Filling the gap: tax and fiscal options for a sustainable UK health and social care system

The NHS and publicly funded adult social care will account for £157bn of public spending across the UK in 2015/16. This is equivalent to 8.4% of gross domestic product (GDP) and accounts for around £1 in every £5 of government spending. This analysis shows that despite government commitments to additional funding for the NHS in the UK, there is still likely to be a shortfall of £2bn in 2020/21, rising to £9bn (above inflation) by 2030/31. For adult social care the pressures are greater. The paper forecasts a funding shortfall of £6bn by 2020/21, rising to £13bn in 2030/31, assuming there is no change in policy. The combined pressures on health and social care funding will amount to an estimated shortfall of £8bn in 2020/21 and £22bn in 2030/31. The government has committed to eliminating the deficit in the national budget by 2019/20 and is planning to run a surplus of £10.5bn (0.5% of GDP) by 2020/21. If the planned fiscal surplus of 0.5% of GDP were spent on health and adult social care, it would close the combined funding gap in 2020/21, but leave an estimated shortfall of £8.4bn in 2030/31. One alternative to taxing income and employment is to tax consumption and in particular consumption that has a harmful effect on health – a so called ‘sin-tax’. The report looks at taxing sugar specifically.