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Tories Told Keeping NHS Afloat Without Tax Rises Is Not "Plausible"

NHS ambulances parked outside the Accident & Emergency department at Leeds General Infirmary hospital (Alamy)

4 min read

The author of the Conservatives' last general election manifesto has insisted it is not "plausible" for a government to give the NHS the funding it needs without raising tax, as many in the party implore Prime Minister Rishi Sunak to cut taxes.

Rachel Wolf, who was an adviser in Downing Street before founding consultancy Public First, said that the challenge posed to the already-under pressure health service by the UK's aging population means future governments will inevitable need to spend more money.

“I don’t think it is plausible that over the next few decades that you can deal with the level of aging population without more expenditure," she said at an an event at Conservative party conference hosted by PoliticsHome and The Health and Care Forum.

"That probably means more taxation as it’s not obvious what you stop spending money on when it comes to something of that size." 

Sunak is under growing pressure from Conservative MPs to reduce overall taxes ahead of the next general election, with the current levels at theirs highest since records began 70 years ago. Labour leader Keir Starmer has indicated that he would not further raise taxes in his bid to become the first Labour Prime Minister in thirteen years.

But according to Wolf, who co-wrote the Tory party's election-winning manifesto in 2019, the reality is future governments will have to fund greater spending on the NHS through more taxes to keep pace with the growing number of people living longer lives and requiring treatment.

In July, the Health Foundation think tank released a report which estimated that the number of people in the UK living with major illness in the year 2040 will be over 9 million – an increase of 2.5 million on the 2019 total.

Wolf said the "political sell" will be very difficult for any government because the general public already believes it is taxed enough, and that it will require ministers to tell the public that working taxes will need to go up to fund more treatment for elderly people. 

“That said, there is a risk in health debates that it always comes down to the level of expenditure," she continued. 

"Politically, when you talk to the public they absolutely get that the NHS needs investment and they don’t think any has gone in. But you are starting to hear more of a concern about efficiency and what the public would say is waste.

"If you’re going to keep the public on side with this, there has to be a recognition that we can get get more out of the same resources as well as putting more resources in.”

Wolf told the Tory party conference in Manchester that future governments will need to pay NHS staff higher salaries to help stem the flow of people leaving the workforce. There were around 140,000 vacancies in NHS trusts at the end of last year, with nurses making up around a third of that number. The health service faces a major challenge in persuading staff, who feel that they are overworked and underpaid, to have long-term careers in the NHS.

"The challenge is where do you get the funding from," Wolf said.

"I don’t think it’s as simple as throwing more money into the NHS, as it is not obvious where else in government you would get that from. It is very hard to raise taxes right now. But in the longer term, you are going to have to raise the relative pay in the NHS against the private sector."

The former No 10 adviser also said that the only way to reduce the healths service's reliance on overseas workers – which some MPs on the right of the Conservative party want to see – is by raising the salaries of domestic health workers.

“The only way you can do it is by paying people more. Its fund a trade-off. One of the reasons that we bring people in is that they are willing to take low pay," she said.

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