After the election last year I was ready to get on with the job, I’d got straight to work on questions and tabling motions, on turning the policy ideas from my manifesto into something more tangible.
So it was something of a surprise to be offered the job of Minister for Health and Social Care – but when someone offers you the chance to try and help fix one of the most important parts of our public service it’s not an opportunity that you’d turn down.
The first thing that strikes me when talking about the NHS is perhaps the most obvious – that it is fundamentally important that it remains almost exclusively free at the point of use.
You should never need a credit card to get access to health or care services.
However, when you scratch beneath the surface it’s not quite that clear cut.
For example, older person’s care theoretically forms part of our ‘cradle to grave’ healthcare system, but doesn’t fall under that banner.
It comes with sometimes astonishing costs that cause families real hardship, often requiring people to sell their homes.
These costs aren’t borne by everyone, and aren’t borne equally, which means the treatment and support you might get are intrinsically linked to your ability to pay – going against that fundamental principle of the NHS.
Why does this matter? Surely if you can afford to pay you should pay, right?
Unfortunately because of the way the system is structured it’s not just asking people to pay a bit more, sometimes it’s asking them to pay almost everything they have – and it’s not just asking those who can afford to pay. This isn’t a fair system.
So how do you solve this?
Perhaps we need to look to the principles of another fundamental bedrock of Manx society, National Insurance. This is designed to work exactly as it sounds – it’s a society wide insurance scheme. We all pay in as we work and so whenever anyone needs help they can access it.
This is perhaps even more important now than ever, when household finances are being stretched and can’t absorb any unexpected shocks.
So why does our insurance cover run out when we need care later in life? Why do we not have similar social insurance for nursing and residential care?
My view is we should. Our NHS should support us throughout our lives and we should all pay in our fair share, so no one is left struggling when they need care.
This is perhaps even more important right now with the cost of living increasing, placing an extra burden on people already struggling with the costs of care.
How might this work? It has to be fair, it has to be progressive and it has to ensure the burden isn’t just borne by hard-working families.
These decisions aren’t going to be made by government alone, there will need to be plenty of engagement with all of us living in the island.
I’m ready to make these big changes and to have these difficult conversations but the real question is – are you?