Sir Keir Starmer - to save the NHS, raise revenue not taxes

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The cost of medical care in the NHS is spiralling into unimaginable proportions which cannot be paid for by tax increases that will just make us all demotivated and poorer. 

Ten years ago, oncologists like myself were worried about a new drug costing £80 a month instead of £5 for breast cancer. Now we are routinely using drugs costing over £3,000 a month. These new drugs, because they work well with continued use, are thankfully keeping our loved ones alive for years longer but this means the number of us that will need NHS care is escalating exponentially.

Every year the cost of NHS prescriptions goes up by 8% and is currently £10.4 billion but I believe this figure is going to rocket. We are in a new dawn of high cost designer drugs that target the underlying genetic causes of disease. These are very rewarding to use as many are highly effective, but they cost tens of thousands of pounds per patient per month so there is a real danger they will only be available to rich individuals or countries.

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Many people in the UK are proud of our health system and having worked full time in the NHS as a doctor and academic for almost 30 years, I am grateful to be part of an organisation which can offer universal care to all members of society without financial burden at initial contact. I believe, this loyalty for the NHS could be utilised to support new financial strategies which could generate the extra income it needs to survive. Here are two suggestions:

Stefan Rousseau/PA Wire

Introduce a "GovPay" financial transaction service

We give companies like PayPal humongous amounts of money each year, most of it taken offshore, which could be re-directed into the national treasury to pay for public services. PayPal alone earnt $30 billion, by creaming around 3% off the top of 1.5 trillion transactions it handles each year. They provide a safe reliable service which has helped many businesses but they have had their rewards. A similar nationalised financial service would require some initial investment and could not be forced on people. However, when buying online, instead of using paypal or a credit card, having an option which could save the NHS may be an attractive, ethical option for many of us.

Decriminalise cannabis

This will have some negative health consequence but the financial gain would massively outweigh these risks. According to a cost-benefit analysis conducted by the Institute for Social and Economic Research, if the UK treasury were to charge cannabis sales with a tax set at the same level as alcohol, this would bring in almost £2bn, and taxing cannabis in the same way as tobacco would generate £3.5bn, enough to pay the annual salaries of all the midwives and ambulance crews in UK - as well as a pay rise they deserve.

Every policy change has its risks and legalising cannabis does not mean that society is condoning it. There is certainly evidence that cannabis use in adolescence can lower IQ and increase some mental health but so can alcohol, vaping, smoking, eating junk food, processed sugar and not exercising. There may be some health benefits for pain control and nausea but most importantly buying cannabis from legal outlets would reduce harm to users by ensuring that products were grown, monitored, tested and sold within required potency limits.

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Decriminalisation would also reduce pressure on over stretched police and courts. The Institute for Social and Economic Research report quotes one study that suggests legalisation would save a total of £291m across the police, court, prison and probation services in England and Wales. In the USA, states that have introduced a regulated market, have found that excess drinking has declined, so legal cannabis could also help alleviate some of the burden that alcoholism and drunkenness places on the NHS.

These policies would require careful planning and initial investment and receive resistance and even anger from some members of society but surveys suggest the majority of the public would support them. Coupled with Labour's substantial parliamentary majority and their determination to save the NHS, the time is right to start "thinking outside the box". 

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