FREQUENTLY
ASKED QUESTIONS

Q: Your quotes and statements are highly selective to the point of scaremongering, to bias people towards your solution?

A: That isn’t the intention. You’ll recall the 2017 ‘winter crisis’, which gave rise to a particularly intense period of debate about the NHS. The future looked very troubling, and it was this which led to devising our ‘top-up’ solution. The problem we have is that we just don’t generate sufficient funds from taxes to meet the country’s needs in respect of acceptable funding for all services. In 2023-24, to meet the country’s planned spending, £132bn was forecast to be borrowed (Sources: HM Treasury, OBR).

Don’t forget also the 2018 winter crisis, which resulted in thousands of operations being cancelled, and the additional backlog of treatment the country faces as a result of the pandemic, staffing and resource issues – defining moments and a wake-up call for us all.

Q: Your solution is only for people who can afford it, which runs counter to the NHS founding principle of not being dependent on ability to pay?

A: Expressed in that way, it is a very reasonable challenge but again, that isn’t the intention. The fundamental issue we have to address is that our health system is underfunded, to the detriment of us all. Other countries have better funded health systems because they generate additional funds by employing methods in addition to tax, whereas the UK almost exclusively relies on tax alone. As our approach results in an underfunded service, other methods need to be introduced. It's not about 'ability to pay', but a meaningful proportion of our population could, in truth, contribute more, where a suitable option existed. This is the premise upon which HEALTH FUND has been created - a publicly owned, incentivised voluntary arrangement encouraging individuals to contribute additional sums to our health system.

Other methods of generating more funds for the NHS are periodically explored, but these would be far less popular, and run directly counter to the founding principle you’re rightly concerned about. Co-payments operate in many other countries – for example, charging to see a doctor, hospital stays. We believe these to be regressive, costly to set-up and administer, and in fundamental conflict with our treasured free at the point of use model.

The Government’s decision that “the funding for health and social care will now come from general taxation” (BBC News, 23 September 2022) is a major concern, given the competing demands of equally deserving services also requiring more investment and support.

Q: Won’t the creation of a health top-up mean we’ll have a two-tier system?

A: Your point is understood, but we all have to be honest and mature about this issue, and acknowledge the reality. A ‘mixed economy’ in healthcare has existed for decades. The NHS treats private patients in its own private patient units, NHS consultants have always been permitted to treat patients privately, the NHS uses the independent sector to access services and help meet demand. Many people use both sectors to obtain treatment, paying accordingly.

Politicians acknowledge the role the independent sector can play in helping to meet the country’s healthcare needs, but understandably they worry that in doing this they’ll be accused of disloyalty and of undermining ‘our NHS’. Our solution reconciles these concerns, recognising the sensitivity with which it can be done, that we believe will be well-received by a public desperate to see seemingly intractable challenges finally resolved.

In most other countries, it’s the norm to operate more obviously integrated provision, using both their public and independent sectors to optimise resources and capacity.

Our solution has not been devised to strengthen the independent sector. The aim is to protect what we most value about the NHS whilst expanding the funds and capacity available to meet ever-growing demand. Critically as well, HEALTH FUND is publicly owned and not-for-profit.

Q: Reference is increasingly made to a 'creeping privatisation' of the NHS, yet your solution allows people to access the independent sector to obtain treatment. Can you clarify this somewhat mixed message?

A: Yes. Experts and commentators are concerned that the NHS is becoming increasingly fragmented by contracting more with the independent sector (in the region of £10bn a year) - it's time-consuming, complex and costly, and diverts much-needed resources away from delivering front-line care. We’re proposing another way of utilising that sector - more of a standalone, parallel relationship - utilising their capacity and resources but funded and organised via the country’s top-up fund.

Q: Is your solution like private health insurance?

A: It is different to private health insurance (PHI), in that monthly contributions have been devised to operate in a way which means you have known contribution certainty for as long as you choose to be a contributor. Like PHI though, contributors have the option of obtaining medical care as a private patient, accessing the additional resources and capacity in the independent sector, including those units owned and operated by the NHS.

That is where any comparisons with PHI end though, as HEALTH FUND has quite different aims: 1) generate additional, long-term, publicly owned funding for health and social care, 2) protect and strengthen the NHS, enabling it to remain free at the point of use, 3) enable social care to be ‘fixed’ and 4) enable more spending on other, similarly deserving and stretched services, by relieving the pressure on government to fund the NHS and social care predominantly from taxation.

Q: You really think a top-up fund in the way you've devised it is the answer?

A: Based on facts and evidence, we do. Fundamentally, Britain's ‘health system model’ (to give the NHS a slightly broader definition in the context of the question) is a good one - a single payer, publicly owned and delivered service. It's free from the complexity, cost and inevitably conflicted interests of multiple payer/provider systems variously employed around the world. It also engenders a unique, powerful ‘national solidarity’. It’s described as 'the envy of the world' because of its founding principles - so the best and strongest foundation to build on.

The UK's fundamental challenge is funding - we are just not keeping up with the needs of a growing, ageing population. A solution and plan for social care also needs to be urgently found - put simply, it is about MONEY. Without more of it, the ability to address these long-term issues is hampered.

We believe a UK-specific top-up (HEALTH FUND) will generate much-needed additional funding and retain/strengthen our model. The NHS was conceived when the country faced very different challenges. We've all benefited from that, which is why we rightly value it so much. Seventy-six years on though the country has a new set of challenges which warrants our model being adjusted accordingly. The UK has changed dramatically. People's aspirations and expectations have also changed and adapted accordingly - we consume differently.

So our ultimate vision is that we have a higher funded, expanded health system delivered by two publicly owned, not-for-profit services. The NHS would fund and deliver the vast majority of the country's healthcare (c. 90%), HEALTH FUND would fund the remaining c. 10%, accessing the immediately available resources of the independent sector (already used by the NHS), including those units provided by the NHS. As the fund establishes and grows, the NHS will reduce what it spends in the independent sector as the top-up assumes that role - those funds can be diverted into delivering front-line care, including better integrating and funding of social care.   

Q: What about social care?

A: What about social care indeed? A major ongoing concern is that, notwithstanding the introduction of a Health and Social Care Levy from April 2022 (axed from 6 November 2022), and the publication of a White Paper in December 2021, ‘fixing’ social care still appears some way off. Writing in the i newspaper (January 2023), Isabel Hardman states: “there is no prospect of a proper reform of social care in the next few years at least.”

Although becoming a ‘top-up contributor’ is entirely voluntary, our ambition is that the more people who join the fund, the more money we generate specifically for health provision. By not adopting traditional methods of taxation to achieve this gives Government scope to use established taxes and funds for other purposes e.g. social care as you specifically query.

We offer a way forward in this regard. Health and Social Care are highly interdependent, and virtually everyone uses the NHS. We’ve used the profile and strengthening of that key service as the mechanism and motivation by which funds for social care could also be increased, devising a number of incentives to achieve this.

Q: You state that your solution would be publicly owned and not-for-profit. What’s in it for you?

A: The solutions have not been designed for personal or commercial gain. If adopted, we would be gifting the Intellectual Property contained therein to the Government. The sole motivation is to increase the money available for funding health and social care, to protect and strengthen the NHS, keeping it free at the point of use, and enable social care to be ‘fixed’, for the benefit of us all.

On 5th March 2021, the Health Secretary stated: “the integration of health and social care is an issue that’s eluded governments of all stripes over many, many years.” Our solutions address this, finally resolving these seemingly intractable challenges.

Q: Covid-19 showed the strength of feeling the public has for our health and care services. Given how your solution works, in the sense of utilising the independent sector, do you think the public would wish to contribute to this top-up fund?

A: Covid-19 made us all think hard about the country’s challenges, not just in terms of protecting the nation's health but also dealing with the economic impact. Our solutions were devised before covid-19, as the funding pressures on health and social care were, and remain, two of the Government's most pressing domestic issues; waiting lists were at record levels before the pandemic.

Our solution has always been a non-ideological evidence-based case for the country adopting a top-up and, based on the facts, we think the public would accept the merits of operating such a service, especially if it's publicly owned and not-for-profit. Underlying our approach is a determination to generate additional funds which enable us to retain and strengthen the NHS's founding principles, see services improve, and link a funding solution into social care in order that this key service can be similarly made better.