The huge bombshell at the heart of Johnson’s care proposals that politicians haven’t appeared to notice

There is understandably furore over Boris Johnson’s announcement today of his plans to reform care. There are plenty of grounds for arguing they don’t do the job they’re supposed to do. They’re regressive — taxing income rather than wealth, and therefore placing the burden on the young and working rather than the older, more affluent. They’re not actually in the immediate term about care, mostly being used to plug a gap in the Health Service budget after a more than a decade of under-funding. They obviously breach manifesto pledges.

And for those of us in Wales (and Scotland, and Northern Ireland), there are big questions about any conditions that may be attached to the funding. That matters because decisions the devolved nations about health priorities and funding have in many cases been different from England, and wholly properly so; devolution means that decisions are made locally.

But there is a hugely important development that has barely been noticed.

The establishment of a health and care levy — to be explicitly shown on payslips as a separate line from other forms of taxation — means that, for the first time since the foundation of the NHS in 1948, it will no longer be wholly funded from general taxation.

That’s a huge change. Part of the principle of the NHS is that we all pay, collectively, to provide it. Access to the NHS has never been about how much we as individuals have put in — health provision has been a core function of Government.

With Johnson and Sunak’s new levy, that principle has been breached. Health and care have become something that we pay for additionally to taxation; even though most health care, on current plans, will still come from general taxation, the principle has been established. This is about changing the way in which we think about the provision of health care. It is all too easy to see how this could be the first decisive step in a move towards an insurance-based system of provision; but whether that is the intention or not, a fundamental principle of the NHS has been breached.

It is early days yet, but I have yet to see a single Opposition politician pick up on this. That may of course change, but it does seem that among all the noise and fury we are — rightly — hearing about the inadequacy and unfairness of Johnson’s proposals, a huge story is being missed.

It is, quite simply, that quietly, without the political establishment and the media noticing, Johnson has just announced the biggest change to the principles of health funding in the NHS’s history. He’s done what Tories have wanted to do for forty years but have never managed — to change fundamentally the NHS’s funding model.

And in the hours since the announcement has made, no politician seems to have noticed this obvious game-changer.

[NB. Second paragraph has been amended to reflect a better understanding of how the funding for devolved administrations will work, which was unclear and thus widely misreported at the time of the announcement]