To ask what should be being done about the economy and the country generally

1. Get rid of the NI increase - it is killing employment and thus the economy
2. Raise VAT real luxury items - executive cars, luxury holidays, fuel for private jets, taxes on footballers/teams
3. Raise taxes on fast food, partially subsidise cost of fresh fruit and veg if British grown and low carbon footprint
4. Bill all missed GP/hospital appts
5. implement a system of a small charge each time you need the NHS
6. Anyone continuing smoking/vaping etc to pay full cost of any medical treatment related to their habit
7. Free access to stop smoking services IF the person stops smoking.
8. Farmers to pay enhanced tax on fields not growing produce for direct sale to UK
9. Asylum seekers offered access to work commensurate with their skills but with strict rules on where they live and freedom of movement.
10. House asylum seekers in disused military bases. Review system of processing claims
11. Review of efficiencies in NHS, revamp of computer systems/silo working and dated practices
12. End Right to buy, end tax break for landlords ‘selling’ properties
13. Reduced Stamp duty for local purchasers, significant raise to stamp duty and council tax for holiday home owners
14. Flat high rate of tax for anyone trading a la Amazon etc
15. Non working parents to be vetted to provide around school care to help other parents to work, to enhance their skills and as a condition of benefits
16. Council tax rebates for households contributing to community improvements (litter picking, elderly befriending, general maintenance, community events etc)
17. Council tax reductions for adherence to school attendance, behaviour etc
18. Sixth form students to have coaching and mentoring younger students as part of their curriculum.
19. Universities to move to an official online model except where face to face is necessary. Upkeep funded by overseas students.
20. Remove permissions for families to be granted permission to stay of students/overseas workers
21. Renewable energy to contribute to council tax in areas of their sites
22. Central governance cap of fuel/utility prices - no bonuses paid until any cost rises are fairly absorbed into dividends

Some of my ideas when I should be in bed

And the NHS scores are absolutely appalling for outcomes. If they’re diagnosing everything later, that may be one factor, alongside the very poor standard of care that is well documented even when the unlucky patient eventually is seen by a specialist or operated on, many months or years after they should have been, using outdated equipment, staying in poor standard hospitals with poor cleanliness, disease control, poor nursing standards, poor monitoring, poor rehabilitation and after-care or convalescence services. But yes, indeed, not bothering to treat patients for years after they present with an issue, or not diagnosing issues long after they would have been diagnosed with timely referral to a specialist, and poor preventative care, low rates of scans, even ignoring some basic vaccinations like the chicken pox vaccine which has been routine in most other developed countries for over 50 years now but is still only available here privately, poor monitoring, no annual healthcare checkups as are standard in many countries…. Etc… no doubt contributes to the extremely poor NHS outcomes.

Regardless, it’s extremely obvious from the data if you look at it that the NHS has poorer patient outcomes than the health services of the vast majority of developed countries, and those who have poorer outcomes but still make it into the OECD data are much poorer countries than ours and spend a fraction of what we spend per year on healthcare.

The NHS is a complete failure. There’s a reason why no other country in the world is trying to copy our system. 18 hour waits for ambulances aren’t desirable. Nor is “corridor care”.

Absolutely. There are despairingly few politicians who are even willing to speak about the problem, and it's alarming.

I appreciate that it is currently nigh-on-impossible to get elected from anything other than a marginally-left-of-centre position but I feel like this is where Labour and others should be making hay.

We should be talking about addressing wealth inequality, reducing the incentive for people to spend most of their 20s and 30s working long hours and, through fiscal incentives, encouraging people to have larger families. At the moment, you cannot "get ahead" and have 3 or 4 kids, too.

You could (justifiably) leverage the electorate's concerns as to high immigration by explaining that it is a stop gap, acknowledging that it cannot go on forever, and explain to people that a more equitable society is the most likely way by which we can realistically reduce immigration over the coming decades.

The harder bit will be selling the much-needed changes to the state pension...

Silly internet duplicating posts, so deleted.

Time for bed, and a lift to another galaxy, ideally!

@QuaintShaker it’s definitely a case of follow the lead of the dolphins at this point, isn’t it? This thread has made me face palm too many times now.

So long and thanks for all the fish! 🐬

That’s exactly what I said! GP practices are run as partnerships. The doctors own them as a business and are paid a fee per patient per year that they have on their books. Some of the other GPs in the practice who are not partners are employed as salaried employees, and when they have shortages the practice can contact in locums of course as well like any other business can hire temping staff. What part of it didn’t you understand??

Agreed. People are so stupid they don’t seem to be able to understand the basic maths that the ageing population has meant population size has continued to go up despite the birth rate falling, masking the effect to some extent - so far. But it makes current irresponsible and fiscally unsustainable public sector structures completely unviable and they have to be changed. The options are change them (which people wont’ like), or simply wait for them to collapse (which will be far, far worse). But people are stupid and politicians are cowards so the ostrich syndrome will continue…

So depressing, that almost all of the problems on this thread could be addressed and made significantly better if people weren’t so selfish and short-sighted. But they are, so they’ll keep voting for morons and focusing on irrelevant nonsense issues that will pale into insignificance compared to what’s to come if we’re unprepared for it, which we will be if we continue as we are.

Shouting into the vacuum is a waste of time though, isn’t it? I think my best hope is to grab a towel, put my thumb out and take my chances with the Vogons.

Yes, this is why I said immigration is a sticking plaster solution at best. It has, in the UK and various other European countries, delayed the worst effects of population decline but does not solve it, and we are still approaching the abyss.

Unfortunately, high immigration is causing politics to lurch to the right, and I don't think that's where the solution will be found.

https://www.ted.com/talks/jennifer_d_sciubba_the_truth_about_human_population_decline?language=en

Less than 3% of immigration is irregular and of people seeking asylum. The other 97% are inter company transfers, points based skilled visas, short term skills gap or agricultural workers or sectors that are in need such as the NHS or the care sector as well as students who prop up the education sector. Where did you get the majority are not net contributors? Even asylum seekers would work if they had the right to do so, rather than live on £9/week subsistence.

in actual fact an immigrant is more likely to be working than a young person in this country who are invariably a NEET.

Immigration will not fix it. There won’t be any immigration available because birth rates are falling off a cliff everywhere outside sub-Saharan Africa. I mentioned this earlier in the thread regarding population collapse and how the effect is exponential and irreversible. At least some countries have Governments that are trying to slow the effect through family-friendly policies and tax breaks like South Korea, Hungary and others in Europe, whereas ours makes life ever less family friendly because they’re so stupid.

But it won’t stop it, and the effect is going to be catastrophic. Particularly if we don’t fix the state pension and public sector pension ponzi scheme problems rather quickly now because they will literally not be payable, and will not be paid.

Comparing disease survival rates is tricky. People who are diagnosed early will inevitably survive longer post-diagnosis than someone who is diagnosed later even if there is no effective treatment for their condition.

I agree that NHS cancer care is in trouble, but I think it's due to patient backlogs, as a result of years of under-investment. My DM was diagnosed more than ten years ago and waiting times for investigations and treatment have slipped significantly since then. In our area, the two-week pathway is now a four-week pathway in all but name. We need to find the money, staff the service fully and sustainably and reduce reliance on expensive staffing agencies. Complaining that the NHS is an "inefficient black hole" won't help.

The Conservative government also introduced a new locally negotiated personal services contract for general practitioners, which became law in 1997.6 This expanded under Labour in 2003, when more general practitioners opted for the greater working flexibility the contract allowed. Doctors could choose to be salaried, paid by the session, or work as locums as well as remaining self employed.

I suppose as a partner in her GP practice she was just making it up, though, just to annoy @Blossomtoes on the off chance Blossomtoes might be writing nonsense on the internet again a couple of weeks later.

Not to mention the basic contractual terms between the practices and the NHS which are publicly accessible if you care to look.

🤔

Although there's merit to discussions about how our healthcare system may be improved, and lessons that can be learned from other countries, it all feels a bit like moving deckchairs around on the titanic.

All of the countries cited as having better healthcare systems have the same, central economic crisis that we do - low fertility rates. We are barreling towards economic collapse, and high immigration, is a sticking plaster at best.

Without radical solutions to that, everything will continue to trend negative.

A good explanation, with South Korea as a case study:

You’re wrong, I’m afraid. They are. In fact, by chance my lovely GP wrote me a letter in which she mentioned this precise issue, just a couple of weeks ago. Random, and I won’t go into the context of why she did so, but I have it right here next to me in my study.

Not any more.

I do think that we fanny around the issue but we just need to tax wealth more and sort the tax system out.

The question is then what to spend that on- health care, housing, and investment in defense and Pharmaceuticals. That's my 5 step plan 😂

They are part of the NHS pension scheme, but GP practices are private practices owned as partnerships by the senior doctors. They are paid a fixed amount per patient on their books per year. They have never been part of the NHS as such, they contract with the NHS.

No, you can’t just compare it with life expectancy, obviously.

I could set up a fantastic hospital with the best world class equipment and cream of the crop doctors in a war zone (if I paid the doctors enough). The life expectancy of the patients would still be significantly lower than a much lower quality health service in another country where people weren’t having limbs blown off daily or being hit by shrapnel.

In some countries people have healthier lifestyles, diets. It’s very difficult to compare but you cannot compare based on just life expectancy, or PPP cost, obviously, because that is really just a reflection of different currency values and salary levels primarily (as salaries make up far more of the cost of healthcare than equipment or facilities).

To reach a sensible comparison you have to do a detailed comparison between survival rates for different conditions, treatment times, quality of patient care, and then compare this against cost. Obviously there’s subjectivity in which ones you weight as more important but primarily the focus of robust comparisons is mainly looking at survival rates/ recovery rates and patient outcomes per condition plus timely treatment and then looking at a ratio of this against percentage of GDP spent on healthcare to ascertain value for money.

The NHS scores extremely low on such measures, despite variation in how they are calculated, given that this is a developed country, it takes MONTHS or sometimes years for people to receive treatment when in most developed countries this happens in days or weeks for serious conditions, our patient care and outcomes are far lower, cancer survival rates are lower, outcomes for most serious diseases are lower, maternity care and infant mortality are far worse than in comparable countries, etc. And yet our system is not costing us a much lower percentage of GDP than most other comparator countries at our level of development. It’s perfectly clear that our system is useless.

It always used to make me laugh when - before Brexit and they were made to feel so unwelcome that most went home for good - without exception my lovely friends here from the EU used to go back to their own countries whenever they needed medical care or even dentistry because they knew they could book two weeks of holiday, go to see family, fix their medical/ dental issues to a much higher standard than would happen here even if they waited for a year, then come home again. And yet people were constantly going on about “health tourism”. You’d have to have a death wish to come to the UK on purpose to get health treatment.

@InPraiseOfIdleness I think you will find they were nhs employees but were contracted to do the GP work. The doctors were and are state employees with large pensions paid for by all of us. Andrew Lansley changed the system to a different set of contracts which we know today. In 1948, a majority of GPs had come into the newly formed NHS as contractors. However they swiftly found they didn’t have much autonomy. Each doctor was personally responsible for their patients. If they were an autonomous business they would need to find their own customers, borrow commercially and, crucially, pay fully for their pensions. They don’t do any of these things.

Which indeed I said in my post . GPs however work in very close partnership with the NHS in providing Primary healthcare in this country & coming under American ownership has been extremely detrimental to the way in which they are allowed to operate regarding both mandated medical investigations and drug prescription.
I am very happy to post links to the many documented discussions between American healthcare companies regarding the NHS ‘proper ‘ . I have been following , generally with great dismay , the political shenanigans that have been the true source of major damage to the NHS over the last 30 years . Marcus Chown succinctly summarised the worst of this in the following article.
www.opendemocracy.net/en/ournhs/great-nhs-robbery/

That was about allowing consultants to work in the NHS and have private practice, not GP practice.

Just part of the whole dysfunction of the NHS in general. When it was first set up in 1948 Bevan boasted about how he’d get the doctors to go along with it by “stuffing their mouthes with gold”.

So, compare the amount spent per capita with life expectancy. Again, the idea that the UK healthcare system is inefficient isn't borne out by the data. No doubt it could do better with more investment, but the figures don't suggest that the system is at fault. Do you know which country has the most efficient system based on this comparison? Cuba, which has nationalised (some would say socialist) healthcare.

I'd like to suggest an experiment. Let's try funding the NHS to the same per capita level as France, Australia or even Ireland. Give it at least ten years, but preferably 20. If, after that time, our health outcomes are worse than theirs, then we can change systems.