A proposal for health and social care

Arthur Kaufman is a former NHS Clinical Psychologist and Medico-legal Practitioner.

Within the last decade, hardly a day even before the arrival of the current pandemic has gone by without being reminded of cash crises in the NHS and Social Care. Indeed, there seemed little, if any, chance of getting over the financial hump for at least several years, and it would have taken a rather brave or naive management consultant to have pontificated otherwise.

Despite repeated utterances of panaceas on “the better use of resources,” the most common denominator underlying problems in both clinical and social services has been a chronic shortage of money, resulting in cost-cutting of already overstretched facilities.

In considering all the economic pressures in the UK, including political and public concerns over how much (and from which source) to raise tax revenues for urgent needs in the NHS and Social Care, obviously more funding was required – albeit without imposing additional burdens on individual and corporate taxpayers – and to do it sooner rather than ‘too much later’ if further cuts in such vital areas were to be avoided.

The most common denominator underlying problems in both clinical and social services has been a chronic shortage of money.

Although it seems a majority of the public are usually willing to pay more in tax for the NHS, and presumably for Social Care, the enthusiasm for doing so is likely to wane when its effects on personal loss of decreasing income are known. There is also the problem of what can, or cannot be afforded from year to year, even by way of ‘ring-fencing’ whatever extra resources become available.

In view of all the financial problems affecting the NHS, plus the increasing and worrying aspects of Social Care, what is proposed here could help in alleviating the effects of Covid-19 and within the next few years if only as a medium term solution. But, as matters now stand, a relatively quick ‘breather’ is needed in the interim before another unknown crisis threatens to overwhelm both of these major services, since its cousin viruses are still very much evolving.

What is important is a means of filling the gap between what is called for and what the government is able to provide following the coronavirus crisis and the recent level of massive borrowing, while still having wider scope in future budgeting.

When the current crisis is under reasonable control, there are bound to be considerable demands from most government departments for increased financial input when compared with what was available prior to the present pandemic, thereby resulting in pressure for more in taxation or more national borrowing in one form or another.

However, in considering the likelihood of political as well as personal and commercial opposition to raising taxes, a government issue of Health & Social Care Bonds would seem a tenable way of raising a substantial amount of finance without imposing further burdens on taxpayers. Even so, it would be important for those purchasing such bonds to have a significant say in how this additional revenue would be disbursed.

This ‘say’ could be done by representatives of bond purchasers in the localities concerned, thereby not leaving such choices mainly or solely to official bodies whose decisions on local spending may not be in keeping with what their consumers of health and social care would rather have, and, in some cases, very much so.

A government issue of Health & Social Care Bonds would seem a tenable way of raising …. finance.

Given the current crisis, including the problems of overburdened GPs, the increase in elderly numbers and the lack of mental health provision for young people, the present proposal could be viewed as health & social care power, and prove attractive to potential buyers of such bonds, particularly in view of the continuing popularity of the NHS.

Obviously, details would have to be worked out, but it seems that this proposal or something equivalent in cash terms is needed to get over the quandary which seriously impacts on the NHS and what has to be provided by local councils.

While the ‘health & social care power’ or decision-making in how the additional money should be spent would be limited to Health and Social Care bond holders, the purchase of such bonds is likely to be very wide indeed, and should be limited to individuals to avoid large numbers of shares being held by commercial interests, with a set limit for members of the public as well.

In addition, consultations with patient and social care organisations representing bond holders would be required before allocation of monies from bonds were made. This could improve morale amongst front line health and social care workers whose views (perhaps all to often not taken on board by governments of either shade) would have to receive serious consideration when it comes to deciding how funding gained from bond purchases should be spent.

Consultations with patient and social care organisations … would be required before allocation of monies … were made.

It would, of course, also be necessary for relatively deprived and poorer areas (i.e. those with fewer bond purchasers) to receive a fair proportion of the funds raised in the better off ones, in order to ensure that communities with the greatest needs would not lose out in the end. This should also apply to those areas of the country where previous funding has been disproportionately lower than it should have been.

Unless the government or other relevant bodies can put forward other proposals for health and social care, which could be implemented at a much faster than the ‘usual’ parliament timetable will allow, then what is proposed here could be considered as an alternative worth considering, and not just another form of ‘privatization’ as some critics might argue.

Needless to say, it seems that a new approach is what is needed and in the near future, especially in view of the backlog of waiting lists for the treatment of serious illnesses – now including a growing number of long Covid cases – along with the certainty of a ‘catch up’ process the government will inevitably be confronted with, plus the risk of being criticized for another extended spell of austerity if it doesn’t respond accordingly.


Featured photo by Christopher Bill on Unsplash

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