We need properly funded, how little funding we have is a joke. The one benefit of COVID-19 is perhaps it'll waken up the powers that be at how poorly funded the NHS is.
People also need to stop taking the p*ss when it comes to the NHS. I worked on a project previously looking at the costs of prescriptions, how much the true cost of a paracetamol prescription to the NHS is disgusting, especially when you can get it out of Asda/Tesco etc for 20p.
Whether it's an increase in taxes to pay for this or whatever, it needs done. The current NHS model is far from sustainable.
For everyone who decided to applaud the NHS, but voted for the Tories, I hope you are ashamed of yourself.
Unfortunately political parties are so terrified of properly looking at the NHS (along with welfare) that it will merely continue to cost progressively more (increasing by 2% of GDP per generation), whilst also offering progressively less in terms of service until it collapses.
I posted in another thread that if spending on the NHS and welfare increases as a % of GDP from 2010 - 2070 as it did between 1950 - 2010 then the entirety of the governmental budget will be consumed by health, education and welfare. Over the latter period we have seen huge reductions in spend for defence, transport, housing, local councils, public order, education etc and of course debt to accommodate the increases in welfare and health. I personally can't see how we can reduce spending in those areas by a much greater degree (unless we look at mass privatisation) to allow for a continued increase in these two areas. At the same time the general belief of the population is that spend in health and welfare need to increase at a quicker rate.
Alongside this belief is the data that also shows we're being taxed more than ever before in peacetime history to accommodate the current expenditure; whilst we're also accumulating debt year on year. These record levels of tax in my view already have us close to the peak of the Laffer curve and therefore I believe anything but minor changes to the taxation system will result in decreased tax take. People will argue that Corporation Tax has decreased, but this is more than compensated by increases to businesses in other taxes such as business rates, IPT, energy taxes, employee taxes etc; that's before mentioning the cost to business of a 20% increase in the minimum wage over the last 3 years. The vast majority of businesses are being squeezed harder than ever before, along with their owners.
We need to be honest that the current welfare and health systems just aren't sustainable. They are ponzi schemes that are currently being funded by a combination of draining resources from other departments and increasing the debt burden for the next generation; both of which aren't sustainable in the medium to long term. Any area of expense in any walk of life that doubles every 30 years, whilst the ability to pay remains somewhat constant, can only end up in collapse.
The truth is the reform is going to be wildly unpopular and so will need to be a cross party backing but everything needs to be on the table. That includes moving across to an insurance style system with free healthcare for the poorest, abolishing the free at the point of use principle (similar Dental), changing what is covered by the NHS (self inflicted problems are funded by the person themselves), allowing greater private sector involvement where wealthier people can pay for a full private health package (they're likely to be happy to pay more to receive a better service), nudging people towards saving for some levels of their own care when they're older (e.g. tax relief for a private pension but solely for social care and also a scheme for joblessness), increases in automatic pension contributions meaning people are less reliant on state pension etc.
The sooner we start talking about these inevitable changes the less drastic the changes will be once they have to take effect. If we wait until 2043 for example the number of people 75+ is projected to have increased from 5.5m to over 9.5m and the number of 85+ will have nearly doubled from 1.6m to over 3m. At the same time the number of people 25-59 who will be predominantly the group paying for them will remain roughly static at 31m.
Huge overhaul needed . Instead of all the bleating about underfunding etc etc , how about we start off by making the NHS much more efficient ? As 11101 said earlier , why does the NHS pay over the odds for everything ? ive never been able to understand how it pays more than the market rate for everything from a lightbulb to the drugs we use , to the beds we buy . Its at every level . Abject waste . In any other business , the more of an item you buy the more discount you get . I went to my local hospital a few months ago and in almost every office i went into there were Dyson fans , on the wards generic fans . Surely things can be standardised ie lets go to the fan manufacturers and buy 2000 or 3000 and see who comes up with the best deal .
Also , as other people have mentioned , lets cut down on costs , starting at a low level . I know people who get prescriptions free due to being disabled , unemployed etc , hell i do too due to having underactive thyroid. Its great , its how it should be , but there are limits . is it unreasonable for people to pay for their own paracetamol from tescos or wherever rather than get it on a prescription costing the state over 9 quid a pop ? its madness and surely people must be educated to not abuse the system for things like that . Same applies to people abusing the doctors surgeries and hospitals by just deciding not to turn up for appointments . I get that we shouldnt punish people for the odd slip up but i know people do the same thing over and over again ( my work partners mrs works in a doctors surgeries and over 10 % of people dont show up at times ) Maybe let them miss one appointment , but after that charge them say 20 quid a pop and it will stop .
Most of us love the NHS and all it stands for but we all have a responsibility to look after it . Yes i get that people say it needs more money , but lets stop it bleeding money before just throwing more money at a broken machine . Fix it first . Its the largest single cost in our country so lets manage it wisely , all the way from the people that use it and abuse it , to the procurement , to the logistics to the understaffing at base levels , to the overstaffing higher up the chain . Some of the salaries of the executives and consultants are eye watering for a few hours work per week .
Many people have been posting about politics , playing the blame game on tory this or blair that . As far as i can see none of that will help matters , it just goes around finger pointing and round and around in circles
Surely with Boris having to lead the country through a crisis and ending up in hopsital doing so, he's going to not only appreciate the NHS more, but the need for public spending on welfare? If not then there's something very wrong anyway.
Huge overhaul needed . Instead of all the bleating about underfunding etc etc , how about we start off by making the NHS much more efficient ? As 11101 said earlier , why does the NHS pay over the odds for everything ? ive never been able to understand how it pays more than the market rate for everything from a lightbulb to the drugs we use , to the beds we buy . Its at every level . Abject waste . In any other business , the more of an item you buy the more discount you get . I went to my local hospital a few months ago and in almost every office i went into there were Dyson fans , on the wards generic fans . Surely things can be standardised ie lets go to the fan manufacturers and buy 2000 or 3000 and see who comes up with the best deal .
Also , as other people have mentioned , lets cut down on costs , starting at a low level . I know people who get prescriptions free due to being disabled , unemployed etc , hell i do too due to having underactive thyroid. Its great , its how it should be , but there are limits . is it unreasonable for people to pay for their own paracetamol from tescos or wherever rather than get it on a prescription costing the state over 9 quid a pop ? its madness and surely people must be educated to not abuse the system for things like that . Same applies to people abusing the doctors surgeries and hospitals by just deciding not to turn up for appointments . I get that we shouldnt punish people for the odd slip up but i know people do the same thing over and over again ( my work partners mrs works in a doctors surgeries and over 10 % of people dont show up at times ) Maybe let them miss one appointment , but after that charge them say 20 quid a pop and it will stop .
Most of us love the NHS and all it stands for but we all have a responsibility to look after it . Yes i get that people say it needs more money , but lets stop it bleeding money before just throwing more money at a broken machine . Fix it first . Its the largest single cost in our country so lets manage it wisely , all the way from the people that use it and abuse it , to the procurement , to the logistics to the understaffing at base levels , to the overstaffing higher up the chain . Some of the salaries of the executives and consultants are eye watering for a few hours work per week .
Many people have been posting about politics , playing the blame game on tory this or blair that . As far as i can see none of that will help matters , it just goes around finger pointing and round and around in circles
The government also needs to look at major investment in curing the homeless and mental crises, plus the yawning gap between rich and poor. This country is a fecking mess if you are unfortunate enough to fall into the bracket of have nots.
I pay for private healthcare to Aviva. Ultimately, if there were an NHS private healthcare that I could use that the fee would be used to fund the NHS I would happily switch to it. That's one way to fund the NHS, on top of the government spend. I am sure there are plenty of others that would switch too. Better than paying some insurance company, money straight into the NHS.
If 10 million people signed up for £25 a month that's a fund of £30 billion annually. I dont think that would be impossible either. There might be some competition crap related to the government or NHS getting into the private healthcare game but I'm sure with Brexit the commons could vote to undo that legislation pretty easily.
I'd be absolutely astonished if they could get away with that again. Stuff like the bedroom tax and the war on benefit thieves was outrageous at the time but to do it again it would lead to things getting very nasty. A lot of people have been struggling very badly over the past decade what with food banks, increased homelessness, universal credit problems. Surely the tolerance levels snap eventually?
Huge overhaul needed . Instead of all the bleating about underfunding etc etc , how about we start off by making the NHS much more efficient ? As 11101 said earlier , why does the NHS pay over the odds for everything ? ive never been able to understand how it pays more than the market rate for everything from a lightbulb to the drugs we use , to the beds we buy . Its at every level . Abject waste . In any other business , the more of an item you buy the more discount you get . I went to my local hospital a few months ago and in almost every office i went into there were Dyson fans , on the wards generic fans . Surely things can be standardised ie lets go to the fan manufacturers and buy 2000 or 3000 and see who comes up with the best deal .
This. I used to supply a service element to the NHS. The whole framework procurement system is broken, suppliers on that framework overcharge.
When i used to supply, the framework provider was adding their own middleman tax, just because they were on this exclusive system. Now that is one element of procurement which is a minor spend in the NHS, but combine that process across every other department and it's easy to see where they can work smarter.
We need properly funded, how little funding we have is a joke. The one benefit of COVID-19 is perhaps it'll waken up the powers that be at how poorly funded the NHS is.
People also need to stop taking the p*ss when it comes to the NHS. I worked on a project previously looking at the costs of prescriptions, how much the true cost of a paracetamol prescription to the NHS is disgusting, especially when you can get it out of Asda/Tesco etc for 20p.
Whether it's an increase in taxes to pay for this or whatever, it needs done. The current NHS model is far from sustainable.
For everyone who decided to applaud the NHS, but voted for the Tories, I hope you are ashamed of yourself.
Agreed. They'll talk about what they're doing to protect such and such a thing because of how needed it was, how they'll improve that by selling this, and it'll be done bit by bit so as not cause as big an uproar. And half the population will probably applaud this too. Fully expect to see people saying "welll, it's been in an awful state for years, it'll be so much better now" etc. and talking about how good a job they've done.
I also suspect it won't be terrible initially, but it will open the door to going down an awful route, and I'm sure capitalism will take us down it.
Unfortunately political parties are so terrified of properly looking at the NHS (along with welfare) that it will merely continue to cost progressively more (increasing by 2% of GDP per generation), whilst also offering progressively less in terms of service until it collapses.
I'm pretty sure this is part of the plan. Let it get worse and worse and plenty of donuts will be clapping for the Tories when they offer a magical way out.
Important to note that the NHS expenditure as a percentage of GDP is still lower than a lot of countries (below average for comparable countries). When you consider things in terms of lack of CT scanners, MRIs, hospital beds per patients, physicians per patient the clinical outcomes are pretty remarkable, more below https://www.ifs.org.uk/uploads/HEAJ6319-How-good-is-the-NHS-180625-WEB.pdf
We need properly funded, how little funding we have is a joke. The one benefit of COVID-19 is perhaps it'll waken up the powers that be at how poorly funded the NHS is.
People also need to stop taking the p*ss when it comes to the NHS. I worked on a project previously looking at the costs of prescriptions, how much the true cost of a paracetamol prescription to the NHS is disgusting, especially when you can get it out of Asda/Tesco etc for 20p.
Whether it's an increase in taxes to pay for this or whatever, it needs done. The current NHS model is far from sustainable.
For everyone who decided to applaud the NHS, but voted for the Tories, I hope you are ashamed of yourself.
I know of examples of protective gear like face masks costing the NHS almost 20 quid when you can buy the same stuff in shops for a fiver. Multiply that over everything they buy and it quickly adds up.
There was also a fairly well known scam back in the day where you could send invoices for small amounts of say 30 or 40 quid for contracting work and it would always be paid, as under a certain amount it was too much hassle to investigate whether the work actually happened. I don't know if that one is still going on.
In my own work it's always been known that all government departments, NHS or otherwise, are clueless when it comes to purchasing.
I don't know how you fix it but i don't believe adding a zero to the budget is the answer.
Just interested, how many Tory voters here would now definitely, certainly and actively vote against them in the next election? There is little doubt their modus operandi has always been to break the country's resources up since Thatcher. I know because my family has benefited personally every time they have been in power (cheap houses in the 80s, lower taxation on high earners, etc).
But since the 80s, up to the last general election to get Boris in, my family and I have always voted Labour. Putting aside the murderous cnut Blair, we have have always lamented losing out to the Tories despite personally gaining each time they won. We always vote for the country and the NHS is always top of our concerns even though we could be comfortable under US style insurance plans which Boris ultimately has in mind for us.
Yeah but think about it. If uk were to separate from NI now they’d surely have to pay some kind of financial package to contribute to it ticking over whilst it migrated to Ireland. UK won’t be able to afford that kind of money now and Ireland won’t be able to afford the financial burden either. It’s a stop in the line. For now at least
If 10 million people signed up for £25 a month that's a fund of £30 billion annually. I dont think that would be impossible either. There might be some competition crap related to the government or NHS getting into the private healthcare game but I'm sure with Brexit the commons could vote to undo that legislation pretty easily.
Yeah but think about it. If uk were to separate from NI now they’d surely have to pay some kind of financial package to contribute to it ticking over whilst it migrated to Ireland. UK won’t be able to afford that kind of money now and Ireland won’t be able to afford the financial burden either. It’s a stop in the line. For now at least
I'm pretty sure this is part of the plan. Let it get worse and worse and plenty of donuts will be clapping for the Tories when they offer a magical way out.
I'm not sure I agree that there's any long term plan. We only have a short term plan which changes as per whatever is the most politically attractive at the time.
Likewise I don't think the plan is to let it get worse and worse; it getting worse and worse is an inevitability given that revenue streams are somewhat constant (as a % of GDP) but age demographics (amongst other things) means to achieve the same service greater investment is required (again as a % of GDP). The only way to maintain service levels whilst also catering for the aging population is therefore divert other departmental spending to the NHS, which is what we've been doing over the last 70 years (with spend increasing from 2% of GDP to 7% over that period)
The problem comes when you hit the point where there are almost no discretionary funds to redistribute. Our defence spend is operating close to the NATO minimum, our education spend is lower than it was in 1950. Our transport spend is at an all time low with the majority of the country agreeing that the infrastructure is in dire need of investment, our debt is at an all time high, our judiciary has seen substantial cuts and there's also widespread agreement that our police/prison service has been cut to the bone. People talk about austerity, but that's a false premise (a term perpetuated by the Tories as it made them seen fiscally responsible). It's merely a reallocation of resources from other departments to fund the ever-burgeoning social protection and health budget. As a % of GDP we're spending more now than we ever have in non-recession peacetime.
Therefore the big question is where does the money come from going forward? We can't invest more in welfare or the NHS without either increasing debt (rolling a snowball down a steep hill for future generations to be crushed by), reducing other departmental spend which most agree is already close to the bone; or large scale reform.
We're at the tip of the ponzi scheme if you will. The below figures show how the NHS and social protections (welfare/pension) have been draining public resources continually for 70 years. At some point Defence, Education and everything else won't be able to be drained any further and my view is that point is now. We might get away for a few years of kicking the snowball down the hill in the form of debt, but that just makes for an even greater collapse down the road.
Social protections 1950 - 5.98% GDP
Social protections 2019 - 12.86% of GDP
Health spend 1950 - 2.73% GDP
Health spend 2019 - 7.06% GDP
Education spend 1950 - 4.37% GDP
Education spend 2019 - 4.13% GDP
Defence Spend 1950 - 6.22% GDP
Defence Spend 2019 - 2.3% GDP
Other Spend 1950 - 17.65% GDP
Other Spend 2019 - 11.57% GDP
My view is we need to look at how the majority of other countries fund health. The vast majority of good OECD healthcare systems (Switzerland, Belgium, Korea, Japan, Germany, Holland, Luxembourg etc) allow far greater scope for non-mandatory schemes and also have a mandatory health insurance system.
Nonsense. It's been this way for years, long before 2012. To @jderbyshire's question of why does it happen?
Everything works from preferred supplier lists. Lots of businesses have them and they work well. Suppliers are vetted in order to get on the list, and then the buyer has to go to them for anything they need to buy. It means you have competition between bidders and you ensure quality levels.
The NHS is just absolutely shit at them. They never get updated and are so hard to get on to, anybody who is already on there knows they can charge whatever they want. The NHS is also terrible at forward planning so they end up buying things in a rush at any cost from whoever can supply them at that time, rather than going out to all possible suppliers on the list. They generally employ the most incompetent people you will ever meet in the departments that look after all this.
I'm not sure I agree that there's any long term plan. We only have a short term plan which changes as per whatever is the most politically attractive at the time.
Likewise I don't think the plan is to let it get worse and worse; it getting worse and worse is an inevitability given that revenue streams are somewhat constant (as a % of GDP) but age demographics (amongst other things) means to achieve the same service greater investment is required (again as a % of GDP). The only way to maintain service levels whilst also catering for the aging population is therefore divert other departmental spending to the NHS, which is what we've been doing over the last 70 years (with spend increasing from 2% of GDP to 7% over that period)
The problem comes when you hit the point where there are almost no discretionary funds to redistribute. Our defence spend is operating close to the NATO minimum, our education spend is lower than it was in 1950. Our transport spend is at an all time low with the majority of the country agreeing that the infrastructure is in dire need of investment, our debt is at an all time high, our judiciary has seen substantial cuts and there's also widespread agreement that our police/prison service has been cut to the bone. People talk about austerity, but that's a false premise (a term perpetuated by the Tories as it made them seen fiscally responsible). It's merely a reallocation of resources from other departments to fund the ever-burgeoning social protection and health budget. As a % of GDP we're spending more now than we ever have in non-recession peacetime.
Therefore the big question is where does the money come from going forward? We can't invest more in welfare or the NHS without either increasing debt (rolling a snowball down a steep hill for future generations to be crushed by), reducing other departmental spend which most agree is already close to the bone; or large scale reform.
We're at the tip of the ponzi scheme if you will. The below figures show how the NHS and social protections (welfare/pension) have been draining public resources continually for 70 years. At some point Defence, Education and everything else won't be able to be drained any further and my view is that point is now. We might get away for a few years of kicking the snowball down the hill in the form of debt, but that just makes for an even greater collapse down the road.
Social protections 1950 - 5.98% GDP
Social protections 2019 - 12.86% of GDP
Health spend 1950 - 2.73% GDP
Health spend 2019 - 7.06% GDP
Education spend 1950 - 4.37% GDP
Education spend 2019 - 4.13% GDP
Defence Spend 1950 - 6.22% GDP
Defence Spend 2019 - 2.3% GDP
Other Spend 1950 - 17.65% GDP
Other Spend 2019 - 11.57% GDP
My view is we need to look at how the majority of other countries fund health. The vast majority of good OECD healthcare systems (Switzerland, Belgium, Korea, Japan, Germany, Holland, Luxembourg etc) allow far greater scope for non-mandatory schemes and also have a mandatory health insurance system.
Even in countries like Norway most people have to pay an effective excess of £150 a year before treatment is ‘free’. Mention ideas like that in the UK and the left melt down and go crazy. I mentioned in another thread that any rational debate about the NHS in the UK is pretty much impossible.
My view is we need to look at how the majority of other countries fund health. The vast majority of good OECD healthcare systems (Switzerland, Belgium, Korea, Japan, Germany, Holland, Luxembourg etc) allow far greater scope for non-mandatory schemes and also have a mandatory health insurance system.
The end conclusion of all those graphs is that:
1. UK's total spending per-capita is low by European standards.
2. UK's total spending as %age GDP is on th lower side of the middle of European standards.
3. UK's increase in healthcare exnepnditure is in line with increase in other European countries with more privatised systems.
4. UK's current spending and historical spending are on or below trend when comparing with otehr countries or countries with equal state involvement.
Hence,
1. Private involvement does not guarantee lower expenditures, in fact, it might do the opposite.
2. Private involvement does not change the growth in healthcare expenditures, which must then be driven by factors like higher lifespan, ageing population and better life-enhancing drugs.
3. Privatisation is no cure to the NHS' problems.
They will cut even more. Those '40 hospitals' that were in reality 6 refurbs and feasibility studies of some potential new hospitals, will never happen. They probably were not going to anyway, but the coming recession will be the excuse.
And in the other discussion I saw lots of mentions of German Healthcare and so forth.
The basic rule with healthcare is the more money the better outcomes. Germany spend around 25% more than the UK per capita, maybe even more since the investment cuts of the last few years.
The only outlier to that is the US, which spends close to 2.5 times we do per capita. The benefits of a system designed for profit rather than treatment.
My point isn't that spend as a % of GDP isnt increasing across the planet, of course it is for the reason I mentioned (aging population). The issue is being able to pay for it.
If people are given free will to spend their money how they see fit they will almost certainly spend more on healthcare as a free choice (on average). However if you try to extract this via general taxation people, businesses and investors will not comply after a certain point (my view is we're already at or damn close to that point)
Taxation is already at an all time high as a % of GDP in non recession peacetime. If the government were able to extract more from the population given our current deficit they already would as it would be an easy silver bullet.
Businesses are being taxed more than ever, the middle classes are being taxed more than ever and even the top 1% are paying a greater proportion of tax than ever before (and the latter category are the ones that are most flexible on where they pay their tax).
The reason Switzerland, Germany, Belgium etc can spend more on health is because it's done (mostly) via the free will of their citizens. Try and extract that level of finance through taxation and you'll find you're on the downward slope of the Laffer curve; upping tax rates but getting less tax.
It needs expanding to provide much more provision for mental health and also social care for the elderly. This is not cheap though and there really ought to be a Royal Commission established to look into such things and the best way to fund it going forward.
If people are given free will to spend their money how they see fit they will almost certainly spend more on healthcare as a free choice (on average). However if you try to extract this via general taxation people, businesses and investors will not comply after a certain point (my view is we're already at or damn close to that point)
Taxation is already at an all time high as a % of GDP in non recession peacetime. If the government were able to extract more from the population given our current deficit they already would as it would be an easy silver bullet.
Businesses are being taxed more than ever, the middle classes are being taxed more than ever and even the top 1% are paying a greater proportion of tax than ever before (and the latter category are the ones that are most flexible on where they pay their tax).
The reason Switzerland, Germany, Belgium etc can spend more on health is because it's done (mostly) via the free will of their citizens. Try and extract that level of finance through taxation and you'll find you're on the downward slope of the Laffer curve; upping tax rates but getting less tax.
Last line is another assertion and an invocation of another controversial concept, and yet again is in contradiction with the facts
Tax as %age GDP: (source is just wiki)
Begium - 47.9%
Germany - 44.5%
EU avg - 35.7%
UK - 34.4%
Switzerland - 27.8%
To sum up you take a world that looks like this, with the UK govt paying for almost all healthcare costs despite receiving the lowest taxes inluding individual ad corporate taxes:
and say that the main problem with the UK healthcare system is high taxes.
Let's rephrase your argument.
You believe that the way to approach the situation of increasing healthcare costs seen across the world including in the UK is to shift the burden to individual expenses. Since your original premise is that UK expenditure can't keep up with demand, and that redistributive taxes are unacceptable, what this means is that <total care> will be redistributed - triage by income.
Edit - won't be responding further. was bad enough digging up dozens of graphs to see what was actually true in what I was replying to (not much is the conclusion)
