No to an NHS tax

I do not think there is a simple extra tax we can invent that will meet the future financial needs of the NHS. The UK government has usually avoided hypothecation of revenues for the perfectly good reason that there is no likelihood that a particular tax will always yield exactly the right amount that any particular service might need for its costs. We will need to spend more in future on the NHS, and that will come out of general taxation. The increased spending may exceed the increased yield of a nominated tax. The settlement will be unstable, with the NHS complaining if the hypothecated revenue falls short of what it thinks it needs.

Nor do I think there is a way to have a ten year financial settlement for the NHS. A ten year settlement will span three Parliaments which will have different governments whether of the same party or different parties, with MPs elected on different programmes and spending priorities. It is difficult to know how much health care will be needed in ten years time and what the technology and service delivery will be like. It may look very different from today given the pace of technical change. We could make what we think is a generous settlement today, only for the NHS to discover it has a good need of more money than settled on it at some future date. I doubt the fact of a ten year settlement would act as an constraint on the request for more cash, which might well be justified. There is a lot to be said for making a firm offer of cash for the immediate year ahead, with indicative budgets for the following few years. It is difficult to know today how much we will need to spend in 2028 and on what.

It is likely many people will want to spend more on their healthcare as they earn better real incomes. This will happen automatically as the tax take increases with rising incomes, and more money will be voted for the NHS. Some of this will also be possible from the increasing take up of private healthcare which many opt for. There is a lot of self treatment with the help of the local pharmacy, where over the counter medicines are bought on a large scale. Some of it takes the form of people taking out subscriptions to Health clubs, and paying for a diet and exercise regime they think will keep them healthier. Some people take out private insurance or have employers that provide it. Some pay for private treatment when they need it to get round long waiting times for non urgent NHS treatment or to benefit from the greater flexibility over timing of treatments and standards of supporting care, including private rooms in hospitals.

There will nonetheless remain a major requirement for the state to vote more money for more and better quality healthcare free at the point of use in NHS surgeries and hospitals. Much of the care and cost will be for the elderly as they live longer and develop more conditions related to old age that need treatment. It will require better integration with social care to cater for this growing group of patients.


  1. Prigger
    March 27, 2018

    I attended my first Labour Party branch meeting as an observer. I was only sixteen and not a member. Someone “high-up” had worked it for me so I could “listen-in”

    Half the meeting was occupied by a middle-aged woman who recalled almost every single minute of her recent holiday in the islands to the north of Scotland.
    She eventually went on to educate us all that “”Russians, it’s terrible over there, they all have to sit at long tables and eat together in the open.” I laughed uncontrollably and she and other Labour members glared at me… with dare I say it, hatred and contempt for my social impoliteness and also my ignorance as I clearly did not believe that all Russians ate at long tables together in the open.
    Labour thinking has not improved. Nor has Prime Minister May. She takes us for fools, the ones of us who are ready to be taken.

    1. Nig l
      March 27, 2018

      What has this go to do with today’s topic?

      1. Prigger
        March 27, 2018

        What has your reply got to do with today’s topic? It, and my comment are not an advert for a smart Alec. Move on!

        1. Hope
          March 28, 2018

          How can public service provision be provided while your govt pursues a mass immigration policy. We were told the U.K. Would take back control during the extension and when we leave. Now this has been surrendered for nothing in return and Croatians can come here from June 2018! May said there would be transitional controls, does anyone want to ask for another useless assurance! How many has she broken over the last year? Must be a record!

      2. Mark B
        March 28, 2018


        The question I like to ask is, why was this post allowed and mine, and I dare say a few others, have been blocked ?

        1. Prigger
          March 28, 2018

          Mark B
          My comments. Many not published. JR has explained for everyone why he has to filter rather than block.
          I enjoy the exercise of writing… a treadmill in a gym.

    2. Hope
      March 27, 2018

      We already pay tax for the same thing several times over. NI was meant to cover health care and social adult care together with my income tax. I now pay an additional amount in my community charge as well as the community charge itself! Am I paying four times for the same thing? It might now be cheaper to pay for private health care with a tax rebate for doing so.

      This is equally true with flood defence and yesterday’s blog about roads! Your govt taxes more than the previous Labour govt.

      All Croations will have the right to our health care from June 2018, was this costed? Moreover was this deducted from the alleged divorce bill?

      May and Davis said several times they would go over the EU demand for money line by line. What happened they offered £20 billion and end up agreeing to pay £100 billion! That is a lot of health care or public services. The same for the waste of HS2.

    3. Hope
      March 27, 2018

      Jr, There should be no guarantee for more money for any public service because it does not equate to a better service, we see this from the BBC every day. It is baffling why your govt has still failed to curb/reduce the funds and make sure it acts within its remit as a state broadcaster with a lower share of the market. Instead your govt has given it more and more money with a 39% stake fo the market which is unfair to plurality to other privately funded broadcasters- the BBC itself shouting about Sky increasing its market share!

      Your govt also fails to plan and cost additional countries joining the EU and your HS sending out an invitation to about 20 million people to come here whenever they wish!

      Do you want to talk about control of borders, laws and money? All relevant to your blog. May has failed on each, failed all her red lines (if they ever existed), failed all points in her Lancaster speech including how the extension would take place, failed to take control over our territorial waters and fishing stocks. May also stated in her Mansion House speech she would not walk away or resort to WTO, so she effectively told the EU she was happy to be a vassal state and accept any terms it offered. We had Davis stating about CFP on Marr that everything would stay the same after we leave! We voted leave and were promised to take back control, good grief he is meant to be our negotiator! What did he not understand? may keeps pointing out you need a good economy to provide services, she is failing and giving away hundreds of billions!

  2. Mark B
    March 27, 2018

    Good morning

    Some pay for private treatment when they need it to get round long waiting times for non urgent NHS treatment . . .

    How is it that a private patient can jump the queue for treatment and a NHS patient cannot, bearing in mind that they may have the same physician, who is self employed. ?

    I mentioned in a post that was deleted a few days ago, that it made no sense that the government think it OK to tax people do having private healthcare / insurance but, seem not think it a benefit if they have private pet insurance.

    It is time that the NHS had some competition. It is time for people to be able to opt-out of the NHS for non-emergency services. Too many NHS managers are paid too much money. There is also far too much bureaucracy and box ticking of PC agenda. And once something becomes politicised, like this has done, it can be used by politicians as a soapbox to stand on.

    1. Mark B
      March 27, 2018

      Held in moderation. What this time ? No links, on topic, not that long, no named or unnamed persons etc. Yet some people here get to post TWICE, and at length, and not always on topic ! You are losing credibility – FAST !

  3. duncan
    March 27, 2018

    And here we go. The vested interest that is the NHS trying to use moral blackmail against government to force us to cough up ever more amounts of cash and construct a system that ties everyone into a tax that is unjustifiable

    This is a Labour party invention.

    I resent my taxes being used to finance a healthcare system that revolves around the needs of NHS employees. Salaries in this bloated, wasteful organisation are now out of control. Their gold plated employment terms and conditions, early retirements and all the expense of the average private sector worker

    What we are seeing is a political stitch up by a vested interest

    The NHS is now little more than an employer of medical professionals. The patient an after-thought

    People today work in the public sector not too perform a public service to the people but to enrich themselves and enjoy elevated levels of remuneration

    I can smell the Labour party and the unions……….all over this. Lobbying as they do for ever more cash and enough is NEVER enough for the public sector.

    The motto of this government as become ‘smash the private, enrich the collective’.

    This PM is no conservative

    Now where’s that magic money tree?

    1. duncan
      March 27, 2018

      The point being is that May, being weak and not of a small state mindset, will probably agree to this public sector union-Labour stitch up for fear of ‘bad headlines in the press’

      It is what she does, capitulates. No principles, just political weakness

      1. jerry
        March 28, 2018

        @duncan; [Mrs May] will probably agree to this public sector union-Labour stitch up for fear of ‘bad headlines in the press’

        Or perhaps because she knows that not to do so would mean loosing the next GE, when ever that is!

        Stop expecting the PM and party to act like the left-wing of the Labour party did in the early 1980s, they simply could not accept that the opinion of the electorate had changed, more of what the Plebs do not want did not get labour elected back and it won’t get the right re-elected either.

  4. jerry
    March 27, 2018

    “there is no likelihood that a particular tax will always yield exactly the right amount that any particular service might need for its costs.”

    VED, and.or perhaps road fuel duty, dispel that notion, raising far more revenue than is needed -ordinarily- to keep our nations roads well maintained, if the revenue was not syphoned off to pay for other govt expenditure.

    “We could make what we think is a generous settlement today, only for the NHS to discover it has a good need of more money than settled on it at some future date.”

    That is true of any and all taxation, for example we as a nation decided on a level of defence spending some years ago and thus the necessary taxes rate to pay for it (or allow tax cuts, I believe it it was called the a post Cold War dividend, ho-hum….) were levied by HMT, today we probably need to spend more than previously planned for as circumstances have changed, if so are you seriously suggesting that there is no way you would support a tax increase?!

    “Some of this will also be possible from the increasing take up of private healthcare which many opt for.”

    Except that private healthcare necessarily cover fully in the long term, meaning that the costs either returns to the NHS or the policy holder ends up paying directly. With a properly funded NHS (and LA leisure centres etc if exercise regime activities count as health care expenditure) why would they need to consider private healthcare?

    1. Lifelogic
      March 27, 2018

      Any new taxes, in the hugely over taxed UK, will be more likely to decrease overall tax take not increase it.

      We already have a chancellor taxing capital (up to 15% stamp duty and 40% IHT) and taxing landlords (& thus tenants) on profits they have not even made. This is not sustainable. If you keep taxing a business on profits it has not made you just put it out of business fairly quickly.

      Hammond and May seem to think they are just a warm up act for Corbyn. “We do all the daft things that Corbyn suggest, but are not quite daft” – this is not the way to win any election nor the way to grow the economy or improve living standards. Please can we have some real Conservative with vision.

      May & Hammond always sounds as if they only ever listen to the bureaucrats and the 20% who work for the state sector. She has not got a clue (and does not seem to give a damn) about the other 80% who work in the competitive sector.

    2. jerry
      March 27, 2018

      Sorry, a “does not” went AWOL in my previous comment, private healthcare does not necessarily cover fully in the long term

      Also just to add, social care needs to be brought back in to the NHS proper, not just better integrated, indeed perhaps also incapacity benefits and even pensions as all are often interlinked as patients get older, the new govt department could be named the Department of Health and Social Security (the DHSS for short)…

    3. sm
      March 27, 2018

      As long as we continue to use a poorly-designed service created 70 years ago to serve a today’s much larger population, and one that lives to a far greater age, with all its concomitant health problems, not even a 100% tax on ALL income and business profits would suffice.

      And I might add that as long as governments of all colours continue to mess around with the NHS instead of instituting a complete rethink, these problems will continue. Yes, Lord Lansley and Alan Milburn, I’m thinking of you…..

      1. jerry
        March 27, 2018

        sm; “As long as we continue to use a poorly-designed service created 70 years ago”

        I have no idea what sort of health service you have in South Africa @SM but here in the UK we have a very good service and it does cope with rising population, as it has always done, you seem to forget that the NHS coped with the baby boomer generation – in the 1950-60s it had to invest in pre & post-natal care along with paediatric care, today it needs to invest in better geriatric care.

        1. sm
          March 28, 2018

          Since I lived for more than 70yrs in the UK until last year, and indeed spent many years as a member of a variety of NHS-linked committees to do with medical research and patient care, I have no need for lectures about UK healthcare from you.

          The NHS financial provision concept was predicated on the short-term view that providing better healthcare would REDUCE the call on its services. (Ernest Bevin warned that this would lead to problems, but he was ignored) This took no notice of the likelihood of medical innovation and development, which has lead to more people living to a greater age and thus suffering from the linked health problems.

          Also in the 1950/60’s, if you contracted leukemia (as an example), you died within weeks of the diagnosis. Thankfully, this tragedy is far more rare today, but such treatments are costly. I have contemporaries who spend probably 70% of their lives receiving life-conserving treatments that each cost the NHS not tens, but hundreds of £thousands, per annum. Similarly, geriatric patients who have no quality of life because
          of severe mental debility are cared for and medicated, when 60yrs ago they would have succumbed to pneumonia, known to the medical profession in those days as ‘the old man’s friend’.

          You don’t win a Formula 1 championship in an original Morris Minor, even if it has go-faster stripes along the side and Lewis Hamilton in the driver’s seat.

        2. jerry
          March 29, 2018

          @sm; “Since I lived for more than 70yrs in the UK until last year, and indeed spent many years as a member of a variety of NHS-linked committees to do with medical research and patient care,”

          In other words what you’re saying is, I was part of the problem and yes I failed! Indeed we should have taken more notice of the likes of Bevin!

          “You don’t win a Formula 1 championship in an original Morris Minor, even if it has go-faster stripes along the side and Lewis Hamilton in the driver’s seat.”

          Indeed, so why do so many on the right want to try and win the Formula 1 championship in a 1930s era Austin 7 -as sporting as they could be, rather than build on the progress made post war.

      2. getahead
        March 27, 2018

        I also believe that ‘ free at the point of use’ is wrong. Some financial contribution should be made for treatment.

        1. jerry
          March 28, 2018

          @getahead; A financial contribution is already made to the NHS, via a means tested, it is called income tax… Duh!

    4. Narrow Shoulders
      March 27, 2018

      How about levying a usage tax?

      Say £25 per hospital appointment and £10 for a GP. £1 flat rate charge for children.

      £100 per appointment plus other costs incurred for tourists.

      1. jerry
        March 28, 2018

        @NS; “How about levying a usage tax?”

        That would be an extra charge for most then, having already paid twice (income tax and NI contributions), what is more would it not be seen as a tax on the sick akin to the ‘Bedroom tax’ & ‘Dementia tax’ that almost lead to Corbyn becoming Prime Minister! Do not under estimate how much even many otherwise Tory supporting voters love both the NHS and how it is free at the point of use.

        Would some not use the NHS when they really should -for the good of us all- do we really want communicable illness to go untreated, or at best poorly treated due to wrong self diagnosis and the use of ineffective off the shelf medication or worse by way of back-room ‘quacks’ and their so called cures.

        Would people seek prompt treatment or delay, many illnesses can be treated quickly and cheaply if caught early, catch them late and they cost far more to treat, perhaps becoming untreatable.

        Your idea would turn the nations health back a 100 years…

  5. Dave Andrews
    March 27, 2018

    The genuine NHS need is masked by hospitals being stuffed with lifestyle diseases. Once you have employed the most suitable healthcare workers, if they don’t meet the need, you have to employ lesser suitable people who are less effective, driving up costs through poorer performance.
    The country needs to be relieved of its obsession with being ill.
    I’m a little surprised there is such aversion in politics to address this issue, as I would have thought the message of looking after yourself is good common sense.

    1. Herumm
      March 28, 2018

      I would like the total of broken bones highlighted as the shoes sold these days are simply not fit for purpose .
      After all we do live in a country where it rains a lot!
      The people who sell them or produce them could be fined ?

  6. oldtimer
    March 27, 2018

    The 0.7% of GDP allocated by law to foreign aid shows the folly of measures which lock governments into spending commitments. Virtue signalling is an unsound way to commit taxpayers hard earned but easily taken cash. As you rightly point out the world of health care can and will change out of all recognition in the space of ten years.

  7. Bryan Harris
    March 27, 2018

    I’d like to disagree with that statement: ” We will need to spend more in future on the NHS.” This sounds like the creation of an ever increasing black hole… one that will give ever increasing problems… A solution is required that avoids this It can’t be that hard!
    1. We make the NHS fit for purpose, by using it for its core purposes, as originally designed – for nationals;
    2. Anybody coming from overseas for treatment should be directed to private hsopitals;
    3. Large companies and cororations should be encouraged to take care of employee’s health care needs
    That’s how we handle the problem known as NHS funding, if anybody has the guts to see it through!

  8. MickN
    March 27, 2018

    I heard a commentator on the radio yesterday state that the public are happy to pay an extra penny on the rate to pay for the NHS. Well let me state clearly that I am not. Not until we revert to a National health service and not an International one. Not until the number of doctors outnumbers the managers. Not until we stop issuing prescription for things that can be bought over the counter at a high street chemist for pennies. Not until for example we have to pay for someone to have the tattoos removed that they thought were a good idea at the time. I could go on but I think you get my drift.

  9. Nig l
    March 27, 2018

    Interesting article in the times this morning. Despite the government’s BS, funding for the NHS has been cut in real terms, (increase/rise in inflation) however it makes a clear case for right first time, increased use of technology and sharing and adopting best practice to achieve savings to increase services elsewhere rather than merely throw more money at it which every one with a business brain knows, delays the need to operate leaner.

    Once again Politicians who advocate more spending without ensuring the existing budget is getting maximum outputs are showing their ignorance of business efficiency, or more likely, are happy to waste taxpayers money for their own perceived political advantage.

  10. Old Albion
    March 27, 2018

    If we were to leave the EU. We would have approx. £10 billion to spend where WE wish.
    The ‘Brexit’ bonus you could say.

  11. Anonymous
    March 27, 2018

    I thought with mass immigration we were going to get an NHS which was

    A) Extremely well staffed

    B) Extremely well funded by the new taxpayers in the country

    Alas no. It is in perpetual crisis as with every other resource out there.

    Drink related injuries in A&E need to be charged for. Obesity too but I’m loathe to propose a blanket tax which hits those who are less greedy less lazy. Both are a big and unecessary drain on NHS resources.

    (Doubtless Andy will tell us old people are an unecessary drain on NHS resources too.)

    Visitors to the UK must have health insurance. Those who do not should have charges deducted from their country of origin’s aid budget if applicable.

    Newly immigrated citizens should not be allowed to bring relatives over on NHS holidays as they do now.

    We cannot go on being the World Health Service.

  12. Narrow Shoulders
    March 27, 2018

    Government should never be granted more tax raising powers.

    However one solution to the NHS might be hypothecation. A percentage or employees and employers NI collections could be ring fenced for the NHS. This amount can go up and down but demonstrates the cost to the nation of providing this resource.

    To access free at the point of delivery care you will need to have paid in or be a dependant in education of someone who is paying in. Benefits recipients could have a notional amount deducted to pay in. No one who has recently arrived in the country and (somehow) qualifies for benefits will qualify for this paying in.

    We could do the same for pensions.

    1. Narrow Shoulders
      March 27, 2018

      Including public sector pensions.

  13. Ian wragg
    March 27, 2018

    There is no shortage of government funds just colossal amount of waste.
    I think Gordon Brown raised NI twice by 1% to pay for healthcare only for the cash to disappear into the abyss of treasury ineptitude. Raising taxes whilst wasting £billions of pounds on foreign aid is a sure vote loser

    1. Chris
      March 27, 2018

      With regard to your last sentence, I understand that DfID sent substantial sums of money to the Clinton Foundation. Why, and on what authority? The money should have been spent in the UK.

  14. ian parkinson
    March 27, 2018

    Over 3bn of PHE money is spent by local councils but there are strict rules that they have to spend it on obesity programs rather than care. Relax those rules (decentralisation is meant to be a goal) and two benefits: more money for care where it is needed; different areas will spend different amounts and we can use this variation to see if this PHE spending is useful or not. I am happy to put £1000 behind a bet that the answer is “not”.

    There, no new taxes and another 3bn, that should buy a bit more time so we don’t have to talk about ways to improve efficiency.

  15. JoolsB
    March 27, 2018

    Keep chucking more money at it will solve all the problems. Yeh right. A typical socialist response from a typical socialist Government under May and Hammond. We could chuck every penny of the nation’s income at the NHS and it still wouldn’t be enough without major reform which your party hasn’t got the guts to do.

    As health is devolved, do these proposals intend to tax the whole UK or just as usual the poor downtrodden English who seem to be the main recipients of all this Tory Government’s austerity measures?

    Before your socialist colleagues think of ever more ways to tax the hard pressed taxpayer John, how about suggesting they stop frittering our hard earned money away on things which are not supported by the public such as £20 billion a year on foreign aid or a £40 billion bung to the EU? When are we going to get £65 billion back from RBS who are using much of that money to top up their depleted pension fund? Finally sort out the wasteful bloated public sector (including MPs) and their over generous taxpayer funded pensions.

    If hapless May needs more money, these are just a few of many ways to achieve it without picking on the hard pressed taxpayers. But it would take a Conservative Government to achieve it – maybe one day we’ll get one.

  16. Sir Joe Soap
    March 27, 2018

    I think with such a large and rising bill there is good reason to split this off from police/fire/education etc. so that people understand just how much is spent. In fact even splitting NHS emergency and elective costs would be preferable. Emergency is indispensable from taxation but elective could be covered with private insurance, as could elderly care if decisions are taken now for 50 years time.

  17. MIke Stallard
    March 27, 2018

    “There will nonetheless remain a major requirement for the state to vote more money for more and better quality healthcare free at the point of use in NHS surgeries and hospitals. ”

    – or on increased pay for the bureaucracy? And I mean especially the people at the very top who are competing on a world stage.
    I was visiting the hospital last week and the nurses were so many they were literally crashing into each other!

  18. John S
    March 27, 2018

    “If you think healthcare is expensive, wait until it becomes free.” P. J. O’ Rourke

    1. Peter Parsons
      March 27, 2018

      The UK spends 9.9% of GDP on healthcare:

      whereas the US spends 17.9% of GDP on healthcare:

      and that’s in a country where, until the introduction of the Affordable Care Act, a significant percentage of the population had no access to health care at all.

      1. a-tracy
        March 28, 2018

        Peter Parsons: Do you know if these figure comparisons include all the same bills so that you are comparing apples with apples on health spending.
        Doctors surgeries, maternity clinics
        School nurses and pre-check clinics
        All hospital costs,
        Subsidised payments to dentistry
        Subsidised payments to Optometry
        Subsidised payments to private Pharmacists to provide services to NHS patients
        Free prescription payments
        All provisions paid for by other taxes such as day care centres, health clinics,
        All tests done and billed back to the NHS by private specialists

        All charity health functions that the public pays for such as: Cancer carers like Marie Curie, cancer research, other healthcare charities providing healthcare such as hospices, and children’s centres providing health care to keep people out of hospitals.

        I wish someone would compare service to service, line by line, in the UK with the USA states like New York or California or France, Germany or Italy. So that we could try to see where we are falling short or where better savings could be made.

  19. Adam
    March 27, 2018

    Prevention is better than cure. Instead of seeking money to remedy preventable symptoms: Prevent!

    Might a tax on deviation from optimal body weight distribute costs fairer?

    Hypothecation was a Liberal idea, & may be more suited to prison. If prison releases were suspended until crime levels reduced, criminals might then act in the interests of all.

  20. Al
    March 27, 2018

    Wasn’t this one of the things National Insurance was supposed to cover, before the income from it got rolled in with general taxation. I suspect a close look at the civil service expenditure in multiple departments would uncover more than enough waste to cover any needed tax.

    The other option no one mentions is making it easier to get jobs or to setup and run small companies. We’re strangling in red tape right now, but if those costs go down, more workers can be hired, we make more profit, and the state’s tax and NI revenue go up (as well as spending on benefits for unemployment going down…).

    1. getahead
      March 27, 2018

      “before the income from it got rolled in with general taxation.”
      Was there ever a “before”?

    2. Lifelogic.
      March 28, 2018

      Indeed and it was sold as National Insurance but is nothing of the sort, just another tax to deter people from working.

  21. Epikouros
    March 27, 2018

    One thing is certain how the NHS is funded and how it provides it services has to change as the methods currently used are no longer sustainable or achieves acceptable outcomes. The system in use today is still the one that was designed under very different circumstances than we now experience. Worse those who set it up had rather romantic ideas about the state being the best provider and funder for healthcare.

    France spends more as a percentage of GDP on healthcare than the UK and it does achieve considerably better results than the NHS. However it does so with a different means of provision. A large part of it is in the hands of the private sector so elements of competition and for profit are built in that ensures that it is patient orientated and by so doing the quality of the service it offers is much better than the NHS. The greater funding is only possible because it is not completely reliant on tax because as we are finding out that is a finite resource. Up to 35% of the funding is provided by the patient either directly or by the patient making use of one of the many insurance schemes on offer. It has safety nets so that any one who is entitled rich or poor never finds healthcare unaffordable. However those who are not have to pay, for instance health tourists cannot take advantage of the system.

    1. Stred
      March 28, 2018

      Yes. Just copy the French or the Swiss or the Germans or the Aussies or any country which has a bloody health system that works.

  22. Denis Cooper
    March 27, 2018

    At the behest of the Liberal Democrat leader there will be a two hour emergency debate in the Commons this afternoon. The “emergency” being that somebody who was involved in one of the EU referendum campaigns has now decided, after nearly two years, that he should reveal evidence of wrong doing. Except that when that person was asked on TV yesterday whether he actually had any hard evidence of wrong doing he admitted that he had no such hard evidence to back up his allegation. Not that this would be the sum total of all wrong doing during that referendum even if his allegation was true, quite apart from the government’s heavy spending on the Remain side there is also prima facie evidence of similar questionable practices among the various Remain campaign groups. It will be interesting to see whether the leader of the Liberal Democrats mentions this …

    1. Denis Cooper
      March 27, 2018

      The level of hypocrisy shown during this debate was nauseating.

      Apparently any mention of that £9.2 million of taxpayers’ money spent by the government on the Remain side, as well as any mention of wrong doing by various groups on the Remain side including the Liberal Democrats, is seen by its leader as just an attempt to “muddy the waters”.

      And of course none of this has anything whatsoever with attempts to overturn the referendum result and keep us in the EU.

  23. a-tracy
    March 27, 2018

    Are they talking of an NHS tax just for England or for Scotland and the RUK?

    Just how much do you think our graduate children are going to be able to afford?

    If they live in Scotland they will pay their
    Scheme 1 English Graduate Tax at
    + 6% over £17,775
    19% above the tax threshold £11,850 up to £2,000
    20% £2001 to £12,150
    21% £12,151 to £31,580
    41% from £31,581 to £150,000
    46% above £150,000
    12% NI above £8,424 to £46,350 then plus
    2% NI above Upper NI earnings level £46,351
    2% NEST workplace pension (increasing in April 2019 to 5%)

    Then if they have children they lose their child benefit if one parent earns over the Higher income level

    Then if they earn £100,000- £123,000 they get their personal allowance clawed back giving them an effective tax rate of 60%

    There is going to be trouble ahead. Serious trouble.

  24. Rien Huizer
    March 27, 2018

    Mr Redwood,

    It remains strange that Conservatives support an originally socialist idea, that the State should be responsible for healt care (I assume you are dealing strictly with the sort of care the NHS cuurently provides and want to keep te borders between health and other kinds of care where they are now, in other words that the state in its non-NHS guis looks after that too but funded and provided in a different way) and that it should be funded from general revenue.

    Do you also believe that the NHS should be a single, vertically integrated enterprise doing diagnostics, in- and outpatient surgical, pharmacological and therapeutic care, general practice, etc) quasi monopolistic (the private practitioners fill gaps but do not truly compete with the State) in the future as well?

    1. Richard1
      March 27, 2018

      Of course he probably doesn’t but he’s a Conservative MP and the NHS is the national religion. Anyone who wishes to play a role in public life in the U.K. must pay obeisance to the NHS.

      1. Lifelogic.
        March 28, 2018


        The NHS can never work as currently funded and structured. It is a total disaster for millions who suffer it. But MPs, even sound ones, can never tell the complete truth.

    2. Stred
      March 28, 2018

      From outside it must look like a cargo cult.

  25. Wessexboy
    March 27, 2018

    Agreed John; any allocation of a fixed percentage by govt. is an inflexible nuisance – foreign Aid budget for example. If we must endure a soviet style health service, let’s at least keep the flexibility of each new government to decide how much money it merits.

  26. Leslie Singleton
    March 27, 2018

    Dear John–Shows how much I know–Wasn’t NI supposed to cover NHS? Look what happened to that. Where’s the difference?

  27. Derek Henry
    March 27, 2018

    Especially since taxes does not fund government spending.

    It’s not about fiat currency it is always about skills and reources and these take years of planning. Nurses and doctors don’t magically appear from the pavement if you throw fiat money at the problem.

    Government spending creates the £ and taxes Destrot the £ to take our spending power away and control inflation.

    These are the facts after studying it for 4 hours a night for 6 years.

    When government spends it requests that its Treasury’s account at the BofE be debited and the reserve account of the recipient’s bank be credited and that the recipient’s current account at his bank be credited. (I’ve been told off for calling the Treasury’s account at the BofE a reserve account, but that is basically what it is.) It can be seen that government spending creates broad money, since new bank deposits are created.

    When government raises tax or sells gilts, the reverse happens. The payer’s current account is debited, the payer’s bank’s reserve account is debited and the Treasury’s account at the BofE is credited. (there is an intermediate step that involves the GBS when paying taxes, but, this just clouds the big picture). It can be seen that government taxing or selling gilts (to the non-bank sector) destroys broad money (unless you define gilts as money, which is a bit of a stretch)

    The other thing to remember is that the government has a self imposed rule that its Treasury’s account at the BofE should not go overdrawn, which means there has to be a sufficient balance in the Treasury’s account before the government can spend. This sufficient balance is acquired by taxing, selling gilts or writing an IOU to a commercial bank. By taxing or selling Gilts in order to acquire a balance in its Treasury’s account at the BofE, the government first destroys broad money and then recreates it when it spends. When it acquires a balance in its Treasury’s account at the BofE by writing an IOU to a commercial bank, it simply creates broad money when it subsequently spends.

    As we all know the fiscal constraints are not worth the paper they are written on when they become stressed they break like raising the debt celing or bailing out the banks.

    Who is the person or entity that can enforce the condition and make it stick. Who gets to say ‘no’ and stay in a job. What backup can they call on?

    With an individual that is obvious. The bank can bounce your cheques and the courts will back them up – all the way to jailing the individual for contempt if necessary. Now try doing that to a government, or even more so to a legislature. Will those running the bank really bounce the cheques in direct contravention of an order from the elected legislature?

    To have any control, you have to identify the control point in the system and who has power and authority to enforce that control point and stop people ignoring it. Otherwise it is just words on a paper somewhere.

    That any ‘constraints’ apply at the end of the day’s banking – after clearing has run and completed. That’s the only point that the checks are made.

    And the reason for that is obvious – during the day payments and transfers occur at all sorts of different times from all sort of different institutions.

    So intra day essentially everybody runs on an unlimited overdraft, and clearing eliminates that by the end of the day.

    If you imagine spending happens in the morning and bond drains happen in the afternoon, you can see that the non-government sector has to breath in money before it can breath out. And from a government point of view that is the way around you want it – a system stuffed full of morning money ensures better bids for the bonds you issue in the afternoon.

    Intra day the clearing system will run with a balance sheet perhaps some 10% bigger than it ends the day with.

    1. Derek Henry
      March 27, 2018

      The self imposed rule was sent to us by the Lisbon Treaty article 127.

      It should be one of the first things we rip up as it is not worth the paper it was written on.

  28. Lifelogic
    March 27, 2018

    “Some of this will also be possible from the increasing take up of private healthcare which many opt for.”

    Indeed and many more would opt for still if you did not have to pay once for others to use the NHS, then again tax on your income to pay the insurance premium and then thank to Hammond so to be 12% IPT on top! Also many more would pay if they had to pay something for the NHS as they should.

    Why should some people have to pay health care costs three times over? Income tax and NI relief is needed and scrap the IPT tax for medical at least as we had under Thatcher. This dreadfully left wing government just has no working compass?

  29. nigel seymour
    March 27, 2018

    Just listened to Patton on DP and how he struck me as being quite childish on his brexit arguments. We are now into the period of platitudes that will be flooding in suggesting any reason at all tp stop brexit. MP’s lie in the commons when they say they respect the referendum, not only do they lie to the public they are lying to themselves. Anyone that says they respect the referendum and then chuck in the BUT then they are liars.

    1. rose
      March 27, 2018

      He is presumably respecting the oath of allegiance he took to the EU which pays his pension.

  30. Potash
    March 27, 2018

    So what is the maximum amount of our nation’s income at any one time is it appropriate to set aside for the NHS? No glib answers pleas like
    As much as it takes
    There can be no max figure because it concerns life and death

    Every nation has to make decisions. For instance the EU has decided over the years that young people shouldn’t necessarily have a job for they are generally lazy, incompetent , bad attenders and mostly disagreeable and mean.

    1. Rien Huizer
      March 27, 2018

      The curious thing about a basically socialist idea like that which underpind the NHS, that health care procision is a government responsibility and “free” in the sense of the individual user, is that the government in its role of care provider, might as well try to controle health care costs (for instance in order to spend scarce resources elsewhere) by three less traditional mechanisms: (1) create access hurdles for those who are careless with their own health (eg smoking, sports, bad diets) (2) eugenics: test the unborn and remove the taboo on discontinuing treatment for those chil;dren unlikely to grow into reasonably healthy and self-reliant individuals and (3) of course to offer a lump sum equivalent of cost saved to the terminally diseased if they opt for voluntary euthanasia.
      Three technically sound solutions that for moral (#3 and less so #2) and political (#1) reasons are highly unfeasible in democratic polities. However, #1 is the subject of lively debate in countries where there is compulsory insurance (where people pay a fee and often a deductible) and where the insurance principle of negligence is becoming less taboo. Nos 2 and 3 are much less fashionable now (although modern enbryo testing temps rule makers to shift the moral boundaries and ideas to offer euthanasia as an option to the vitims of life inprisonment are considered humane by experts).

      People consume healthcare and to a certain degree, do so voluntarily. The responsibility of the government is merely to protect the most disadvantaged (subject to them dealing with the neglicence problem), providing catastrophic health insurance to everyone (without means testing) and preventing epidemics. In addition, to regulate safety and market structure of private sector provision. No need to accommodate risky lifestyles or endless IVF treatment (for instance).

  31. Atlas
    March 27, 2018

    Agreed John. Some politicians are very good at spending other people’s money for them.

    We have had such siren calls in the past and they never fixed the problems.

  32. English Pensioner
    March 27, 2018

    There seems to be no concerted effort to improve the efficiency of the NHS.
    It appears to have far too many people “managing” and receiving exorbitant salaries. There is a need to examine well run hospitals in other countries and even in the private sector to determine the ratio of management staff to medical staff and find how our hospitals compare.
    The NHS Trusts seem to me to be a great mistake, all that seems to have happened is that there are more highly paid administrators. There seems to be no co-operation between Trusts; where I live the local A&E has been closed and the nearest one is now in a different Trust. No wonder the local Trust can claim that the A&E is now more efficient; they’ve lost maybe 10% of their patients!
    Personally, I’ve no objection to the privatisation of hospitals provided that one can get treatment that is free at the point of delivery.

  33. stred
    March 27, 2018

    Yesterday,EUBC Politics chose the Conservative MP who is a GP and turned to campaign for Remain after deciding that we had avoided war because of the EU. She was asked whether a wealth tax should be considered to fund the NHS and said that everthing should. This as France is reconsidering its wealth tax after large numbers of people left the country and anyone with a big house and savings was caught, with Hollande becoming the most unpopular president.

    Where do the Conservative Party find this variety of Conservatives? Do they advertise in the Guardian?

  34. ian
    March 27, 2018

    Every government worker has private health cover paid for by the government, they use benenden private health.
    First, they see their GP and then the GP books you in to see a benenden specialist, they see if it’s something they can handle or book you in NHS some way up the ladder of the queue to have an opp.
    All private health works the same, after seeing your GP in the case of gov workers or going to the private health provide yourself and paying cash or a monthly plan pay by you or your company.
    On private healthcare, it takes about a week to see a specialist.
    Some private health providers have their private rooms and clinics inside the NHS hospitals.
    You would be hard press to find somebody who has had private healthcare dying in their care, that’s because if it big opp it is done in NHS and then you are taken back to the private side and if you look like you are about to die taken back to the NHS and put on award for your last few hours, if possible.

  35. rose
    March 27, 2018

    The arguments for a special hypothecated NHS tax are emotional and manipulated. We could just as easily have an argument about a hypothecated tax for the Army, the Navy or the Police. Others would want one for education; yet others for a decnt transport system with dedicated bike lanes at the side of every major road. Then there is the environment and farming; border protection…all could be made special cases and in each case your arguments would apply: it is not a sensible way of managing public spending.

  36. agricola
    March 27, 2018

    I have concluded that you cannot solve the question of the funding of NHS short of a fundamental overhaul of the whole tax system ,national and local. The way we conduct ourselves in almost every respect has changed and continues to change at an accelerating rate. While such changes can be thought through they cannot be put into effect until we are well clear of the EU. Accept that you can only play catch up for a limited period moving forward.

    The mantra that the NHS should be free at the point of need is fine with me providing you accept that nothing is for free. Question is , should you perpetuate the myth or should the people be allowed to get closer to the reality. Problem is that the NHS has been allowed to take on the qualities of an untouchable religion with fatwahs awaiting anyone who proposes changes even if those changes do not alter the free at the point of need tenet.

    Let matters run for the next five years while the tax regime is re-thought, then have the courage to apply well thought out solutions. They must be flexible solutions because the field of play is constantly on the move.

  37. lojolondon
    March 27, 2018

    Every single person, no matter what their circumstances, shall pay £10 to see a doctor. Done. Appointments will reduce by 20%, and revenues through the roof. But you will need to defund the BBC first, because they will stop any sensible action on the NHS.

  38. ian
    March 27, 2018

    Giving pay raises is always a favourite with headline figure as now, of 4 billion for NHS workers, a lower paid workers will pay 52 percent of that money back to the treasury in the first year, 20% income tax, 12% NIs, 20% VAT and as much as 67% for high wage earner.
    So the headline figure is really about 1.7 billion pounds.

  39. ian
    March 27, 2018

    Paying for healthcare out of general taxation is ok and increases in old age pension, but that means everything else has to be put on the back burner.
    When you consider old age pension goes up by 2.5 to 3 % a year which 5 to 6 billion a year and the NHS is about 3 to 4 billion a year going forward, that’s 9 to 10 billion a year out of wages growth of 2.5 % a year which just about cover it.

  40. ian
    March 27, 2018

    also that without gov workers pension going up in leaps and bounds of over 5 million workers.

  41. Dennis
    March 27, 2018

    “there is no likelihood that a particular tax will always yield exactly the right amount that any particular service might need for its costs.”

    What inflexible thinking! If it too little then top it up, if too much let it go to the general pot. Is that so difficult?

  42. Derek
    March 27, 2018

    Maybe NOT an NHS Tax but certainly a special NHS fund.
    Such a fund could be made the focal point for all of those persons who come to this country, either as visitors or to work and who should be obliged to register with the fund providing FULL details of a valid Insurance Policy and/or a direct serviceable method of payment. And definitely before any of them gain consultations or any treatment outside of A and E. This type of health system payment is accepted in countries all over the world. Indeed we Brits have to accept it every time we go overseas.

    The NHS is OUR National Health Service. We pay for it through OUR taxes.
    It is not, nor was it ever intended to be, the International Health Service it has become and I know of no other Nation in the World that continues to treat anyone who cares to walk in the door and regardless of their ability to pay for their operations. Indeed many come here for free major operations and births to capitalise on the lax security and I/D rules of our Health service.
    For they are never asked UP FRONT for their Insurance Certificates nor their credit card details, as we and they always are in other countries.
    If the NHS cannot manage on £120 Billions per year and rising (equivalent to £1850 for every man, woman and child in the country) they cannot manage. Full Stop.

  43. mancunius
    March 27, 2018

    “only for the NHS to discover it has a good need of more money than settled on it at some future date.”
    Alas, but a national command economy such as is – essentially – the NHS, can ‘discover’ it ‘has a good need’ of a helluva lot ‘more money’ at a moment’s whim: whether it suddenly ‘needs more staff/resources’ (i.e. at the behest of its unions and their political allies) or ‘cannot cope’ (with a government-promoted surge in the population or an epidemic that does what epidemics naturally do) or whenever a particular medical condition is highlighted (e.g. by a Prime Minister of the day foisting his or her own family medical problems on the nation, and confusing the care of trained medical professionals with the type of system that funds them).
    Providers, on the other hand, are unsentimentally hard-nosed: e.g. medical patents and pharma copyrights are as expensive as the systems that buy them will allow. The BMA will perennially push for higher GP and consultant pay. And so on.
    What is needed is a system that puts a lid on costs. This can best be done with a very basic no-frills system for the poorest, to which individual patients can add via personal, tax-deductible contributions to insurance systems, overseen by a vigilant national watchdog proactive in cutting costs and waste, both by providers and by the insurance companies.
    Medicine, like food, shelter, tv, education and clothing, is a good for which we all have to pay. Taking away more individual income to throw ever more taxation at the NHS is simply another triumph of hope over experience.

    1. mancunius
      March 27, 2018

      Sorry, the final para should read ‘Medicine, like food, shelter, tv, education and clothing, is a good for which we should all pay according to our own personal needs and desires. Taking away more individual income to throw ever more taxation at the NHS is simply another triumph of hope over experience.’

  44. Realpolitik
    March 27, 2018

    Including a previous fact finding mission to America from a certain committee member.

  45. Ms Speaker
    March 27, 2018

    The White Van Driver’s is not for turning!

  46. juter
    March 27, 2018

    When we leave the EU then their tax (VAT) can be spent elsewhere…TIC

  47. Andy
    March 27, 2018

    Lots of you don’t like paying for the NHS. I bet, however, you are very grateful to have health care when you actually need it.

    Maybe we should make it ths NHS opt out system. If you don’t want to contribute your share – fine.

    When you then get sick your choices are either to pay in full for your treatment or to not get treated at all.

    A fine choice if all you ever get is a cold. Not so good if you end up with a life long debilitating condition like MS.

    Still it will have been your choice to die slowly and uncomfortably. At least you will have saved a few hundred quid a year.

    1. juter
      March 28, 2018

      NI contributions are a bit more than a few hundred pounds each year for working people.

  48. leavewon
    March 27, 2018

    My local paper, the Echo published a list of Masonic councillors yesterday, nearly fell off my chair.
    Not that I have any gripes with the council, they do an excellent job , apart from that tiny little lapse recently, where they put iron hoops on the middle of benches so the homeless couldn’t kip on them. They said at first it was for poor oldsters to be able to get up easily with the aid of the hoop ! but have since retracted and removed the hoops.
    Do you all remember the excellent series The Prisoner with the wonderful Patrick McGoohan ? Fairly phrophetic.
    Keep up the good work JR

  49. ChrisS
    March 27, 2018

    The problem with the NHS is that it thinks that it can just pull some numbers out of the ether every year and if that proves insufficient, it just expects a further cheque to be written out for whatever else it demands.

    Nothing works like that.

    It is not beyond the best brains to come up with a three or five year financial plan and broadly stick to it.

    Lets forget the softy terms such as “Our NHS” This is a corporation which needs a business plan and sound budget control like every other large entity. It can’t be allowed to blackmail the rest of the economy into providing ever more funds with no apparent limit.

  50. Cis
    March 27, 2018

    The elderly mother of a good friend was admitted to hospital as an emergency case last Thursday, suffering from a severe infection requiring hospital-administered antibiotics and a suspected mini-stroke. She has spent the last four days on a dementia ward in the only available geriatric bed in a big city hospital. The infection has responded to treatment, but she is not yet well. Nevertheless, she is being sent home tomorrow because the hospital team say the particular ward is not a suitable place – not quiet enough – for her recovery. There is no other bed available, no chance of a medical referral for convalescent care, and no care package being offered either because one of her children (who is still working full time) lives with her and is expected to get extended leave from the job to care for her. The patient is herself a retired medic. She gave the best years of her life to the NHS, and this is how it treats her.

  51. Ron Olden
    March 28, 2018

    In 2015 the existing management of the NHS demanded £8 Billion a year more for the NHS in the (then) coming Parliament . Labour refused to commit to the full sum because it hadn’t ‘been costed’. The Tories however promised and delivered it.

    A year later, the NHS was complaining that it hadn’t demanded enough, and wanted even more.

    More recently the same boss of the NHS has been demanding that he get £350 Million a week extra because someone (definitely not Mrs May of Philip Hammond), wrote on the side of a bus he’d get it if we voted Leave.

    He appears oblivious to the fact that at the time every single Remainer, he himself, Philip Hammond and nearly all independent observers were saying that no such sum of money would be available if we did so.

    I’ve never met, or even heard of, a single person who voted Leave in the expectation that it would immediately result in £350 Million a week rise in the NHS budget.

    So what conceivable chance is there, of the NHS being able to cope with a budget set ten years in advance, let alone being able to live with funding it from a tax, the receipts from which are impossible to forecast?

    I suppose there might be case for hypthecating all the receipts of some existing taxes e.g. VAT, tobacco, and sugar taxes etc, which between them raise more or less the amount we currently spend on the NHS, and raising them or lowering them as appropriate in accordance with what we choose to spend on it

    At least it would create a direct connection in people’s minds, between an increase in the amount the NHS gets, with an increase in what they have to pay. And there is, in some cases, a vague connection between our consumption of these things, and the demands we place on the NHS.

    But I doubt if even that would work. The NHS would, as ever, come along demanding more, and the latest political opportunist would say that it’s unfair that it should go on VAT and demand that some other tax be put up instead, or that we just borrow more to ‘invest’ in the NHS.

    I don’t, however, share John Redwood’s optimism that, as their incomes rise, people want to spend more on their health care. In my experience they demand that other people, many not yet even born, pay the extra for them. Or better still conjure the money up out of thin air.

    People prefer to spend their own rising incomes on other things, some of which make their health worse.

    1. Dennis
      March 28, 2018

      Ron – “More recently the same boss of the NHS has been demanding that he get £350 Million a week extra because someone (definitely not Mrs May of Philip Hammond), wrote on the side of a bus he’d get it if we voted Leave.”

      No one wrote that. This fake news never seems to end.

  52. Stred
    March 28, 2018

    Take away preventative health care for obesity, smoking, drugs, booze, etc. Make early detection of disease slow. The lowering of lifespan would solve the problem. This is how the Mandarins think.

  53. Dario R Melkuhn
    March 29, 2018

    We already pay a NHS tax, it is called social security payments. These payments were supposed to fund health care and our pensions. However what in reality is happening is that our payments are giving free health care to immigrants who have contributed nothing and to those coming on holiday with the sole reason of free health care. There is not one other country in or out of the EU that allows this. I am currently living in Spain and have had to contribute into the Spanish social security to be able to receive health benefits anyone who has not paid into the system is charged before any treatment. This needs addressing as it is the main reason that our health system is failing. Politicians are living in a bubble totally oblivious to the plight of the people as our taxes are funding your pensions, healthcare, expenses etc and are always with their hands out for more. If politicians had to live on minimum wage as to many do they would soon pull their fingers out. It is so easy for all you politicians to talk and do nothing that helps the country and people. The people voted with a majority to leave the EU and just look at those who were elected on the promise of delivering that make a deliberate mess of it all and cow to the EU for their own profit

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