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Editorial Tuesday 12 January 2016: Why a cross-party health and care funding commission probably won't happen or work

NHS funding arguments fall into three broad categories. In ascending order of usefulness, these are: how to fund; how much to fund; and what value the funding delivers. The first two categories are more political and philosophical; the third is more technical-economic.

Former Lib Dem health minister, mental health champion and good egg Norman Lamb recently proposed a cross-party commission on health and care funding.

It's an attractive idea in the abstract, given the mismatch between the available funding and demand under the existing NHS system and offer.

I just don't think it's likely to happen.

There are two main reasons for this: both political ones.

The first is that with an Opposition that takes four days to reshuffle its shadow team (and four-and-a-quarter years out from the next general election campaign, this is more than usually politics' version of Fantasy Football), it is difficult to conclude that we can expect the Government to be robustly held to account - which is half of what an Opposition should do.

The other half is about being (or becoming) a plausible alternative government.

Mmmm. Let's not intrude on private grief.

Not only did almost all Conservatives not expect to win an overall majority, they could not have dreamed of the Corbyn supremacy over Labour. In short, the Conservatives find themselves in an unexpected and unseriously-opposed imperial phase. All power delights; absolute power is absolutely delightful.

So politically, they do not need to reach out to other parties. The Government also see no current need for a funding commission because many in the Treasury remain unconvinced that there is a significant NHS financial crisis under way.

Due to hard work from clinicians and (thus far) a mercifully mild winter and reasonably successful guess about the flu vaccine, there has not yet been widespread evidence of the problems building up in parts of the system.

The move away from weekly A&E waiting time reporting may also be helping matters.

This is likely to change as the financial outturn from 2015-16 becomes clearer. It may also change once the first major social care provider can no longer refinance its debts. Richard Humphries of the Kings Fund has this good summary in The Guardian on the financial crisis facing social care.

The second reason is obvious, but worth re-stating: the decision how much we will spend on the health and care systems is political. We fund the NHS (mainly) and such public provision of social care as remains almost entirely through general HMRC taxation. The CSR-permitted 2% local percept for extra social care that councils who choose to do so may raise will be a tiny contribution.

Politicians and the public alike, rightly, want to see accountability for public spending.

The BBC model, where the Government decides on the level of the licence fee, is unlikely, given the money involved. The BBC gets £2.65 billion a year from this monopoly tax on television ownership. The NHS budget is around £116 billion.

The Treasury will agree to devolving that amount of tax or tax-raising powers to NHS England at no point in the near future.

The historical precedent is unpromising: in March 1999, the Royal Commission on the funding of long-term care recommended that personal care and accommodation costs should be split, with the former made free and the latter means-tested. The Government slipped out its rejection alongside July 2000's The NHS Plan, one of whose main authors was a certain Simon Stevens.

A cross-party funding commission on health and social care might get traction if funding issues represented an imminent and significant political challenge to the Government.

Thanks to The Fixed Term Parliaments Act and the tacit, uncivil war within the Labour Party, this does not seem likely.

Not yet, anyway.