Friday, 12 January 2018

Policy, not money, is the main problem with the NHS

One recent response to the problems of the NHS has been the call for an extra penny on tax to provide more funding.  I don’t doubt that many will find this an attractive idea, and it’s certainly one way of ‘selling’ a tax increase, but I’m not convinced.  An extra 1p on all rates of income tax would raise an estimated extra £5.5 billion a year, or around 3.5% of the total health spend.  That certainly looks like a lot of money (although a cynic like me would point out that it is less than a third of the bonus which the NHS was allegedly going to get from Brexit: that infamous and largely imaginary £350 million a week works out at £18.2 billion a year).
However, I’m dubious about the idea of hypothecated taxation, particularly when the hypothecated tax in question only funds an ‘increase’ in spending.  I don’t trust governments to use the extra cash in the way that those supporting such a tax increase would prefer beyond the first year.  It would be very difficult to prove that the whole of the money raised by the extra penny was actually being used on the NHS, given that the bulk of NHS spend would still be coming from ‘other’ taxes, and the amount of that spend will vary.  And with a total budget of around £147 billion, it doesn’t take many years of a stagnant base budget for the ‘extra’ £5 billion to disappear, even if inflation remains very low.  I’m also not convinced that the problems with the NHS are as simple as a need for extra money (which is not to say that extra money isn’t required).  There are other policy issues as well.
But my main reason for disliking this proposal is that it reinforces and perpetuates the myth that the problem with public services is that the government doesn’t have enough money to meet the needs of citizens.  The prime constraint on the amount of money provided to the NHS by the government isn’t affordability, it is policies and priorities. For all the fine words uttered by ministers about the NHS being a national treasure and ever so close to their hearts, their actions don’t match those words; they choose to follow a policy of reducing overall expenditure rather than one of providing necessary services.  The obsession with balancing the budget is based on ideology, not economics.  And the fact that it isn’t a necessary policy objective is underlined by the continued ‘adjustment’ (i.e. deferral) to the timescale for achieving it.  We can fund a proper health service if we want to, without gimmicky proposals like this one.


Anonymous said...

I think you miss the point. The problem with the health service isn't about funding, it's about what services the NHS is meant to provide.

Significantly less than it currently provides is the honest answer. And to provide 'significantly less' it has more than enough money.

But try telling that to an ever demanding population. And try getting them to understand the why's and wherefore's.

John Dixon said...

"Significantly less than it currently provides is the honest answer." Perhaps unsurprisingly, I don't agree with that statement, although it's so devoid of detail as to be meaningless. But if by any chance I did want to "try telling that to an ever demanding population", I think that I might start by explaining what it means rather than assuming that it's their problem for not instantly agreeing with a wild assertion stated as though it were incontrovertible fact.

Anonymous said...

Your point about policy seems to be backed up by the recent British Dental Association report about tooth decay in England. Tooth decay is the number one reason for youngsters going to hospital in England. Unlike Wales, England has no dedicated child oral health programme and the BDA feel that England has a second rate service compared to Wales and Scotland. The Royal College of Paediatrics and Child Health Smith said the figures were "startling" and "should act as a wake-up call to policy makes".

Spirit of BME said...

Throughout my adult life the one consistent theme about the NHS has been -it’s not working.
More and more money does not solve the problem; therefore, it could well be the structure, constraints and general bad policy and timidity in taken on this emotional emblem that is carefully nurtured by the vested interests that support their way of life.
This vast apparatus is never going to work as it`s size makes it unmanageable, all policies are compromises and one size fits all has wreaked havoc, so money is not the problem, what is the problem is productivity.
To give an example Imperial Collage issued data on GP`s (who are private contractors), showing the big increase in women GP`s, but only one fifth elect to work full time, with male GP`s only fifty percent elect to work full time. I checked with my very busy surgery that has five doctors (male and female) and none work full time. So, the extra money put in to create doctors do not increase capacity.
The reasons can be personal, but the amount the get paid puts them higher tax bracket and the more hours they work brings the per hour rate down and might well put them in the super tax bracket, -airlines have the same problem with pilots.

Anonymous said...

In my experience, basic administration within the health service is often shockingly chaotic which in turn results in enormous waste. Furthermore, although no politician would dare to say it, the quality of the staff the NHS employs is hugely variable. Some are, of course, outstanding. But there are others who fall well short of adequate. I am not sure if that is down to inadequate training or simply a reflection of the quality of the available abour force. In both cases though, I doubt that more funding will, of itself, resolve the problem.