How to Solve 'The NHS Problem', Part Three

Since I started this blog, I have promoted my view that, in society, we are all consumers - and that professional marketing and advertising, and 'upstream creative thinking', could be better employed for the good of society as a whole. All of us...

Give is better than take

Since I started this blog, I have promoted my view that, in society, we are all consumers - and that professional marketing and advertising, and 'upstream creative thinking', could be better employed for the good of society as a whole. All of us.

In 2008, a new book about marketing theory called Nudge was published. It showed how 'behavioural insights' could influence human behaviour.

In 2010, a Nudge Unit was established at the Cabinet Office 'to use behavioural economics and market signals to persuade citizens to behave in a more socially integrated way.'

In 2014, the 'nudge unit' was 'part-privatised'.

Critics such as Dr Tammy Boyce of The King's Fund, said: 'We need to move away from short-term, politically motivated initiatives such as the 'nudging people' idea, which are not based on any good evidence and don't help people make long-term behaviour changes.'

Well, I hope Dr Boyce and The King's Fund will like the nudge I am about to reveal.


One word: funding.

Separate 'treatment' from 'care'

In my last two posts, I proposed splitting the NHS into two services:

- 'treatment' would remain the responsibility of the NHS.

- 'care' would be the responsibility of a newly launched 'National Care Service' (NCS).

The reason for needing to do this is clear:

The post-war Bevan model, where the NHS is funded by National Insurance contributions, is bust. As currently financed, the NHS is doomed. New thinking is required. So is new money.

I propose that delivery of new National Care Service be managed by the charity sector, financed by both central government money and charitable donations.


One word: funding.

A behavioural insight applied to the NHS

When you think about it, the NHS has a hospital curtain around it.

Walk around and you don't see much NHS do you? Step inside a hospital and there's all sorts going on. Inside GP surgeries, the walls are swathed in NHS posters and leaflets. Outside, there are hardly any.

And yes, after a successful operation, you may have paid for the NHS through taxation, but have you ever donated money back by way of thanks to the heroic doctors and nurses who treated you?

You haven't have you?

This needs to change.

As I showed in my last post, in Britain we are a very charitable people. Our charities raise over £60billion a year.

The NHS is funded by taxation which the UK Government take from working people. On the other hand, people give to charity.

We need to encourage the spirit of giving into the 'care' of our people.


One word: funding.

A call to 'charitise' all NHS care services

Privatising NHS services is politically sensitive. I am not calling for privatisation.

I am calling for all NHS care services to be split off from the NHS and 'charitised'.

This would require them to be managed by independent charities in the not-for-profit charitable sector and overseen by the new 'National Care Service' (NCS) and thus by the new 'Department of Charities and Care' (DOCC).


One word: funding.

The National Care Service (NCS)

'Treatment' would be provided by the NHS; it would continue to be 'free at the point of delivery'; and it would continue to be funded by central taxation.

'Care' would be provided by the new National Care Service (NCS) and managed by specialist charities in specific areas of medical speciality i.e. 'cancer', 'strokes', 'paraplegia', 'age' etc.

Like 'treatment', 'care' will also be 'free at the point of delivery' and funded by a combination of central taxation and charitable donations. If you can afford the care you need, you will be asked to make a donation - but you won't be forced to.

Raising money from charitable donations to the NCS will become a major national initiative. Everyone, the whole population, will be asked to contribute in one way or another, in terms of time and/or money, including - perhaps especially - the very rich.

Nudge the rich

I know some very rich people. In fact, if over £100million counts, some obscenely rich people. They are not thieves. Nor are they evil. Most of them are driven. Many of them are socially aware. Some of them even do good things for other people.

All of them are obsessed by earning money. None like giving it away. When asked to do so, they apply the same rigour, and forensic eye for detail, to spending money as they did to earning it.

Very rich people don't like paying tax. Why would they? Knowing money as they do, they can see the inefficiencies in the way public funds are managed and spent and wasted away.

Like it or not, very wealthy people are very smart people. Smarter than our politicians. Not such good degrees, perhaps. But smarter. More nous. And harder. More ruthless. Over-tax them and you will turn them away. Engage with them, cuddle up to them, and you have more of a chance.

One idea would be to provide an income tax option for highest rate tax payers whereby, rather than pay tax at 45%, they are given the option of paying 30% as long as they match that sum with a donation to a recognised charity for the management of care within the new National Care Service.

Boost their egos, and the very rich might donate even more than this. The key thing, with the very rich, is not to take their money but to make them want to give.

For very rich people will give money away. Look at this guy:

His name is Anil Agarwal. He has given away over £2billion.

Lord Sainsbury has given away over £2billion too.

These people will give to charity.

But you have to nudge them.

Appeal to vanity

Another way to inspire rich people to give money to charity is to appeal their vanity.

We need to develop a programme of 'naming rights' whereby large donors to the new National Care Service can, if they like, have their donations publicly recognised by naming wards, wings and whole care homes named after these people.

We need to engage them with local communities and specific causes (cancer etc).

As I demonstrated in my last post, the UK charity sector is highly fragmented.

The whole thing needs to be pulled together, joined up, so all the time spent by heroic volunteers, and money spent equally heroic donors, adds up to more than the sum of the parts.

It can be done.

Yes it can.

And please don't think donations to the new NCS will be restricted to the very rich. All of us, however poor, will be encouraged to donate money and contribute to the NCS too.

There is a special way we can do this.

Which I will reveal next time.

Yes I will.


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