Lib Dems to consider NHS tax #ldconf

The Liberal Democrats are to set up an independent expert panel to consider the case for a dedicated NHS and care tax,  Norman Lamb will announce in his Conference speech at Brighton later today.

Members of the ‘New Beveridge Group’ will include Dr. Clare Gerada, former President of the Royal College of GPs, Prof. Dinesh Bhugra, former President of the Royal College of Psychiatrists and current President of the World Psychiatric Association, Peter Carter, the former General Secretary of the Royal College of Nursing, and the chief executive of the Patients’ Association, Katherine Murphy.

It will report its recommendations to the party in six months’ time, presumably in time for Spring Conference.

Speaking to party members in Brighton, Lib Dem Health spokesperson Norman Lamb will say:

That great Liberal, William Beveridge, first proposed the NHS. But the needs of today are so different. It is time for a new Beveridge for the 21st century. A new long term settlement for the NHS and care. We need a national conversation about what sort of service we are prepared to pay for. For my part, I am clear. I don’t want a hollowed out, bargain basement service with people with mental ill health still suffering outrageous discrimination in terms of access to treatment.

We should surely aspire to have a modern, efficient, dynamic NHS and care system which treats mental and physical health equally; which ensures that elderly people and those with disability get kind, generous support which helps to prevent ill health and prevents a deterioration of condition; a health system which delivers the best outcomes for patients.

Let’s look at the case for a dedicated health and care tax, shown on your pay packet. Let’s look at whether we could use National Insurance as a basis for such a tax. We need to consider how we could make it more progressive. We need to think about fairness between generations.

Be in no doubt: the funding crisis is real and overwhelming.

We must be honest with the British people. If we conclude that we all need to pay perhaps an extra penny in the pound then we must be prepared to say it.

Today, I am announcing that we will establish an independent expert panel to advise the party on the case for this reform.

It speaks volumes that such a high powered group of people have agreed to help us in this way. They all understand just how high the stakes are. They understand the urgency of the situation.

The Scottish Liberal Democrats fought the Holyrood elections earlier this year proposing putting a penny on income tax for education. This came out of a Conference motion which asked for it to be considered for the NHS.
Talking about more tax is never a particularly easy thing to do, but it’s a debate we urgently need to take seriously.
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15 Comments

  • Jenny Barnes 17th Sep '16 - 8:39am

    The Lansley proposals should have been rejected. They were explicitly excluded from the Tory manifesto “no more top down reorganisations” and have proved, as expected by many, to be a Trojan horse for more privatisation. Mr. Hunt’s privatisation project is going well, it seems. I think this was a worse move by our then leadership (Clegg and Williams in particular) than the tuition fees debacle.
    If we’ve enough money for nukes we’ll never use, and fancy trains, we’ve enough for a decent NHS. But that’s not the ideology we’re living under.

  • Little Jackie Paper 17th Sep '16 - 8:55am

    I’d make two points here:

    1 – ‘We need a national conversation about what sort of service we are prepared to pay for.’ – Why restrict that to the NHS?

    2 – The NHS has been one of the sacred cows, protected from fiscal consolidation by a ringfence. In short we have protected the NHS (and pensioners) by deeper cuts elsewhere and some have taken a hammering. Now, obviously, those are political choices – but has there really been a debate on that? Or, whisper it very quietly – is it time to think the unthinkable and ask whether the NHS can be trimmed?

    And, before everyone jumps on me, I’m not saying privatise or move to a German style system. I’m simply asking whether we can always go for the ever-expanding NHS and whether it’s so unreasonable to look to trim it when we’ve been doing just that to every other area of spend.

  • Tom Papworth 17th Sep '16 - 11:46pm

    Hypothecated taxes are a stupid idea. We considered this specific question last year and rejected it.

    Here’s 30 pages of reasoning: http://www.centreforum.org/assets/pubs/hypothecated-taxation.pdf

  • A dedicated health and care tax is the most sensible idea I’ve heard from the Lib Dems in years and Norman Baker would be the best person to pursue the idea and influence both government and public thinking.

    We all want a high quality NHS and care service …. the latter is becoming increasing important as an aging population lives longer but we need to start being realistic …. a service par excellence costs much more money than is currently being provided.

    I wish Norman and the ‘New Beveridge Group’ (like the name!) all the best as they develop this idea and present it to ministers and the public. I hope you get lots of air time eg Daily Politics, the Andrew Marr Show.

  • Sorry …. Of course I meant Norman LAMB !

  • Duncan Greenland 18th Sep '16 - 9:10am

    A very welcome initiative : please do read the Centre Forum analysis cited @ Papworth , which sets out the issues well but absolutely does NOT reject hypothecation out of hand .Hypothecation is a GOOD idea worth studying very carefully indeed !

  • Sceptical on this. With the ongoing pressures on the NHS so great, a relatively fixed funding increase would help for a short period, then we’d find ourselves in exactly the same position, and people asking why they should pay the new tax when the NHS is in such a perilous state. We could be blamed for imposing a new tax without showing the benefits. Is this sustainable? Sounds like a way of kicking the fundamental issues with the NHS one election into the future.

  • Laurence Cox 18th Sep '16 - 12:40pm

    Probably the simplest way of changing National Insurance to raise more tax would be to remove the upper limit, that is make it a flat rate 12% for all earned income. The Green Party paper on Basic Income proposes this for their plan and say that HMRC figures show it would have contributed £25.6bn in 2013/14, so it is of the right order to fill the NHS hole.

  • Barry Snelson 18th Sep '16 - 1:40pm

    I agree with Jenny Barnes on the complete nonsense of Trident 2 and HS2 when the nation is in such dire straits and that money could preserve the NHS for much longer

    However, the debate on the NHS needs to be mature and brave. A 1% NHS tax will only be a sticking plaster and will have to be raised again and again.

    God will not give the British a convenient plateau where what the nation can afford nicely provides all the care the nation wants.

    Better health care = longer lives = ever more expensive health care = still longer lives ad infinitum.

    The British are 1% of the world’s population and expect free unlimited health care. The other 99% realise that is unaffordable, sooner or later. So what do we do?

    I expect to be denounced as a right wing nut but we need to view the NHS as just a health provider and not a religious totem to try and reach a system that will endure for another fifty years. Otherwise we will limp from funding crisis to funding crisis.

  • Paul Holmes 18th Sep '16 - 9:58pm

    Barry, Britain spends 30% less on the NHS than equivalent Western European countries such as France and Germany and 50% less than the USA spend on their health provision. Yet it is judged to be the most efficient Health provider.

    The money, in wealthy countries such as ours, is there. The question is should it be raised by General Taxation or by greater personal payment through various charging and insurance schemes all the way through to the horrendous US system.

    I for one completely support the General Taxation route that has underpinned the NHS from Day One.

  • Lorenzo Cherin 18th Sep '16 - 11:19pm

    Barry is correct to raise this, and I like his implications , and he is no right wing nut, just as Paul , who is to the left of me , is correct that taxation is the better route,of many.

    Where Paul is not saying it as it is , on this, is the countries mentioned that do all spend more, do not do so out of general taxation only , and all involve the private sectors far more flexibly and imaginatively , and less ideologically ,than us .

    Sorry Paul , but the Landsley proposals in many countries would have been considered moderate at best , left wing at worst , in some countries used to a regular utilising of private and individual involvement and responsibility, which is most of them.

    We need to be far more radical on many aspects if we are to catch up and have what we need. Massively , large increases, need funding through more than a welcome extra penny !

  • Lorenzo I think I in fact very precisely refer to “various charging and insurance schemes”.

    I do not think that they are the route we should take.

  • Lorenzo Cherin 19th Sep '16 - 5:02am

    Paul, you are correct. Thank you. I meant you did not show the systems are different to each other and ours.

    Where Barry Snelson above , is correct , is in questioning our uniqueness ,as wholly a good thing , and where I take issue with you , Paul , is on the view often quoted , that we have the best system. We can improve the NHS greatly.

    It is really only one study has ever placed us top . It was not on all aspects. We are , as a nation ,one of the lowest ranked ,for treatment speed and outcome for the very serious illnesses, in the western world , it is our very low infant mortality that places us higher than some , in many statistics, and our emergency care, due to traditionally good NHS provision in this area.

    For access to specialists we are low , compared to many of the other front rank countries, most women in those countries, for example, see their own , regular gynaecologists, as a matter of course , in this country , only when ill and referred , after a wait , and with little or no choice of doctor.

    I have an elderly relative in her late eighties , in the USA, who , for cancer of the uterus, had a hysterectomy , performed by a oncologist ,expert in that area, in his own , local , specialist , surgery , chosen by her, paid for by Medicare. Yes, the US system, or non system,is horrendous over all, but for senior citizens , admittedly , who have to pay a fee for it every month, the system works . Other European countries for example , are better, and favour local specialists, in private independent practices,often , and contracted to the state.

    In Nottingham, nearly the whole of the greater city area is referred to Queens medical centre as a matter of course , or sometimes the City hospital if the specialism is there instead , rather than ,as well, even for physiotherapy often ! A half a million people catered for by one main ,and an occasional, extra, hospital, even for low level treatments , is too centralised.

    We need to create a far more holistic service , local , and non ideological . More personal and responsive to the patient needs , more flexible and inclusive in the provision available, free at the point of use , but paid for with the recognition it must be paid for !

    But it all needs paying for with money , and that means funding !

  • Barry Snelson 19th Sep '16 - 7:25am

    Paul,
    I am never sure how these health cost comparisons, between nations, are calculated. It seems easy but all nations will have different cost attribution models and I don’t know whether there are different cultural norms in areas such as self diagnosis and use of pharmacies instead of a ‘health service’. Certainly I have little admiration for private health schemes as the USA gives us a perfect example of how such a lot of the money goes to so many of the wrong people.

    The issue I would take is with “The money, in wealthy countries such as ours, is there.”
    We have a huge national debt and much more future cost, I think, is hidden, in that we have no sensible provision for the consequences of ageing.

    Certainly we have no money to waste on Trident, HS2 and a lot of other nonsense.

    We run a massive deficit, as well, so there is little prospect of paying the debt down and this Brexit nonsense will make a bad situation much worse.
    Some (I have to say left leaning) economists say that’s all right as we will just print some more money. At this point I burst into tears.

    So the solution that we find someone with some money left and take it off them is only a temporary one and I would like to hear a debate on how to protect our sick and elderly as best we can in the face of (I expect) a deepening economic crisis similar to Greece and Cyprus. We have told the world that we will stand alone so can expect no bail outs from anyone.

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