We have now all glimpsed the foothills of the mountain range which, if we want to remain a civilised society, we must climb.

The NHS is 70 and healthcare now vies with public pensions as the biggest item of public expenditure. The NHS is not perfect but it plays to a British sense of fair play and community, the public remain solidly behind it.

The demands on the NHS are increasing rapidly. We don’t look after ourselves well - we smoke, we drink, we eat too many sweets, above all we grow old. New treatments, wonderful for those who regain hope and health through them, tend to be expensive.

The result is, to keep pace with changing demographics and needs, the NHS requires about 4% more resources each year in real terms - in nominal terms about 6% - which means a doubling roughly every 12 years. This is only healthcare; social care faces the same challenges. The impacts on public finances and the way we look after our older citizens will be profound.

Part of the increased resource must come from innovation and better productivity so that the extra cash needed is less than 6% each year. More money will be required though, a lot of it. We can pretend that economic growth will provide it - it will to a degree but what about the roads, police and schools? - the reality is that there are demands across the public spectrum. Taxation is going to have to rise.

I actually think there is a consensus in our society for increased tax to fund the NHS and Social Care, as long as it is done fairly. Fairly does not mean smashing higher earners - they will only stop trying or move away - we will all be the losers down that road. Fairly means across the board I’m afraid - we all have to pay. Here are some ideas.

First, adopt an American style tax system whereby if you have a British passport you pay British taxes - it doesn’t matter if you have moved to Switzerland or Monaco - you still pay.

Second, reform the crazy system of two taxes on income - income tax and National Insurance. Why on earth does somebody with a salary of £150,000 pay a marginal combined rate of 47% (48% in Scotland) and somebody who has a pension of £150,000 pay 45% (46% in Scotland)? As a first step the 2% additional National Insurance brought in by Gordon Brown should be applied to all income. In the long run income tax and National Insurance should be merged, with a combined top rate of 50%. Ending the favourable tax regime applying to unearned income would not only be fair but bring a huge amount of extra revenue.

Third, reform Capital Gains Tax. The 20% rate is too low but the removal of indexation relief is grossly unfair. Reintroduce the latter but tax real gains at 40%.

Fourth, Inheritance Tax. The most ludicrously structured tax of all. Up to £325,000 you pay nothing, then 40% but if you have the right sort of assets or you give them away and live 7 years you pay nothing. How stupid is that? Replace the exempt amount with an annual allowance of £10,000 and tax all types of asset whenever they are given away, no exemptions, but change the rate from 40% to 5%. A fairer tax which would collect far more.

You can argue with any one of these proposals but all of them lean in the direction of greater fairness and simplicity - debating this sort of things is what we are going to have to do.

Pinstripe is a senior member of Scotland's financial services community.