NHSreality is against hypothecated taxation as a simple solution. Comments are listed in the postings below. The Times feels we need it, but NHSreality predicts that it will solve no problems. It will just delay solutions… We may become even more polarised, but share more…
When a strike by the British Medical Association threatened the incipient National Health Service, its founding minister Aneurin Bevan pushed up the wages of the nurses and gave so much to the hospital consultants he could reflect later that he had “stuffed their mouths with gold”.
The pay deal for NHS staff in England announced in Westminster yesterday was not exactly a gold stuffing but it was an overdue rise which will cost £4.2 billion in total. More than a million NHS staff have been offered increases of at least 6.5 per cent over three years south of the border and the Scottish government is now holding talks to agree a matching deal for 147,000 workers in Scotland. The English package, if it is ratified by staff, will mean that the lowest paid staff — cleaners, porters and catering staff — will receive a 15 per cent pay rise and a nurse will receive a rise of 21 per cent over three years. This is salutary news. Vacancies for nurses and midwives in Scotland have risen 353 per cent since 2011.
As welcome as it is, however, more money in the NHS can never be enough.
This is more of a commentary on the changing nature of health needs than it is a criticism of the NHS which is, by international standards, an efficient system. An ageing society in the developed world spends the bulk of its health budget on chronic conditions. As the frontiers of technology move back, patients expect better, more expensive, treatment. Social care, outside the NHS but vital to its smooth functioning, has been savagely cut and this throws costs back on to the NHS. Health inflation has been running well in advance of whole-economy inflation for many years now.
Reform programmes need to be accelerated. As long as the NHS remains organised around large hospitals it will be out of date, but attempts to centralise services in Scotland have hit such public and political backlash that progress has been stifled. Social care also needs to be integrated properly into the health service.
The creation of joint council and NHS boards to oversee community care in Scotland is yet to deliver this vision — the very reason for what has been a time-consuming re-organisation. The new joint boards still work with funding streams funnelled through health boards and councils and services talk about “set aside” budgets for hospitals. If real reform does not happen, every few years there will be a reckoning; a higher budget will be sought which will never suffice. Britain spends 8.3 per cent of its GDP on healthcare. The Kings Fund and the Office for Budget Responsibility have both estimated this will need to rise to 12 per cent by 2025 to keep pace with demand.
The funding, though, has to be made secure and the best way to do that is to separate it from general taxation. The Treasury has historically been suspicious of dedicating taxation to particular purposes but Nick McPherson, a former permanent secretary, is one of many prominent figures arguing for a hypothecated health tax. Nick Boles MP suggested rebranding National Insurance as National Health Insurance to help win public consent for the extra resources the health service needs. This would also remind users that while the service is free at the point of delivery, it is not free.
The NHS occupies a special place in British life. Its importance will not be recognised, though, by going slow on change. If we want the service to stay the same, its funding will have to change.