own care—yes or no? [Hon. Members: “He just told you.”] Well, let us hear him make the commitment, at the Dispatch Box, that under his plan no one will have to sell their own home to fund their own care, and then we will come back to it.

Social care is about so much more than this. The blunt and uncomfortable truth is that under the Prime Minister’s plans the quality of care received will not improve—there is no plan for that. People will still go without the care that they need—there is no plan for that. Unpaid family carers will still be pushed to breaking point—there is no plan for that. Working-age adults with disabilities will have no more control over their lives—there is no plan for that. Pay and conditions will not improve for care workers—there is no plan for that. Let me spell it out: a poorly paid care worker will pay more tax for the care that they are providing without a penny more in their pay packet and without a secure contract.

The Prime Minister shakes his head; my sister is a poorly paid care worker, Prime Minister, so I know this at first hand.

This is a tax rise that breaks a promise that the Prime Minister made at the last election, a promise that all Conservative Members made—every single one of them. It is a tax rise on young people, supermarket workers and nurses; a tax rise that means that a landlord renting out dozens of properties will not pay a penny more, but the tenants working in full-time jobs will; and a tax rise that places another burden on businesses just as they are trying to get back on their feet. Read my lips: the Tories can never again claim to be the party of low tax.

The alternative is obvious: a timetable and plan to clear waiting lists, just as we did under the last Labour Government, and a comprehensive reform plan for social care that deals with the inadequacies that I just pointed out and drives up the quality of provision—not just tinkering with the funding model. We do need to ask those with the broadest shoulders to pay more, and that includes asking much more of wealthier people, including in respect of income from stocks, shares, dividends and property. [Interruption.] Chancellor, I was listening. The Chancellor knows the numbers just as well as I do—he will have done the sums and we have done them. Tinkering and fiddling with dividends will not do it. The Government are placing the primary burden on working people and businesses struggling to get by.

As I have said to the Prime Minister, if the Government come forward with a plan to genuinely fix the crisis in social care and they have a fair funding model, yes, we will work together. Thousands of families who are struggling with the current system and only want the best for their loved ones deserve nothing less.

Now we know why over decades the Labour Government totally refused to deal with this problem, and now we know why both Blair and Brown failed to do it: the right hon. and learned Gentleman has absolutely no plan. I was waiting, and I am amazed that he sat down. What is his answer to the backlogs in the NHS? What is his answer to the problems in social care? The Opposition have absolutely no plan. They have no idea how they would raise the money.

Let me answer some of the right hon. and learned Gentleman’s questions. We will of course be investing in social care. I thank his sister for what she is doing in social care, but we have lifted people’s wages across the country with record increases in the living wage; we are investing in 700,000 training places for people in social care; and we are making sure that we invest £500 million—that is in the plan I announced today—in the social care workforce.

What this plan will also do is enable us to get our wonderful NHS back on its feet and enable it to deal with the backlogs. The right hon. and learned Gentleman totally failed to explain how a Labour Government would do that. One year of capital gains tax would not even begin to deal with this problem. He has not got a solution and it is deeply irresponsible of him to come to this place without having any kind of alternative.

Let us be in no doubt: if we did what we have heard from the Labour party over the past few weeks, we would still be in lockdown, because the right hon. and learned Gentleman opposed coming out of stage 4; we would have absolutely nothing by way of dealing with the NHS backlogs; and after decades of inertia from the Labour party we would have absolutely no way of dealing with the anxiety of millions of families across this country who face the prospect of catastrophic social care costs.

This Government are dealing with those things—we are dealing with all of them. We are getting on with it. We are taking the decisive action. We are doing it all together. This is the Government who get on and deal with the people’s priorities; this is the Government who tackle social care; and, indeed, this is the party of the NHS.

Raising taxes is an incredibly difficult thing for any Conservative Government to do, so I thank the Prime Minister for biting the bullet on this intractable issue that I and many former Health Secretaries have wrestled with.

Does the Prime Minister agree that the demographic challenge—which I know he is personally trying to address with a bit of population growth in Downing Street—means that whether someone pays insurance in America, social insurance in Germany or taxes in the UK, everyone is going to pay more for their health and care? Any Government have a responsibility to make sure that resources are allocated where the electorate’s priorities are, and in this country that is health and social care.

I thank my right hon. Friend not only for his support but for all the campaigning and hard work that he did when he was Secretary of State—the first Secretary of State for both health and social care because he sees that the two things go together, unlike the Labour party. What he said is entirely correct.

I thank the Prime Minister for an advance copy of his statement. Let me quote from it:

“Although Scotland, Wales and Northern Ireland have their own systems, we will direct money raised through the levy to their health and social care services.”

Let me tell the Prime Minister that health is devolved to the Scottish Government. The Prime Minister can get his mitts off our health system, because the people in Scotland trust the Scottish Parliament and the Scottish Government to run health and they certainly do not trust the Prime Minister—[Interruption.]

Order. Quite rightly, we heard the Prime Minister and the Leader of the Opposition; I expect everybody to listen to the leader of the SNP.

Thank you, Mr Speaker. When we have an attack on devolution, we have the baying mob of the Tories trying to shout down the voices from Scotland.

Government briefings in advance of the statement on social care told us that this was supposedly a key part of securing the Prime Minister’s legacy in office. Well, the Prime Minister is certainly creating a legacy, but it is definitely not the one in his vivid imagination. The real legacy of this Government is now well defined: a Tory Government who blatantly break manifesto promises and blatantly break international law.

It is telling that as we hopefully emerge from the covid crisis, the first act of this Prime Minister is to impose this regressive tax. The scandal of the tax hike is that it will fall hardest on the young and the lowest paid—the two groups that have suffered the worst economic consequences of the pandemic. Pre-covid and post covid, the pattern is the same, and this Government have learned nothing. Westminster keeps adding to the growing burden that young people face while stripping them of the benefits that previous generations enjoyed.

The unfairness of this tax hike will be especially felt in Scotland. The Scottish Government are responsible for social care and already funds provision—including SNP policies such as free personal and nursing care—from existing budgets and tax receipts. We have done it. As the Prime Minister well knows, by raising this levy across the UK, the Tories are taxing Scottish workers twice and forcing them to pay the bill for social care in England as well as at home in Scotland. This is the Prime Minister’s poll tax on Scottish workers to pay for English social care. Scottish people remember that it is this Prime Minister who said that

“a pound spent in Croydon was of far more value to the country than a pound spent in Strathclyde.”

Can the Prime Minister explain to the people of Strathclyde and across Scotland why he is now going after the pounds in their pockets to solve a social care problem in Westminster, which has failed to fix problems in Croydon and right across England? If their pound is really of less value, as the Prime Minister claims, why are we paying the price? Is he willing to stand up and explain to the families in Scotland why we are being hit by another Tory poll tax?

The NHS is a UK institution and we are all proud of it, and we are proud of what NHS Scotland does as well. The right hon. Gentleman is completely wrong in what he says about those who pay this tax. The burden falls most heavily on those who have the broadest shoulders, as it should, and it is the richest 14% who pay at least half the taxation. As I have just explained to the House, there is a massive Union dividend of £300 million across the whole of the United Kingdom, and the whole of the UK will find that there is more money for health and social care, which is, I think, what the people of Scotland will understand.

There will be millions of people right across the country who are so relieved today that, at last, the matter of health and social care will be resolved, with fairness to everyone. Can the Prime Minister reassure the many people who are concerned about prevention? We need early intervention, providing support for families with the very youngest children in our society, so that they too can have healthy and fulfilled lives throughout the United Kingdom.

I thank my right hon. Friend for everything that she does on this issue of early years. She and I have campaigned on this together. I have listened to her attentively over many years and I know that my right hon. Friend the Chancellor is determined to ensure that we get the proper funding for early years because the investment that we make in those first three years repays society and families massively.

Let us set aside for a moment the Prime Minister’s unbridled record on reneging on his promises, because, today, he has chosen what I consider to be the least progressive option to fix both our health and social care system. It is unfair between generations, unfair between individuals and unfair between those who derive their income from assets or from work. He is ignoring a raft of better alternatives: raising income tax; and making dividend tax equivalent to income tax or capital gains tax. Why?

The simple reason that I gave earlier is that none of those measures raise anything like the funding that we need. I have explained that very clearly, and I think that colleagues understand it and I think the country understands it. People are very suspicious. They know that this country has been through an enormous fiscal impact from the pandemic. They know that the Government have put their arms round people and spent £407 billion. They would be very suspicious of a Government who pretend that they can get the NHS back on its feet without some kind of serious, responsible, fair, fiscal effort and that is what we are doing.

I pay tribute to my right hon. Friend for gripping this issue. We are not in Government to be afraid of doing anything for fear of offending anyone. I will study the plans that the PM has promised to set out and I thank him for them. On behalf of my constituents and their families trapped right now in the spiral of rising care costs and fast disappearing resources, may I urge him and the Health Secretary, as we develop the new system that he has promised, to consider those for whom this is an issue in the present and not just many years into the future.

I absolutely agree with what my hon. Friend has said. The tragedy of decades of failure to tackle this matter is that people are now facing these costs. What we are doing is investing—as we have done throughout the pandemic—about £6 billion, I think, in dealing with the immediate costs of social care to try to help people through this very difficult time. What this package offers is a way of developing a long-term solution, enabling, we hope, the private sector to come in and give people a long-term plan to fix the costs of their own social care, knowing that the Government will remove the risk of those catastrophic costs. That is the advantage of what we are doing today.

Putting aside the unfairness of the national insurance tax rise that the Prime Minister is proposing, is it not the case that the expenditure cap will be his poll tax? In his Uxbridge constituency, the average price of a house is £500,000; in parts of mine it is £130,000. That would leave people in his constituency with an inheritance of more than £410,000 per family, and in mine £44,000 per family. That is unjust and unfair. It is not about levelling up, is it, Prime Minister? It is about doubling down on everything that is wrong, and yet again the poorest will pay the most.

This is a massively progressive measure that increases the floor on people’s liabilities four times. It protects people up and down the country from catastrophic costs, which anybody can face. Everybody across the country will benefit not only in the investment in social care and in care workers, but in making sure that we deal now and deal properly with the NHS backlogs and their effect on our NHS, which is what this country wants to see.

Let me just say to Members that we will be running this statement for around an hour, so, please, let us try to rush on and get through.

During the summer recess, I spent a week looking after my father who has advanced Alzheimer’s as my mother had a respite holiday. I pay tribute to all those who look after their loved ones in similar circumstances and all those who work in the care service. I certainly welcome the Prime Minister’s statement today. May I seek assurances that, through the health and social care levy, money raised will go to fund local authorities that do so much brilliant work in this area as well as the NHS?

My hon. Friend asks the question that everybody wants to be certain of. Absolutely, this is a legally hypothecated levy, but we will ensure that the funds that are fixed for social care go to social care so that we deal with the problem of the catastrophic costs. This will not be dispensed by the NHS, but by the Treasury in the normal course of Government spending.

After a long career of listening to Liberal Democrat opportunism, I do not think that I have heard anything quite so absurd. The right hon. Gentleman calls for more funding and then attacks the Government for providing the wherewithal to do exactly what he wants. We will be spending half a billion pounds supporting carers, and there will be 700,000 more training places. The plan supports adult care. It supports everybody who needs care up and down the country; it is not just care for the elderly.

The reform of social care has been ducked for decades because successive Governments have put it in the too difficult box. I congratulate the Prime Minister on delivering on our commitments and his commitment. May I ask him to ensure that, as well as the money, we integrate properly the NHS with social care so that people can get the dignity that they deserve?

I thank my right hon. Friend, because he played a major part in the gestation of these policies and knows them intimately. He is completely right and has been massively encouraging to the Government over the last few weeks.

We will be bringing forward a White Paper on the integration. Of course this is going to be difficult, but it has to be done. We must have a system whereby people can work across both the health sector and the care sector in an integrated way. We have to have single budget holders and we have to ensure that, for instance, we have single electronic records in both health and social care. These are things that need to be fixed. We need to make sure that people are cared for appropriately and in the right setting, and that is why we are bringing forward the White Paper.

The Prime Minister will know that a number of young people are carers for their elderly relatives and family members. I was a carer for my late mother, who suffered from complex needs, including sickle cell anaemia and renal failure. Without those carers, our local government would have to pick up more issues. What assessment has the Prime Minister made of the high vacancy rates in the care sector, and will he be honest and say that this social care plan announcement has no impact on addressing those rates?

No, this plan does address the problems in the care sector. In addition to the £6 billion that we have put into supporting local government with social care during the pandemic, we are putting another £0.5 billion into supporting the care workforce. I have mentioned the 700,000 training places that we are investing in. We are also trying to ensure that people who become carers—they are wonderful people; I thank the hon. Member for what she has done—get the progression and career structure that they need, and understand how valued and respected they are.

The public will welcome the certainty in my right hon. Friend’s announcement today, particularly with regard to the cap and the floor, but does he agree that it is time that we had a real and informed debate about the nature of old age, now that we are all living longer? The longer that we can live independently, the better it is for everyone’s wellbeing, and we can all make lifestyle choices to encourage that. Does he agree that we need a fair debate about new models of care and housing models to encourage exactly that discussion?

My hon. Friend is completely right. One of the things that we are bringing in today is the housing and innovation fund, to ensure that we care for people in the right settings. She is completely right that there is no point in having residential care when a domiciliary option would be better, more effective and perhaps less expensive. That is exactly the right approach. The patterns of care and way we do things will change and improve—very rapidly, I believe.

Prime Minister, most people recognise that if we want more services, we have to pay more. But if we are going to pay, it should at least be fair. Despite your claim that this is a progressive tax, it is not. It is a flat-rate tax, the benefit of which will go mostly to better-off people. Those who are less well off will therefore be subsidising those who are better off. At a time when we are trying to create more jobs, young people and employers are going to feel the impact. Could I ask you—

Order. Can I just say that the right hon. Gentleman has been here a long time and knows that I am not responsible—I certainly do not want to be responsible for this—so could he not use “you”? I call the Prime Minister to respond.

Will the Prime Minister—

Sammy, sit down; come on, son.

The right hon. Gentleman is a formidable campaigner for his constituents, but I believe that these measures do serve them. This plan is progressive; the burden falls most heavily on those who can most afford to pay. It will, above all, help to deal with the current waiting lists in Northern Ireland, which are excessive and need to come down.

The NHS has been outstanding during the pandemic. However, as the Prime Minister has said, there is now a large waiting list of people needing treatment. As a hospital doctor, I am delighted to hear about the increased investment in the national health service that we are getting today, but as well as money we will need medical and nursing staff hours to reduce the waiting list. What are the Government doing to increase the numbers of those medical and nursing staff?

We are massively recruiting NHS staff. I think I am right in saying that, as I stand here today, there are 11,600 more nurses in the NHS than there were this time last year, and we will go on to deliver on our manifesto commitment to recruit 50,000 more nurses.

Having been a care worker, I know that it is a hard and skilled job that deserves decent pay and recognition, not a Tory tax hike. Does the Prime Minister really believe that his tax hike, which will fall on the shoulders of care workers, is any way to reward the heroes who have got us over the last 18 months?

Yes, because the burdens fall overwhelmingly on those who can best afford to pay, and the benefit for care workers is not only the increase in the living wage, but the colossal investment that we are making in care. That is something that will benefit not just care workers, but their charges: their patients, and the families who desperately need care up and down the country.

A decade on from Dilnot and with the demographic challenges becoming more intense, my right hon. Friend is to be commended as the first occupant of Downing Street to grapple with this immense challenge. Some of the most distressing cases that we encounter as constituency MPs are families who are caught in that tension between those who are in hospital ready for discharge and the local authorities. We see distressed and anxious families—confused, bewildered and vulnerable people. The greatest reform that we can make to the system is to put those who need the care at the very centre of our reforms.

I thank my right hon. Friend deeply; in that intervention, he has summed up the heart of the issue that I was trying to explain in my statement. It is the anxiety of millions of families up and down the country who face this uncertainty—about the finance, but also the proper setting for their relatives—that we are addressing today.

The backbone of the social care system is an army of underpaid and hard-working home carers and carers. How does the Prime Minister begin to justify to them a tax rise that not only breaks a promise, but hits them hard in their pockets?

Because we are investing massively in the sector. We are putting half a billion pounds into supporting care workers and investing in 700,000 training places. We are lifting the living wage by record amounts. Above all, we are valuing care workers and showing the respect to them and their careers that I do not believe has been properly shown before, by any Government.

I welcome that paying for this proposal is going to fall predominantly on the well off and those with the broadest shoulders. My right hon. Friend has pointed out that those who are earning less than £9,500 a year will not have to pay for the proposal, but what other mitigating factors can he put in place to help those on lower incomes to pay for it? Once the financial conditions allow, will he look at continuing to raise the living wage and at cutting taxes for lower earners?

My right hon. Friend is right consistently to campaign in the way in which he does for low earners. We are increasing the threshold for which people can be liable for paying anything at all from £14,000 to £20,000, which is a benefit that has not really come out properly in the conversation. People need to understand that we are lifting the minimum assets for which people can be liable from £14,000 to £20,000; that helps people on low incomes. As my right hon. Friend knows, we are also increasing the living wage. I am pleased to see that one of the effects of the current rebound in the economy, which I know he will be studying, is that wages are now starting to rise again—in exactly the way that some of us who campaigned for Brexit wanted to see.

When I was first elected to this place in 1997, one of the first people who came to see me in my surgery was the wife of a man who had been waiting two years for open heart surgery, and we are back there again with the waiting lists. There was no righteous indignation from the Tories when the list reached 2 million before the pandemic hit. Will the Prime Minister commit today to hitting the 18-week target for waiting lists, and to clearing the backlog by the end of this Parliament?

I think what the Labour party needs to do is come up with any type of plan at all. Every day in this country, plan beats no plan. We are putting record investment into the NHS. We have a plan to clear the backlogs—to reduce the backlogs as fast as we possibly can with this levy. What would Labour Members do? Answer comes there none: they have no plan.

For years, people have come to my surgery with horror stories about the difficulties of accessing care and the frankly squalid conditions that their loved ones have to be in in residential care. Can the Prime Minister reassure me that, as well as protecting the things people have worked hard for all their lives, we will also protect people from having to put their loved ones into conditions that not one person in this House would ever want for their loved ones?

Yes, because in addition to the caps and the floors that we are introducing to protect people from catastrophic costs, we are also introducing a fair cost of care.

Paul Johnson of the Institute for Fiscal Studies said that there were really no good arguments for using national insurance to raise these moneys, and having been briefed on the Government’s plans, care leaders are extremely disappointed, furious and depressed at the Government’s meagre plans on social care. But the question is: why is it necessary at all? This will raise about £12 billion a year, but the Prime Minister’s Brexit bonus of £350 million a week would aggregate to £18 billion a year. So where is this money, or did it never exist?

I think the whole country understands that we have been through a pandemic that obliged the Treasury to spend £407 billion on protecting people, jobs and livelihoods by furlough and other measures across Scotland. That was the right thing to do. I think people also understand that it is the reasonable and responsible thing to do now to put the NHS back on its feet with the funding it needs, and to sort out social care at the same time. That is what we are doing.

Is not the starting point in this discussion that greater demand for social care is bound to require greater money to pay for it, and anyone who does not like these proposals needs to explain what the alternative is, which is unlikely to be clear, simple and popular? Is it not the case that, in order to create an insurance market to give people even greater reassurance about their future care costs, we need to put a cap on and that is why the cap is most welcome? Will the Prime Minister do all he can to make sure that that insurance market is stimulated? Finally, will he confirm that that cap applies to those who have care needs regardless of their age?

Yes, I can certainly confirm that my right hon. and learned Friend is right on the last point—that the cap applies regardless of age. He is completely right in what he says about the logical necessity for the cap if we are to have any hope of the private sector coming in with the financial instruments that will help people to protect themselves against the cost up to the limit. That is the virtue of what we are setting out today. And what do we hear from the Labour party? Deafening silence.

People living with dementia and their families have been particularly affected by the social care crisis. They represent 40% of care home residents and they pay a dementia premium of 15%. On average, they spend £30,000 a year on their care. Dementia is an outcome of different diseases, which are increasing; we are going to see more and more people living with dementia. Therefore, can I ask the Prime Minister whether he will also fulfil his commitment in the general election manifesto for a dementia research moonshot? We know that we can, in the same way that we have developed a vaccination programme, develop cures and treatments for dementia.

The hon. Member is right to focus on the issue in the way that she does. It is a very cruel lottery that one in seven face these catastrophic costs as a result of dementia, while those who have other conditions are funded in full by the NHS. I can certainly confirm that the moonshot programme that was begun by my right hon. Friend the former Secretary of State for Health—one of his many moonshots—continues.

Can the Prime Minister confirm that this funding injection will go directly into frontline NHS services, not middle management, and that patients will be able to see the tangible benefits from it?

Yes. Not only will it go to frontline services and to beating waiting lists, but we will make sure that this money—this massive, unprecedented investment—is accompanied by the reform, change and productivity gain that the NHS needs to see.

My former colleagues where I used to work as a care worker sacrificed so much during the pandemic and now, under the Prime Minister’s plans, their pockets will be raided with a tax that will hit hardest those who are older, young and less well-off. Does he agree that it is now time for a national care service and a wealth tax to fund it?

The funding that we need on the scale that we need simply could not be raised in the way that the hon. Member describes or in the way that the Leader of the Opposition has vaguely indicated today; I do not think I heard a clear description of what he actually intends to do. But of course we want to make sure that people in the caring profession get the support and the investment that they need. That is why we are putting money into their training and into supporting carers, but also lifting their wages with the biggest ever increase in the national living wage. We will continue to support that.

I declare an interest as chair of the all-party parliamentary group on local government, in thanking my right hon. Friend for making the tough choices that he has today, rather than kicking the can down the road, as the Labour party did for 13 years when it had the opportunity to do something. As welcome as this injection of cash is, can I ask for an assurance that it is going to be met with the same rigorous reform that is necessary to make the system viable for years to come?

Yes. I thank my hon. Friend for everything he does for local government. Of course we will make sure that we bring forward the White Paper, which will show how we intend to join up healthcare and local government in a way that they have not been since the foundation of the NHS more than 70 years ago.

The Prime Minister is behaving like Father Christmas; he does not know what he has not delivered in government for the last 11 years. In this House last night, we had cross-party consensus on covering the costs of medicinal cannabis. So while Father Christmas is at the Dispatch Box, can he deliver on a Government promise to immediately set up a fund to pay for prescriptions for medical cannabis for children with intractable epilepsy?

I thank the hon. Lady. The prescriptions that she asks for are actually already provided for on the basis of clinical advice.

There has been much debate about how the money is being raised, but of more concern is how the money is going to be spent. My fear is that, once you start spending on perfectly proper things like the NHS backlog, there will never come a point where there is enough money in the new fund to transfer to social care, which needs it now. You cannot spend the same pound twice. So can my right hon. Friend guarantee that the social care sector will itself see a significant uplift in its support in the immediate future?

My right hon. Friend has done great work on this subject and I am indebted to him for some of the advice that he has given to me personally about how to proceed in this. He is right in what he says. The issue is making sure that the funding goes where it is needed and that it is specifically ring-fenced. The investments in social care will be protected by the Government and by the Treasury.

There are better ways of doing this than to take money from the less well off in work and the young to give to better off pensioners. Can I commend to the Prime Minister and my own Front Benchers the work of the Health and Social Care and Housing, Communities and Local Government Committees in their joint report of 2018, agreed unanimously by all Members of all parties in this House, which would deliver a system that is sustainable and equitable, address poor quality and low pay, and allow the proper integration of health and social care—none of which, from what I have heard today, his proposals would deliver?

Time and again, Labour Members have stood up and said that there is a better way to do this, without offering a single idea. A plan beats no plan.

Can my right hon. Friend confirm that the sums passed to Wales under his proposals will not only be ring-fenced for health and social care, but that the Welsh Government will be required to apply the same £86,000 cap as will be applied in England? It would be grossly unfair if care users in one part of the country were to be worse off than those in another.

My right hon. Friend makes a very important point. Members across the House will know that the lower limit in Scotland is £12,500 at the moment. Lifting that to £20,000, as we are now, is something that people in Scotland may want to address. I certainly think that the cap of £86,000 is something that people in Wales will want to see, too. There is a strong benefit to the whole of the UK proceeding as one.

As chair of the all-party parliamentary health group, I have been hearing concerns from older adults across the United Kingdom who are in social care or in the community and have experienced loneliness, anxiety, isolation from loved ones, illness, bereavement and loss. The British Journal of Psychiatry has today documented a significant rise in depression in this group. Will the Prime Minister commit to ensuring that older adults in social care and the community have access to adequate mental health services and that those services are fully funded?

The hon. Lady is completely right to draw attention to the suffering of people throughout the pandemic, particularly in care homes, including the mental stress they have suffered as a result of not being able to see or hold loved ones in the normal way. It has been one of the most appalling features of this pandemic, and we are certainly investing record sums in mental health to deal with that issue and many others.

Does the Prime Minister share my disbelief at the Leader of the Opposition’s response to his statement, considering that waiting times for treatment and discharge for my constituents in Wales are much longer than they are in England? Can he confirm that Wales, Northern Ireland and Scotland will be net gainers out of the social care levy? Will he further guarantee that the additional sums available will be spent on health and social care in the nations?

I can certainly confirm that Wales, Scotland and Northern Ireland will be getting an increment. There will be a Union dividend in the way that I described, but clearly it is up to those parts of the country to ensure that that money is spent on the people’s priorities, and I believe that the people’s priorities are health and social care.

As well as the 30,000 beds that the Prime Minister talked about, we know there has been a 36% increase in people dying at home through the pandemic in circumstances that we know not much about. The mental, physical and financial torture and cost born by families is unknown and will shock many of us when we hear from our constituents. He may be flying a kite today, but I do think he is breaching a dam, and that is something that we all need to grasp. Targeted help is not a long-term solution. My right hon. Friend the Member for Exeter (Mr Bradshaw) highlights what that solution could be, but there is some certainty offered today. Can the Prime Minister clarify whether he is going to bring forward a White Paper? Will he bring forward different forms of legislation? How are we going to understand the impact?

I thank the hon. Lady very much. We are setting out the plan today on the caps and floors and how to deal with social care. We are setting out the plan on nurses’ pay and dealing with the backlogs. What we will also be doing is setting out the finer detail of the integration between health and social care in the ways that I have described: everybody should have electronic records for both health and social care; there should be movement between the two services; community nurses and adult social carers should not be doing these radically different professions with different pay spines—there should be an integration; people should be having care in the appropriate setting; and there should be a single budget holder. Those are some of the things that we will be discussing in the White Paper.

Additional investment is welcome, but that has to come with assurance. My constituents in Tipton, because of the Labour party, are getting turfed out of their care home, despite a £2 million underspend by Sandwell Council on adult social care. Can my right hon. Friend assure my constituents in Tipton that their campaign to save Walker Grange care home is not in vain? Will he ensure that assurance comes with the investment to stop the Labour party turfing out some of the most vulnerable people in my community?

Yes, Mr Speaker, and I think my hon. Friend speaks to the profound indifference of the Labour party to this issue for decades. That is why we are taking the decisive action that we are to address the problems in the whole social care system, to support care homes and to support those who must face the cost of social care.

Does the Prime Minister agree that any new money must go alongside reform of our NHS? Does he agree that, as we have a system where most people’s entry into the health system is through a GP, it surely cannot be right that in many of the most deprived communities in our country, people cannot get a GP for love nor money? There must be something wrong in many parts of our country that in this day and age, people cannot get a GP and cannot even get a dentist. When can we do something to change that?

The hon. Gentleman is entirely right in what he says, in the sense that we are doing 50 million more GP appointments. That is part of our manifesto pledge. What we are also going to do as part of these reforms—I do not think anyone wants to see money just funnelled into the NHS without reform—is look at GP contracts to make sure that GPs see the right patients at the right time.

If there was an easy solution to the problem of social care, it would have happened years, if not decades ago. I believe that everybody in this House, but particularly those from parties offering no alternatives, should welcome how the Prime Minister is tackling health and social care together with a hypothecated tax, which means that this health and social care levy is ring-fenced for all our constituents’ benefit. On the issue of intergenerational fairness, my right hon. Friend said that the recently retired would contribute and the lowest earning would not contribute, so will he encourage the Health Secretary to lay out the details of the tapers as soon as possible, so that everyone can see that this is a progressive levy?

My right hon. Friend the Health Secretary will certainly be laying that out. What everybody in the country understands is that there is no intergenerational issue here, because in the end all families are affected by this. Everybody has older relatives whom we love, and the cost of whose care makes us anxious. Everybody understands that families across the country are liable for this and we must take steps to fix it, and that is what we are doing.

Confidence in job creation is crucial right now in our economy. What assessment has the Prime Minister made of the number of jobs where employers will look at the extra national insurance contributions and say, “No, I do not think I will take on those extra staff”?

The hon. Lady should remember that 40% of companies will not be affected at all by this. I am sure she also knows that the labour market is so buoyant that not only are there huge numbers of vacancies, but wages are rising, and that is a good thing.

During the pandemic, the Government stepped in to save lives and jobs. In Rutland and Melton, 47% of jobs would have been lost without those efforts. Does the Prime Minister agree that it would be wrong to meet the cost with higher borrowing and debt, which would be carried by our children? Will he commit to look at those councils that are worse funded, specifically Leicestershire and Rutland, which need real help with social care above and beyond a generic formula across the country?

Yes, Mr Speaker. I thank my hon. Friend for what she says about Rutland and Melton, and we will certainly make sure the councils get the funding they need. She has hit on the fundamental point: borrowing more is no answer. We are borrowing a lot, and in the end borrowing is just future tax rises for younger people or even people unborn. That is not what this Government are going to do.

Health and social care do need massive investment, especially after Tory austerity has so undermined our national health service over the past 11 years. A 10% tax on the wealth of those with over £100 million would raise £69 billion. Surely a wealth tax is how we should be funding these vital services. Is the truth not that despite the rhetoric and the promises, the Tories do not have the guts to take on the super-rich who fund their party, and that is why they will not back a wealth tax?

I thank the hon. Gentleman for his contribution. At least he has the guts, unlike the leader of his party, to say that he would tax people in this country to the tune of £12 billion or £13 billion a year to pay for this. This is a wealth tax on that scale. We believe that this is the right way. What we have not heard from those on the Labour Front Bench is any credible alternative.

Will my right hon. Friend confirm that as a result of this announcement today, the Scottish national health service will receive billions of extra pounds in funding? Does he share my astonishment—and, I am sure, the astonishment of the people of Scotland—at the remarkable reaction of the SNP today? It seems that because the SNP has not asked for it, it does not want Scotland’s NHS to get this extra funding.

That was brilliantly and succinctly put. Does the SNP want the money or not? Do the people of Scotland want investment in their healthcare and social care or not? There is more money coming for Scotland; let us hope that the SNP spends it wisely.

A little over two years ago, the Prime Minister stood on the steps of Downing Street and promised the nation an oven-ready deal on social care, yet the announcement of a tax on jobs only promises a plan later this year. Crucially, the detail in the statement says that only people starting care after October 2023 will be helped with these catastrophic costs. What does the Prime Minister say to the 1.5 million people missing out on care and to the millions of hard-working families facing crippling costs between now and September 2023 but paying for it from April next year?

What I say to the hon. Member is that, frankly, she should take that up with the former leaders of the Labour party, Tony Blair and Gordon Brown, and all the former Ministers responsible who did absolutely nothing to fix the problem when they were in office. It is this Government dealing with it now.

The Prime Minister was absolutely right to focus on the importance of the social care workforce. Unfortunately, the Government’s own estimate is that due to our compulsory vaccination measures, 40,000 people in that workforce will leave the sector by November. Are there urgent measures in his plan that the Government will take to replace those missing care workers so that we can deliver the high-quality care that I think everyone in the House wants to see?

My right hon. Friend makes an important point about compulsory vaccination. I believe it is the right thing, and, in the ways that I have described, we are making sure that we encourage more people to join the social care workforce, with the £500 million of investment and the training places. We must also understand that many of those social care workers are leaving to join the NHS, where vaccination is not currently compulsory. Almost 10% of NHS frontline workers are not vaccinated. That is something on which we need to reflect, and that is why we are having a consultation on the way forward for the NHS. I do not think it is right that almost one in 10 frontline NHS workers should be unvaccinated against covid.

It is telling that, in the Prime Minister’s statement, there was not a single word of tribute to our extraordinary social care workforce or any mention of the pay increase that they so desperately need. Many of those social care workers are on low pay and will face a £1,000 cut in their income as a consequence of the Prime Minister’s cut to universal credit, on top of the national insurance increase they face. What has the Prime Minister got to say to our dedicated social care workforce who spend their time caring for our precious loved ones every single day?

Let me say again what I have said repeatedly: the social care workforce of this country have done an amazing job and continue to do so. They did an amazing job throughout the pandemic as well as before it and beyond. I met more of them today. What they are getting from this package of measures is not only investment in their careers and progression but the long-term structure and respect that they need as a profession and the prospect of integration between what they do and what the NHS provides. That is a massive prize.

I congratulate my right hon. Friend on grasping an issue that his predecessors have been ducking for decades. Does he agree that what has been announced restores some equity to a system that relies on pooling our risk and that, in particular, people who have been excluded with dementia, neurodegenerative disease, Parkinson’s disease and the general frailty of old age, and their relatives, can look forward with some confidence to the system that has been there for others also applying to them?

My right hon. Friend knows exactly what he is talking about, because he is a former GP who has seen these issues at the frontline. With this measure, we are not only investing in care and in the NHS but bringing the magic of averages to the rescue of millions.

Before the pandemic, the Conservative-led Local Government Association said that there was a gap in social care funding and local authority funding of about £5 billion. It has got worse since. Will the Prime Minister therefore state clearly, of the £36 billion to be raised through this addition to national insurance contributions in the next three years, how much will go to local authorities to fund social care? When, in 2023, he brings in the cap and floor system, that will mean less money coming in from people’s own funding, so what will the net addition be for local authorities from the increase in national insurance payments and the reduction in payments from the cap and floor system?

The hon. Member makes an exceptionally important point. In addition to the £6 billion that we put into supporting local government throughout the pandemic, we are putting more in precisely to support social care. That will ramp up over time as the system kicks in. The distribution will be set out in due course by my right hon. Friend the Secretary of State for Health and Social Care.

Nobody in this House, and I doubt anyone in the country, will be surprised that the Prime Minister has the guts to take on reforming social care when none of his predecessors did. I was amazed that in the statement he pointed out that roughly one in three hospital beds are occupied by people who could be better treated and cared for elsewhere. It seems to me from my surgeries that the problem is largely due to local government and the health service not working together. When can we see some improvement in that?

My hon. Friend is completely right, and I am sure he speaks for Members across the House who have experienced this problem in their surgeries for years. There is a mismatch between health and social care and there is not a proper system for deciding where people should be treated for their own benefit, and the result is that we get these huge pressures of delayed discharge that make it more difficult to deal with the elective surgery that people need—particularly now. That is why we must do both things at once, and that is why we are doing what we are doing.

The right hon. Member for Ashford (Damian Green), the hon. Member for Cities of London and Westminster (Nickie Aiken) and my hon. Friend the Member for Sheffield South East (Mr Betts) have hit the nail on the head: there is no plan for social care. What the Prime Minister has listed is money to go into the NHS. Will he tell us now when the money will go to local authorities so that it can go to those domiciliary and residential social care providers who actually need it?

It is all in the plan. The overwhelming bulk of the funding begins with support for frontline NHS electives, for nurses’ pay and for vaccines; then, as the social care plan ramps up, the ratio changes. It will be set out by my right hon. Friend the Secretary of State for Health and Social Care.

May I quote from a recent report from a joint inquiry by the Health and Social Care Committee and the Housing, Communities and Local Government Committee on the future funding of social care, on which I sat together with 12 Opposition Members? It says:

“We therefore recommend that an earmarked contribution, described as a ‘Social Care Premium’, should be introduced, to which individuals and employers should contribute. This can either be as an addition to National Insurance, or through a separate mechanism”.

Does that not show that there is cross-party support for such a proposal and that the Opposition’s objections are simply political opportunism?

I thank my hon. Friend for making that elegant but telling point about the cross-party support that there should be. We are trying to create the conditions by decisive Government action for exactly the kind of insurance systems that I know he wants to see.

It has been a long time coming, but this announcement is too little, too late for the 34,000 people who have died of covid with dementia. Will the Prime Minister tell us when he will honour his manifesto pledge to double research spending into this cruel disease that took my mum—it was isolating before covid—or is this just another one going the same way as the money for the NHS promised on the side of the bus?

I am very sorry to hear about the suffering of the hon. Member’s mother. Dementia is a very cruel affliction, and it is because of the cruelty of that lottery about who gets it and who does not that we are putting in the measures that we are. But we are also funding extra research into dementia, and my right hon. Friend the Health Secretary is determined to ensure that we continue with the moonshot that I was referring to earlier.

May I ask the Prime Minister why he decided to reject other forms of insurance as a model? The Germans brought in an insurance model back in the 1980s, facing the same problems that we had, and it relies on the private insurance sector. The noble Lord Lilley from the other place has brought forward a Bill that would see the Government set up a state insurer. Those retired householders would then pay a premium, which would be fixed as a charge, and then that charge would only be paid upon the death of that individual. Do not those models do a little more to intergenerational fairness?

I thank my hon. Friend for his thoughtful question. We looked at all those models of course, Mr Speaker, as you can imagine. I think that the problem is that we need to go for an insurance system that works and has a genuine chance of being set up, and the only way of encouraging the financial services industry to come in and offer products, whether they are insurance or annuities or whatever, is to take away that risk of catastrophic cost. That is a very substantial risk for too many people and it means that the insurance market has not been able to develop. We believe that this is the best way forward for the country.

My hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands) referred to comments by IFS director Paul Johnson earlier, but Paul Johnson has also said he is

“bemused as to why such a bad tax policy instrument has to be used”,

and pointed out that the under-50s would pay two thirds of the costs of social care if they paid through NI. Prime Minister, that means young people and the lowest-paid bearing the brunt. Many of these are also working with universal credit—people in Scotland paying that and elsewhere. Does he think it is fair to progress this while also cutting the £20 a week from hard-pressed families on universal credit?

No, because obviously older people continue to pay the levy and the richest 14% pay half the cost of this transformation, and that is entirely the right thing to do.

If there had not been a pandemic, how would we have funded this reform of social care without having to raise taxes?

The pandemic and the cost of the pandemic have impacted both our health and our social care systems. As I have tried to explain to the House today, they are intimately related. The best way to put them on a sound footing—both of them on a sound footing—for the future is to treat them together and to put in the levy in the way that we are.

We all know that the Prime Minister’s promises are a wee bit dodgy. Today, he promised that his extra taxes will go to the frontline, so by how much will he increase the pay for people in the social care profession or is it just going to be another round of applause?

People in the social care profession, overwhelmingly, are not paid by the Government as the hon. Member knows, but they are the beneficiaries of the living wage, which the Government have increased by record amounts. What we are doing is investing in their training, investing in their careers and making sure that they get the respect and the progression that they need.

The devil, as ever, will be in the detail. However, may I initially broadly welcome these proposals, particularly compared with what we were expecting, which was a rise across national insurance as it stands at the moment? This is a much broader-based levy: it includes those who have retired and those who are receiving dividends. It seems to me that that has a very welcome consequence; the broadest shoulders will pay the most. But can my right hon. Friend also address one of the criticisms of what we feared might have been brought forward today, which was the impact on the young in particular and this issue of intergenerational fairness, and how he feels that this approach is going to be useful in that respect?

I thank my right hon. Friend very much for his support, because it is extremely important, and I think he is completely right. We are trying to make sure that those who can pay the most do pay the most. We are trying to make sure that we address the issue of intergenerational fairness. But there is a bigger point, which I have made repeatedly. This is not something that simply affects one generation, the elderly. There are huge numbers of younger people in care who will benefit from what we are doing and every person in this country has relatives who face the problems that we are trying now to allay or to defeat.

The Prime Minister today was supposed to be announcing a social care plan, but there was no vision, no detail and no real sense of understanding the complex web of issues that create the social care crisis. In particular, he made no mention of the millions of unpaid carers, whose commitment to their loved ones props up the failing system. So will he now say very specifically what is in his plan to identify and support unpaid carers, and particularly young carers, and what resources will he commit to them?

I thank unpaid carers for everything that they do, and the hon. Member is quite right to point out the huge contribution that they make. What unpaid carers have now is the certainty that if they need to pay for the cost of care in some way or other, there will be a limit and they will not have to continue with their unpaid exertions, their care and love forever, because the Government are coming in to help them.

I welcome my right hon. Friend’s investment into the NHS, particularly into the beds, which have obviously clogged up. We see this in Stoke-on-Trent, where the Royal Stoke University Hospital was built under the last Labour Government, with a disastrous PFI debt that steals £20 million a year from the frontline. It also has 200 fewer beds than the previous hospital. So can my right hon. Friend ensure that previously forgotten areas such as Stoke-on-Trent will get their fair share of funding?

With the PFI contracts and the endless borrowing that Labour instituted, hospitals up and down the country are paying the price for the approach advocated by the last Labour Government—the completely financially reckless and incompetent approach. That is the opposite of what this Government are doing. We are taking the fiscally responsible, reasonable and right approach to fixing this problem.

The Prime Minister said at the Dispatch Box, though it is not in the printed copy of his speech, that the NHS backlog that we face will get worse before it gets better. How much worse?

It would be a great thing if the Labour party would support what we are doing. With the package we have brought forward, we will be able to fix that backlog even faster. If the hon. Member or the right hon. and learned Member for Holborn and St Pancras (Keir Starmer), the leader of the Labour party—[Interruption.] By the way, we did not hear from him whether he is going to vote for these proposals or not: as usual, a great vacuum at the heart of the Labour party. Does he actually support these proposals—yes or no? That is what I would like to know.

I think the Prime Minister, the Chancellor and the Health Secretary deserve enormous credit for coming together and working out a plan for this incredibly difficult problem, and I think people outside this place will recognise that. But does the Prime Minister agree with me that one of the most difficult parts of this challenge is ensuring that we bring out the very best now in our NHS—that we bear down on unnecessary costs and increase quality output from the NHS? Does he agree that that is the key to freeing up that extra resource to get to the frontline of social care?

Yes, we cannot simply continue to funnel huge sums into the NHS without getting the productivity gains that I know that everybody wants to see around the country. Of course, we want to value our frontline NHS workers. That is why we have put up the wages of nurses. It is why we are increasing salaries and recruiting many more. But we must see the gains in efficiency that go with the investment we are making. We are investing record sums, and we also need to see improvements in the NHS service as well.

Cabinet Ministers, Tory Back Benchers and Lords, and businesses large and small are all opposed to this proposal. There is universal criticism of how it will affect young people and those who are less well-off who are working, and, to top it all, the Prime Minister cannot resist interfering in the devolved settlement, even though Scotland voted for a majority of independence supporting MSPs. How long—how long—does this Prime Minister think he can carry on like this before he follows in the footsteps of the right hon. Member for Maidenhead (Mrs May) and loses his majority due to a botched plan?

I leave it to the hon. Lady to speculate on that time, but it is very bizarre that yet again the Scottish nationalists—I think she is a Scottish nationalist—seem to be rejecting the Union dividend that this produces. I hope, and the people of Scotland deserve, that this money is spent on health and social care in Scotland; let us hope it is so spent.

Many in this House have discussed the burden placed on councils, and I echo the concern that this money must be ring-fenced for the local authorities, who take the lion’s share of the burden for adult social care. Can the Government give greater assurances as to how the funding streams will be safeguarded and directed towards local authorities?

My hon. Friend is spot on, and the Secretary of State for Health and Social Care will set out later how we will ensure local councils get the support that they need.

The Prime Minister failed to say a word about the broken private care market that fleeces the frail and suppresses the wages of the workers. Why has he failed to lay out plans to end this broken market and introduce a public national care system?

I know that the Labour party wants to nationalise everything, which would be typically insane since the vast majority of care is provided by the private sector. What we are doing is lifting people’s wages with the national living wage, investing in training and putting half a billion pounds into progression of the caring workforce, and we will also make sure that local councils get the funding they need to support a fair cost of care.

When people cannot get an appointment with their GP they often turn to hospital A&E departments, or miss out on early intervention which places greater pressure on our health system further down the line. As part of his plan for the NHS to recover, will the Prime Minister make sure that everybody can get face-to-face appointments with their GP without further delay?

My hon. Friend is completely right and speaks for colleagues across the House: we need to reform the system so that GPs see the right people at the right time and in the right numbers.

Mike Cherry of the Federation of Small Businesses has said that these plans unquestionably mean fewer jobs and economic damage and that they are “devastating” for businesses trying to

“get back on their feet”.

Why is the Prime Minister intent on damaging the very fragile recovery we have had for the past year?

I disagree vehemently with what the hon. Lady says because the economy is coming back much more strongly than many predicted, including the Office for Budget Responsibility, which is a good thing. If we had followed the advice from the Labour party we would still be in lockdown, but we are seeing growth returning and jobs being created, and I do not believe anything in this plan will do anything to dent that confidence. On the contrary, businesses want to know that their workforce have the security of a good health and social care plan to back them up, and that is what this Government are providing.

As Conservatives, broken pledges and tax rises should concern us. Our finances are in a perilous state; surely a radical review of the NHS is needed if this money is not going to disappear into another black hole. Does my right hon. Friend agree that the Conservative way to raise revenue is to lower taxes, not raise them?

I do agree with that general proposition, but in the current circumstances, after 18 months in which it has been necessary for the Government to perform the most enormous fiscal exertions to put their arms around the country at a very difficult and dangerous time, it is right that we take these steps to put the NHS back on a sustainable footing and to deal with the problems of social care which make long-term solutions for the NHS—the very reform that my hon. Friend and I want to see—so difficult to achieve.

Words I never thought I would say: the Prime Minister is right, we cannot fix the NHS without fixing social care. But we cannot fix social care without fixing local government, and of course in the lifetime of this Government £15 billion has been taken out of council budgets, disproportionately hitting some of the least affluent parts of England and impacting on social care outcomes. Councils need assurances now that funding will follow and clarity on when they will get it and how much it will be; does he understand that?

Actually in the last few years we have seen record increases in local council spending power, and we have continued to support councils throughout the pandemic. My right hon. Friend the Secretary of State for Health and Social Care will be setting out how we propose to support local government going forward with the fair cost of care, but in the meantime may I thank the hon. Gentleman for his unprecedented support for these measures?

I can probably say that in the last 18 months during lockdown I have seen more of the NHS than most people—I have had a neck operation, my baby was born, my back exploded, for want of a better word, and I was paralysed—and I would like to go on record and thank the Royal Lancaster Infirmary for getting me walking again and looking after me and my family.

I say the following in a collegiate sense to everybody. What the Prime Minister has done here is what Andy Burnham wanted to do 10 years ago but never brought it through when he was the last Labour Health Secretary and the shadow Secretary. What the Prime Minister is doing is brave, but I have been saying for years when knocking on doors in my constituency, “Put an extra penny on taxation for the NHS,” and everyone has agreed with me. So, whatever these tax rises are going to be, so be it: we have to protect the NHS—it is our moral duty.

It is wonderful to see my hon. Friend looking so well, and I echo his thanks to our healthcare professionals for everything they do. I believe it is the fixed view of the British people that after a very difficult time it is fiscally right and responsible to protect frontline healthcare and support the NHS but also at the same time to fix the underlying problems, of which social care is just one.

I thank the Prime Minister for introducing this long overdue measure to address the NHS and social care. Across the United Kingdom, and in my constituency of Strangford, small and medium-sized businesses are critically important in providing jobs and boosting the economy. Can the Prime Minister assure this House that across the United Kingdom of Great Britain and Northern Ireland SMEs will not shoulder the burden, as they can little afford it?

I am a fervent admirer of the businesses of Northern Ireland and their ingenuity and ability to innovate, which I have seen many times at first hand. I know they are capable of a very dynamic recovery, and indeed believe that is going on right now. I have every confidence in my right hon. Friend the Chancellor to keep bringing forward those business-friendly, supply-side measures which will drive a very strong economic recovery.

I welcome my right hon. Friend’s commitment to improve and raise NHS capacity. For decades bed occupancy rates in the NHS have been kept too high in the name of efficiency but at the expense of resilience. When it comes to reforming long-term care we need a clear set of principles to be followed: we need to encourage and make it worthwhile for people to save for a rainy day; we need to support families to look after their loved ones; and we must allow enough money to pass down the generations to make it worthwhile to save in the first place. Can my right hon. Friend reassure us that his proposed reforms will meet these tests?

Yes, and I thank my right hon. Friend for his support; he knows a great deal about this subject from many points of view. It is certainly right to bring in the measures that will help to create a private sector market for support in the way I have described, but also more fundamentally from our point of view—my right hon. Friend’s and my point of view—these are measures that support thrift, that support people who save, and that support people who do the right thing: who pay off their mortgage and work hard all their lives to build up something for their families and descendants. So I think these measures are profoundly in the interests of the people of this country.

Let us be clear: Scottish taxpayers are being asked to bail out England’s failing social care system from a mess created by the UK Government. I ask the Prime Minister, in all good sincerity: does he believe that his new poll tax will help or hinder the cause of Scottish independence?

Good luck with that one. That is all I can say to the hon. Gentleman. What the people of Scotland and the whole of the UK are getting is £2.2 billion more across the whole of the devolved Administrations and a £300 million Union dividend. If they do not want to spend it on health and social care, or if they do not want to spend it at all—if he is handing the money back—then let us hear it from the Scottish nationalist party. Do they want it or do they not?

Will my right hon. Friend work with me to examine ways that I can see of getting the finance, technology and political sectors together to do this in a way that can be less of a burden on the taxpayer?

Yes. I thank my hon. Friend. I have been reading some of his brilliant contributions on WhatsApp groups about this issue, and I share his idealism about the ways in which the private sector—the financial services industry—can take advantage of what we are doing to help ordinary people up and down the country to protect themselves in exactly the way that he describes. I know that my right hon. Friend the Secretary of State for Health and Social Care would very much welcome his help as we work towards the White Paper.

I thank the Prime Minister for at least providing clarity that any reference to a “Union dividend” simply refers to devolved nations getting back the taxes that they pay and having the balance filled up with UK borrowing. In his belated attempts to tackle England’s social care crisis, with hedge fund owners to the left of him and millionaire property owners to the right, can the Prime Minister explain what it was that persuaded him to embed the advantages of inherited wealth and privilege, and instead shift the burden for paying for this policy on to the lowest earning and the youngest in society—those with the least assets?

I do not think there is anything much inherited on the left, the right or the middle of this particular trio. Again, I find it extraordinary that the Scottish nationalist party would rather not have the Union dividend that this programme produces. The people of Scotland need to look at what is now being offered in terms of raising the thresholds for protection and helping people across the UK, and I hope that we can all move forward together.

I commend my right hon. Friend for keeping a promise that he made on the first day of his premiership and for his frankness about the difficulties of funding the challenges. There will be millions of hard-working families today looking at his proposals for the cap and floor and welcoming them. Can he confirm that the cap will cover all types of care—residential and domiciliary—and that, given that there is likely to be a need for more care workers, there will be up to £500 million as a training fund within the levy?

I thank my hon. Friend, who knows a great deal about this issue and the pressures that the sector faces. I can tell him that, yes, of course it covers both residential and domiciliary, and yes, there is a £500 million fund to help the caring profession, and we will provide 700,000 training places as a direct result of what we are doing today.