NHS Crisis. Are you willing to pay more in tax?

I'd pay more.

I would like to be told what my tax is paying for.

Crack down on waste first.

I work in a care home. Two of the relatives saw another resident receiving a new wheelchair. They jumped on the bandwagon and wanted new chairs for their loved ones.

The residents were duly fitted out with new NHS chairs.

Nobody thought to ask any of the nursing staff if these new wheelchairs would actually be used the residents in question never use a wheelchair as they use their wheeled recliner chairs during the day and never leave the building.

The new wheelchairs are both sitting in a corner out of the way

Hundreds of £s wasted

Yes, happy to be taxed to fund NHS. It is one of the best things about being British - in principle an utterly civilised system. Stop buggering about with private companies though. It never works out well!

Fine the drunks who clog up A&E services and put a levy on the businesses who sell cheap alcohol that allow people to get into these states

The UK spends 23 million per day on foreign aid....., there sorted!

It accept people's arguments that you wouldn't care at the time if the service you were using was private or public. I also accept that private firms could probably provide a good level of service for the same price or cheaper too.

The stone wall which I can't get past is what would happen in 5, 10 or 20 years? At some point the profit motive is bound to put shareholder value above medical care.

Indeed there is a great incentive for private firms to operate a loss leader, then once the NHS was gone they could charge whatever they liked.

Just look at the PFI contracts. £50 billion worth of hospitals results in £300 billion to pay over 30 years - which effectively was a bribe for the firms to take the contracts on.

GDS is an interesting case. I've worked with them extensively and I only have two observations.

Everything they do is cocked up, but their philosophy is bang on. It is only really by the warped standards of the public sector that they are effective, though the central message of open source and ditch the consultancies is powerful.

Saying that the GCloud is likely to be a step too far.

Privatise it ASAP

Yeah cos that worked for the trains

Oh and energy companies do you know how much the government is going to spend propping up the energy market

Yes privatisation of an essential basic public service is the answer.

Give me proof that private companies do it better. We only know about the mistakes of the public sector because they're publicly accountable. Private organisations are not hence you don't hear quite so much about the shit when it hits the fan.

There's no evidence that private is better than public.

*pet not let

If they stopped pissing money away on let projects then the NHS would be fine.

They wasted £3bn reorganising the NHS but what has happened? They've fucked it up. They could have stopped that shit and put the money back in as it has done nothing good.

Can't believe anyone thinks privatisation would do anything except stuff the pockets of the corporations picking up the contracts. Plus add yet another layer or dozen to deal with!

Re: government IT, basically what others have said. There's a government dept actually doing tendering well now - GDS. Managing to do projects internally at a fraction of the cost of going out to the usual private corporations who get the contracts.

Agree with others saying the NHS is horrendously inefficient. Parts are being outsourced to private companies who (in some cases) are doing it cheaper and getting better clinical margins, while still making a margin - just shows what waste there is. And the purchasing is ridiculous. So no, I don't want to throw more money into a bottomless pit for zero benefit.

Well I'm totally against privatisation and would like to see the last 20 years worth of PFI 'outsourcing' privatisation reversed.

My reasons are simple, profit motive and monopoly. On the one hand thank god the days when a local doctor had a free hand to charge whatever he liked. Medical emergencies are both time critical and essential for the recipient and their family. Nye Bevan had a simple solution to the medical profession's resistance. "I will stuff their mouths shut with gold".

It strikes me that the modern NHS, or which I'll happily admit to knowing little about, has a real problem with change. On the one hand all medical practitioners are required by their profession to maintain their skills up to date, change is built into the very nature of the business as drugs and techniques improve. This is quite enough for any profession, and as someone who works in the constantly changing IT industry I'll vouch for it first hand.

Hence I suspect if you added political meddling to my industry the results would be shocking. I'm sure most people are aware of instances without in depth knowledge however it was roughly explained earlier in the thread. If you ask for a house to be built, then ask for changes once it is finished, you'll be paying through the nose for them.

Apply this to the NHS where pointless politicians who have never managed a welk stall decide that they need x % reduction in y by May 2015... The results must be easy to predict. Add in constant reorganisations forced by the politicians which are barely finished before the next begins and I think I can see nothing but problems with no easy solutions.

Frankly we need to take control of the NHS away from these shysters, and their lackeys in middle management.

Bear in mind that every time the government increases taxes they bring in far less revenue than they expect. This is only logically because we are way past the peak of the laffer curve. Increasing taxes for the NHS is a noble aim, but I suspect the beneficiaries are not the nurses but the corporations. Some time ago I was rather shocked to hear that despite their purchasing power drugs cost more to the NHS than they did on the open market. Instead of being an economy of scale the drug companies had realised that they had to buy, and increased their rates accordingly.

I don't think I've written anything contentious, however I realise that I haven't proposed any solutions.

Frankly other than directly electing people who are licenced by the BMA ( as in doctors and nurses) to oversee the NHS and stating their priorities and direction in manifestos I can't think of any. So we would either have to have parliament stuffed with doctors or something separate would have to be set up.

One thing is for sure though, I trust the medical staff. I just think their problem lies in Westminster.

Dominic Cummings' blog makes some thoughtful points about why large projects (eg public sector IT) so often fail: not least of which is the fact that such projects are often run by people with experience only of trying to get elected and zero experience of specifying, running and delivering multi-billion pound projects. There is little incentive within the public sector - especially government - to develop proper project management skills. So these projects go tits up, again and again and again, and waste billions in the process.

In answer to the question: no, I wouldn't want to pay loads more in tax to fund the NHS. I think it's a bottomless pit and just throwing more money at it isn't going to solve the problem of waste and mismanagement.

Why is public sector ALWAYS ripped off on IT.

I can try to answer this one. There's multiple reasons.

Firstly government's aren't very good at defining their requirements. In short they don't know what they really want. Politician's get elected on the promise of spending money and doing 'something'. But nailing that down into a contract they're piss poor at. Then they run a hugely complicated tender process that even the multinationals run scared of.

Because companies know it'll be horribly complex they load it full of extra costs which the govt then sign. Later it'll all come out that things are more complicated than first thought so they'll want to make changes.....except the company will want more money to analyse the changes they want, the impact it will have and throw even more people at it.

The minister in charge is usually just some elected numpty with no experience of managing a multi billion pound contract and whose sole priority is to get re-elected, not make the system work. In fact chances are they won't even be in the job by the time the system gets put in. So it becomes SEP. Somebody Else's Problem. Remember, most of our elected politicians nowadays are career politicians who have never had to make a profit before. They're trained in media spin but not how to make widgets.

Secondly multinational companies load the projects up with as many people as they can get away with. Each 'consultant' is charged at say...£1000+ a day. The more consultants you can shoehorn into the project the more money your company earns. If/when the govt wants to do something not in the terms of the contract....KERCHING!

To make matters worse the govt dept then hire a team of identical IT staff to manage the supplier. So back when I was working on a project for the DWP, I had a counterpart who was employed by the DWP to work with me. In effect we had two people doing the same job. Same with the project manager. We had ours....they had theirs.... Usually for commercial customers they let us get on with it and nail us if we fail.

Lastly the UK is at that awkward size where we're not so big that we NEED to have lots of separate IT systems like they would do in America but we're pretty big to make any IT system a big challenge to scale up and make robust.

Coming late to the party, but I really don't understand how anyone can think privatization is the answer. In theory private companies are run for the benefit of profit and shareholders, not the public (private inefficiency and ineffectiveness was well-known 150 years ago when the public sector was being set up, in contrast to the ideology of our own times). In practice we have the sterling example of tbe USof A hanging over our shoulders.

I am not actually in the UK at the moment but I too would in principle pay more to keep the NHS, especially after living with Belgium's inefficient and ineffective public/ private partnership. The care is good but the admin is appalling - you ain't seen nothing in the UK.

But there is still the point about top-heavy wasteful admin, management, and yes, god help the public sector the IT. Why is pubic sector ALWAYS ripped off on IT.

Are any of you familiar with John Seddon, Vanguard and the systems thinking approach? He essentially says what any front-liner could tell you about any public service but does it in language closer to the managements own (he also still complains that they just don't listen). Namely that the services have all been run from a top-down perspective for far too long and are now not fit for purpose because they are no longer designed against the NEED. I'm a big fan, as an ex-front liner, he just said exactly what I'd always thought and with the facts and figures to back it. Here try this: www.systemsthinking.co.uk/6-news-0.asp

The Health budget is estimated to have risen by more 4% in real terms in 2015-16 from the level it was in 2010-2011. It is currently under demographic pressure of course (which is going to get worse) so this raises the question whether it is just poorly run through the current system of governance or whether the entire model is flawed and the demographic shift in the general population is going to expose it further.

Privatise it ASAP

Unlike private businesses the NHS does seem to have an endless pot of money which comes every 5 years when politicians need to buy votes

The pharmaceuticals take up a hell of a lot of the budget. I know a lot of time and resources go into creating the drugs, but some of the medications cost thousands per patient per year. Interferon is 24k a year, just for one patient. I do think the companies milk the NHS for all they can get, and this is the tip of the iceberg.

Pretty much agree with what everyone else has said.

It needs to be managed properly and ironically that means less managers.
There needs to be less waste.
Less money wasted on agency staff and overseas doctors etc.
Any health executive who spends riduculous amounts of money on unnecessary items such as paintings and clocks as mentioned above needs to be sacked.
They need to utilise their massive purchasing power. Properly.
And I think some services could be charged for.

All in all though I think the NHS is fantastic. Just very big and unwieldly and catering for millions more than it ever was designed for. And badly managed.

The tax doesn't go where it should though, ItsAllGoingToBeFine. I worked in the NHS and the prescription bill, the waste bill, the fees to external agencies etc is shocking. The NHS is a cash cow for a lot of different places and this impacts on frontline services as they can't afford to hire new staff.

I remember watching a programme on the TV (could have been on BBC news) where they use trays of instruments for simple operations, most of which they don't actually use. These instruments have to be replaced, checked, sterilised and someone has to take them to the theatre. They are not used but they are checked and sterilised again and again. It's basic things like this when added to 50K plant pots and whatnot which turn it into a financial wreck. If the NHS was a private company it would have gone bankrupt by now.

If we want top quality state care (schools/nurseries/NHS/elderly care etc) we need to pay more taxes. Lots more tax. And I for one don't have an issue with that.

No. They will hire more managers. They need to address the waste and cost of medication, and this will help to free up some cash for frontline staff. I know of one hospital that spent 50k on self watering plant tubs, which were outside and uncovered It's things like this which need addressing.

I was coming on to say what WetAugust has said. I would be prepared to pay more if the shocking waste of money in the nhs is curbed. Its out of control and nobody seems to know what to do.

I've posted before about being asked to purchase some plastic boxes for the ward stockroom. The sort of stuff which is £3 in Wilkos is £55 from nhs purchasing.