A taxing question for the NHS

There is serious trouble ahead if the Conservatives enact their planned reforms of Britain’s health

Attempts to overhaul the National Health service have descended into an insurgency battle, with the people who make the NHS work, united with policy experts on one side, and the Health Secretary on the other.

The King's Fund released a devastating critique of the coalition's health reforms on Thursday, warning that there's a £1bn black hole in funding for care of vulnerable people. It's the latest in a line of warnings about the reform programme by this influential think tank. There is serious trouble ahead.

Here's the long-shot question. Could this lead to a form of local income tax or local insurance by the back door?

I ask this because there's a good chance that your local council will end up picking up the pieces when the NHS falls apart. And that is a "when", not an "if".

There's been a lot of smoke and noise about the government's health reforms, which are currently going through parliament. The focus has been on GPs taking over the commissioning work of primary care trusts (PCTs).

But this is only one part of the headache that has led to personal interventions by both David Cameron and his policy overlord, Oliver Letwin. Despite claims from No 10 that the problem is communication, neither has been that happy, which might explain the rumours in the Department of Health HQ at Richmond House that Phillip Hammond could be set to take over Health in a post-local election reshuffle in May.

If Hammond gets the gig, it will come with a toxic in-tray of failing hospitals, closing hospitals, collapsing care-home businesses, militant doctors and a budget crisis. But what is really eating at GPs and hospital managers is the fear of what kind of system Lansley is going to leave them.

The King's Fund has warned that there will be more emergency admissions as care for older people collapses. This is because councils are cutting back on social care spending. They are limiting provision to only those rated as having "critical need". At the same time they have frozen care-home fees.

The freeze led to Southern Cross, the country's biggest residential care firm, warning that it is facing deep financial problems.

There are others in a similar position and as interest rates go up, those with severe problems will go to the wall.

No warning lights

And the foundation trusts, set up by Alan Milburn, have warned, hospital closures are inevitable. Hidden within this a deeper problem, that the internal market created by Labour has destroyed relations inside hospitals as departments compete for patients. That's before the hospitals start competing with each other.

Worse still, with the move to "light-touch" regulation, the government has no idea where the system is failing. Nor does it have the capacity to handle its reforms, as there's no "dashboard" with warning lights.

Monitor, the body that inspects management of hospital trusts, has already warned that it cannot guarantee future oversight in its part of the system, for example.

What we'll be left with is a fragmented, cash-starved contraption that barely functions outside the A&E units. And it will be councils that will have to step in as the Health Bill also re-creates public health officers to oversee their communities.

We have already seen what happens when it goes down. Kent County Council stepped in when Maidstone and Tunbridge Wells NHS Trust collapsed in October 2007, after a damning report showed 90 deaths were linked to Clostridium difficile outbreaks in its hospitals at Maidstone, Pembury and Tunbridge Wells.

That was in the good times, when the council had managers with health expertise at the top. The situation hasn't got better there, either.

So as the cash runs out across the system and the poor performers break, the GP consortiums will push down decisions to close services to councils.

Which will create more rows like the one running between Enfield Council and its health partners, over the decision to close an A&E unit at Chase Farm Hospital. The matter has been referred to – you guessed it – Andrew Lansley.

One outcome is that, as the waves come crashing in, the coalition will look to inject emergency cash quickly into the NHS. Councils will by then have oversight and some of the budget, and so will demand more. One option would be to allow council-tax increases, which Labour would use to tear the Tories apart.

Someone in the Lib Dems will remember a dusty pledge to hypothecate and localise taxes with a form of local income tax. You just create a localised version of NI to pay for care, linked to the survival of your local hospital.

Imagine the press release: "Nick Clegg saves NHS with NI for 21st century". I'd put money on it – and pray that the coming winter is a mild one.

Chris Smith is a former lobby correspondent.

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The Women's March against Trump matters – but only if we keep fighting

We won’t win the battle for progressive ideas if we don’t battle in the first place.

Arron Banks, UKIP-funder, Brexit cheerleader and Gibraltar-based insurance salesman, took time out from Trump's inauguration to tweet me about my role in tomorrow's Women’s March Conservative values are in the ascendancy worldwide. Thankfully your values are finished. . . good”.

Just what about the idea of women and men marching for human rights causes such ill will? The sense it is somehow cheeky to say we will champion equality whoever is in office in America or around the world. After all, if progressives like me have lost the battle of ideas, what difference does it make whether we are marching, holding meetings or just moaning on the internet?

The only anti-democratic perspective is to argue that when someone has lost the argument they have to stop making one. When political parties lose elections they reflect, they listen, they learn but if they stand for something, they don’t disband. The same is true, now, for the broader context. We should not dismiss the necessity to learn, to listen, to reflect on the rise of Trump – or indeed reflect on the rise of the right in the UK  but reject the idea that we have to take a vow of silence if we want to win power again.

To march is not to ignore the challenges progressives face. It is to start to ask what are we prepared to do about it.

Historically, conservatives have had no such qualms about regrouping and remaining steadfast in the confidence they have something worth saying. In contrast, the left has always been good at absolving itself of the need to renew.

We spend our time seeking the perfect candidates, the perfect policy, the perfect campaign, as a precondition for action. It justifies doing nothing except sitting on the sidelines bemoaning the state of society.

We also seem to think that changing the world should be easier than reality suggests. The backlash we are now seeing against progressive policies was inevitable once we appeared to take these gains for granted and became arrogant and exclusive about the inevitability of our worldview. Our values demand the rebalancing of power, whether economic, social or cultural, and that means challenging those who currently have it. We may believe that a more equal world is one in which more will thrive, but that doesn’t mean those with entrenched privilege will give up their favoured status without a fight or that the public should express perpetual gratitude for our efforts via the ballot box either.  

Amongst the conferences, tweets and general rumblings there seem three schools of thought about what to do next. The first is Marxist  as in Groucho revisionism: to rise again we must water down our principles to accommodate where we believe the centre ground of politics to now be. Tone down our ideals in the hope that by such acquiescence we can eventually win back public support for our brand – if not our purpose. The very essence of a hollow victory.

The second is to stick to our guns and stick our heads in the sand, believing that eventually, when World War Three breaks out, the public will come grovelling back to us. To luxuriate in an unwillingness to see we are losing not just elected offices but the fight for our shared future.

But what if there really was a third way? It's not going to be easy, and it requires more than a hashtag or funny t-shirt. It’s about picking ourselves up, dusting ourselves down and starting to renew our call to arms in a way that makes sense for the modern world.

For the avoidance of doubt, if we march tomorrow and then go home satisfied we have made our point then we may as well not have marched at all. But if we march and continue to organise out of the networks we make, well, then that’s worth a Saturday in the cold. After all, we won’t win the battle of ideas, if we don’t battle.

We do have to change the way we work. We do have to have the courage not to live in our echo chambers alone. To go with respect and humility to debate and discuss the future of our communities and of our country.

And we have to come together to show there is a willingness not to ask a few brave souls to do that on their own. Not just at election times, but every day and in every corner of Britain, no matter how difficult it may feel.

Saturday is one part of that process of finding others willing not just to walk a mile with a placard, but to put in the hard yards to win the argument again for progressive values and vision. Maybe no one will show up. Maybe not many will keep going. But whilst there are folk with faith in each other, and in that alternative future, they’ll find a friend in me ready to work with them and will them on  and then Mr Banks really should be worried.