Coughing up for the NHS: The danger of the tax Labour is considering is that it would stand in for urgently needed reforms to the health service

We are becoming an older nation at a faster rate than ever before, and that increases the burden on GPs, hospitals and care homes

Share

How to pay for the National Health Service? Since its inception, the question has been evaded by most governments, for two very good reasons. First, as is often remarked, the NHS has become the nearest thing the British have to a national religion. Second, the British have always begrudged paying for their “envy of the world”. Thus, any remotely grown-up ideas about sustaining the health service are to be welcomed.

The latest is Labour's apparent conversion to the notion of a special NHS tax. There is something to be said for it. For an electorate that is so distrustful of the political class, it gives reassurance that any increase in tax or national insurance - for that is all the NHS tax amounts to - will go in the intended direction, and not be siphoned off for, say, some Blair-esque foreign military adventure. As old disciples of Gordon Brown, Ed Balls and Ed Miliband may be thinking of the successful pitch that New Labour made at the 2001 general election - a stated rise in national insurance specifically to pay for investment in the NHS. This was dreamed up by their old boss, Chancellor Brown, as about the closest thing to socialism they could pull off in the days when New Labour was still terrified of its tax-and-spend image. It worked electorally, and it led to a marked increase in real-terms spending. As a rebranded version of that exercise for more cynical times, the Balls-Miliband NHS tax has its merits.

Yet earmarked taxes carry dangers. They make it difficult for governments to cut spending without reducing taxes, for example to fix a deficit, and they invite the public to pick and choose between public services, thereby undermining the case for general taxation. Why, for example, should the childless pay for education, or pacifists contribute to the cost of an aircraft carrier? And, as in this case, they are often the product of simple cowardice; politicians and public alike refusing to face up to the real problem of funding decent public services.

As a substitute for a proper debate about the demands the NHS and social care are about to make on taxpayers, a small NHS tax would do more harm than good, and would not in any case stay small for long. We are becoming an older nation at a faster rate than ever before, and that increases the burden on GPs, hospitals and care homes. Fresh restrictions on immigration - promised now by every party - will make matters worse by reducing the population of working-age people to pay for all that, as well as choking off the supply of skilled medics and support staff to work in the NHS. New drugs, new treatments and new, higher, public expectations add to the pressures, as they always have.

The brutal truth is that the British economy is unlikely to grow fast enough to keep up with those demands, and raising more taxes is always going to be politically difficult - though some tax hikes are inevitable.

So the health service has to become radically more efficient and concentrate on what is most important.

That, in turn, means improving productivity within the NHS, with voters being less silly about the closure of some smaller, inefficient units. It means taking a fresh look at the way we pay for GP surgeries, and the relationship between private providers and the NHS, ensuring that they pay a fair share for the use of NHS facilities and staff trained at public expense. It means being harder on failing trusts. It means investing in earlier screening. It means being tough on NHS pay, painful as that is: Andy Burnham, we may ask, are you up for that?

In its seventh decade, the NHS is in surprisingly fine fettle, but things are going to get tougher for it, and it will need to adapt to the fact that it may not be able to do everything in the same way as it did when it was younger.

React Now

Latest stories from i100
iJobs Job Widget
iJobs General

Quantitative Analyst (Financial Services, Graduate, SQL, VBA)

£45000 per annum: Harrington Starr: Quantitative Analyst (Financial Services, ...

Application Support Engineer (C++, .NET, VB, Perl, Bash, SQL)

Negotiable: Harrington Starr: Application Support Engineer (C++, .NET, VB, Per...

C# .NET Software Developer (Client-Side, SQL, VB6, WinForms)

Negotiable: Harrington Starr: C# .NET Software Developer (Client-Side, SQL, VB...

C# Developer (Genetic Algorithms, .NET 4.5, TDD, SQL, AI)

£40000 - £60000 per annum + Benefits + Bonus: Harrington Starr: C# Developer (...

Day In a Page

Read Next
Jihadist militants leading away captured Iraqi soldiers in Tikrit, Iraq, in June  

Middle East crisis: We know all too much about the cruelty of Isis – but all too little about who they are

Robert Fisk
India's philosopher, environmental activist, author and eco feminist Vandana Shiva arrives to give a press conference focused on genetically modified seeds on October 10, 2012  

Meet Vandana Shiva: The deserving heir to Mahatma Ghandi's legacy

Peter Popham
Middle East crisis: We know all too much about the cruelty of Isis – but all too little about who they are

We know all too much about the cruelty of Isis – but all too little about who they are

Now Obama has seen the next US reporter to be threatened with beheading, will he blink, asks Robert Fisk
Neanderthals lived alongside humans for centuries, latest study shows

Final resting place of our Neanderthal neighbours revealed

Bones dated to 40,000 years ago show species may have died out in Belgium species co-existed
Scottish independence: The new Scots who hold fate of the UK in their hands

The new Scots who hold fate of the UK in their hands

Scotland’s immigrants are as passionate about the future of their adopted nation as anyone else
Britain's ugliest buildings: Which monstrosities should be nominated for the Dead Prize?

Blight club: Britain's ugliest buildings

Following the architect Cameron Sinclair's introduction of the Dead Prize, an award for ugly buildings, John Rentoul reflects on some of the biggest blots on the UK landscape
eBay's enduring appeal: Online auction site is still the UK's most popular e-commerce retailer

eBay's enduring appeal

The online auction site is still the UK's most popular e-commerce site
Culture Minister Ed Vaizey: ‘lack of ethnic minority and black faces on TV is weird’

'Lack of ethnic minority and black faces on TV is weird'

Culture Minister Ed Vaizey calls for immediate action to address the problem
Artist Olafur Eliasson's latest large-scale works are inspired by the paintings of JMW Turner

Magic circles: Artist Olafur Eliasson

Eliasson's works will go alongside a new exhibition of JMW Turner at Tate Britain. He tells Jay Merrick why the paintings of his hero are ripe for reinvention
Josephine Dickinson: 'A cochlear implant helped me to discover a new world of sound'

Josephine Dickinson: 'How I discovered a new world of sound'

After going deaf as a child, musician and poet Josephine Dickinson made do with a hearing aid for five decades. Then she had a cochlear implant - and everything changed
Greggs Google fail: Was the bakery's response to its logo mishap a stroke of marketing genius?

Greggs gives lesson in crisis management

After a mishap with their logo, high street staple Greggs went viral this week. But, as Simon Usborne discovers, their social media response was anything but half baked
Matthew McConaughey has been singing the praises of bumbags (shame he doesn't know how to wear one)

Matthew McConaughey sings the praises of bumbags

Shame he doesn't know how to wear one. Harriet Walker explains the dos and don'ts of fanny packs
7 best quadcopters and drones

Flying fun: 7 best quadcopters and drones

From state of the art devices with stabilised cameras to mini gadgets that can soar around the home, we take some flying objects for a spin
Joey Barton: ‘I’ve been guilty of getting a bit irate’

Joey Barton: ‘I’ve been guilty of getting a bit irate’

The midfielder returned to the Premier League after two years last weekend. The controversial character had much to discuss after his first game back
Andy Murray: I quit while I’m ahead too often

Andy Murray: I quit while I’m ahead too often

British No 1 knows his consistency as well as his fitness needs working on as he prepares for the US Open after a ‘very, very up and down’ year
Ferguson: In the heartlands of America, a descent into madness

A descent into madness in America's heartlands

David Usborne arrived in Ferguson, Missouri to be greeted by a scene more redolent of Gaza and Afghanistan
BBC’s filming of raid at Sir Cliff’s home ‘may be result of corruption’

BBC faces corruption allegation over its Sir Cliff police raid coverage

Reporter’s relationship with police under scrutiny as DG is summoned by MPs to explain extensive live broadcast of swoop on singer’s home