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To save the NHS, we need a ring-fenced tax

The Liberal Democrat spokesperson for health explains why her party are proposing a health and social care tax. 

No one can be in any doubt that a crisis has been unfolding in our NHS and social care services in recent months. The reports of cancelled operations, patients stranded on trollies, treatment standards reduced and ambulances queuing for hours outside A&E departments have been relentless. And while the headlines and the statistics are bad enough, the personal toll on the patients seeking treatment and the staff working in these conditions is more horrifying still.

Needless to say, this adds yet more weight to the already overwhelming case to give the NHS and social care more funding. Even Theresa May, who only a couple of months ago was claiming the NHS was “better prepared for the winter than ever before”, now appears to have conceded that her government can no longer bury their heads in the sand and pretend that services are not close to breaking point. 

In the 2017 general election, the Liberal Democrats proposed increasing income tax by a penny in the pound. This would generate estimated additional revenue of £6bn, to be ring-fenced and spent only on health and social care.

It is well known that the NHS chief executive, Simon Stevens, called for the government to give the NHS in England at least £4bn more in 2018-19. Social care faces a funding gap of just over £2bn by 2020. So, the amount raised by this tax increase could put both these vital services back on a stable footing.

No political party takes the decision lightly to go into a general election telling voters that they want them to pay more tax. But I am proud that we were prepared to be honest with the public about the tough decisions needed to safeguard services in the longer term. The question of how we manage the growing pressure on our NHS and social care is arguably the biggest domestic crisis facing the country. To resolve it, we all need to chip in a little more.

While I don’t underestimate the impact of asking anyone on a stretched household budget to pay more tax, this is a far fairer option for raising this much-needed money than the alternatives. 

Thanks to increases in the income tax personal allowance fought for by the Liberal Democrats during the Coalition no one pays income tax on the first £11,500 they earn, so this will not hit the lowest earners. And of course, at the other end of the income scale, the more people earn the more they will pay.

Contrast this with the government’s approach, to date, of trying to plaster over the cracks in social care by allowing local authorities to raise additional revenue through a “social care precept” – a ring-fenced council tax increase. There have been myriad problems with this. Council tax is known to be unprogressive, as it takes no account of ability to pay (with the exception of council tax benefit) and is based on extremely blunt and outdated measures of property values. 

This system also risks exacerbating the postcode lottery in services, with the least affluent areas (where, as a general rule, we would expect there to be the highest need) being able to raise the least through the precept. Thirdly, the amount which was raised by the precept to date has simply been far too little to bridge the funding gap. 

Our health system will only work if we get social care right. We need to have a conversation about paying for care when we get old. It is not free, like the NHS. It is means-tested, and includes the value of your home. For many this comes as a huge surprise, especially if they live within the M25 where care home fees can be in excess of £1,000 a week. 

During the coalition period Lib Dem ministers in the Department of Health proposed that there should be a cap on what we will be required to pay. The Conservative government has promised a green paper on this issue, first in the autumn of 2017, then after Christmas and now “in the summer”, but it is rumoured that it is proving to be “difficult” and it will be towards the end of the summer recess.

While there is certainly no magic wand to fix the growing need for NHS services, underfunding and staff shortages, we need to be prepared to look at bold solutions and to be honest with the public about the scale of these challenges. In the longer term, the Liberal Democrats want to see a move towards a single earmarked tax, bringing together the entire health and care budget, and based on a remodelled version of national insurance. 

We have also urged the government to launch a cross-party commission to review the funding settlement for the NHS and social care in the longer term, working with patients, the public, and NHS and care staff. 

To oversee the future sustainability of NHS and care budgets, we also strongly advocate the establishment of an Office of Budget Responsibility for Health, which would make recommendations to government about the funding required for a fixed period, just as the current OBR does for the economy and public finances. Their considerations should take account of the costs of meeting projected demand for services and of meeting any new policy commitments by the government.

We simply cannot get to this time next year and have our NHS battling through another winter crisis as bad as this one has been – or worse. If they are serious about protecting these vital services on which we all rely, policymakers from every party must be prepared to sit around a table and take some tough decisions. We wait with bated breath.

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My constituency needs more doctors - a new medical school will help

Boston and Skegness will get one of the five medical new schools recently announced by the government. 

Boston and Skegness is the constituency that – infamously – voted more vigorously than anywhere else to leave the European Union. More than three-quarters of voters turned out for the referendum, and 76 per cent of them wanted to leave. What was the specific reason cited most often for doing so? 

It was either “I can’t get an appointment at my GP”, or “A&E is full to burst”. These answers were proffered as an example of the pressures stemming from immigration, because the lens through which Brexit was seen on the ground was as often as not, the NHS. No wonder, then, that big red bus was so powerful.

On talking to local NHS staff, however, it wasn’t immigration per se that had challenged the system most profoundly: it was the difficulty in recruiting staff to rural and coastal Lincolnshire, and it was the blessing of a population that is living longer and longer. Some pointed out that prior to the surge in immigration, the less and less used maternity unit at Boston’s Pilgrim Hospital was on a trajectory that would have threatened closure as it would have become harder to run safely. Hugely dedicated local NHS staff were being put under increasing pressure, and ultimately the limited number of doctors training in the system were more likely to go to larger hospitals where opportunities to teach or specialise were hugely attractive.

So from even before I was elected in 2015, and well before the referendum, it was obvious that Lincolnshire needed a radical shot in the arm to alter patterns of recruitment for doctors. That, said the universal consensus, was a medical school based in the county.

Still, it was truth be told a campaign I signed up to lead in Parliament with little genuine hope of success. Most recently, in every departmental Health Questions in the Commons, it felt as though every MP in the place stood up solely to say that their constituency deserved a slice of the government’s plan to increase medical school places by 1,500.

The government’s criteria, however, did dictate that it was places that were “under-doctored” that would be given a first look at the new scheme, and there was a particular focus on increasing GP and mental health services. All these the Lincoln University bid did, and by signing up to do the scheme jointly with the well-established Nottingham University Medical School a good deal of bureaucracy was cannily avoided. It was rightly not enough to say that Lincolnshire needs more doctors. Doctors tend to practice near to where they train; ergo we get a shiny new facility. Knowing that Lincolnshire fitted government criteria so well, I was conscious that the role of a local MP must surely be to make sure the bid accurately reflected that reality.

Some 6,000 medical students start their training each year, and Jeremy Hunt’s 25 per cent expansion of that number by 2020, hand in hand with a similar expansion in nursing training, is a transformational exercise for the NHS. It addresses the long-term deficit in doctors that we’ve locally sought to plug with overseas recruitment and a £20,000 golden handshake for GP trainees, and demonstrates that for all the talk of the NHS needing increased investment, the challenges don’t simply require extra cash. Indeed, with more doctors in the system there are likely to be lower bills thanks to fewer locums with their higher wages, and less stress on the existing workforce resulting in sickness and absence. It’s a classic case of investing to save. And on the way there’s a commitment to increase the diversity of medical students, attracting more applicants from state schools and making the typical doctor look a little and sound a bit more like the typical patient.

So alongside Lincoln, Sunderland, Lancashire, Chelmsford and Canterbury each get new medical schools, while other existing ones expand. All this, of course, is only possible if there is the money to fund that expansion, and Conservative stewardship of the economy has delivered that. These are announcements that defy the accusation that the government is consumed by Brexit, and indeed, they also address concerns that leaving the European Union might further challenge recruitment. That, in truth, remains to be told but inarguably expanding medical schools can do no harm. 

Speaking personally, however, there’s a second truth: voters routinely tell their MPs that we achieve nothing for the man or woman on the street, and rural areas each claim to be forgotten counties. Every one of these new medical schools demonstrates not only genuine commitment to the NHS from this government, but also the fruits of huge coalitions of MPs, healthcare professionals, university staff and others, all making a single, local case to Whitehall. This is a plan that will take a number of years to bear fruit, but it is also one that will last for generations – and it’s an example of long-term thinking on healthcare from public servants across the board. More of that, hopefully, is to come soon.


Matt Warman is the Conservative MP for Boston and Skegness.