NHS tax hack — time for action

An experiment to mobilise the 70% who would pay more tax to fund the NHS.

A few weeks ago I wrote this post outlining the idea of an ‘NHS tax hack’ — a way of mobilising the 70% of us who say we are prepared to pay more tax to fund the NHS. The idea is that willing citizens would be able to pay extra ‘tax’ voluntarily via a trusted third party until such a time as the government implement the increased funding through the tax system.

My main goal in writing this down was to get some feedback on the idea, which had been going round in my head for some time. I wanted to break it down into a set of assumptions and try to validate them independently. I linked to a survey so that anyone who was interested could tell me what they think. So far 32 people have taken the survey (thanks friends, mum, granny, but also those of you I don’t already know).

The survey questions were:

• Would you be prepared to pay 1% more tax to fund the NHS?
• Would you hypothetically give your ‘tax’ to a trusted third party (not the government) in order to get it to the NHS?
• What would make you trust this third party
• In your opinion, what would be the best way to get this money to the NHS
• If you think that an nhs tax hack is a good idea, how many of your friends do you think might do it too?
• Is there anything else you’d like to say about this idea?

Here’s a summary of the answers so far (detail below):

• 97% of you would pay 1% more tax to fund the NHS
• 88% of you could be convinced to give your ‘tax’ to a trusted third party
• The third party would need to be really transparent
• We should have a team of NHS experts decide what to do with the money
• 60% of respondents have lots of friends who would also be up for this
• If the people who took this survey and their friends were able to do this tax hack, they would be able to pay for 2 full time nurse’s salaries.

What next

This has been a really helpful exercise for clarifying the idea of an NHS taxhack. I’m reassured that there’s the seed of an idea here. But there are some significant assumptions that haven’t been validated by this survey.

What I’m hearing is:

IF there was a transparent and trustworthy third party that could get your money to the NHS in a way that has a positive impact THEN a lot of people would be prepared to do it.

There are three big assumptions underlying this:

1. It is possible to find/build a third party that is transparent and trustworthy enough for potential hackers to believe in it
2. It is possible to identify a way of getting the money fairly to where it is needed most in the NHS
3. If the other assumptions were satisfied, people genuinely would pay more ‘tax’ on a monthly basis to fund the NHS (rather than just saying that they would)

It’s the final assumption that’s the big one on which the whole thing rests. It’s certainly the thing people challenged the most in the free-text fields:

“I don’t think nearly as many people who say they would pay more tax would actually do it “

I’m keen to test this third assumption independently of the others, because if it doesn’t hold then there’s no point putting the effort into validating the first two (which would be a lot of work).

Here’s the test I propose to validate this assumption. It’s not perfect, but it feels like it’s good enough to provide compelling evidence that people would genuinely take part in a tax hack. If you’ve got ideas for improvements or can think of reasons why it’s flawed, I’d be really happy to hear from you.

The test

• Identify the most ‘failing’ NHS hospital by a well known measure of ‘failure’ accepted by NHS experts
• Approach the charity that is associated with the hospital (most hospitals have these — it will have a clear and transparent governance structure) and identify what they would do with, say, £25,000.
• Find 70 people within my network who will give £30 to this charity each month as a ‘rough and ready’ version of the NHS taxhack.

Hypothesis:

If I can find 70 people in my network who will give £30 a month to this NHS charity, then there is a segment of people who are prepared to act on an NHS tax hack.

Challenges/risks

• These people will need to trust me quite a bit because they’re going to need to do something quite clunky
• A potential flaw in the experiment is that it focusses on people in my network, and could be strongly dependent on my persuasive skills rather than the merits of the idea. I will try to recruit hackers from the fringes of my network and friends of friends (with the friend as the advocate, not me) to combat this.
• I will probably hear “no” quite a bit. I will aim to document these as much as I can to understand where more could be done to turn each into a “yes”

There are some clear benefits and dis-benefits with this first test. I’ve outlined these here:

tax hack v1.0

Your thoughts

I’m really keen to hear from anyone who is interested in this idea and has thoughts / criticisms / helpful suggestions or would like to collaborate. Please do reply below or message me directly at tccorfield at gmail dot com

HERE’S THE RESEARCH DETAIL….

Here are the detailed responses to each of the questions asked in the survey with a bit of criticism and then a summary of ‘so what’ for each one.

97% of you say you would pay 1% more tax to fund the NHS

Ok so this is a bit of a daft question, because if you’re in my network, you’re interested in this idea and you’re taking the time to complete the survey. This was more of a pre-qualifier to validate the later questions. But still, if the 30 of you who are prepared to pay an extra 1% tax to fund the NHS had a way to do so (assuming you’re on average you’re roughly earning the same as me) then we’d be half way to funding a full time nurse. That’s not nothing!

Most of you would pay more tax to fund the NHS — no surprise there

For me the interesting stuff here (and throughout this research) is actually in the negative responses. What was the reason for the ‘no’?

The ‘no’ said that they ‘might’ be convinced to give money to a third party if it was necessary. But the issue raised was whether the NHS funding crisis was about allocation of funds rather than absolute amount of funding available to the NHS. Which I interpret to mean that the NHS could choose to spend money in different ways and perhaps to become more efficient.

I’m not an expert on this data set, so I’m just going to leave this information here for discussion — I’d be interested to hear perspectives from both sides:

According to the British Medical Association

‘the NHS in England is heading for a mismatch between resources and patient needs of nearly £30 billion a year by 2020/21’

and the already planned (‘ambitious’) 2–3% per year efficiency savings will not make up for the projected shortfall in funding.

88% of you say you could be convinced to give your ‘tax’ to a trusted third party

Again, I guess a bit of a self fulfilling prophesy here with my self selected audience, but half of you said that you would hypothetically give your extra 1% to a trusted third party who was not the government. A further 37.5% might do if you were convinced of a few things. In a moment we’ll look at what might need to be done for everyone to be convinced.

Of those that would not give money to a third party, the general view was that the most trusted party is government and that any additional money raised should go to the Department for Health or to specific hospitals with no intermediary involved.

The third party would have to be really transparent

So what would convince you to give your money to a third party in order to enable the ‘hack’? This was a free-text field so there were a lot of really rich and detailed responses. For a readable/measurable output, I’ve broken all the free-text down point by point and coded it using the most common emerging themes so that I can get a clear set of priorities.

The third party must be transparent, particularly around its goals, plan and impact tracking, and this must be guided and reinforced by a good governance structure. Further to this, the organisation must have a track record of delivery before it can be trusted.

We should have a team of NHS experts decide what to do with the money

Again, there was a lot of free-text detail in the ‘other comments’ field about this question of ‘how do we get the money to the nhs’. My initial proposal was in the short term to give the money directly to a specific hospital to spend on something tangible, like nurses’ salaries. There was good support for this idea, particularly as a short term measure to get people engaged in the hack.

But longer term, as the thing scales, there was a strong sense that there should be a team of ‘NHS experts’ deciding what to do with money. This makes total sense. There were a few suggestions on what this group could look like, but the main emphasis was on

1) making sure that there was not an unknown non expert group making decisions

2) not allowing the ‘hackers’ to decide as a group, because that would put non experts in charge of decisions that should be highly informed

60% of you think that lots of your friends would also be up for doing this

Finally I asked how many of your friends might also be interested in something like this.

The question had a free-text field so that people could say whatever they wanted. Some people said things like ‘lots’ or ‘most’ and others gave actual numbers of friends that would likely be interested. 60% of respondents said that ‘most’ or ‘lots’ of their friends would be interested, or gave a specific (quite high) number.

Counting up only the raw numbers given, and ignoring the ‘most’ and ‘lots’ comments we get 129. If we add to that the 31 positive respondents who took the survey we get 160. Obviously this is all hypothetical and there are a lot of unknowns. But just for some context, if the small number of people within the network who took this survey were to do the tax hack (assuming they’re on a roughly similar salary to me) then together we could fund two full time nurse’s salaries. That’s not nothing.