Intended for healthcare professionals

Feature Data Briefing

Who should pay for social care and how?

BMJ 2021; 375 doi: (Published 13 October 2021) Cite this as: BMJ 2021;375:n2418
  1. John Appleby, director of research and chief economist
  1. Nuffield Trust, London, UK
  1. john.appleby{at}

The government’s announcement in September that the NHS and adult social care services across the UK will receive more money over the next few years is potentially an historic change.1

To do so, the government has decided to find the extra cash from an increase in national insurance contributions (NICs) paid by employees and employers, and then to separate out these new sums as a “health and social care levy” in 2023. This essentially introduces a new tax hypothecated to spending on the NHS and social care. Although the new tax will fund only a small proportion (less than 10%) of the total spending on the NHS and social care, it marks an important shift in how we pay for care.

On the one hand, the use of NICs as a source of extra health funding is not new. In 2002 Gordon Brown, the then chancellor, raised NICs by one percentage point to increase NHS spending, for example.2 On the other hand, such moves were …

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