To rant because this NHS is not a charity

[Monty27]

Wtf is all this about having to donate to a service that is national.
The clue is in the name:
NATIONAL HEALTH SERVICE
and breathe 😭

Don't forget the money the nhs pay to rent after labour sold of all the land the hospitals sit on.

I hope we never move to an insurance backed scheme as I am virtually uninsurable - it would cost me a fortune each month that I cannot afford.

That's not how it works in Germany. You pick the insurance company and their premium (which is fixed as a percentage of your salary) is deducted at source (like NI Contributions or PAYE).

If none of the insurance companies will accept you, you are insured by the biggest one, the AOK, which will cover everyone who can't get cover elsewhere as well as other people who choose it intentionally based on what it offers.

The insurance companies must offer a set of minimum requirements (including dental) and often you can have add-ons or add family members (eg. non-earning spouse, student child living at home not earning etc). It is nothing like private insurance in, say, the USA.

The effect is that it is like the NHS but the income from people's contributions (which are matched in an equal amount by your employer) go directly to the insurance company. There is government oversight of all insurance. (for reference i think i pay 13% of my net salary, i keep forgetting the exact amount. my last insurance company charged 12.5%. And often when they run a surplus they send everyone a cheque for the overpaid amount proportionate to what they paid in)

I can see why 13% of salary night be an issue here when people are paying 9% grad tax and 20-40% income tax and NI too. That’s quite a big chunk and effectively makes income tax 33% plus NI at 12% for the fairly modestly paid. Is it 12% for lower earners? Are there cheaper options? My DD would be paying 62% tax plus self employed NI on some earnings!

Hi Brefugee. I'd be interested to know what additional treatments you're entitled to if you pay for (say) the top-whack insurance as opposed to the basic AOK offering. In other words, in what circumstances under the German model does the system turn round and say 'sorry, can't treat you'?

This isn't meant as goady btw - I'd really like to understand this.

Don't forget the money the nhs pay to rent after labour sold of all the land the hospitals sit on

Is there any proof of that because it’s the first I’ve heard of it.

I am guessing they are referring to PFIs, which were first introduced by the Conservatives, and expanded on quite heavily by Labour. Essentially they work sort of like a lease- the contractor will build the hospital and provide services for a set period, usually around 30 years, and the government pays to use it. The advantage is of course that you can have things built when you don't have much money, the negatives are that often you end up paying back substantially more than it would have cost if it was done in-house, and money to pay the 'lease' every year comes out of that annual budget, rather than the budget dating back to when the PFI was agreed. So in essence you are already burdened with these costs before you even start to figure out spending for the year. The real shame is that some of the buildings haven't even been utilised, so we are paying loads for nothing. It is more complex than that, and there is loads of fake info floating about regarding it, but that's it in a nutshell. They don't do PFIs anymore as a rule as they have proven to be a burden.

Oh right. PFI is more like a mortgage, isn’t it? The principle was fine, unfortunately all the big construction companies saw NHS management and their incompetence to negotiate a decent contract coming and finagled them into signing off on items like £250 to add an electrical socket. Bloody scandalous.

PFI is more like using a credit card to build a hospital. Our local hospital cost £148m to build, but the PFI contract will end up costing taxpayers £766m.

and it’s well known in the trade they use the most expensive defence lawyers out there (despite all the bleating about penury and being crippled by litigation)

Of course they use the best defence lawyers, they’re trying to avoid massive payouts of public money. I’d be extremely pissed off if they didn’t. It’s interesting that the case was settled out of court, though, which seems to indicate that Virgin was probably justified in this instance.

and it’s well known in the trade they use the most expensive defence lawyers out there (despite all the bleating about penury and being crippled by litigation)

So would I. I'm a lawyer who handles some contentious work. Paying for the most expensive lawyers doesn't just mean you get the best advice; it also has cosmetic value as it will be clear to potential claimants that they will have a serious fight on their hands. Some medical negligence claims are enormous and unfortunately it probably makes financial sense for the NHS to chuck the kitchen sink at the problem.

I've seen people suggest that it should be impossible to sue the NHS. I actually think that would be an interesting proposition provided there was some other kind of check or balance against fuck-ups. It's not something I expect to see in my lifetime.

It's an outdated and failed model

That’s because you don’t know enough about the business of law

And I suppose @thedancingbear doesn’t either. You have absolutely no idea what I know.

Road tax is used to pay for care after road accidents 😡 what an odd thing to do -

The same people who won’t have any threads re Owen Harding disappearance - costing £££ - 😡

^That’s because you don’t know enough about the business of law. Outside the city, firms with the highest hourly rates generally act for large corporates who might set off the pretty obscene fees (high overheads - plush offices, high rolling partners etc) against profits, often profits directly arising from the matters on which the lawyers advise (like an asset sale, for example). They are excellent at corporate deals, but not exactly known for medical negligence defence work.

On the other side, the victims of medical negligence often have no choice but to use “no win no fee” lawyers for the simple reason that they can’t afford the outlay of even a reasonably-priced high street lawyer. The lawyer still needs to eat so only takes the strongest cases that he knows he can win.

Which type of firm do you think the NHSLA chooses? Which type of firm has the better medical negligence practice?^

I'm not a medical negligence expert but my understanding is that the NHS instructs lawyers on a trust-by-trust basis (ie. different trusts will instruct different people at different times), and they will certainly instruct medical negligence specialists. The best-known is probably Capsticks who (last time I checked) had pretty ordinary offices in Putney (?).

The senior guys at a place like that would still be pretty expensive (think mid hundreds of pounds an hour) but would not be in the same category as the megabucks city lawyers.

You'd have to be a nutjob to instruct a corporate/m&a lawyer on a negligence case: they would freely admit that they wouldn't know what they are doing.

Well, with all these people donating millions to the NHS, it's making sure the government don't need to pay anymore.
It's lovely that people have been charitable, but it sort of shoots the NHS in the foot.
I think it will be the nail in the coffin.

The money raised isn’t for the NHS, it’s for NHS related charities which buy the nice to haves the NHS can’t afford. It’s also a one off so won’t be available after this year. No feet have been shot.

In court, where it is a big money case or ground breaking difficult case, they will use specialist barristers. As in the Charlie Gard case for example. Yes, the whole process is very expensive and of course this money cannot then be spent on clinical care. However we do have a country where the rule of law is available to citizens who can either afford it, or who get pro bono solicitors and barristers, and the NHS is not above the law.

The original concept of the NHS is not really relevant any more is it? There wasn't an ageing population back then or a social care crisis nor was there an epidemic of obesity, diabetes etc. We demand cures for everything, even old age and all this costs. We also allow people to openly abuse it. Most people would agree that the current model is not sustainable.