My National Health Service – Rethinking the funding of ‘My NHS’

No system or structure is fool-proof but some are better than others. The point is that for too long the NHS has been used as a political football and there has been a lack of transparency, or honesty about the real cost of providing such a comprehensive and universal public service. There is an urgent need for a rethink about how the NHS is funded. The British people have a shared interest for a health and social care service that is well funded and properly managed. I believe the Covid-19 pandemic has provided us with the opportunity to revisit the funding of the NHS and also, to some extent, social care. There is a need to consider a new funding structure that takes account of the growing population and anticipates dynamic trends. My premise is not to ignore the vision of an NHS that is funded by general taxation, as set out in the 1944 White Paper, however a rereading of the National Insurance Act 1911 would show that a dedicated taxation structure was envisaged and indeed it already exist in the form of the National Insurance Contribution, NI. The premise of NI was to provide social security, child benefit and health care support. My suggestion is that the National Insurance contribution should now revert to its original purpose. As is the case now, the idea is that everyone of working age, (including those who are retired and on benefits), would continue to make contributions towards the health and social care pot. This New NHS NI contribution funding structure would be ring fenced and all underspend or profit generated would be ploughed back into front-line services. To ensure that the money raised is administered in a transparent and apolitical way and with a view to long term planning a new body called NHS Governing Board, should be set up to manage, administer and distribute the funds. The NHS Governing Board would consist of Medical and Nursing professionals, Social Care professionals, health and social care researchers and Lay members. The structure and organisation of the NHS Governing Board would be similar to the BBC board of Governors, The Bank of England Monitory Committee and the Welcome Trust Board of Governors. While there would still be Ministerial oversight the role of the Health Secretary would be more nuanced. Primarily it would be more administrative and longer term strategic consideration rather than the micro-management of the service. The role of the NHS Governing Board Specifically; a) the NHS NI contribution would go to a New NHS Governing Board be would be completely ring fenced from other central government taxes and spending b) funding allocations, decisions about priorities, planning and future developments would be under the stewardship of the NHS Governing Board c) there would be subsidiarity with devolved powers to local hospitals/trusts d) the whole structure would still be under the Health Secretary control (but quality would be overseen by a Ministerial appointed QCQ department) but e) no Health Secretary can change or interfere with the structure, operation or workings of the Board without public endorsement Long-term planning f) one of the key remit of the NHS Governing Board would be to plan and budget for TEN year cycles, with light touch review very 3years g) financial plans must be in place to provide funding support in case of emergencies and other unforeseen possibilities h) an NHS sovereign wealth sub-committee (chaired by a respected international industrialist) would be set up to manage an investment portfolio (10% of the yearly budget is top sliced to create an investment fund similar to the Welcome Trust). A percentage of the profit from investments would be distributed, yearly, to hospital as unconditional additional funding i) no hospital would be penalised for underspending, saving money or creating a substantial contingency funds for itself. It may be that policy wonks have already consider such an idea and perhaps rejected it for whatever reason. However, I still think it is worth reconsidering in its totality. As you know the love and affection that the British people have for the NHS is unparalleled. There is a heartfelt warmth and a kind of mystical, doe-eyed quality in the way people think about the NHS and as a result there is an unrealistic expectation in the range and type of services they expect from it. People want a universal service that is free at the point of delivery and accessible to all, irrespective of their geographic location. However, in my view and as proven by the state of the NHS at present, the difficulty is that the current NHS funding and administration model is unsuitable in the long-term. There is interference, problem of overcapacity (increased population); chronic health and social care needs (ageing population) and an increasing range of new health and social care concerns. In otherwords the NHS is expected to maintain existing services as well as anticipate and respond to new health related trends. If we continue with the current funding structure then I believe that at some point there will be a devastating collapse of the whole system at worst or a ramshackle health service that would no longer be supported by the British people. I would encourage you to test out the idea presented to see whether people are willing to support such a comprehensive proposition.




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