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A call for action on NHS, social care and public health

In a report ‘A Call for Action’, a team of experts have urged ministers to increase spending on the NHS, social care and public health that needs to rise by £102bn over the next decade, funded by big tax rises, to improve Britain’s health in the wake of the coronavirus pandemic, an inquiry has said.

The massive funding boost would cut avoidable deaths from cancer and heart disease, tackle glaring health inequalities and rebuild the NHS after Covid exposed weaknesses such as a lack of beds and staff.

Where would the money come from?

The money would come largely from increases in income tax, national insurance and VAT, which evidence suggests the public is willing to pay, according to a four-year commission of inquiry by the London School of Economics and the Lancet medical journal.

“Without concerted action and increased funding we risk the UK falling further behind other high-income countries in health outcomes and life expectancy, continued deterioration in service provision and worsening inequalities, increased reliance on private funding and an NHS that is poorly equipped to respond to future major threats to health,” said Dr Michael Anderson of the LSE, the commission’s joint research lead. The government must seize on the pandemic as an opportunity to transform the NHS, social care and public health so that they can drive much-needed improvements to the nation’s health, which still lags behind that in many other high-income countries in key respects.

‘A call for action’

In the report, which they describe as “a call to action”, they called for UK spending in those three areas combined to increase dramatically from £185bn today to £288bn by 2030/31, with every sector getting a 4% budget uplift for each of the next 10 years. Under their plans, the NHS budget across the four home nations would soar from £162bn to £239bn.

Their blueprint envisages the extra money coming in two major phased rounds of tax rises: 1p on income tax, national insurance and VAT by 2025-26 and then a further 2p increase in both income tax and NICs, plus another 1p on VAT, by 2030-31. That would mean someone on £25,000 a year paying an extra £6 a week, and someone on £50,000 an additional £15 a week, by 2025/26.

The plan has been drawn up by two highly rated economists: Paul Johnson, director of the Institute for Fiscal Studies, and Prof Anita Charlesworth, director of research and economics at the Health Foundation.

“For the NHS to be truly the envy of the world again politicians will need to be honest with the public that this will require increased taxation to meet funding levels of other comparable high-income countries,” said Prof Elias Mossialos of the LSE, the commission’s co-chair.

Britain is lagging behind on spending as a proportion of GDP

The Report highlighted how, despite being the world’s fifth largest economy, Britain comes only ninth in an international league table of health spending as judged by the proportion of GDP invested, its 10.35% coming behind Germany (11.7%), France (11.2%) and Japan (11.1%). Judged by health spending per head, the UK comes 13th, based on allocating £3,620 per person.

Reform of social care

Social care should be reformed to make it easier for Britain’s ageing population to access by increasing the level of savings someone can have before they are charged from £23,250 to £100,000, and by capping lifetime care costs at £75,000.

But Sally Warren, director of policy at the influential King’s Fund think-tank, said tax rises were highly unlikely under Boris Johnson.

“This government has manifesto commitments to not increase income tax, national insurance or VAT. Public polling has often shown that people support increases in taxation to support the NHS, but it is less clear if that extends to related services such as social care and public health.

“If not, there is a risk of repeating the mistakes of the last decade, which saw NHS funding prioritised but spending on other services that promote health and wellbeing neglected. This meant that improvements in life expectancy stalled, inequalities widened and demand for NHS services soared.”

Ministers insist, “Improving adult social care remains a priority for this government and we will bring forward proposals later this year,” the spokesperson added.

Summary

The report ‘A Call for Action’ highlights the critical underspending of Britain on the NHS, social care and public health compared to the proportion of GDP spent by other leading economies.

Whether the report will have the desired impact on this government remains to be seen. However, given this governments manifesto commitments not increase income tax, national insurance or VAT, something will have to change markedly if we are to see an increase in spending of this magnitude.

Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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