Time to talk about tax and the NHS

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ViewsJanuary 19th, 2015

For months the UK and Welsh news has been dominated by the NHS.

Most recently it has been stories about the crisis in accident and emergency departments – from ambulances failing to meet their target response times to waiting times in A&E to the strains imposed on staff as well as patients.

Before that the stories were about the performance of Wales’s NHS compared with England’s, access to new and expensive medicines, and the reconfiguration of services.

I would bet that there hasn’t been a week when the NHS has not featured in the news headlines for some time.

It’s not surprising because the Welsh and UK public are very much in favour of the NHS – about two-thirds say that they are satisfied with the NHS [1] [2]. The public also sees the NHS as a hot issue – it is consistently in the top three or four priorities along with immigration, the economy and unemployment. [3]

Discussion about explanations and what to do are lively too.

They range from reducing demand, by a variety of techniques; increasing efficiency, again through a host of measures from reducing referrals to A&E to quicker discharges; reorganising services – ditto; to setting minimum standards e.g. for the number of nurses.

But there is one issue that has not featured in the public debate – increasing taxes to pay for the NHS.

Nobody likes to pay taxes – and some are expert at avoiding them. But what might be the most obvious solution to at least some of the challenges facing the NHS seems to be off the agenda.

In fact the evidence suggests that the public would be willing to pay a bit extra. A survey for the Nuffield Trust found that 48% suggested increasing taxation was a solution, more than twice as many as thought that spending should be cut on other services. ComRes’s survey found that an even higher proportion – 57% – would be willing to pay more.

If these surveys are right, increasing taxes for the NHS would popular – or at least not unpopular.

While the political parties have yet to unveil their manifestos, the mood music from virtually all of them consists of variations on austerity – discussions about taxation generally are mainly about avoidance or low earners, not about paying more to maintain or improve public services.

The NHS is facing all sorts of pressures – not only the so-called winter pressures but the time bombs of an ageing population, cancer, dementia, obesity and mental illness – to name just a few.

So let’s talk about taxes, as well as all the other solutions.

Victoria Winckler is Director of the Bevan Foundation.  

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[1] The Kings Fund analysis of the British Social Attitudes Survey 2012 suggests 61% were satisfied.

[2] The most recent IPSOS Mori survey for the Department of Health shows that 66% of those in England are satisfied.

[3] See IPSOS Mori’s Issues Index from 2007.

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