Mal Fletcher
Tax Rises Not Enough To Protect The NHS

The National Health Service is an institution of which Brits are rightly proud and which we all want to preserve and protect. Obviously, anything that can realistically be done to boost its chances of future success would be welcome.

Today, the Liberal Democrats are recommending an “extra penny in the pound” tax increase to support the cash-strapped NHS.

As a social futurist, I’m sometimes asked in sessions presented to civic leaders what shape the NHS might take in 10-20 years time. My honest response is that I can’t see the NHS existing in its present form two decades from now – for one simple reason: we can’t afford it.

Like most institutions – and most things in life – the NHS will need to adapt to survive. In its present form, it likely won’t last. Ours is a rapidly ageing population, which will continue to rely on ever more sophisticated technologies to keep it healthy and alive.

Medicos will find it increasingly difficult to keep up with a plethora of new drug treatments – not to mention new variants of existing illnesses. Rapid advances in technologies such as nanorobotics and gene manipulation will require that GPs and nurses are constantly doing refresher courses.

Of course, new technologies will also mean a stream-lining of some services, cutting down on the time investment for medicos in some areas. For example, Skype consultations, which are already being tried in some regions, will doubtless prove time-savers when it comes to smaller complaints. Nurses may well handle some of these consultations, passing more difficult cases up to doctors.

New technologies, however, won’t diminish our need of the human medical practitioner. In fact, the presence of more high-tech will boost our need and desire for high-touch. When facing an illness, we need more than a paper to read on the internet, or screen time with someone. We need the reassurance, comfort and guidance that only a highly trained, in-the-room human being can provide.

Financially underwriting a free-at-the-point-of-delivery service will become increasingly challenging. Successive governments will face a rather stark choice.

Either the NHS will need to start charging for selected forms of treatment, including those which are now offered free at the point of delivery, or taxes will need to increase. The increase may need to be marked one, too – possibly, in the long run, to levels akin to those in Scandinavian countries.

I lived for a decade in Scandinavia and I’ve worked extensively there. Nations like Denmark, Sweden and Norway have excellent healthcare services, but citizens pay a high price in taxes to support them. When my family and I lived in Denmark, from the mid-90s onwards, we were paying sixty percent in combined taxes.

I’m not sure we Brits would want to contemplate such high levels of taxation, even if it meant the salvation of the health service.

I think we’re more likely to move in increments toward a “free enterprise” situation, where certain treatments, which are now free, are paid for at the point of delivery. Whether that would work and on what criteria those paid-for services would be selected is up for debate.

However, whilst financial considerations are hugely important and probably central, they are just some of the issues that will decide the future viability of the NHS.

There are also important questions surrounding the core culture of the NHS.

Recently, we saw junior doctors striking to stave off government changes to work contracts. A second strike was called off when the BMA advised against it, sensing a change in the public mood.

Until now, the medical professions have managed to escape the worst effects of a creeping trust deficit which has impacted almost every institution central to British life.

The public’s relationship with society’s foundational institutions has arguably taken a turn for the worse.

Trust in business leaders was perhaps at an all-time low in 2007-8, when business – particularly banking – was seen as responsible for the worst recession since the second world war.

Not long after that, members of Parliament were caught up in an expenses scandal, the impact of which is still being felt today. Opinion polls taken in the closing stages of the recent EU referendum campaign reflected that large swathes of the public could not decide on their vote. This was partly because they didn’t know which political voices to trust – or which ones to distrust least.

Meanwhile, our courts and police were held to question because of their conduct during or after England’s riots of August, 2011. The police service has also taken a hammering over its various bungled investigations into child sexual abuse, especially those involving public figures.

The press were held up to scrutiny and found wanting when it came to the hacking of telephones and the worlds of media and entertainment saw their reputations besmirched by ugly and painful child abuse scandals.

It wouldn’t take much for the healthcare community to be added to the list. And when it comes to the trust stakes, medicos have more to lose than most other professionals. An Opinium study earlier this year suggested that nurses and doctors are still the two most respected professions in the UK.

A fall from grace for healthcare professionals would be especially quick and painful compared to that of other professions, partly because we expect of them a greater degree of selfless commitment to the common good. After all, we show them such unusually high levels of respect, which at times border on (and often become) deference.

Already, there are signs of public impatience with medicos. In the eyes of the public, the fact that a GP consultation under the NHS lasts for an average of just ten minutes – and the fact that five of those ten precious minutes are spent with the doctor consulting a computer screen – suggests a fundamental loss of interest in the customer.

This problem has a financial component, to be sure. But it also raises a question of essential values. How much does the GP actually value the patient? Has the client now little more than a retail customer, to be dispensed with as quickly as possible and with the bare minimum of attention and care?

Unless we opt to see our health system take on a slightly more “free enterprise” tone, tax rises to guarantee its future are inevitable. I’m not an economist, but I see no reason why those rises wouldn’t be substantial.

Yet the future survival and shape of the NHS is not a purely a matter of public finances. It also has to do with the values; the culture within the healthcare community. This should also form a key part of our debate on the future of the NHS.

Mal Fletcher (@MalFletcher) is the founder and chairman of 2030Plus. He is a respected keynote speaker, social commentator and social futurist, author and broadcaster based in London.

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