Every day, politicians and journalists come up with new ways of telling the same stories to keep people interested, to ensure the issue stays at the top of the agenda. With the NHS and social care, the same story has to be told and retold. This week, the case of 89-year-old Iris Sibley, who spent six months in hospital despite being well enough to be discharged but too frail to go home, has breathed new life, new urgency into the stubbornly old story of social care. Everyone knows there isn't enough money to fund social care, and yet we have to keep telling the story. We have to keep talking about Iris, and others like her, because the problem – at its heart, the lack of funding to care for our elderly - isn't going to go away.
Opposition parties demand answers, think tanks come up with policies, governments make promises, and we look to abroad for new ways to tackle the problem. And yet the very thing that could solve the lack of funding is exactly what we are not talking about. It is the elephant in every hospital ward, GP's waiting room, care home bedroom and MP's office: tax.
Our public services are underfunded. Yes, the Government is ploughing "record levels" of money into the NHS, but this is still not enough to meet the huge demand on A&E, extra hours for GPs, and the shortage of midwives and nurses. Now they have to pay for social care, as the row over leaked text messages from Surrey County Council has underlined, local authorities face tough decisions to meet the staggering cost, which will only rise as our population gets older.
The National Audit Office this week found that the Government's £5.3bn ($6.6bn) Better Care Fund to treat more patients in the community had not eased pressure on hospital beds. Ministers also say they are putting "record levels" of cash into schools, and yet a funding crisis is emerging in education. A head teacher of a Chesterfield primary is taking part in the Great North Run to raise money to plug gaps in his own school budget. Current levels of spending on public services are clearly not sufficient.
In response, we are happy to have an open discussion about introducing charges in public services at the point of use. Grammar schools are considering asking parents for monthly donations to cover cuts to their budgets, while the idea of GPs imposing a pay-as-you-go system for some out-of-hours appointments has also been floated. At this point, the tax elephant is sitting on the table tapping out "I've got a lovely bunch of coconuts" with its trunk, and we are still ignoring it, as if not talking about it makes it go away.
If we want to preserve our beloved NHS, good schools for our children and the hope of decent care in old age, we are going to have to pay for it.
Politicians don't want to talk about tax rises because it is politically toxic. Yet every general election campaign, voters are asked to believe pledges about better schools and hospitals. It is time to acknowledge that we cannot have the latter without the former. If we want to preserve our beloved NHS, good schools for our children and the hope of decent care in old age, we are going to have to pay for it.
The Government, in its first term under the coalition, raised VAT – a regressive tax that disproportionately hits poorer households – to 20%. Pay-as-you-go charges for schools and hospitals are also regressive – unless they are means-tested, which becomes a costly and disincentivising business.
So it should, faced with the most serious pressure on public services in recent years, consider raising taxes in a more progressive way, either through increasing income tax or introducing a new hypothecated NHS and social care tax, also operated through PAYE.
Ring-fencing money for NHS and social care would show taxpayers exactly where their money was going, so may sound more palatable, but it would mean extra bureaucracy for HMRC.
A penny on income tax would be simpler, and raise £5.5bn a year. It is not going to solve the funding crisis in public services overnight, but it is more sustainable than trying to pass the same limited amount of money around different budgets. At the very least, we need to stop pretending that the tax elephant doesn't exist and talk about it.