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PODCAST A brand new nursing podcast episode coming soon The latest clinical education on the go Stoma complications: using patient education and engagement to improve outcomes ln this episode, Fiona Le Ber, Clinical Nurse Specialist for Bladder and Bowel, describes the cost and impact of stoma complications to patients and the health service and explores how informing and empowering patients can help both avoid their occurrence and quickly manage the problem when it does occur Fiona Le Ber Clinical Nurse Specialist for Bladder and Bowel, Queens Nurse. RCN Bladder & Bowel Forum -Chair Apple Spotify Soundcloud Sponsored by: Listen to the latest clinical expertise and insight www.bjnpodcast.com
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EDITORIAL Editor in Chief Ian Peate Editor Sophie Gardner sophie.gardner@markallengroup.com Subeditors Carolyn Crawley carolyn.crawley@markallengroup.com Janet Perham janet.perham@markallengroup.com Vicqui Stuart-Jones vicqui.stuart-jones@markallengroup.com Clinical Series Editor Barry Hill Commerical Manager Nicholas Barlow nicholas.barlow@markallengroup.com Circulation Director Sally Boettcher sally.boettcher@markallengroup.com MedEd Manager Tracy Cowan tracy.cowan@markallengroup.com Production Manager Kyri Apostolou Production Assistant Larry Oakes Designer Hal Bannister Publishing Director Andrew Iafrati andrew.iafrati@markallengroup.com Managing Director Anthony Kerr Chief Executive Officer Ben Allen UK PERSONAL SUBSCRIPTION RATES Quarterly Direct Debit £47 Annual Direct Debit £184 Annual Credit Card £194 2yr Annual Credit Card £330 3yr Annual Credit Card £466 Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 Contact: institutions@markallengroup.com for institutional pricing Part of www.markallengroup.com British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6702 Sales: 020 7501 6732 Email: bjn@markallengroup.com Websites: www.britishjournalofnursing.com td Healthcare L 2022 MA © © MA Healthcare Ltd, 2022. All rights reserved. No part of British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. Please read our privacy policy, by visiting http:// privacypolicy.markallengroup.com. This will explain how we process, use & safeguard your data British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) The views expressed do not necessarily represent those of the editor or British Journal of Nursing. Advertisements in the journal do not imply endorsement of the products or services advertised. ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: Adobe Stock The levy is not a magic fix Ian Peate FRCN OBE, Editor in Chief, British Journal of Nursing The announcement that extra taxation measures would be introduced for the whole of the UK (the Health and Social Care Levy Act 2021) was made on 7 September 2021, with a call for its implementation at the earliest opportunity so as to increase funds for the NHS and equivalent bodies.The levy proper, which will come into effect in April 2023, is a tax of 1.25% on earnings, the proceeds of which are payable to the Secretary of State towards the cost of health care and social care. In the meantime, for the fiscal year 2022/2023, National Insurance (NI) contributions for employers and employees will increase by 1.25% temporarily (HM Revenue and Customs, 2021).The self-employed are also subject to the increase. From April 2023, when the levy starts, contributions will return to the current rate.Those above state pension age will not be affected by the NI increase but will be subject to the levy next year. The funds generated will be, in theory, ring-fenced. The estimated £12 billion raised will be used directly to fund increases in health and social care spending (Winchester, 2021). Initially, the money raised will go towards easing pressure on the NHS, and then a proportion of this will be moved into the social care system.Total spending on health and social care in England alone equates to around £235 billion, with the gap covered by some of the roughly £800 billion a year that the government receives from other sources (Pope and Hourston, 2022). The plans for a new ‘health and social care levy’ to fund increases in spending on health, alongside reforms to the provision and funding of social care, follow the Prime Minister’s pledge in 2019 to ‘fix the crisis in social care once and for all’ (Johnson, 2019).This was said to be once-in-a-generation transformation of adult social care and how it is funded, and would better integrate it with health care. However, the bulk of the funds will go not to social care but to health, so how this will ‘fix’ social care and its crises remains to be seen. Over 3 years the sum dedicated to social care is £5.4 billion, while the NHS takes the larger share (Murray, 2021). It is anticipated that the extra money generated will be used to reduce the post-COVID backlog, and to put the NHS back on a sustainable footing, acknowledging the challenges that face general practice, mental health and other services. As regards funding of social care, in England, if a person has assets worth more than £23 250, they currently have to pay for their social care and there is no cap on costs—some people have to sell their homes to cover these. Under the new system, anyone who has assets below £20 000 will not have to pay anything from these assets, although they might have to make a contribution from any income. It is likely that there will be an impact on family formation, stability or breakdown as individuals who are currently just about managing financially will notice their disposable income reduce as a result of the increased contributions.There have been calls to put on hold or reconsider the introduction of the higher NI contributions as household budgets are under pressure as a result of soaring energy prices and food bills—inflation is at its highest level in 30 years.The concern is that the increase will adversely impact younger and lower paid people. The challenge will be to make this reform work. If there are new hospitals and hospital upgrades a bigger workforce will be needed, and more investment in nurse education. Any meaningful attempts to address, for example, the backlog of people needing care and support will mean an increased need for skilled staff. Failing to invest in the nursing workforce will result in waiting lists that will continue to grow and not decline. BJN HM Revenue and Customs. Health and Social Care Levy. Policy paper. December 2021. https://tinyurl.com/474vxz79 (accessed 17 May 2022) Johnson B. Boris Johnson’s first speech as Prime Minister. 24 July 2019. https://tinyurl.com/24wschry (accessed 17 May 2022) Murray R. Raising the Levy:Will the new Health and Social Care Tax work? The King’s Fund blog. 9 September 2021. https:// tinyurl.com/yt4urf4n (accessed 17 May 2022) Pope T, Hourston P for Institute for Government. Explainers: Health and Social Care Levy.April 2022. https://tinyurl.com/2p93vxyt (accessed 17 May 2022) Winchester N for House of Lords Library. Social care funding: a rise in national insurance. 10 September 2021. https://tinyurl.com/ mray6ppa (accessed 17 May 2022) British Journal of Nursing, 2022, Vol 31, No 10 521

EDITORIAL

Editor in Chief Ian Peate Editor Sophie Gardner sophie.gardner@markallengroup.com Subeditors Carolyn Crawley carolyn.crawley@markallengroup.com Janet Perham janet.perham@markallengroup.com Vicqui Stuart-Jones vicqui.stuart-jones@markallengroup.com Clinical Series Editor Barry Hill Commerical Manager Nicholas Barlow nicholas.barlow@markallengroup.com Circulation Director Sally Boettcher sally.boettcher@markallengroup.com MedEd Manager Tracy Cowan tracy.cowan@markallengroup.com Production Manager Kyri Apostolou Production Assistant Larry Oakes Designer Hal Bannister Publishing Director Andrew Iafrati andrew.iafrati@markallengroup.com Managing Director Anthony Kerr Chief Executive Officer Ben Allen

UK PERSONAL SUBSCRIPTION RATES Quarterly Direct Debit £47 Annual Direct Debit £184 Annual Credit Card £194 2yr Annual Credit Card £330 3yr Annual Credit Card £466 Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 Contact: institutions@markallengroup.com for institutional pricing

Part of www.markallengroup.com

British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6702 Sales: 020 7501 6732 Email: bjn@markallengroup.com Websites: www.britishjournalofnursing.com td

Healthcare L

2022 MA

©

© MA Healthcare Ltd, 2022. All rights reserved. No part of British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. Please read our privacy policy, by visiting http:// privacypolicy.markallengroup.com. This will explain how we process, use & safeguard your data British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) The views expressed do not necessarily represent those of the editor or British Journal of Nursing. Advertisements in the journal do not imply endorsement of the products or services advertised. ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: Adobe Stock

The levy is not a magic fix Ian Peate FRCN OBE, Editor in Chief, British Journal of Nursing

The announcement that extra taxation measures would be introduced for the whole of the UK (the Health and Social Care Levy Act 2021) was made on 7 September 2021, with a call for its implementation at the earliest opportunity so as to increase funds for the NHS and equivalent bodies.The levy proper, which will come into effect in April 2023, is a tax of 1.25% on earnings, the proceeds of which are payable to the Secretary of State towards the cost of health care and social care. In the meantime, for the fiscal year 2022/2023, National Insurance (NI) contributions for employers and employees will increase by 1.25% temporarily (HM Revenue and Customs, 2021).The self-employed are also subject to the increase. From April 2023, when the levy starts, contributions will return to the current rate.Those above state pension age will not be affected by the NI increase but will be subject to the levy next year.

The funds generated will be, in theory, ring-fenced. The estimated £12 billion raised will be used directly to fund increases in health and social care spending (Winchester, 2021). Initially, the money raised will go towards easing pressure on the NHS, and then a proportion of this will be moved into the social care system.Total spending on health and social care in England alone equates to around £235 billion, with the gap covered by some of the roughly £800 billion a year that the government receives from other sources (Pope and Hourston, 2022).

The plans for a new ‘health and social care levy’ to fund increases in spending on health, alongside reforms to the provision and funding of social care, follow the Prime Minister’s pledge in 2019 to ‘fix the crisis in social care once and for all’ (Johnson, 2019).This was said to be once-in-a-generation transformation of adult social care and how it is funded, and would better integrate it with health care. However, the bulk of the funds will go not to social care but to health, so how this will ‘fix’ social care and its crises remains to be seen. Over 3 years the sum dedicated to social care is £5.4 billion, while the NHS takes the larger share (Murray, 2021).

It is anticipated that the extra money generated will be used to reduce the post-COVID backlog, and to put the NHS back on a sustainable footing, acknowledging the challenges that face general practice, mental health and other services.

As regards funding of social care, in England, if a person has assets worth more than £23 250, they currently have to pay for their social care and there is no cap on costs—some people have to sell their homes to cover these. Under the new system, anyone who has assets below £20 000 will not have to pay anything from these assets, although they might have to make a contribution from any income.

It is likely that there will be an impact on family formation, stability or breakdown as individuals who are currently just about managing financially will notice their disposable income reduce as a result of the increased contributions.There have been calls to put on hold or reconsider the introduction of the higher NI contributions as household budgets are under pressure as a result of soaring energy prices and food bills—inflation is at its highest level in 30 years.The concern is that the increase will adversely impact younger and lower paid people.

The challenge will be to make this reform work. If there are new hospitals and hospital upgrades a bigger workforce will be needed, and more investment in nurse education. Any meaningful attempts to address, for example, the backlog of people needing care and support will mean an increased need for skilled staff. Failing to invest in the nursing workforce will result in waiting lists that will continue to grow and not decline. BJN

HM Revenue and Customs. Health and Social Care Levy. Policy paper. December 2021. https://tinyurl.com/474vxz79 (accessed 17 May 2022) Johnson B. Boris Johnson’s first speech as Prime Minister. 24 July

2019. https://tinyurl.com/24wschry (accessed 17 May 2022) Murray R. Raising the Levy:Will the new Health and Social Care

Tax work? The King’s Fund blog. 9 September 2021. https:// tinyurl.com/yt4urf4n (accessed 17 May 2022) Pope T, Hourston P for Institute for Government. Explainers: Health and Social Care Levy.April 2022. https://tinyurl.com/2p93vxyt (accessed 17 May 2022) Winchester N for House of Lords Library. Social care funding: a rise in national insurance. 10 September 2021. https://tinyurl.com/ mray6ppa (accessed 17 May 2022)

British Journal of Nursing, 2022, Vol 31, No 10

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