“A big political moment.” That’s how the BBC’s Laura Kuenssberg described the lead up to the recent announcements about changes to funding the NHS and social care. The systems are now being given a significant headline grabbing cash boost. Considering the scale of challenges we are facing, there are very few voices who oppose that. But public systems are ultimately paid for by taxes and decisions related to our tax system always divide opinion. Yes, we should all pay our fair share. But, when it comes down to it, what’s fair?
The complexities of public funding
Income tax, National Insurance, VAT and Capital Gains are just a few of the methods our government uses to collect cash to spend. As an NHS doctor, the fact that you pay into the public purse and, at the same time, are paid by it can heighten the conflicting emotions connected to these questions. It feels great when you and your colleagues are awarded a salary increase you deserve. But you then find you are to be taxed more in order to fund NHS pay-rises and additional staff, along with improved facilities and treatments. At the same time, you may see cuts to other public services which you care about and want more to be done in those areas.
Our democratic model means we empower our government to make decisions on our behalf. That’s fine when things go the way we want them to. On the other hand, it can be infuriating if and when our collectively elected representatives hold different views to your own. Ultimately, regardless of political persuasion, we have to answer some big questions. For example:
- How much are we willing to spend on our public services in general?
- How much of that do we want to spend on health and social care?
- What’s the balance between each person paying for our individual needs versus supporting our relatives, friends and neighbours?
- Should we all contribute the same or should those who can afford it pay more?
- How do you work out who can afford what?
- If there’s a limit to what we can or are willing to contribute, then what do we spend less on if we want to spend more on health and social care?
And then there’s perhaps the biggest question on this subject of all. Are taxes an imposition or an investment?
Having an impact
Like many things in life, making decisions about taxation, public spending and government policy related to accessing services is likely to be beyond your control. But that’s not to say that you have no influence beyond your occasional opportunity to cast your vote. Your opinion matters. Everyone’s does. But, as a doctor, your opinion can count for more. People will take heed of your opinion as long as it is informed, considered and aligned with your everyday actions. A society’s collective opinion is shaped by individuals.
If you are to be a proactive participant, then it’s important that you have a good grasp on who’s who in terms of the various organisations which collectively make up the health and social care systems. You will understand how the money flows in a general and be aware of the conflicting demands which come into play. You will be able to engage in discussions around topics such as the pros and cons of big surgical hubs versus providing access to care which is close to a patient’s home. And you will be able to not only recognise waste or inconsistency, but to work with others to address this. Influence and genuine change comes around through numerous moments of everyday medical leadership.
What steps are you taking to learn about the system and the part which you can play in it?
Stephen McGuire – Managing Director