The logjam in the political debate on how to finance our welfare state, and particularly the NHS, is described clearly by Rafael Behr (At the heart of the NHS cash boost lies a dishonesty: tax, 8 January).
The way to break this logjam and reach a satisfactory funding settlement for the welfare state is to initiate a regular “strategic welfare review”, based on the long-established strategic defence review. This is the central argument that Andrew Forsey and I advance in Not for Patching, recently published by Haus Curiosities.
The task of projecting our country’s needs, the changes in the machinery of government required to meet those needs, the costs of seeing them through and how those costs will be covered is a mammoth one. But the Office for Budget Responsibility is ideally placed to produce the necessary data on a regular basis for health, social care and social security.
Equally necessary is political courage from the prime minister to seek that longer-term settlement with the electorate on what outcomes our country desires from the welfare state and how their pursuit is to be financed.
A strategic welfare review should be tasked with looking at the potential role of a reformed national insurance base – applied to all citizens – in financing a combined health and social care service.
Frank Field MP
Independent, Birkenhead
• Rafael Behr omits an explicit reference to Theresa May’s statement that the NHS plan is possible because the UK would no longer send “vast annual sums” to the EU. This is a classic magician’s trick: look, she said, here is the money we are saving by leaving the EU. But if you look again, that money has gone: since the Brexit vote our GDP growth has slipped from the top of the G7 group to the bottom, and all the government financial assessments indicate that we will be worse off with any type of Brexit.
And if you want to look at medical opinion on the impact of Brexit on the NHS, read the 17 November issue of the British Medical Journal: the editorial and some articles argue that leaving the EU would have a seriously negative impact. There is a fundamental problem with magic tricks: they are just illusions.
Giuseppe Bignardi
Durham
• The new money, £20bn, coming to the NHS in the next five years is welcome. Indeed, based on World Bank data as a percentage of GDP coming to health, 9.6% is the largest ever, topping the 9.4% of 2010. But this hides the fact that the percentage of GDP going to health fell in 2011 and 2013.
Moreover, the money has to go to 140 English health trusts, so it is questionable whether it meets the need. The only way to judge NHS funding is to compare it with other western countries: for example, Germany spends 11.5% of GDP, France 11.7% and the US 16.8%.
Over the past 30 years, the UK has been at the bottom of the league table, averaging 7.6%, compared with France and Germany at 9.6%, and the US at 12.3%. But in terms of reducing adult mortality rates, we do better than most, including the US, indicating that the NHS achieves more with a proportionately smaller but feasible budget.
Prof Colin Pritchard
Bournemouth University
• A repeal of the 2012 Health and Social Care Act is long overdue, but it is not necessary to repeal key sections of it in order to end “automatic tendering” (Time to curb privatisation of care, NHS chiefs tell PM, 8 January). The act only empowers the government to require tendering and the requirement is imposed under secondary legislation – the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013. These can be revoked with the stroke of a ministerial pen.
Getting rid of these and abandoning the intended long-term “integrated care provider” contracts would start to give some credibility to claims that privatisation of the NHS in England is ending.
Peter Roderick
London
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