Would you pay an additional tax for the NHS?

[Whatisthis543]

I’m torn on this one, surely our taxes should cover a well funded NHS but it seems that they don’t...

Is that systematic I.e too much bureaucracy and poor allocation of resources (within the trusts and elsewhere) or is there genuinely not enough money with an ageing population and rapid growth?

I think that something that materially impacts your quality of life is an illness.

The amount spent on IVF is negligible compared to Diabetes related comorbidity.

Personally, I think we should be funding IVF.

The amount spent on IVF is negligible compared to Diabetes related comorbidity.

and unlike diabetes, infertility is largely not a lifestyle disease. Diabetes is the single biggest expense for the NHS and so much could be done about it to prevent or reverse.

Blair/Brown trebled the NHS spending but just loaded it with debt via PFI and other long term contracts. They "saved" the NHS by increasing NIC contributions, and then had to increase them again a second time. The NHS is a leaky bucket. Pour more money in and more leaks out through waste and inefficiency. The holes in the bucket need to be fixed first.

@flattyres

The amount spent on IVF is negligible compared to Diabetes related comorbidity.

and unlike diabetes, infertility is largely not a lifestyle disease. Diabetes is the single biggest expense for the NHS and so much could be done about it to prevent or reverse.

Indeed, for a start, GPs and "specialist" diabetic nurses should stop regarding it as a money making tick box exercise for their practice. They can't wait to diagnose you with diabetes (to get the extra funding) but don't actually do anything for you beyond an occasional blood test and a superficial foot test (when they can be bothered). They spend more time on asking the same questions each year to tick their questionnaire boxes. (Heaven knows why the answers don't save from year to year - not many people will suddenly start smoking or drinking yet they ask the same damn questions every year leaving no time to give you any actuall guidance/advice).

@notapizzaeater

I think the taxing of 'benefit in kind' of private health care should be stopped or diverted directly to the nhs. We pay a fortune each year for private healthcare as do many many others and we save the nhs a fortune / time / waiting lists by using it.

My DH is currently in a hospice with terminal cancer and the cancer treatment we've recd during COVID hasn't changed at all for that I am grateful but there is so many systems that just do not work together which wastes so much time and money. He needs reg blood tests fir different departments - there seems to be no way (or at our trust anyway) for the doctors to put a request on and just have one set of tests for all. Last month he needed bloods fir kidney doctor, diabetic doctor and oncology. Because of the system he needed 3 trips to the gp for three lots of blood in 4 weeks. Madness ! Some repeats in there - logic says the doctors could put on what was needed and they got consolidated when he went.

Similar with my OH who has cancer and needs regular blood tests. The GP can't see the regular blood tests ordered via the oncologist even though the blood is taken at the GPs. That means whenever he has an infection or other health problem, he needs an extra blood test for the GP, despite having them every 3 weeks for the oncologist. Same with the lack of joined up thinking where the oncologist won't prescribe anything non cancer related, such as iron tables but the GP won't do it either because they havn't got a blood test result showing low iron, so have to order another blood test to see for themselves! Apparently, impossible for the GP surgery to ask the oncology dept for the blood test results or even authority/instruction to issue the prescription.

But even better (worse) was that when he was diagnosed, it follow a full body x-ray, MRI scan, CT scan, heart scan, bone marrow sample, breathing tests etc etc - basically a full set. After initial treatment, 3 months later, he was sent to a different hospital for further treatment - at the first consultant appointment, he had no records of any of those tests and ordered them ALL to be done again - he said they want to do their own and don't use anything done by a different hospital, even though it was the same trust. It's all bonkers.

and unlike diabetes, infertility is largely not a lifestyle disease.

You cannot say diabetes is a lifestyle-related disease - this is why T1 diabetes sufferers receive so much judgment from people when there’s absolutely nothing they’ve done to cause it.

Yes although as NHS staff I’d like a pay rise to help cover the increase

No I wouldn’t, but only because I’ve come up against nothing but brick walls when trying to access NHS services for DS over the last 5 years. They are just not interested, second I can afford to I’ll be moving to private health care.

However, I think the NHS badly needs restructured and it is going to continually decline in services until it is. I also think health care workers with the NHS aren’t at fault for anyone being unable to access services either, they do what they can and attempt to help as much as they can but a lot of the time they’ve got their hands tied by red tape.

@SinkGirl

and unlike diabetes, infertility is largely not a lifestyle disease.

You cannot say diabetes is a lifestyle-related disease - this is why T1 diabetes sufferers receive so much judgment from people when there’s absolutely nothing they’ve done to cause it.

You have to be fair: diabetes can be caused by lifestyle much more plausibly than infertility.

You cannot say diabetes is a lifestyle-related disease

T1 is not but the far more common type 2 is very much down to lifestyle. Can we not say that diabetes is for many down to eating and drinking the wrong stuff and moving too little because it might upset those with T1???

@Kazzyhoward The problem there is that all NHS digital systems are outsourced to a small group of private companies and are unbelievably often not designed to link up. The NHS spends literally millions on these systems, and often a short while later they need to be replaced because they don’t link up with new systems implemented by other services since. I’ve been sort of involved in the procurement of a couple of systems and it’s really shocking the money involved.

The NHS should have a central development department which designs systems that can be used across the country. There’s no reason this couldn’t be done. It would be more effective and less expensive. Outsourcing of so much has had such a negative effect.

You cannot say diabetes is a lifestyle-related disease - this is why T1 diabetes sufferers receive so much judgment from people when there’s absolutely nothing they’ve done to cause it
Type 1 constitute 10% of diabetics. We are talking about the other 90%. The best treatment is lifestyle choice. GP can't make us adopt a healthier lifestyle.

Yes although as NHS staff I’d like a pay rise to help cover the increase

So you’d be happy to pay an extra £1k in tax per year provided that you got it all back in the form of a pay rise? I’ll let somebody else explain the maths to you.

I think those running it should be Medics, nurses or other HCP’s that are also commercial. Run programmes that allow them to go and work in McKinsey etc so they can gain skills in running organisations while having a Medical background.

Not this nonsense again: let the medics run the hospitals and sack all the ‘pen pushers’ (the meaning of this term appears to be flexible but here it seems to mean ‘anybody who isn’t clinical’).

Tell me, how will senior medics run a hospital as well as covering a full list of clinical duties? Whilst you are merrily sending these people off to McKinsey, or wherever, to become ‘commercial’, who will cover their surgical lists? If you send nurses to be trained as management consultants, and they are any good at it, what’s to stop them leaving the NHS entirely for a new career?

I think the T&Cs of Nurses and Doctor’s contracts need to change to make the profession more attractive. E.g flexibility in working hours and financial incentives or even just a remuneration package.

Revolutionary thinking: offer medics a remuneration package! Why has nobody thought of that?

Re the flexible working: how do you run an acute trust when you give all of the clinical staff flexibility over when they come in? Oh, hang on. You’ll need a load of ‘pen pushers’ to arrange that, won’t you?

@dontdisturbmenow

You cannot say diabetes is a lifestyle-related disease - this is why T1 diabetes sufferers receive so much judgment from people when there’s absolutely nothing they’ve done to cause it Type 1 constitute 10% of diabetics. We are talking about the other 90%. The best treatment is lifestyle choice. GP can't make us adopt a healthier lifestyle.

So say T2 diabetes then if that’s what you’re talking about. T1 diabetics are tired of receiving judgement for having an illness they didn’t cause, and there are an alarming number of people who don’t get the distinction. It’s not exactly arduous to be specific.

Not for this NHS. It is a national religion but no other country has replicated it. Any change and it’s automatically ’we can’t have a US type system’. I value free at the point of use but there are many ways to get there that are more efficient and have better patient outcomes that are no more expensive. I’m more than happy for a private provider to do routine surgery for less than an NHS hospital. I hope we get a new model that incorporates social care reform in the next couple of years.

@Iamthewombat

Well what do you propose ?

No,i pay enough income tax,NI and indirect taxes, i sometimes wonder WTF i am actually working for !! There is far to much waste, profligacy and freeloading in this country.

No.. already pay a lot of tax- would love to see the NHS restructured to be fit for purpose.

Iamthewombat

Well what do you propose?

In relation to what, specifically? I’m not whining that I pay too much tax already, or demanding that hospitals divest themselves of ‘pen pushers’ to allow Hattie Jacques to run the show, or identifying specific changes that the NHS must bring in before I’ll pay another penny etc etc.

Ask me a specific question and I’ll answer it. Spoiler: I don’t have a foolproof plan to run the NHS on a shoestring whilst simultaneously delivering european level medical care.

@iamwombat

Okay - are you happy for money to be spent on consultancy firms such as McKinsey ?

How would you get more permanent staff? How would you boost morale ? How would you encourage more into the profession? Are you happy for the NHS to be staffed by agency staff ?

In terms of the remuneration packages that you sniffed at ? What kind of packages do staff get now ? Not consultants, I’m talking about middle grade/juniors. What about nurses? Is it’s sufficient?

In terms of care, should we treat all or should there be a line ? Where is this line ?

How would you make careers conducive to a good family life and work life balance? ( I actually think some places are doing 12 hours shifts for nurses which means they have more days off in a row and many seem really happy ). But besides this ?

Okay - are you happy for money to be spent on consultancy firms such as McKinsey?

Yes, where there is a specific requirement that can’t be met within the NHS. For example, it would be uneconomical for the NHS to maintain a permanent team of experts in very specific IT installations. Why not bring in temporary expertise when you need it?

How would you get more permanent staff?

In which disciplines?

How would you boost morale?

Show me a statistically significant sample of large employers where the staff don’t regularly complain that ‘morale has never been lower’. This really is a non-question: it resolves to “how do you make pessimistic people stop complaining that they are hard done by?”. There is no answer.

How would you encourage more into the profession?

The NHS incorporates many different professions. Which do you think need more entrants?

Are you happy for the NHS to be staffed by agency staff?

There is always going to be a need for agency staff in any organisation that is required to operate 24/7, to cover absences. So, yes.

In terms of the remuneration packages that you sniffed at ?

No, I didn’t ‘sniff’. I was poking fun at your lack of understanding of what the term means. Anybody who is employed on a contract of employment receives a remuneration package. It includes salary and benefits, both financial and non-financial. Pensions, for example. What do you think that the term means?

What kind of packages do staff get now ?

See above.

Not consultants, I’m talking about middle grade/juniors.

See above.

What about nurses? Is it’s sufficient?

I’m familiar with the agenda for change pay scales. Are you arguing that nurses are badly paid? Relative to whom? I’m inclined to think that The A for C pay scales have been set by well-informed people. Do you disagree?

In terms of care, should we treat all or should there be a line ? Where is this line ?

Yes, I do think that we should treat everyone who needs care. Don’t start with “what about IVF? What about smokers? What about people who have skiing accidents?”.

How would you make careers conducive to a good family life and work life balance? ( I actually think some places are doing 12 hours shifts for nurses which means they have more days off in a row and many seem really happy ). But besides this ?

If you become a medic in an acute setting, you need to accept that the role will make demands on your time. Do you genuinely think that a theatre nurse or an anaesthetist should be able to decide at the drop of a hat that they don’t want to work their shift on Wednesday? Some roles are compatible with home working and increased flexibility. Delivering care to people who are ill enough to require hospitalisation isn’t one of those roles. You must see that?

@Iamthewombat

But McKinsey didn’t do something in some specialised IT capacity. They restructured ( very badly) why could that have not been
done internally ?

By permanent staff I mean all the professions that have shortages. But let’s go with Doctors and nurses.

In terms of remuneration packages - make them more competitive. Why are junior doctors so keen to pack up off to Australia? Why are we not retaining them? Why is it sometimes better to stay as a trust grade Doctor rather going after a specialisation?

I think nurses should be paid more. I’m looking at risk versus reward. Very highly regulated and many nursing jobs take a toll on someone’s physical and mental health when compared to other professions.

In regards to work being conducive to a decent family life it’s not just about hours worked. Many medics have to relocate because they can’t get places on training programmes near them. HCP’s could also have help with childcare ( on-site childcare, pay to subsidise childcare).

Is that systematic I.e too much bureaucracy and poor allocation of resources (within the trusts and elsewhere) or is there genuinely not enough money with an ageing population and rapid growth?

I'd say it's a bit of both, but mainly the first

Like others I'd be happy to pay more if thorough reform happened first, but there's little chance of that so I'm afraid the answer is no

But McKinsey didn’t do something in some specialised IT capacity. They restructured ( very badly) why could that have not been
done internally ?

No, you asked whether I was happy for money to be spent on consultancy firms. However, if you want to concentrate on the example you have described, which is McKinsey presumably restructuring the trust you work in (you haven’t given details of what they did): if a consultancy firm delivers savings and improvements then yes, I do think that it is money well spent.

As for why it couldn’t have been done within the NHS: who in the NHS do you think should have done it? Do you think that organisations are capable of dispassionately identifying problems with themselves and resolving them for the greater good, even if it’s to the detriment of the people identifying and delivering the required changes? I don’t. I think that in any organisation, not just the NHS, the people within it would (1) be tempted to act in their own best interests and (2) lack the experience of other organisations required to assess the position scientifically.

I suppose you think that you and the other nurses should have been allowed to restructure the trust? How would that have worked out?

By permanent staff I mean all the professions that have shortages. But let’s go with Doctors and nurses.

How many doctors is the NHS short of? In which disciplines? Ditto nurses? I’m asking because I want to understand the evidence base. I suppose you want me to say, “pay them all more”?

In terms of remuneration packages - make them more competitive.

Thought so!

Why are junior doctors so keen to pack up off to Australia?

What percentage have actually left for equivalent roles in Australia? How do you know whether those who act on the threat are happier in Australia?

Why are we not retaining them?

What is the churn rate for junior doctors? How many leave the profession, compared to the numbers remaining as junior doctors but apparently leaving for Australia? What reasons do they give for leaving the profession, or leaving the NHS? They didn’t confide in me personally.

Why is it sometimes better to stay as a trust grade Doctor rather going after a specialisation?

In the nicest possible way, how on earth should I know this?

I think nurses should be paid more.

Yeah, I think we all got that. You want more money for fewer hours. Don’t we all.

I’m looking at risk versus reward. Very highly regulated and many nursing jobs take a toll on someone’s physical and mental health when compared to other professions.

Are you sure that you want to start this particular argument? There are plenty of people doing equally demanding roles for less money than nurses. Do you think that those people should pay more taxes so that you get a pay rise?

In regards to work being conducive to a decent family life it’s not just about hours worked. Many medics have to relocate because they can’t get places on training programmes near them. HCP’s could also have help with childcare ( on-site childcare, pay to subsidise childcare

Loads of people, in many professions, need to relocate for work. It’s a career choice. Do you think that the treasury should give relocating clinicians a free house? If not, what?

As for childcare: it’s already subsidised if you use the tax-free childcare scheme or your child is old enough to qualify for free hours. Why do you think that medics should have their childcare more heavily subsidised, compared to people working in care, or in nurseries, or in other low paid professions?

You’re good at asking questions but not great at answering them, I notice.

@Iamthewombat

Well you seem to be good at articulating your opinion. But not very good at doing it nicely ( while making assumptions).