Scottish ministers are likely to prioritise the NHS when they decide how to spend additional revenue raised by a UK government tax aimed at ‘fixing’ social care, says an independent think tank.

Scotland will receive an extra £1.1bn a year from the UK government’s health and social care levy by 2024, according to a Scottish parliament briefing.

But a new report from Reform Scotland voices concerns most of the cash could go to health service waiting lists, raising questions over how a promised National Care Service will be paid for.

Research director Alison Payne said the debate had largely focused on setting up a new agency rather than paying for improvements to care and staff conditions, as the bill looks set to rise beyond the initial estimate of £660m.

“The eligibility and the wage element contained in the Feeley review are really important,” she told healthandcare.scot.

“Clearly there’s political agreement that work needs to be done. But we are not yet having the hard discussion about how we are going to find just under a billion pounds.”

Earlier this year Scottish Care’s Dr Donald Macaskill said no-one was having a discussion about how to pay for a National Care Service “worthy of its name”.

An independent review published earlier this year called for the creation of a National Care Service, saying this would cost at least £660m.

Last month Derek Feeley described the figures as a “reasonable approximation”.

The review lead told a Scottish parliament committee: “The numbers are as realistic as we could get them in the time that we had available. However, we spent most of our time talking to people rather than doing financial analysis.

“Again, those are probably floor rather than ceiling numbers and they exclude investment in fair work, because we could not quantify that before we knew what the hourly rate would be, for example.”

Local government body COSLA has suggested the figure could be closer to £1bn.

In a paper published this week, Reform Scotland calls for a 1p rise on all rates of income tax as a stopgap measure while a cross-party commission develops a long-term funding model.

A social insurance model, which would see everyone pay into a central pot, is recommended in the research paper.

In a foreword, Paul Gray, former Chief Executive of NHS Scotland, said policymakers had to be open to ‘radical change’.

‘This might (and in my view must) include the removal of some existing silo boundaries, changes to working practices and skill mixes, and more effective recognition of the third sector,’ he says.

‘It must leave open to question whether we need so many governance bodies and organisations, or whether this landscape could be simplified for the benefit of the public.’

Despite the national insurance rise being billed as a way of funding care reforms, just £5.4bn of the combined £36bn – less than one in every six pounds – that will be raised by the new levy is earmarked for care in England.

The new tax will be collected from taxpayers across the UK. Kate Forbes, the Scottish finance secretary, said the money will go to health and social care in Scotland but has not indicated how this will be split.

Reform Scotland’s report says: ‘It is also important to note that the majority of the revenue raised for Westminster will be directed towards the NHS, not social care.

‘Similar backlog issues exist in Scotland, which will likely result in the NHS in Scotland also being the priority for expenditure.’

Read more: Social care review: What does the report say?; ‘Top down’ care review plans branded ‘huge mistake’; Election social care funding plans ‘fall short’

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