NHS must remain for all – we have to act fairly

blackmorevaleSeptember 29, 20210 Comment0

Pledges and promises made at general elections are contingent on events. Covid has changed everything.

In 2019 the manifesto on which I stood pledged to fix social care and to continue increasing NHS funding. At that time, it could be done without increasing taxes or breaking the triple lock on the state pension. Covid means that’s no longer possible. So, either we bin our promise on the NHS and social care or we raise taxes.

So which tax? Well, a penny on National Insurance would need rather more on income tax to raise the same amount because of the employers’ NI contribution. We could of course tap employers by other means but that would also be unpopular, potentially disincentivising investment.

NI isn’t paid past state retirement age, sparing the cohort benefitting from much of our social care provision. And yes I do have sympathy with the idea that it’s unfair on struggling working youngsters to exempt people of pensionable age from NI. That said, it’s surely right to incentivise economic activity past state retirement age. Pensioners will point out that they have made decades of contributions already and might be cut a bit of slack as they extend their working lives. On taxing the working young to subsidise the elderly, I would point out that, if we’re spared, old age and potential dependency comes to us all. Indeed, it looms sooner than those in the blossom of their youth might imagine!

I support the announcements made this week and have been in touch with ministers to urge precisely the things that have been unveiled. For me it’s wrong that the 1940s healthcare settlement pooling our health risk regardless of personal wealth should exclude the care of people with neurodegenerative conditions like dementia and Parkinson’s as well the general frailty that for some of us will attend old age.

There are those who say that the so-called Dilnot cap aimed at limiting social care costs for those with assets will be regressive, subsidising the better off from the pockets of already hard pressed working families. But be careful since the logical extension of that argument undermines the concept of pooled risk underpinning the NHS which in this country we achieve through taxation. You would in effect be arguing that wealthy company boss should not have his hip replacement paid from the taxes of his shop floor workers. Do that and it’s the end of the NHS as we know it. Do that and we end up with two-tier healthcare, writing out one of the cornerstones of our post war social compact to which all main political parties are firmly committed.

I’m a backbencher so I’m allowed a caveat. The caveat comes from the observation that the Gordon Brown NHS spending splurge was not followed by a commensurate increase in output. Putting more money into the system is necessary, but it’s not sufficient. Dealing with the NHS backlog is dependent not primarily on cash in but on capacity that can’t readily be switched on and off.

Although we have more healthcare workers than ever before, it isn’t clear to me that there are enough right now to translate the extra money announced into meaningful health activity, for example cuts in waiting times. In three years when we are meant to have restored the NHS to a post-covid even keel and be flipping the extra money announced this week to social care we may find we just can’t. That’s because the system, as Gordon found, has an unnerving capacity to swallow it up.