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As we begin to deal with the middle stage of the COVID-19 crisis, it’s time to relook how the UK funds its excellent National Health Service.
On that note, you may recall that I’ve said many times on this website that things ‘evolve’ but they don’t always ‘evolve’ to the best result. While each individual decision over the decades on behalf of the NHS was well-meant and likely the only logical choice at the time, were we to now create the NHS ‘from scratch’ in 2020, it would look much different than the National Health Service we see today.
For example, we might see more, but smaller Hospitals — instead of the fewer, but larger Hospitals built in the 19th and 20th-centuries. Also, NHS Hospitals might be located closer to areas where the highest annual concentrations of injuries occur, complete with NHS-only access to on-ramps and off-ramps to get Ambulances on and off the motorways more quickly. Also, helicopters sitting and ready to fly from the roof of each Hospital, every minute of the year. And more.
Obviously, there are plenty of ideas that should receive fair consideration because continuing to do things the way we’ve always done them isn’t good enough when it comes to the health of every UK citizen, resident and tourist.
To wit; Early on in the Coronavirus timeline it became known that enough Personal Protective Equipment (PPE) for NHS workers hadn’t been stockpiled and lives were thereby endangered. Who knows how many were endangered, but enough that the government must ensure it never happens again.
In Germany, the same thing occurred (not enough PPE’s on hand to deal with their COVID-19 crisis) until someone remembered that many years earlier a brilliant person in the German military had decided to stockpile millions of PPE’s — consequently, the German healthcare system had surplus PPE’s, even delivering some to the UK’s NHS. Impressive. Los Deutschland!
Thinking ahead like Germany did costs money. (But it costs more if you don’t think ahead) It also takes political will and perseverance. It speaks to the quality of government delivered or not delivered to the people by the politicians in each decade, and that’s the whole point, isn’t it? Either the politicians are up to the task, or they’re not. If they’re not, let’s hope they become unemployed at the next election.
Now, let’s not lay all that on Boris and his team, after all, he’s only been Prime Minister for 9-months and he’s had some rather large items to deal with… Brexit, a future trading relationship with the EU, his own serous bout with COVID-19, and more recently, a newborn son with his partner Carrie Symonds. Congratulations to Boris and Carrie!
So let’s cut Boris some slack, shall we?
Still, we should add momentum to the idea that we need to fund the NHS properly instead of expecting them to provide the best healthcare in the world without the funding to accomplish the task.
One Tax to Fund Them
It’s time for the UK to add 1% to the existing VAT — and every pound sterling of that 1% should go directly to the NHS without being touched by any level of government. In fact, new legislation should be created to make it illegal for anyone in government (even the Prime Minister or the country’s Head of State) to delay or divert any of that 1% VAT NHS funding with mandatory prison sentences for any person involved in interfering with the 1% VAT NHS revenue stream.
Without healthy citizens and a well-funded NHS the United Kingdom is a much-diminished country, therefore, NHS needs to be well-funded and that funding must remain untouchable by any UK politician.
In practical terms, it means each of the devolved territories and England need to enact their own 1% VAT and direct all the revenue collected within their own jurisdiction to their own NHS organization to form the baseline of their respective NHS funding. (Let’s call the proposed 1% VAT “primary funding” for their respective NHS organization)
“Secondary funding” would be allocated via the respective Northern Ireland, Scotland, Isle of Man, Wales, and England annual budgets and “tertiary funding” can be allocated by the UK government.
Why would the UK government want to provide tertiary NHS funding to each of the five jurisdictions?
In order for the central UK government to have any say in Scotland’s NHS (for example) the UK government would need to provide some funding towards Scotland’s NHS.
To illustrate this further; In Canada, healthcare is the exclusive domain of each province which raise their own revenues from a combination of provincial income tax and provincial sales tax. Consequently, nowhere in Canada must people pay healthcare premiums. Therefore, almost the entire cost of each provincial healthcare system is raised via provincial revenue. But the federal government of Canada also kicks-in additional healthcare funding for the provinces each year (representing about 6.5% of each provincial healthcare budget) to, (a) ensure uniformly high healthcare standards across the country, (b) to ensure that citizens and residents of all provinces are treated without delay if injured while visiting another province, (c) and to maintain an universal healthcare database so that out of province visitors can be treated without delay if they suddenly become ill or sustain injury.
Why would the five jurisdictions want to accept tertiary NHS funding from the UK government?
Remember, primary healthcare funding would come from each territory’s 1% NHS VAT (including England) but it might not be enough to cover the full cost of providing all the healthcare necessary for their own residents. Therefore, secondary funding for each territory’s NHS service would come from a combination of (‘provincial’) income and sales tax, while tertiary funding would be provided to each NHS unit (annually) by the UK central government in a sort of ‘top-up’ modality to meet 100% of the annual costs of each of the five NHS units.
In this way, no monthly or annual healthcare premiums would be paid by individuals or companies and each NHS unit would receive funding from their devolved government with supplementary funding courtesy of the UK government.
Three funding streams, and one stream arrives completely free of government interference. If you’re a healthcare professional or healthcare administrator you’ve got to like that!
- No healthcare premiums for individuals or companies — ever!
- PRIMARY NHS FUNDING: All the 1% VAT revenue collected in each territory would go directly to their own NHS unit (only) bypassing government control or restrictions, thereby raising significant revenue to fund their own NHS unit.
- SECONDARY NHS FUNDING: Each territory (Northern Ireland, Scotland, Wales, Isle of Man, England) would levy its own (‘provincial level’) income and sales taxes on their respective residents and use some of that revenue to help fund their own NHS unit.
- TERTIARY NHS FUNDING: By definition, the UK government collects (‘federal level’) taxes and some of this revenue can be used to ‘top-up’ the budget of each NHS unit. This top-up should never exceed 10% of the funding of any NHS unit and the exact percentage would be negotiated annually between the (‘provincial level’) territories bloc and the UK government.
Finally, a shout-out to today’s NHS heroes, who risk their lives every day to protect us from a killer virus. Thank You! for your professionalism, sacrifice and courage.
A MUST-READ for anyone wanting to understand why the UK should adopt Canada’s excellent healthcare funding model
- Canada’s Health Care System (Government of Canada website) click here.
Britain’s National Health Service is famous for being two things: One of the highest rated healthcare services in the world, and for being chronically underfunded.
It isn’t about politics, Prime Ministers or technology — it’s about how costly it is these days to operate a modern healthcare system. Every Western country is grappling with the same issues, the UK isn’t extraordinary at all in this regard.
Here’s what one British Prime Minister said about the NHS
“One of the wonderful things about living in this country is that the moment you’re injured or fall ill — no matter who you are, where you are from or how much money you’ve got — you know that the NHS will look after you.” — former UK Prime Minister David Cameron
For all the griping that goes on about the NHS it continues to excel, turning in first-place performances in prestigious healthcare surveys.
Quite obviously the problem is funding a National Health Service that is tasked with caring for a growing and aging population.
How does the NHS stack up against other Western nation healthcare systems?
Five ways to improve Britain’s NHS
- Lower healthcare costs by improving the environment
- Lower healthcare costs via healthy activity programmes
- Increase NHS revenue via public/private partnerships
- Increase NHS revenue and lower demand on certain healthcare services
- Augment NHS revenue via resident-payer healthcare premiums for those earning £25,000+ annually
Lower healthcare costs by improving the air we breathe
Of all the ways to lower NHS healthcare spending — improving the environment that Britons live in is easily the most cost-effective.
A highly regarded Harvard Medicine study informs us that coal-burning is responsible for up to $500 billion per year in additional healthcare, infrastructure and agricultural spending in the U.S. — so yes, up to half a trillion ‘externality’ dollars (annually) in America from burning coal alone. In the United States, coal accounts for 33% of America’s total electricity generation although coal-burning used to provide 70% of America’s primary energy demand.
In the UK, coal-fired power generation is also falling. In 2016 we saw wind power generation surpass coal-fired power generation for the first time. Coal provided 9.2% of the UK’s total electrical demand in 2016, but for decades it provided more than 50% of UK electrical demand. As coal-burning in the UK continues to be replaced by clean energy (wind power = 11.5% of total UK demand in 2016) respiratory and related ailment rates continue to fall.
It would be nice to think that leaving coal behind would lower NHS spending to an affordable amount. But that would be overly optimistic. Howevermuch Britain leads America in the race to leave coal behind, toxic air pollution from the thousands of diesel-powered lorries that pass through UK cities daily more than make up for it. In fact, air quality in London, Birmingham and Manchester is so bad that alarms are beginning to sound in many quarters.
Some might underestimate the healthcare impacts of petrol and diesel-fueled vehicle pollution within cities. However, in 1974 it was common knowledge that an average of 80 people per day died in the city of Los Angeles alone as a result of air pollution from cars and transport vehicles during so-called ‘smog days’. People were dying on the sidewalk as they waited for the Ambulance to arrive.
Fortunately, California implemented the first of many clean air laws and soon set the global standard for cars and truck emissions. And it has been a stunning success! With a population more than double since 1974, daily premature deaths due to air pollution in Los Angeles are practically unknown in 2017. And the L.A. economy continues to grow — no longer held back by an ailing population (who didn’t realize they were ‘that’ ailing until the new clean air standards kicked in) and everyone began to feel much better, and consequently found themselves outdoors and enjoying the fresh air more often.
Due to topography and weather patterns in London, smog is a serious problem and has a measurable effect on the NHS budget. Manchester isn’t any better, nor is Bristol. Therefore, the UK must pass clean air legislation that exceeds even L.A.’s stringent air quality regulations.
And the easiest way to do that is to lower coal-fired burning to a maximum of 5% of total UK electrical demand and ban diesel lorries from any city with more than one million residents. With the existing technology in hand these aren’t difficult targets.
Many trucks (lorries) in the United States are now converting to compressed natural gas (CNG) in an effort to meet modern air quality standards. The trucks continue to run on diesel fuel, but CNG is injected into the engine any time the vehicle in under load (climbing a hill, getting up to speed, etc) and during times of city travel the vehicle can run on CNG exclusively which emits zero pollutants and zero particulate matter. CNG-burning produces carbon dioxide and water vapour only (neither is toxic) with a small penalty in overall power output. And such engines last longer than diesel-only engines.
Lower healthcare costs via healthy activity programmes
In Canada, former Prime Minister Pierre Eliot Trudeau passed legislation on a novel programme called ParticipACTION. It was a programme designed to get people walking, moving, exercising and it created awareness among citizens — that activity, especially outdoor activity, was a prerequisite for good health and long life.
It was a popular government programme complete with kooky TV adverts that compelled an entire generation to get up off the couch and exercise. Government officials from all provinces handed out placards and Participaction lapel buttons, and flags with the Participaction logo emblazoned on them. If you couldn’t make it from your comfortable television viewing position out to the street in one minute — no cheap Participaction prize for you! And your neighbours thenceforth suspected you were somewhat less than a loyal Canadian on account of it.
Participaction ended after years of success with many studies attributing Canadians good health to the Participaction programme. It produced measurable results and the politicians loved meeting citizens and giving them tacky Participaction merchandise in completely random and impromptu settings.
Long after the programme ended, then-Prime Minister Stephen Harper restarted the Participaction programme and it continues to save all levels of government in Canada billions of healthcare dollars annually.
All it took was simple legislation, some committed politicians from all levels of government, catchy TV adverts and tacky Participaction merchandise, to save billions of dollars in healthcare spending per year! Who’da thunk it?
Increase NHS revenue via public / private partnerships
Many businesses are excellent corporate citizens, they just need to be asked.
In many cases, corporations will fund a new construction (say, a new wing of a Hospital) in exchange for their corporate logo appearing prominently on the building, in the building lobby, or etched in concrete among the property landscaping. Sometimes it’s a tax write-off for a corporation involved in the construction of the project, sometimes it’s a corporation donating funding in lieu of paying tax on their profits. Either way, large corporations can become part of the solution. It doesn’t hurt to ask corporations how to make that happen more often (Perhaps a minor tax change?) You never know until you ask.
In a time of obscene excess liquidity (multi-billions sitting in banks, doing nothing productive for the economy) a minor tax adjustment could trigger billions of pounds sterling to hit the NHS budget allowing it to add entire new wings to existing Hospitals, adding new technologies to Emergency Room facilities, or it could be used to purchase more Ambulances and train more Paramedics.
A minor corporate tax change could free-up billions of pounds in sponsorship funding for NHS facilities.
Increase NHS revenue and lower demand on certain healthcare services
Due to long wait times to get an Alberta government MRI scan in Alberta it was thought that private companies might take the risk, invest in the expensive and relatively new technology, and open MRI clinics for walk-in clients.
It was expected that Alberta doctors would discuss with their patients the expected wait time for a government provided MRI (long wait, but no cost to the patient) vs. a private MRI clinic (an $800. fee, and typically a 1 hour wait) and it was the patient’s choice where they would get their scan.
The liberal media went into a frenzy. Asking people to PAY for an MRI? Outrageous! And, anyhow, no one in their right mind would pay for an MRI, when the government-funded MRI’s were available at no cost to the patient!
It was such a bad idea that it’s now the de facto state of affairs in Canada.
In the final analysis, what the private MRI clinics did more than anything was to dramatically reduce the wait times at government MRI locations.
Thousands of relatively wealthy citizens decided to pay out-of-pocket to access the results of their MRI scan more quickly. Which, until you’ve actually had cancer or some other serious ailment or injury, seems quite illogical. But waiting months to find out ‘how bad it really is’ just isn’t what patients prefer. Imagine that!
Not only did private MRI clinics lower wait times for relatively wealthy Albertans, the clinics also lowered wait times for patients waiting in the government-funded MRI lineup — consequently, many seriously ill people were able to receive their treatment sooner and at much lower cost to the government healthcare system in the case of progressive diseases, due to sooner diagnostic access.
The end of this story is that private MRI clinics saved Alberta Healthcare so much money, the Premier of Alberta later ordered that anyone who had paid for their own MRI at a private clinic, be partially reimbursed by Alberta Healthcare. Instead of an $800. bill for the patient, it became a $200. bill or even less, depending upon the exact MRI procedure.
In Canada, it’s no longer MRI clinics only that function as private (for-profit) clinics. Many procedures or treatments can be arranged more quickly at the patient’s option, at a private medical facility.
Augment NHS revenue via resident-payer healthcare premiums for those earning £25,000+ annually
The by far simplest and easiest way to increase NHS revenue is to charge each UK resident £20 each month for an NHS healthcare premium, and operate it like any other insurance plan (car insurance, home insurance, etc.) and provide a discount for those who pay in advance, instead of monthly. (‘Resident’ in this case, means all UK citizens, expats, foreign students, and anyone else living in the country longer than one month)
Not only that, but this additional premium (‘additional’ for those that already pay NHS premiums) could be deducted via automatic payroll deductions, while some banks might offer mortgages with NHS premiums built right into the loan, as they sometimes do with life insurance.
Assuming that 40 million UK residents earn over £25,000 annually, the total yearly revenue added to the NHS would be in the range of £9 billion annually!
Which would cover the NHS’s £450 million annual shortfall nicely, wouldn’t it?
Instead of ‘just getting by’ on the national healthcare front, Britain could build one new Hospital per year, fill them with even more of the world’s best medical professionals, and add free dental work up to £200 per year to the many benefits of Britain’s National Health Service.
That’s what I call a sustainable NHS budget plan.
But imagine if all of the above suggestions — #1 through #5 — were implemented throughout the UK. Not only would NHS budget deficits disappear, stable and long-term funding would become the norm, and the result would be better healthcare and shorter wait times for everyone.
Find more statistics at Statista
The Shared Society speech by UK Prime Minister Theresa May at the Charity Commission’s annual public meeting on January 9, 2017. She set out her vision for the shared society, the government’s role within it and her plans to transform mental health supports in Britain.
“Thank you for inviting me to be here this morning to deliver the prestigious Charity Commission annual lecture.
I am delighted to have this opportunity to express my appreciation for all those who work in our charity sector and for those who freely give their time, money and expertise in the service of others. We are a country built on the bonds of family, community and citizenship and there is no greater example of the strength of those bonds than our great movement of charities and social enterprises.
But the strength of that civil society – which I believe we should treasure deeply – does not just depend on the ingenuity, generosity and commitment of countless volunteers, social entrepreneurs and philanthropists. As with other parts of our economy, it also depends on the practices that our charities and social enterprises adopt; and above all on the public trust they command.
That is why the work that William, Paula and their team at the Charity Commission are doing is so important. Because the reforms they are leading are strengthening the sector – and together with the new Fundraising Regulator – ensuring public confidence in our charities and the contribution they make in helping to meet some of the greatest social challenges of our time.
The challenge of our time
And let’s be clear that some of those challenges are significant and long-standing.
We live in a country where if you’re born poor, you will die on average 9 years earlier than others. If you’re black, you’re treated more harshly by the criminal justice system than if you’re white. If you’re a white, working-class boy, you’re less likely than anybody else in Britain to go to university. If you’re at a state school, you’re less likely to reach the top professions than if you’re educated privately. If you’re a woman, you’re likely to be paid less than a man. If you suffer from mental health problems, there’s not enough help to hand. If you’re young, you’ll find it harder than ever before to own your own home.
There are not easy answers to these problems, but it is vital that we come together to address them. For they are all burning injustices that undermine the solidarity of our society and stunt our capacity to build the stronger, fairer country that we want Britain to be.
But the challenges don’t end there. Governments have traditionally been good at identifying – if not always addressing – such problems. However, the mission I have laid out for the government – to make Britain a country that works for everyone and not just the privileged few – goes further. It means more than fighting these obvious injustices. It means acknowledging and addressing the everyday injustices that too many people feel too.
Because while the obvious injustices receive a lot of attention – with the language of social justice and social mobility a staple of most politicians today – the everyday injustices are too often overlooked.
But if you’re from an ordinary working class family, life is much harder than many people in Westminster realise. The injustice you feel may be less obvious, but it burns inside you just the same.
For you have a job but you don’t always have job security. You have your own home, but you worry about paying the mortgage. You can just about manage but you worry about the cost of living and getting your kids into a good school.
You are putting in long hours with little time for yourself – working to live, and living to work. You give work your all, but there is still little left over at the end of the month to spend on the things that really matter to you. Your wages have stagnated for several years in a row, and you feel you are getting by, not necessarily getting on.
And at the same time, over recent years these people have felt locked out of the political and social discourse in Britain. If they voiced their concerns, their views were shut down. Decisions made in faraway places didn’t always seem to be the right decisions for them. They saw their community changing, but didn’t remember being consulted – or agreeing to – that change. They looked at the changing world – the onset of globalisation and the advances in technology – and worried about what the future held for their children and grandchildren.
It is clear to me – and I believe that last year’s vote to leave the European Union partially revealed this to be true – that there are growing numbers of people in every part of our country – in our cities, suburbs, towns, countryside and coastal areas – for whom this is the reality of life.
And the consequence is this: when you see others prospering while you are not; when you try to raise your concerns but they fall on deaf ears; when you feel your very identity – all that you hold dear – is under threat, resentments grow, and the divisions that we see around us – between a more prosperous older generation and a struggling younger generation; between the wealth of London and the rest of the country; between the rich, the successful and the powerful, and their fellow citizens – become entrenched.
That’s why I believe that – when we consider both the obvious and the everyday injustices in unison – we see that the central challenge of our times is to overcome division and bring our country together by ensuring everyone has the chance to share in the wealth and opportunity on offer in Britain today. And that starts by building something that I call the shared society.
The shared society
The shared society is one that doesn’t just value our individual rights but focuses rather more on the responsibilities we have to one another.
It’s a society that respects the bonds that we share as a union of people and nations. The bonds of family, community, citizenship and strong institutions.
And it’s a society that recognises the obligations we have as citizens – obligations that make our society work.
A few months ago at the Conservative Party Conference in Birmingham, I upset some by saying that “if you think you’re a citizen of the world, you’re a citizen of nowhere”.
But my point was simple. It was that the very word ‘citizen’ implies that we have responsibilities to the people around us. The people in our community, on our streets, in our places of work. And too often today, those responsibilities have been forgotten as the cult of individualism has taken hold, and globalisation and the democratisation of communications has encouraged people to look beyond their own communities and immediate networks in the name of joining a broader global community.
I want to be absolutely clear about what I am saying here. I am not arguing against globalisation – nor the benefits it brings – from modern travel and modern media to new products in our shops and new opportunities for British companies to export their goods to millions of consumers all around the world. Indeed, I have argued that Britain has an historic global opportunity to lead the world in shaping the forces of globalisation so that everyone shares in the benefits of economic growth.
But just as we need to act to address the economic inequalities that have emerged in recent years, so we also need to recognise the way that a more global and individualistic world can sometimes loosen the ties that bind our society together, leaving some people feeling locked out and left behind.
And the central tenet of my belief – the thing that shapes my approach – is that there is more to life than individualism and self-interest.
We form families, communities, towns, cities, counties and nations. And we embrace the responsibilities those institutions imply. And government has a clear role to play to support this conception of society.
It is to act to encourage and nurture those relationships, networks and institutions where it can. And it is to step up to correct injustices and tackle unfairness at every turn – because injustice and unfairness are the things that drive us apart.
This means a government rooted not in the laissez-faire liberalism that leaves people to get by on their own, but rather in a new philosophy that means government stepping up – not just in the traditional way of providing a welfare state to support the most vulnerable, as vital as that will always be. But actually in going further to help those who have been ignored by government for too long because they don’t fall into the income bracket that makes them qualify for welfare support.
It means making a significant shift in the way that government works in Britain. Because government and politicians have for years talked the language of social justice – where we help the very poorest – and social mobility – where we help the brightest among the poor. But to deliver the change we need and build that shared society, we must move beyond this agenda and deliver real social reform across every layer of society so that those who feel that the system is stacked against them – those just above the threshold that attracts the government’s focus today yet who are by no means rich or well off – are also given the help they need.
So we will recalibrate how we approach policy development to ensure that everything we do as government helps to give those who are just getting by a fair chance – while still helping those who are most disadvantaged. Because people who are just managing, just getting by, don’t need a government that will get out of the way, they need a government that will make the system work for them. An active government that will help them share in the growing prosperity of post-Brexit Britain.
That’s why we will shortly launch a new housing white paper to boost supply, tackle the increasing lack of affordability, and so help ordinary working people with the high costs of this most basic of necessities.
It’s why we will shortly publish a green paper to put forward our approach for a modern industrial strategy, setting out our plans to encourage growth, innovation and investment and ensure that as we aim to increase our overall prosperity – that prosperity is shared by people in every corner of our country.
It’s why as part of building a great meritocracy I have already outlined plans to increase the number of good school places so that every child – not just those who are fortunate to have parents who can afford to move to a good catchment area or pay to go private – can enjoy a school place that caters to their individual interests, abilities and needs.
So with all these steps we will deliver this new agenda of social reform. And government will step up to support and – where necessary – enforce the responsibilities we have to each other as citizens, so that we respect the bonds and obligations that make our society work.
This means government supporting free markets as the basis for our prosperity, but stepping in to repair them when they aren’t working as they should.
It means standing up for business as a great driver of prosperity and progress, but taking action when a minority of businesses and business figures tear away at the social contract between business and society by working to a different set of rules from everyone else.
It means creating an environment in which our charities and social enterprises can thrive – but responding when a small minority pursue inappropriate and unacceptable fundraising practices.
And it means not being ambivalent about the efforts of all those who give their time, money and expertise in the service of others; but recognising, supporting and championing those who lead the way in shaping a civil society that can bring the talents of so many in our voluntary sector to bear on some of the great social challenges that we face together.
That is why I have continued the important work that David Cameron began through the Points of Light programme, using the office of Prime Minister every day to recognise an outstanding volunteer in Britain whose service can be an inspiration to us all. It is why we are making National Citizen Service a rite of passage for every young person in Britain and supporting all those brilliant organisations in the Prince of Wales’ #iwill campaign who are encouraging our young people to give their time in the service of others.
And it is why we will continue to lead the way internationally in the development of social finance to harness the full potential of our charities and social enterprises in working with business and government to tackle some of the biggest social challenges in our country.
Our opportunity and responsibility
This is the new approach – the new philosophy – that we need in Britain today. An approach with fairness and solidarity at its heart.
And as we reflect on – and implement – the result of the referendum, we must recognise that we have a unique opportunity and responsibility to deliver the change that people need.
An opportunity because Britain is going through a period of great national change, and as we do so we have a once-in-a-generation chance to step back and ask ourselves what kind of country we want to be.
A responsibility because a failure to take this opportunity to show the ability of mainstream, centre-ground politics to respond to public concern would further entrench the very divisions we seek to overcome.
For we know what happens when mainstream, centre-ground politics fails. People embrace the fringe – the politics of division and despair. They turn to those who offer easy answers – who claim to understand people’s problems and always know what – and who – to blame.
We see those fringe voices gaining prominence in some countries across Europe today – voices from the hard-left and the far-right stepping forward and sensing that this is their time.
But they stand on the shoulders of mainstream politicians who have allowed unfairness and division to grow by ignoring the legitimate concerns of ordinary people for too long.
Politicians who embraced the twin pillars of liberalism and globalisation as the great forces for good that they are, but failed to understand that for too many people – particularly those on modest to low incomes living in rich countries like our own – those forces are something to be concerned, not thrilled, about.
Politicians who supported and promoted an economic system that works well for a privileged few, but failed to ensure that the prosperity generated by free markets and free trade is shared by everyone, in every corner and community of their land.
Politicians who made the deals and signed the agreements that changed the nature of their country, but failed to listen to the public’s concerns – dismissing them as somehow parochial or illegitimate instead.
The result of this consensus – this way of conducting politics – has been to bring us to a place where all the old certainties are called into question.
People are questioning whether the system of globalisation, free markets and free trade – one that has underpinned so much of our prosperity – is actually working for them.
When they lose their jobs, or their wages stagnate, or their dreams such as owning a home seem out of reach, they feel it is even working against them – serving not their interests or ambitions, but those of a privileged few.
And they are questioning the legitimacy of all the old institutions and systems we have relied on for decades. They have seen a small minority in the banking and business sectors appearing to game the system and play by their own rules. They have watched Parliament dragged into a row about political expenses, the media mired in questions about phone-hacking, a system that allows lawyers to get rich by hounding our brave troops. And they come to a simple conclusion: that there is one rule for the rich and powerful and another for everyone else.
This is dangerous for it sows division and despair as the gap between those who are prospering and those who are not gets ever larger, and resentments grow.
And it emboldens the voices of protectionism and isolation who would tear down all we have achieved and take us back to the past.
So our responsibility is great. It is to show that mainstream, centre-ground politics can deliver the change people need. That mainstream, centre-ground politics can respond to public concern. And that a mainstream, centre-ground government understands what needs to change and has a plan to set things right.
Our plan for a stronger, fairer Britain
And that’s why this government has a plan, not simply to manage our withdrawal from the European Union, but to take this opportunity to fundamentally change Britain for the better.
A comprehensive, wide-ranging plan for the kind of country we want to be. A plan to build a country where wealth and opportunity are shared; where all of us, no matter what our background, play by the same rules; and where future generations enjoy the same opportunities from which their parents have benefited throughout their lives.
I will say more about this plan in the coming weeks. I will talk more about our plans for economic reform, our plans to build a global Britain and our ambitions to build a more united country.
But at the heart of the plan is a commitment to building a fairer society and tackling the burning injustices that have been allowed to stand for too long.
The burning injustice of mental illness
And I want to turn to one of those burning injustices in particular – the burning injustice of mental health and inadequate treatment that demands a new approach from government and society as a whole.
Let me be clear: mental health problems affect people of all ages and all backgrounds. An estimated 1 in 4 of us has a common mental disorder at any one time. The economic and social cost of mental illness is £105 billion – roughly the same as we spend on the NHS in its entirety.
And for children – 1 in 10 of whom has a diagnosable condition – the long term effects can be crippling: children with behavioural disorders are 4 times more likely to be drug dependent, 6 times more likely to die before the age of 30, and 20 times more likely to end up in prison.
We all know someone – a family member, friend or colleague – who is directly affected by mental health problems. But while people talk about ‘parity of esteem’ – and it was a Conservative-led government that legislated for it – there is no escaping the fact that people with mental health problems are still not treated the same as if they have a physical ailment – or the fact that all of us – government, employers, schools, charities – need to do more to support all of our mental wellbeing.
As Home Secretary I was determined to take on the grave injustices concerning mental illness that were within my remit – and I made improving the police response to people with mental health needs a top priority.
And I am delighted that we have taken great strides forward in reducing the number of people suffering a mental health crisis who end up in a police cell, for want of somewhere else to go.
Since 2011 to 2012, there has been an almost 80% reduction of such incidences across England – so more people detained under section 136 of the Mental Health Act are rightly being taken to a health-based place of safety, rather than being held in a cell.
And for children and young people the reduction is comparable, and through the Policing and Crime Bill I personally introduced, this practice will be abolished entirely for under 18s from this spring.
This proves that innovative reforms that challenge the established way of doing things can improve the response to mental illness.
Now as Prime Minister I want us to go further. I want us to employ the power of government as a force for good to transform the way we deal with mental health problems right across society, and at every stage of life.
For years the only people who have stood up for those with mental ill health have been civil society groups and charities. Now I want us to build upon your success and the fantastic work that many including those here today are doing.
Organisations such as Mind who have led the way in helping those experiencing mental health problems. The Heads Together campaign – and the fantastic leadership shown by their Royal Highnesses the Duke and Duchess of Cambridge and Prince Harry – that aims to break the stigma surrounding mental health problems.
And the tremendous campaigning work by Black Mental Health UK – with whom I worked at the Home Office – to expose injustices in the way black people with mental ill health in particular are treated, and ensure politicians take action to put things right.
So you are leading the way – but today I want us to forge a new approach recognising our responsibility to each other, and make mental illness an everyday concern for all of us and in every one of our institutions.
What I am announcing are the first steps in our plan to transform the way we deal with mental health problems at every stage of a person’s life: not in our hospitals, but in our classrooms, at work and in our communities.
This starts with ensuring that children and teenagers get the help and support they need and deserve – because we know that mental illness too often starts in childhood and that when left untreated, it can blight lives, and become entrenched.
There is, for example, evidence to suggest an increase in self-harm among young people, with the number of 16- to 24-year-old women reporting self-harm increasing threefold – to 1 in 5 – between 2000 and 2014.
And we know that the use of social media brings additional concerns and challenges. In 2014, just over 1 in 10 young people said that they had experienced cyberbullying by phone or over the internet.
First, we will introduce a package of measures to transform the way we respond to mental illness in young people starting in our schools.
We will pilot new approaches such as offering mental health first aid training for teachers and staff to help them identify and assist children experiencing mental health problems. And we will trial approaches to ensure schools and colleges work closer together with local NHS services to provide dedicated children and young people’s mental health services.
These steps will accompany a major thematic review – led by the Care Quality Commission with input from Ofsted – looking at services for children and teenagers across the country to find out what is working, and what is not.
Following this, CQC and Ofsted will consider how their future joint programme of inspections can ensure child and adolescent mental health services are properly held to account for performance.
And alongside these reviews, later this year we will bring forward a new green paper on children and young people’s mental health to transform services in education and for families.
These measures will build on the work we are already doing to put a stop to the untold misery of hundreds of children being sent halfway across the country to access mental health services.
By 2021, no child will be sent away from their local area to be treated for a general mental health condition.
But treatment is only part of the answer. We must look at what more can be done to prevent mental health problems, and work with you to capitalise on the crucial role civil society has to play in helping young people – and indeed people of all ages – build resilience.
Second, I want us to do more to support mental wellbeing in the workplace. So I have asked Lord Stevenson, who has campaigned on these issues for many years, and Paul Farmer, CEO of Mind and Chair of the NHS Mental Health Taskforce, to work with leading employers and mental health groups to create a new partnership with industry, and make prevention and breaking the stigma top priorities for employers. Because mental wellbeing doesn’t just improve the health of employees, it improves their motivation, reduces their absence and drives better productivity too.
We will also review employment discrimination laws for employees with mental health problems to ensure they are properly supported.
And we will do everything we can to get the right support to those with mental health problems who are out of work. For example, through our global leadership on social impact bonds – which drive investment in social outcomes – we are already providing up to £50 million to support those with mental health issues back into work and to help local areas tackle the link between drug and alcohol dependency and co-existing mental health problems.
Third, I want to ensure more people get the support they need, when they need it, in their communities. So we will make up to £15 million of extra funding available for community clinics, crisis cafes, and alternative places of safety to support a wider range of preventative services in the community, and ensure that charities, churches and community organisations can access funding to run them too.
And we are already investing over £10 million to support the fast track Think Ahead programme – which aims to increase the number of high-calibre mental health social workers – by at least 300.
Fourth, we will rapidly expand the treatment available by investing £67.7 million in digital mental health services. Online therapy has the potential to transform the way mental health services are delivered by allowing people to check their symptoms, be triaged online and receive clinically-assisted therapy over the internet much more quickly and easily, assuming it is clinically appropriate. These treatments have been tested in other countries and they work. In the right cases, they can offer access to treatment far quicker than traditional services.
Fifth, we will right the everyday injustices that those with mental illness encounter – starting by examining GP forms relating to mental health and debt. Because sometimes those whose illness has resulted in debt, or means they are struggling to pay their debt, have to prove their mental ill-health to debt collectors and pay their GP to fill in a form to do so. Such a process can worsen both mental illness and financial difficulties, so we will work with the Money and Mental Health Policy Institute to consult on these forms, with a view to ending the practice.
And finally, today we are publishing a strengthened cross-government suicide prevention strategy, which sets out a comprehensive plan to reduce the suicide rate in this Parliament, and targets those most at risk such as young and middle-aged men, those in contact with the criminal justice system and those in the care of mental health services. Because, on average, 13 people kill themselves every day in England, and if we want to improve the life chances of current and future generations, we need to address this shocking reality.
And in addition to all this we will ensure that the NHS itself takes the steps it needs to ensure that parity means just that: parity. We will hold the NHS leadership to account for the extra £1 billion we invested in mental health last year. We will make sure that mental illness gets the attention it deserves, in funding, research and technology investment. And we will be clear that when NHS leaders are redesigning services and developing new local solutions, mental health should get its full weighting.
As I have said these are just the first steps in our plan to transform our approach to mental health in this country. Meeting this challenge will take years and require more than government action alone – it will need a sustained effort on the part of everyone in this room and everyone across society.
But this is a historic opportunity to right a wrong, and give people deserving of compassion and support the attention and treatment they deserve. And for all of us to change the way we view mental illness so that striving to improve mental wellbeing is seen as just as natural, positive and good as striving to improve our physical wellbeing.
For too long, mental illness has been something of a hidden injustice in our country, shrouded in a completely unacceptable stigma and dangerously disregarded as a secondary issue to physical health. Yet left unaddressed, it destroys lives, separates people from each other and deepens the divisions within our society. Changing this goes right to the heart of our humanity; to the heart of the kind of country we are, the attitudes we hold and the values we share.
I remember the reaction when, back in 2012, Charles Walker and Kevan Jones spoke in Parliament about their own personal challenges with mental illness. The courage of these 2 MPs – Conservative and Labour – to speak out in this way, encouraged us all to put aside party differences and come together in solidarity.
That sense of solidarity will be essential in helping us to transform the support we offer those with mental health conditions and to defeat the stigma that makes addressing this issue so much harder than it should be. But I also believe that in a wider sense, that commitment to strengthening the bonds we share as a union of people, can be a defining part of how we meet the great challenge of our time and bring our whole country together.
It is by tackling the injustice and unfairness that drives us apart and by nurturing the responsibilities of citizenship that we can build that shared society – and make it the bedrock of a stronger and fairer Britain that truly does work for everyone