UK General Election - 12th December 2019 | Con 365, Lab 203, LD 11, SNP 48, Other 23 - Tory Majority of 80

[Sweet Square]

 

[Grinner]

The food standards question will definitely be the main negotiation point, I think the NHS stuff is a red herring.

If you feed people with shite like they eat here in the US then the NHS will collapse in ten years anyway. Obesity, diabetes, and general ill-health will just run rampant.

 

[T00lsh3d]

I don't know specifically about health and africanspur will provide a better answer there but generally with government tender it's the low price point the government has increasingly enforced over the last decade. It just makes it inevitable that a poor service will be delivered because they give it to the one who will overpromise and cut corners to be competitive in cost.

You can move between the regular outsourcers in whatever industry but they're all competing under the same constraint.

This is a strange concept to me. I have only once worked for a business that supplied the state. It supplied 3 counties foodservice, for hospitals, schools and other local authority places. They were revered contracts, endless investment and manpower was put into them to keep them happy and cope with their unique ordering and requirements, to such an extent that specific customer profitability was eroded. But they were still prided business. So I find the idea of things turning to shit when the state has to have a close partnership with a private company very strange, and I can only guess that it’s because it would be, much like you say, driven by it being an uncompetitive market.

 

[africanspur]

Can I ask, with regards to the standards dropping when privatised, why are the services not tendered again based on poor performance? On a very basic premise, when a supplier underperforms in the private sector, you take the business elsewhere, therefore the standard has to stay good enough, because someone else will come along and do it better. Is it that there aren’t enough providers of the necessary size and scale to give competition?

Often they are but we're usually talking after 2-3 years of this terrible performance.

And unlike for example when you tender out your cleaning to a shit company in your local office, where it doesn't really affect anyone but a few dozen employees...when you tender out your transport service to a shit company in a healthcare system, you get knock on effects.

To give an example of how stupid this is, we often can't discharge elderly patients on care packages unless they have been restarted with adequate notice. This genuinely happened to one of my juniors a few years ago:

-You'd organise a discharge for a patient at say midday
-You'd call the care company in advance to make sure that this patient, who gets care three times a day, will get their evening care visit
-Transport booked for 12 doesn't show up
-Nurses and doctors then waste time in the afternoon chasing the company up, asking where they are, rather than seeing patients
-Transport arrives at 4
-By the time they're home at 530, carers have come, found nobody and left again. So the transport have to bring the patient back to the hospital
-So the patient gets an extra night in the hospital, as a completely fit person. This not only clogs up a bed and costs the NHS a huge amount of unnecessary money, it also exposes these patients to getting further infections.

They would often also not turn up for outpatient appointments because the transport didn't pick them up in time.

By the time the NHS had to step back in and go back to the old company, I can only assume they'd realised the money they were having to spend on things like the above outweighed the savings this company were offering. However, you can't really measure the human impact this has had on all of these patients.

Sometimes however, the company may do a just about adequate job and, faced with financial pressures elsewhere, the trust will just have to accept it.

A shambles would be an understatement.

 

[Fiskey]

If you feed people with shite like they eat here in the US then the NHS will collapse in ten years anyway. Obesity, diabetes, and general ill-health will just run rampant.

Yeah, that's my impression. I would like to see UK gov supporting it's farmers to have the highest environmental and animal welfare standards in the world post Brexit, and that will be difficult to combine with a US trade deal.

 

[Grinner]

Regarding the BBC, surely their plan is to decimate that institution too? I'm sure they figured out long ago that it can be a commercial power house if they just destroy the public confidence in it, and thus the willingness to publicly fund it. I reckon it'll end up like PBS here in the US, constantly begging for private money to fund a very limited offering of content.

 

[Fiskey]

Often they are but we're usually talking after 2-3 years of this terrible performance.

And unlike for example when you tender out your cleaning to a shit company in your local office, where it doesn't really affect anyone but a few dozen employees...when you tender out your transport service to a shit company in a healthcare system, you get knock on effects.

To give an example of how stupid this is, we often can't discharge elderly patients on care packages unless they have been restarted with adequate notice. This genuinely happened to one of my juniors a few years ago:

-You'd organise a discharge for a patient at say midday
-You'd call the care company in advance to make sure that this patient, who gets care three times a day, will get their evening care visit
-Transport booked for 12 doesn't show up
-Nurses and doctors then waste time in the afternoon chasing the company up, asking where they are, rather than seeing patients
-Transport arrives at 4
-By the time they're home at 530, carers have come, found nobody and left again. So the transport have to bring the patient back to the hospital
-So the patient gets an extra night in the hospital, as a completely fit person. This not only clogs up a bed and costs the NHS a huge amount of unnecessary money, it also exposes these patients to getting further infections.

They would often also not turn up for outpatient appointments because the transport didn't pick them up in time.

By the time the NHS had to step back in and go back to the old company, I can only assume they'd realised the money they were having to spend on things like the above outweighed the savings this company were offering. However, you can't really measure the human impact this has had on all of these patients.

Sometimes however, the company may do a just about adequate job and, faced with financial pressures elsewhere, the trust will just have to accept it.

A shambles would be an understatement.

Sounds like a very bad situation. Do you think it could be resolved as a public private partnership or would public delivery be best?

 

[Kaos]

Yeah, that's my impression. I would like to see UK gov supporting it's farmers to have the highest environmental and animal welfare standards in the world post Brexit, and that will be difficult to combine with a US trade deal.

Good luck with that.

 

[Sweet Square]

 

[africanspur]

He was wrong about that of course. But more broadly, he isn't wealthy. I just think the argument about whether you should tax people a load more on an 80k salary is pointless - they are already pretty well taxed. The real argument IMO should be about wealth taxes, or inheritance taxes or capital gains taxes - taxes on the asset piles that are the real drivers of inequality. We should be going after the rentiers, not the salary earners.

Why is he not wealthy? What is wealth to you and him exactly? I think people really have such skewed perceptions of what makes someone wealthy.

I came to the UK a long time ago as a refugee with nothing, ended up becoming a doctor. My wife comes from a much more stable background but still by no means a millionaire family. I make good money (though I laughed when that guy said all doctors are on over 100k) and so does she. We've worked hard to get here and lived through some hard times but I would still consider us wealthy.

I would have no problems paying more in my yearly tax and frankly, I wouldn't mind paying more on things like inheritance tax either. I've already given my kids the best start they could possibly have (my genes ), what more could they need?

In all seriousness, I would also be in support of those kinds of taxes. But I don't think it is an either/or situation. Problem in the UK is that we like low tax but want high levels of services.

 

[NWRed]

Genuinely shocking, [even if it's only an empty threat] I can't believe this is where we are and that it won't effect the polls at all.

 

[Ultimate Grib]

You stated that the 10 point swings were unrealistic, which brought the reliability of the model into doubt. I was saying that I thought the 10 point swings in favour of Labour in 2017 were unrealistic. That's the opinion part (which is why I bolded it.)

I said 20. The model is only valid for polls and data up to now, 2 weeks before the election. It has no way of knowing the outcome 2 weeks later as we don’t know what will happen. Polls usually narrow towards election day with undecideds making up their minds.

 

[africanspur]

Sounds like a very bad situation. Do you think it could be resolved as a public private partnership or would public delivery be best?

To be honest mate, I'm not sure.

I'm not necessarily an NHS zealot like some other doctors, I've worked in Australia before and the system is actually very good there for patients and employees alike so I do think private and public systems can co-exist very nicely (though I don't think patients always appreciate the negatives of private healthcare, even if they can afford it). It can also get incredibly frustrating as a doctor when patients don't bother turning up for the appointments in the UK because there is literally no penalty to doing so.

Perhaps it can be through PPP but there needs to be very clear targets and penalties if they're not met if the contracts will be tendered out? Increased oversight and responsibility? I'm not sure exactly how it would work though

 

[RedChip]

To be fair, your link also has a study which has the UK at 15th in Europe. That study also specifically makes the claim that the Beverige model isn't working very well for the UK. I don't know anything about that myself, but since you linked the article I thought it proper to point it out.

I wouldn't say I know enough about it either. But the poster I quoted was arguing that the NHS is both costlier and poorer outcomes than some other unnamed healthcare systems. But I have seen it ranked highly within OECD on quite a few measures given its relatively low cost per head. Of course rankings vary wildly depending on subjective criteria and how they are weighted; so they should all be viewed with scepticism.

 

[Fiskey]

Perhaps it can be through PPP but there needs to be very clear targets and penalties if they're not met if the contracts will be tendered out? Increased oversight and responsibility? I'm not sure exactly how it would work though

Yeah, it would seem ridiculous that there isn't a fine for private transport providers not turning up on time. I would also have a small fine for people who miss GP appointments.

 

[Paul the Wolf]

Many of those countries are islands, such as Japan or Taiwan. Taiwan literally has recognition from 15 countries, mostly completely irrelevant pacific islands and is consistently threatened by the powerhouse of the region, who see Taiwan as an indisputable part of their countries. Some of them are countries like South Korea with a very hostile neighbour to the North, no land links to any country and currently in a trade dispute with what should be a friendly neighbour to the East and concerned about a powerful China to the North.

Australia are yet another island, isolated completely with NZ.

Singapore's defence doctrine is based around deterring its neighbours, one of whom it was expelled from mere decades ago.

Norway and Switzerland do just fine.

I have to say, your posts on the matter are a combination, with all due respect, of incredible condescension and slightly weird attacks on Corbyn seeing as he will never get near Brexit negotiations.

As I said above, I desperately wanted the UK to remain part of the EU and still do. Short term, especially in the event of a no deal Brexit, I think there will be very negative impacts on the British economy. Medium to long term though, you, I nor anyone else really has any idea what direction the British economy may take, how it may be restructured, what it may look towards producing or exporting.

You cannot compare most of these countries to the UK. Their economy is not set up in the same way at all as the UK. None of them are not in some kind of agreement with other countries, two of them Norway and Switerland are even in the EEA/EFTA but are tiny countries in comparison to the UK and have a different economy but both have a hard border . The Uk were desperate to join the EC/EU in the sixties and will be again, but have to suffer the pain first.
There's nothing condescending, just a matter of logical outcome.
Corbyn could have had a different approach - but as leader and a politician I have zero regard for him and make no apology for that - that's before I get to his policies or his popularity. He could beat Michael Foot's record if he's not careful.

What will the UK be producing when the firms who rely on the UK's presence in the EU start to leave.

 

[africanspur]

That's far different to 'selling it down the river'. Pretty much all the world's best healthcare systems have some kind of mixed model or co-pay element to them. Only the NHS is totally free and the level of care is some way below those others, not because they get more money (many of them dont), but because the NHS a gigantic black hole for money. The model desperately needs updating.

We spend less on healthcare as a percentage of GDP than..well, a lot of OECD countries. In fact, our spending per person is almost exactly the OECD average.

https://data.oecd.org/healthres/health-spending.htm

You can see here as well the PPP adjusted figures:

https://www.healthsystemtracker.org...-spend-half-much-per-person-health-u-s-spends

A lot of British people want top quality healthcare, education, roads, defence, politics etc etc without spending the appropriate amounts of money to do so.

 

[NWRed]

 

[sun_tzu]

You aren’t going to raise much money from the very few people who earn that. What’s the point? Half of all taxes are paid by the top 20% of salary earners as it is. There comes a point when you have to widen the tax base if you want to fund more things, not continually narrow it. You need to go after assets not paycheques.

Paycheques are the low hanging fruit... Change a tax code and the employer collects it for you and pays the revised amount 1 month later
Go after assets and people lawyer up... They use tax advice to find loopholes... They use trusts... They offshore and believe me my tax adviser earns a lot more than the civil servants in HMRC and tax avoidance becomes the norm
My assets are a mix of company held, in trusts and offshored and I doubt I'm unique in that
It's not to say a really comprehensive change to asset taxation couldn't be brought in but given the time needed to craft something above legal challange and without big loopholes will be more than enough for people to take it out of hmrc's reach

 

[nickm]

I think in the costings doc Labour reckon it'll bring in about £11b or so, though I've no idea how reliable that estimate is. I don't entirely disagree with the bolded. I do disagree that a person earning £100k should be outraged at the prospect of shedding an extra £1k of it.

I don't believe the £11b figure. The £100k earner also recently lost the tax free allowance that everyone else gets, so who knows, maybe they would decide they were annoyed at being targeted again. It's really easy not to pay that extra £1k tax after all, you just stick it in your pension instead... and win twice.

 

[nickm]

Paycheques are the low hanging fruit... Change a tax code and the employer collects it for you and pays the revised amount 1 month later

There's ways to reduce your tax bill even as a PAYE earner.

Go after assets and people lawyer up... They use tax advice to find loopholes... They use trusts... They offshore and believe me my tax adviser earns a lot more than the civil servants in HMRC and tax avoidance becomes the norm
My assets are a mix of company held, in trusts and offshored and I doubt I'm unique in that
It's not to say a really comprehensive change to asset taxation couldn't be brought in but given the time needed to craft something above legal challange and without big loopholes will be more than enough for people to take it out of hmrc's reach

I agree. But there are assets that can be taxed fairly easily - capital gains, house sales, dividend income, inheritance.

 

[africanspur]

You cannot compare most of these countries to the UK. Their economy is not set up in the same way at all as the UK. None of them are not in some kind of agreement with other countries, two of them Norway and Switerland are even in the EEA/EFTA but are tiny countries in comparison to the UK and have a different economy but both have a hard border . The Uk were desperate to join the EC/EU in the sixties and will be again, but have to suffer the pain first.
There's nothing condescending, just a matter of logical outcome.
Corbyn could have had a different approach - but as leader and a politician I have zero regard for him and make no apology for that - that's before I get to his policies or his popularity. He could beat Michael Foot's record if he's not careful.

What will the UK be producing when the firms who rely on the UK's presence in the EU start to leave.

Right, again, I don't think you're reading my posts. I am not talking about the short term or perhaps even medium term. You and I have literally no idea what our economy will look like in 50 years for example because nobody does. So many things can change.

You're right, those economies aren't structured like ours. A few decades ago, they were structurally, sociopolitically, geopolitically, in a much worse position than the UK are now.

Let's survey some of those countries in the early 50s shall we?

Taiwan: Exiled government after a brutal civil war, still openly hostile and claim it as part of China
South Korea: Civil war, invaded by North Korea, then the USA, then China. Dictatorship.
Japan: Nuked and occupied by America. Total defeat and restructure of their society
Singapore: Expelled from Malaysia, president literally on TV crying about the decision
China: Mao, great leap forward. Cultural revolution not far away.

I mean if we're also looking at some of the countries in the EU now...Germany, devastated by war and split in two. Italy, devastated by war. Dictatorships still across the continent.

My point is that these countries were not exactly in a great position were they? I'm only imagining the doom and gloom if we were to go back to the 50s.

So while I think we can make pretty accurate predictions on the short term, there is literally no point making such confident statements as you have done about the long term, when neither of us will likely be around anymore.

 

[Ubik]

I said 20. The model is only valid for polls and data up to now, 2 weeks before the election. It has no way of knowing the outcome 2 weeks later as we don’t know what will happen. Polls usually narrow towards election day with undecideds making up their minds.

And I assumed you were talking about the ones that showed Labour overcoming a 20 point gap, which is a 10 point swing. Are there any 20 point swings, which would be overcoming a gap of 40 points? There's none on the list of Tory wins, any it would be pretty extraordinary for that kind of swing not to result in a win, but I'm open to correction.

 

[africanspur]

Yeah, it would seem ridiculous that there isn't a fine for private transport providers not turning up on time. I would also have a small fine for people who miss GP appointments.

Yeah, agreed mate, it is a ridiculous situation. Fine for missing GP appointments, especially if it is a regular thing. Similar for hospital.

 

[Ekkie Thump]

I don't believe the £11b figure. The £100k earner also recently lost the tax free allowance that everyone else gets, so who knows, maybe they would decide they were annoyed at being targeted again. It's really easy not to pay that extra £1k tax after all.

Yeah, I checked the costing sheet and my memory was off. They computed $11.4 billion before pricing in "behavioral response." Their net figure is £5.4 billion.

As for the tax free allowance, that kicks in at £100k - so someone earning that amount would not lose a penny. For every £2 you earn above £100k you lose £1 of your tax free allowance so you only lose the whole lot once you earn £125k+. That would take your tax hike to around £4.5k total.

 

[Grinner]

Yeah, agreed mate, it is a ridiculous situation. Fine for missing GP appointments, especially if it is a regular thing. Similar for hospital.

Who will organize and collect these fines? You going to create another bureaucracy just for that? When poor people say they can't pay it, then what?

 

[Kaos]

Or you can just implement a three-strikes-and-youre-out like policy where you punish habitual no-shows by blacklisting them. No fines, no bureaucracy, but still enough of a fair incentive to not abuse the booking system.

 

[T00lsh3d]

Often they are but we're usually talking after 2-3 years of this terrible performance.

And unlike for example when you tender out your cleaning to a shit company in your local office, where it doesn't really affect anyone but a few dozen employees...when you tender out your transport service to a shit company in a healthcare system, you get knock on effects.

To give an example of how stupid this is, we often can't discharge elderly patients on care packages unless they have been restarted with adequate notice. This genuinely happened to one of my juniors a few years ago:

-You'd organise a discharge for a patient at say midday
-You'd call the care company in advance to make sure that this patient, who gets care three times a day, will get their evening care visit
-Transport booked for 12 doesn't show up
-Nurses and doctors then waste time in the afternoon chasing the company up, asking where they are, rather than seeing patients
-Transport arrives at 4
-By the time they're home at 530, carers have come, found nobody and left again. So the transport have to bring the patient back to the hospital
-So the patient gets an extra night in the hospital, as a completely fit person. This not only clogs up a bed and costs the NHS a huge amount of unnecessary money, it also exposes these patients to getting further infections.

They would often also not turn up for outpatient appointments because the transport didn't pick them up in time.

By the time the NHS had to step back in and go back to the old company, I can only assume they'd realised the money they were having to spend on things like the above outweighed the savings this company were offering. However, you can't really measure the human impact this has had on all of these patients.

Sometimes however, the company may do a just about adequate job and, faced with financial pressures elsewhere, the trust will just have to accept it.

A shambles would be an understatement.

That is shite, I agree. It does surprise me though, as I would have thought that the NHS or some other state body would be considered prized business (I used an example in the post above, I should have tagged you). I think it’s poor from a commercial POV, because the public sector pay pretty quick in my experience, so it can only be that the requirements of the contract are too demanding for the price to make it runnable to a high standard and still profitable

 

[nickm]

Why is he not wealthy? What is wealth to you and him exactly? I think people really have such skewed perceptions of what makes someone wealthy.

I came to the UK a long time ago as a refugee with nothing, ended up becoming a doctor. My wife comes from a much more stable background but still by no means a millionaire family. I make good money (though I laughed when that guy said all doctors are on over 100k) and so does she. We've worked hard to get here and lived through some hard times but I would still consider us wealthy.

I would have no problems paying more in my yearly tax and frankly, I wouldn't mind paying more on things like inheritance tax either. I've already given my kids the best start they could possibly have (my genes ), what more could they need?

In all seriousness, I would also be in support of those kinds of taxes. But I don't think it is an either/or situation. Problem in the UK is that we like low tax but want high levels of services.

Congratulations on your success. What is wealth? How about financial security. 80k gets you a mortgage on averagely priced house in the UK these days.

 

[sun_tzu]

When poor people say they can't pay it, then what?

Make them plant some of these 2 billion trees Corbyn has pledged?

 

[Paul the Wolf]

Right, again, I don't think you're reading my posts. I am not talking about the short term or perhaps even medium term. You and I have literally no idea what our economy will look like in 50 years for example because nobody does. So many things can change.

You're right, those economies aren't structured like ours. A few decades ago, they were structurally, sociopolitically, geopolitically, in a much worse position than the UK are now.

Let's survey some of those countries in the early 50s shall we?

Taiwan: Exiled government after a brutal civil war, still openly hostile and claim it as part of China
South Korea: Civil war, invaded by North Korea, then the USA, then China. Dictatorship.
Japan: Nuked and occupied by America. Total defeat and restructure of their society
Singapore: Expelled from Malaysia, president literally on TV crying about the decision
China: Mao, great leap forward. Cultural revolution not far away.

I mean if we're also looking at some of the countries in the EU now...Germany, devastated by war and split in two. Italy, devastated by war. Dictatorships still across the continent.

My point is that these countries were not exactly in a great position were they? I'm only imagining the doom and gloom if we were to go back to the 50s.

So while I think we can make pretty accurate predictions on the short term, there is literally no point making such confident statements as you have done about the long term, when neither of us will likely be around anymore.

No I agree with most of what you say there but we don't know what the world will look like in 50 years time and I definitely won't be around but everything has changed so much since the 50s and will change considerably again in the next 50/60 years. But I feel the UK are stepping back in time by 50 years and I expect more countries to become closer aligned not just in the EU whereas the UK seem like they want to separate, hanker after the past and go their own way.

 

[Grinner]

Or you can just implement a three-strikes-and-youre-out like policy where you punish habitual no-shows by blacklisting them. No fines, no bureaucracy, but still enough of a fair incentive to not abuse the booking system.

Yep, 3 strikes then you just let them die. That'll learn them.

 

[nickm]

Yeah, I checked the costing sheet and my memory was off. They computed $11.4 billion before pricing in "behavioral response." Their net figure is £5.4 billion.

As for the tax free allowance, that kicks in at £100k - so someone earning that amount would not lose a penny. For every £2 you earn above £100k you lose £1 of your tax free allowance so you only lose the whole lot once you earn £125k+. That would take your tax hike to around £4.5k total.

Or, to put it another way the marginal tax rate on £100k-£125k is already 60%, without Labour's extra taxes - and more with.

 

[Walrus]

I am all in favour of the NHS like pretty much every British person. But there is definitely some reform needed in my view; fines for missing appointments would be a good start, I would also look at targeting self inflicted ailments (alcoholism, smoking) as well as those who simply dont follow doctor's advice. At the moment it is simply too easy to exploit and take advantage of the fact that you get free healthcare.

 

[Pexbo]

Somehow they are aware of these but completely unaware of the actual impartiality the political branch of the organisation is absolutely infested with? Beyond parody at this point.

 

[Kaos]

Yep, 3 strikes then you just let them die. That'll learn them.

You'd obviously assess on a case by case basis, I'm not suggesting punishing those with genuine circumstances. But if a patient fails to turn up to a sought out appointment three times in a row for no good reason, then you should consider a blacklisting system. GP surgeries aren't A&E wards.

 

[esmufc07]

You'd obviously assess on a case by case basis, I'm not suggesting punishing those with genuine circumstances. But if a patient fails to turn up to a sought out appointment three times in a row for no good reason, then you should consider a blacklisting system. GP surgeries aren't A&E wards.

The cost to implement and track such a system would take away from any potential savings, which are likely to be minimal anyway.

Pretty sure Germany tried testing the fining of patients who missed appointments and it was deemed to be pointless in the end.

Ed Miliband and Geoff Lloyd also did a good podcast about the NHS in which this issue came up.

 

[Mr Pigeon]

"Damage perceptions of our impartiality" thanks, I needed a good laugh this evening.

 

[Smores]

You'd obviously assess on a case by case basis, I'm not suggesting punishing those with genuine circumstances. But if a patient fails to turn up to a sought out appointment three times in a row for no good reason, then you should consider a blacklisting system. GP surgeries aren't A&E wards.

What you're suggesting is quite likely to push people to use A&E more unfortunately. It would also hit those with mental illness.

Not really that related but i do recall a study i read sometime back that nurseries who introduced a late fee found that parents offended more because the social pressure was replaced with a cost theyd feel okay just paying. I wouldn't be surprised if the same occured, people thinking oh well I'll just pay the fine.

 

[Kaos]

The cost to implement and track such a system would take away from any potential savings, which are likely to be minimal anyway.

Pretty sure Germany tried testing the fining of patients who missed appointments and it was deemed to be pointless in the end.

Ed Miliband and Geoff Lloyd also did a good podcast about the NHS in which this issue came up.

What you're suggesting is quite likely to push people to use A&E more unfortunately. It would also hit those with mental illness.

Not really that related but i do recall a study i read sometime back that nurseries who introduced a late fee found that parents offended more because the social pressure was replaced with a cost theyd feel okay just paying. I wouldn't be surprised if the same occured, people thinking oh well I'll just pay the fine.

These are both fair points. Hadn't known about the German experiment. In truth I wouldn't really know how to solve an issue like that, but again I'm rather focus on tackling the issue of there not being enough GPs.