Time to save our NHS

It will probably not surprise anybody who reads me regularly to know that I am not a supporter of the Royal Family. In 2019, the latest figures available, it is estimated that the Royal Family cost the British taxpayer £67 million.  As a comparison you could provide around 16.75 million school kids with a breakfast for that amount. The National Association for Primary Education, estimates there are nearly 800,000 children who do not eat breakfast every day.

So, by defunding the Royal family we could feed all of them for approximately 3 weeks. For the Royalists amongst you the Windsors would not need Universal Credit to survive their net worth is around £88 billion according to one source. In other words if they lost their public subsidy it would amount to about 0.076% of their income. A person on the highest rate of Universal Credit losing £20 (obviously I’m just plucking numbers out of the air here) would lose 3.5% of their income. So, if there was a proposal to opt out of paying taxes toward their lavish lifestyles I would probably say that was fair. After all, why should I pay taxes for things I don’t support?

Similarly you might wonder why, as a pacifist, you are contributing your taxes to pay for nuclear weapons which we have a commitment never to use. It is estimated that the cost of Trident will be £140 billion over 30 years, that is over £4.5 billion per year, every year. That is approximately £167 per household. What could your household do with an additional £167 each year? The answer might be pay the increase in gas and electric that the main companies have just been given the go-ahead to hike by Ofgen. 

Is it just choice?

It seems, on the face of it, fairly obvious that it is unfair to force you to pay for things which you either don’t need or have a moral objection to. Imagine if you were being forced to buy spinach every week, which you then threw away because you simply can’t stand it. Now, of course, some people might say spinach is good for you. Apparently, according to fruitsandvegetablesbenefits.com it is rich in nutrients, helps prevent a number of diseases, and promotes healthy skin. It did Popeye no harm either. But, would it be right, even if all that is true, to force you to eat it? Of course not, it should be a personal choice. Now for some people, let’s call them libertarians, taxes are much like spinach. They might be ultimately good for you but the things they fund, particularly welfare, health and education, should be your personal responsibility.

The current Conservative Party in the U.K. have, since the 1970’s set about reducing public spending on the things they don’t like, such as providing health and education free at the point of use, so that they can spend your taxes on things they do like, such as making them and their friends richer. It’s a neat trick because the party which claims to dislike public spending is very keen on using the public purse for their own ends. When they say, for example, things like “The NHS is safe in our hands” what they mean is “the NHS budget is safe in our hands” though the word ‘safe’ is probably superfluous. 

You do not need to have much interaction with the NHS to realise that it is being run down. I’ve mentioned before I spent time in a heart ward last year and I was very grateful for the care I received. They literally saved my life. But, what was clear was that the service itself was being put under enormous stress through its financing. As a very small example, I spent about 40 nights in hospital and I never once had a sheet that did not have holes in it. It’s a small example of the way in which the NHS is struggling to maintain a service. When there are cuts to be made you start with the smaller things and move upwards.

Campaigning

I know many people who are campaigning on the NHS. My friend and comrade Ann Marcial is part of a Save Our NHS group in Eastbourne where she regularly stands on a stall trying to bring the plight of the service to the public. This is what she told me: “I have belonged to a campaign group to ‘Save the NHS’ for about 4 years. We get shouted at in the street ‘Fake News’. We can’t get people to join the fight even if they are aware of the destruction.  There is an element of ‘others are fighting we don’t need to’.  Average age of campaigners is 70+ what does that tell people?  By the way people have told us they ‘don’t care’.  Currently they don’t see the shift towards the US style Health Insurance health model.”

Unfortunately, the pandemic which should have cemented the NHS in people’s consciousness as their saviour has seen a counter narrative in which a far right nutcase could address an anti-lockdown rally in Trafalgar Square and call for nurses and doctors to be hanging from lampposts. How did we go from clapping our NHS workers to demonising them in this way? 

In 2017 the Kings Fund commissioned research ahead of the NHS’s 70th anniversary (for some reason they called it a birthday but the pedant in me says you can’t have a birthday unless you were actually born), and what they found was widespread support for the NHS. Seventy-seven per cent of the public believed the NHS should be maintained in its current form. Around 90 per cent of people supported the founding principles of the NHS, whilst a clear majority (66 per cent) of adults said they were willing to pay more of their own taxes to fund the NHS, “underlining growing support among the public for tax rises to increase NHS funding.”

Is tax fair?

This last finding is interesting because it brings us back to how much say you should have in the way in which your taxes are spent. This is predicated on a very simple notion. The tax system has to be seen to be fair. It is likely that if I felt that the public sector was properly provided for, I would not care very much about money going to the Royal Family or being spent on nuclear weapons. Not that I would suddenly support these things but my critique would be on a moral or democratic basis not a fiscal one. To put that another way, royalty is wrong because it cements a status and prestige system based on birthright not because it is too expensive. Similarly nuclear weapons are wrong because they are indiscriminate and impossible to contain which they would remain even if they came at a fraction of their cost.

The Institute For Fiscal Studies ran an interesting experiment on taxation in 2017. They asked a group of people whether they thought the tax system in the U.K. was unfair because the rich paid too little tax. Over half (51%) thought it unfair. But a second group were given two ‘facts’ before being given the question. Those facts were:

• The point at which income tax starts to be paid has increased in recent years. 4 in 10 adults now pay no income tax.

• The income tax system is top-heavy. The top 10% of income taxpayers pay 60% of all income tax. 

Amongst this group only 33% thought it unfair. But, a third group were given two alternative ‘facts’:

• The richest 10% of income taxpayers earn more income than the entire bottom 50%.

• Someone earning £45,000 faces the same income tax on an extra £1 of earnings as someone earning £145,000.

Amongst this group 72% thought it unfair because the rich paid too little tax. Whilst the IFS are quick to point out that this was a small poll of only 129 people so hardly scientific their conclusion seems to me to be correct: “small amounts of information can radically shape people’s stated views.”

Kill The Bill

When Ann and her friends Judy and Lucette take to the streets to engage the public they are running across a wide spectrum of issues which prevent their message getting across. One thing is that, taking childbirth out of the equation, hospital admissions have increased with over 16 million admissions in England in 2016. However, and this rather supports Ann’s point, nearly 10 million of those admissions were from the over 65’s. Of course, people’s interactions with the NHS are not simply to be counted in hospital admissions, but this is illustrative of a point which I made last week, people do not tend to take seriously issues until they are directly affected by them. Younger people are far less concerned about health matters than older people, for whom health is, let’s face it, their major pre-occupation. In the same way that telling people that unless they act they won’t have a planet in 30 years tends to fall on deaf ears so telling younger people that their NHS is disappearing before their eyes tends to be largely ignored.

The alternative to the NHS and the one favoured by the Conservatives is private health insurance, largely run by large American companies. Those with good memories may recall in the 2019 General Election campaign Jeremy Corbyn produced a document which he claimed showed that the Tories were planning to sell the NHS to American healthcare companies. The newspapers worried that their American owners might not be able to cherry pick the NHS were united in their view as expressed by the Daily Express ‘Jeremy Corbyn’s leaked documents with Russia links are FAKE, readers say in shock poll’ or as The Sun put it ‘RED JEZ ALERT Leaked NHS papers used by Jeremy Corbyn to smear the Tories linked to Kremlin fake news campaign’. Last week the Government brought forward legislation that will, according to one campaign group mean that: “American health insurance and digital technology companies are poised to take up near-monopoly positions running the NHS, once its fragmentation into up to 42 so-called Integrated Care Systems is cemented by proposed legislation that would take effect from April 2022.” Fake news from Moscow? No, a truth the rich proprietors of our mass media, abetted by the so-called public service broadcaster BBC, just did not want people to be aware of.

Now we should be clear here that running the NHS is not quite the same as replacing it. We should also be clear that these proposals only apply to NHS England for health is devolved in Scotland and Wales and neither the SNP or Welsh Labour are as hostile to a publicly owned NHS as the Westminster-based Tories. The NHS budget will remain at around £129.9 billion a year. But, that budget will, in future, be expected to provide a dividend for the shareholders of the multinational companies who will, bit by bit, take over the running of this vital public service. How will this additional money be found? I’ll guess. Pay freezes, reductions in some services with some departments being removed from the NHS altogether, longer waiting lists, more small fees for non-essential items, such as food and toiletries during hospital stays? For the enterprising management accountant there are numerous ways in which dividends can be filtered out of already underfunded services.

More tax is not the answer

Would you pay additional tax to help fund the NHS? For most of us the answer is easy and it is ‘of course’. A few would not on the basis that they don’t need the NHS as they can afford private healthcare. The fact is that the majority of clinical staff working in the private sector are either former or current NHS staff. And, the problem with paying more tax to fund the NHS is that it simply disappears to private consultancies rather than on the services people want to improve. So, what should we do?

Most importantly is to support campaigns to support the NHS and NHS staff. You can start by supporting Andrew Godsell who founded the FBNHS campaign. His Twitter handle is @AndrewGodsell.You can also tell people about the Government’s Health and Social Care Bill. As Keep Our NHS Public point out: “Abolition of competitive tendering and the public contracts regulations will mean that NHS contracts will no longer have to be tendered but can just be handed out to any contractor, regardless of their track record or reliability, as we saw with the billions of pounds worth of contracts dished out to incompetent and wasteful companies, without competition, during the Covid pandemic.” Well worth a visit to their website (by following the link).

Many of us grew up with the NHS literally from the cradle to the grave. Whenever we have needed it, the NHS has been there for us. Now is the time to return the favour, whilst there is still a public, as opposed to just a publicly funded, health service to defend.

Post publication addition:

This petition has been brought to my attention https://petition.parliament.uk/petitions/581077

There are a number of resources on this page:

https://allysonpollock.com/?page_id=1860