This is why I propose to raise through National Insurance half of the monies required to plug that £90 billion deficit and that these new monies should be used not only to reshape the service, away from hospitals to GPs, but also to drive through productivity increases while keeping the health service free at the point of use. But I don't think this new injection of cash will by itself result in the changes necessary to gain a new deal for patients. It hasn't in the past.
Acting on the principle that every crisis can be used for radical reform, I have proposed that the next government establish a National Insurance mutual. The mutual would have all the functions that NHS England and Monitor—the sector regulator—currently have. But the mutual would be owned by us, the contributors. Its governance could follow the John Lewis model whereby the members elect a strategy board which then appoints an executive board to carry out the policies it decides upon.
Crucially, the strategy board would receive all the additional funding from the National Insurance increase. When Gordon Brown put a penny on National Insurance to "save" the health service, he secreted away almost half the sum to other pet projects. The mutual will set future contribution levels in negotiation with the contributors and the government. This leads on to the mutual's other function. It needs to inform, educate and seek approval from us, the contributory owners, on the range that a future free health service should take and to gain our support to drive through productivity increases with our money.
It is here that the national mutual would break further ground in the health debate in this country. At the moment the clinicians largely decide on the pattern of NHS treatments. Further down the line, the politicians have to pick up the bill, however reluctantly. The new health mutual would dispel the idea that voters have of a bottomless pit of money from which resources can forever be drawn.
National Insurance has also struck a deep chord with the nation's gut feelings about fairness: you have to have paid in before you can establish an entitlement. To reinforce this crucial feeling, I proposed that contributors and their families would have an entitlement card. These entitlement cards would also prevent NHS tourism. We would need to present our cards when visiting our GPs or going to hospital. Pie in the sky? I think not. It's how events will play, dear reader, and it's these events that will deliver an NHS Mark II.
Acting on the principle that every crisis can be used for radical reform, I have proposed that the next government establish a National Insurance mutual. The mutual would have all the functions that NHS England and Monitor—the sector regulator—currently have. But the mutual would be owned by us, the contributors. Its governance could follow the John Lewis model whereby the members elect a strategy board which then appoints an executive board to carry out the policies it decides upon.
Crucially, the strategy board would receive all the additional funding from the National Insurance increase. When Gordon Brown put a penny on National Insurance to "save" the health service, he secreted away almost half the sum to other pet projects. The mutual will set future contribution levels in negotiation with the contributors and the government. This leads on to the mutual's other function. It needs to inform, educate and seek approval from us, the contributory owners, on the range that a future free health service should take and to gain our support to drive through productivity increases with our money.
It is here that the national mutual would break further ground in the health debate in this country. At the moment the clinicians largely decide on the pattern of NHS treatments. Further down the line, the politicians have to pick up the bill, however reluctantly. The new health mutual would dispel the idea that voters have of a bottomless pit of money from which resources can forever be drawn.
National Insurance has also struck a deep chord with the nation's gut feelings about fairness: you have to have paid in before you can establish an entitlement. To reinforce this crucial feeling, I proposed that contributors and their families would have an entitlement card. These entitlement cards would also prevent NHS tourism. We would need to present our cards when visiting our GPs or going to hospital. Pie in the sky? I think not. It's how events will play, dear reader, and it's these events that will deliver an NHS Mark II.
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