I posted this thread on Twitter this morning because an immediate opportunity to use my new report n NHS funding arose when Sajid Javid took the Guardian front page to say that NHS appointments should be charged for. This is exactly why I wrote the report: we need to have counter-arguments:
Sajid Javid says we need to pay £20 for a GP appointment and £66 to go to A&E as a way to solve the NHS funding crisis. He's wrong because there are so many better options in my new report on funding the NHS. A thread…..
There are 367 million GP appointments in the NHS each year. Assuming everyone had to pay (and I bet children and pensioners would not) at £20 a time that would raise £7.3bn in extra revenue.
In England there are roughly 27 million A&E appointments a year, which at £66 each, assuming everyone paid, would raise £1.8 billion a year.
So, Javid wants to raise £9.1 billion a year by imposing a sickness tax on those wanting to see a doctor. But that's before exemptions and before the massive cost of actually collecting this money, which can't be ignored. So, let's guess it's £6 billion after exemptions.
In my new report on NHS funding out today I suggest the NHS needs £30 billion extra a year to function properly. So Javid is not proposing anything that will make any big difference to its fortunes. But he is going to hit the poorest hardest.
I have suggested how to find the £30 billion required to pay for the NHS we need. Half would come from extra taxes paid simply as a result of spending the extra money on the NHS or by making people well enough to work again. In the real world that's what happens.
But that stills leaves £15 billion to find. That could come from halving the tax reliefs given to the wealthiest 10% in the UK on their pension and ISA accounts which cost a staggering £30 billion a year in total. Wouldn't that be better than charging the sick?
Or we could double the rate of capital gains tax and collect maybe £15bn a year. It is absurd that right now this tax, paid almost entirely by the wealthiest, is charged at half the rate of income tax. Wouldn't that be better than charging the sick?
Alternatively, we could invest £1 billion in HM Revenue & Customs to tackle tax abuse. It is reckoned they collect £18 for every £1 spent. So that could also raise the money needed. Again, wouldn't that be better than charging the sick?
And there are other tax options as well on top of which the government could simply run a deficit to pay for this or do QE to fund the NHS as the Tories did for other crises.
But what we do not need to do is charge the sick what is, in effect, a new tax when being sick is already a good indicator of being on lower than average income and Javid's sole aim in doing this is to pave the way for NHS privatisation, and his scheme raises insignificant money.
We need a debate on NHS funding but crass ideas from Sajid Javid and his like on NHS charging need to be dismissed out of hand when vastly better options from taxing the best off more fairly or from borrowing are available.
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Not sure where the data resides but a look at Prescription charge revenue versus number of prescriptions issued might give a decent proxy for how much charging for a GP visit might raise. There should be a link between no. of appointments and number of prescriptions and it would be odd if someone were deemed poor enough to deserve free medicine but not poor enough to see the doctor (for free) to get it prescribed.
I suspect looked at in this way that £7.3bn from GP appointments would be massively lower.
The truth is that we must spend more on health… one way or another. Either
(1) a universal insurance system where premiums are determined by the ability to pay. Or…
(2) a free market where organisations can provide medical services wherever it makes commercial sense to do so.
My preference is (1)….. and I would call the premiums “tax” and call the provider of the service “NHS”!
Or we just tax the wealthy more…..much easier
… that is my point – we already have the system. It is called “tax” and is the fairest way to fund health spending.
We agree again
As much as I can see the sense in tax the rich to pay for this 12 year in the making ‘crises’ – given that some of the rich are telling us until they are blue in the face that they are undertaxed, I would have mixed feelings about using a wealth tax to fund the NHS long term.
I’m uncomfortable with it, given what I’ve learnt over the years about taxation verses sovereign money creation and the functional inability for a currency producing nation of not having enough money or running out.
So, not only does taxing the rich jar against the fact that the NHS is actually affordable by the money creating agency that created it, I further object because it creates once again a ‘them and us’ situation that is ripe for abuse and manipulation.
As the late John Hills says, there is no such thing as ‘them and us’ – there is just ‘us’ (Good Times, Bad Times’ – 2017).
If I remember correctly Prof Paul Spicker might favour a form of insurance system noting how the numbers lessen the costs but I’d have to re-read some of his output. ‘How to Fix the Welfare State’ (2022) is still on my ‘must read’ list and he points the finger at too many bad reforms in the introduction. Having consumed many of his books over the years I’d trust his viewpoint.
In his 2000 book ‘The Welfare State: a General Theory’, Spicker emphasises welfare as a mode of collective action, of which government – for all its role as final arbiter – is a mode of such collective action itself and also redistribution (echoing Hills) : ‘People live in society and have obligations to each other’. Prof. Spicker notes that collective action and mutual aid develop naturally in society, and such schemes are attractive to most people. Spicker’s ‘General Theory’ in my view should be used to relaunch and recommit government to paying for the NHS, added to a much better understanding and recognition of its outputs.
What bothers me about the tax issue is that just becomes a political football in itself – something to be used manipulated to get people to vote for you. Look what happened to the poll tax.
I remain unconvinced but at least the ideas you have shown in the blog show a damn sight more imagination than the government.
I wholly accept your point
But Reeves, Starmer and Streeting won’t
So I framed my comments within their paradigm
Sometimes I am pragmatic
The mainstream and social media will probably report this as ‘the alternative’ to the present situation, and debate it as such. The Thatcherite ‘there is no alternative’ is a key weapon in their armoury.
Usually linked to it is the suggestion that the NHS ‘must be reformed’ and ‘the existing model can’t continue’. In fact as Richard pointed out recently, it was ‘reformed’ in 2012 and sone of its problems result from the Health and Social care Act 2012. The unstated implication is that we must switch to an insurance system.
I see signs we are being ‘softened up’ for such a discussion.
The real alternative is to remove most of the ‘market mechanisms’ ; use the NHS staff to suggest innovation as they have a better idea of how things work in the real , non-ideological world and fund it properly.
I have shared this with a nurse I know and I hope more do so.
Thanks
It is going well on Twitter
Why not expose the whole corruption in straightforward simple terms like tax dodging is running at £120bn annually and rising, the rich are money fiddling and laundering and hoarding and sitting on £11trn in off shore accounts whichis 4 times more than our GDP. They are economic terrorist and have turned the city of London into the money laundering centre of the world and Britain into the most corrupt country in the world.
The rich have become a world wide Cabal, and are economic terrorist, responsible for 99% of the world’s problems. A 10% windfall tax would give us £1.1trn enough to put our country back on its feet, and we don’t need to raise taxes only to collect taxes properly.
We need to highlight these facts laud and clear on a daily basis until the British public get it, perhaps then we could turn around the economy and run our country properly instead of running it on the cheap.
Andrewdaviswdt@yahoo.com retired community worker
Some of those figures are out of date
Richard I assume you mean that the numbers have got bigger?
there is massive and growing inequality in this country and it needs to be addressed Most people i know- myself included, are aware but have no idea on how to improve things. thanks for talking about this stuff.
One simple way to raise more revenue would be to bung a bit of money to HMRC (a few tens of thousands, I’d imagine), to investigate the tax affairs of the current cabinet. Should raise a few quid.
If the investigation was backdated to investigate every minister since 2010, it could probably pay for a hospital or two…
“on top of which the government could simply run a deficit to pay for this”
Isn’t this the real message.
The rest perpetuates the myth that tax “funds” government spending…often a Tory, right wing message
But I have to be careful how I say it
‘The current model is unsustainable’
Of course, inserting a parasitic wealth extraction structure in to the nhs is unsustainable! It clearly hasn’t worked for railways, energy, water, the postal service, buses, or any public service. I’m not saying private enterprise is bad, I run my own business, but should we really be funding this profiteering with payments to see doctors and a&e? That’s what national insurance is for. It’s not free for point of use we already pay for it. If we need to debate whether we should be paying more NI that’s fine, Australia has a good private healthcare system but they pay more for it under the Medicare levy. Private doesn’t always mean bad but the dismantling of the health service is mendacious. We can even debate the scope of what the NHS should provide going forwards but there needs to be a root and branch reform removing the parasites that have hamstrung the NHS, then we might find that, like during the last 70 years, public healthcare is affordable. Since 2012 the end game was this situation, what is needed is the vision to sort out this complete shit show that the Tories have intentionally created. Somehow I doubt labour are up to this task from what I’ve been hearing from the shadow health secretary.
My only point is NI is not a hypothecated tax
I’m not wholly against privatised health care, if it’s done well as part of a fair and coherent structure.
Problem is the UK doesn’t really seem to manage privatised public services very well. UK governments tend to just privatise things in isolation without having an actual system for how services will integrate and end up with choas, or privatised ‘milking’ of profitable elements like PFI.
In the Netherlands they have a kinda socialised private healthcare system, if that makes sense. The poor are protected. Premiums and coverage have to adhere to certain basic guidelines, such as a minimum basic healthcare premium, which has to cover 90% of what would be required. You can then top up other areas with a more expensive policy (smaller excess, additional coverage etc). So although it’s privatised, it’s nothing like the wild-west situation in America. People (including the poor) are protected, it’s just a more convoluted way of arranging things than a nationalised system.
Hospitals are allowed to fail. A large hospital went bankrupt recently and was not bailed out by the government.
I find it infuriating though, that the NHS has been deliberately de-funded for a decade, and now the consequences of this are being held up as evidence of its unsustainability. No – if you deliberately de-fund any service it will eventually fail. The NHS and social care need substantial investment and reinvigoration, and simplification of structures and mission. Don’t make it more complicated than it needs to be. Start by funding it properly.
I think dentristy is the canary down the coal mine in terms of UK healthcare.
NHS provision has dwindled over a long period and many people rely on private provision but without having a socialised form of health insurance to shield them against large bills.
Since leaving the UK I realised that the stereotype about “English Teeth” really is a thing. So many people in the UK, not just poor either, have extremely poor dental health and hygiene. It’s really, really shocking when you notice it, but living in the UK you just accept it as normal and don’t notice it compared to other comparable countries. It really needs improving.
In the report summary you posted in the blog post about your report on NHS funding you suggest that £15billion (50%) of the £30 billion required would come back to the Treasury from tax raised from increased and better paid NHS employees, from the multiplier effect (though that wasn’t immediately clear) and from healthier people being able to return to the workforce.
What is interesting me is ‘What about the other £15 billion?’. I’m not disputing the figure, just wondering what the rationale for it is. Are you calculating that none of this money will be subject to UK taxation because it will either go to foreign suppliers of goods to the NHS; or be diverted to savings which will only be subjected to UK taxation when, or if, it is spent at an unknown date in the future, so cannot be relied on? (Or something else I’ve not thought of…)
No, it’s just to be cautious and to avoid being accused of optimism I used the lower end of assumed multiplier effects for healthcare spending
Is there any generally assumed and accepted set of standards for the multiplier effect?
No
Look – call me old fashioned, call me addicted to Clem Attlee but why don’t they just print the bloody money the service needs?
That was the original deal. That was the original commitment from the sovereign currency producing government that we have.
Some commentators (Byline Times for example) refuse to see the NHS as in crisis, because a ‘crisis’ is something that emerges out of the blue, something sudden. And I agree with them and therefore our solutions need to reflect that, but I also realise that the optics we use have to operate in the reductionist philosophies we suffer under.
What is happening to our NHS has been engineered right from when that complete arse David Cameron said he would not reduce the NHS budget in 2010 (he did not increase it either – and that is why we are where we are now).
And I will talk about NHS dentistry again – which is in worse condition than the rest of the NHS and where practices are literally taxing patients for broken teeth and other misfortunes in a country addled by austerity and declining wages .
It’s a disgrace. What we are seeing is the individualisation of misfortune and ill health – a totally stupid idea that refuses to acknowledge the collective power of insurance systems and instead will lead to people being impoverished by their circumstances very often beyond their control. So much for ‘society’.
I’m getting really sick and tired of pricks like Javid opening their traps and talking like this. Is he prepared to die for his ideas? I wonder?
“Look – call me old fashioned, call me addicted to Clem Attlee but why don’t they just print the bloody money the service needs?”
Because the way that the NHS is set up, and the use of Private Finance Initiative (PFI) schemes would mean that much of the money would go into private hands. Some NHS locums are being paid £3,600 per day, which I don’t think is value for money. PFIs are a scandal, and the public are paying the price.
Ian – come on – you know what I mean – I’m talking about the NHS as it was set up – with no PFI or the marketisation nor the 2012 ‘reforms’. The ‘reforms’ in 1974 did not seem to help either according to some pro-NHS commentators and academics.
There has been too much emphasis on cost over quality and political management of what are clinical problems.
This government will do anything except fund the NHS properly. And I do worry that Labour are no different.
And that also extends to how both parties seem to reluctant to alter our market driven lives that pollute our air, water and food stuffs and actually cause clinical problems in the first place.
#psg. In which case, I entirely agree, funding is purely a political decision, and it could be funded if they wanted to
There is not only a problem with the NHS, but teachers, ambulance workers, physiotherapists, bus drivers, rail workers, university staff, and civil servants are all striking. This suggests a common problem, and not a problem specific to any particular industry.
If the Tories had just ousted a Labour government, it might suggest Labour policies were at fault. But the Tories have been governing for 12 years, equivalent to over 2 full parliaments.
In summary, it suggests that Tory policies are solely to blame for the collapse of public services, the evidence we see around us shows that they do not work.
You are right
This book looks interesting and depressing: How to Dismantle the NHS in 10 Easy Steps by Youssef El-Gingihy (2nd ed 2018). 71 pages.
“The remit of my book is charting how the NHS has been insidiously converted into a market-based healthcare system over the past 25 years. [..] Although nobody has told you this, the NHS has been effectively abolished. The national in National Health Service has been removed.” A preview can be found on Amazon https://www.amazon.co.uk/dp/1789041783
The first edition was reviewed in the Independent.
https://www.independent.co.uk/voices/how-the-nhs-is-being-dismantled-in-10-easy-steps-10474075.html
Youssef El-Gingihy is on Twitter: https://mobile.twitter.com/elgingihy
Here’s another Tory policy that adds extra costs to the NHS, summarised quite nicely in Telegraph in 2011. Some of the examples given are truly shocking, bordering on the criminal.
Private Finance Initiative: hospitals will bring taxpayers 60 years of pain
Andrew Gilligan, 24 January 2011
“Private contractors who agreed PFI deals with the Government are set to make billions of pounds in profit, with some due to see returns of up to 71 per cent. ”
https://www.telegraph.co.uk/news/politics/8279974/Private-Finance-Initiative-hospitals-will-bring-taxpayers-60-years-of-pain.html
We watched the delightful Bank
Of Dave last week. Based on a true story .I think you would love it. It is still functioning today.
I have followed you for nearly 20 years Richard, when we produced the video Stamp out Poverty . Jon Snow fronted it and believed it could happen. The small currency transaction tax was promised by Brown when he would eventually come into office when Blair stepped down. Of course it would never be allowed by the City as it was perceived that this tiny
tax on trading (it would raise 2 billion per year I believe) would ‘open the floodgates’ to a fairer taxation system and start to make our country a fairer place. At the time the staff at HMRC were too
Few, too inexperienced and has no power over than going for ordinary people instead of real tax evaders.
You are right, Starmer and his current band are no better than the Tories. They will keep the status quo .
So sad .
I remember the film Min