If everyone was taxed an extra pound, would that save the NHS?

[EddyF]

Might be a silly question but if you don’t ask, you don’t learn!

I have just a post elsewhere (not MN) where people are discussing their wait time to be seen at A&E and it’s quite shocking.

I think people would be In favour of paying a slight tax increase of a minimal amount such as £1/1.50 from tax to try and fix the NHS. Is this unrealistic?

I have attended a hospital in the US, and the experience was such a stark contrast to the feel of hospitals here. I know obviously because the US is not ‘free’ like the NHS. I just remember it being like a spa service.

No. You have to increase training places. Just shovelling money in will just lead to more waste

Where are the students going to come from? and who will train them on placements?

You think there are all these unemployed people with 2 or 3 A levels waiting to go to Uni to work for 27k and a 50 hr week?

Well, if there are no suitable people at all, then it is what it is.

After all, we are on an inverted population curve now - increasing olds and decreasing working age people. Add in increasing energy costs = everything gets harder, more scarce and more expensive.

The NHS doesn’t need extra money (although it would help), it needs better management. It needs to be worked as a business and wastage seriously reduced.

I have far too many letters, there are too many steps, and too many managers. there needs to be systems reform, and far better, focused spending at point of contact care. Scrap communications campaigns telling us to eat healthier etc. the NHS needs to be point of care service and there is little evidence those campaigns do anything other than make marketing agencies money.

Draw a line under some services. Not popular but cosmetic surgery, fertility treatments, gender surgery etc should carry a fee - not the cost of private but a fee to subsidise it.

Social care for the elderly needs a reform too.

@ILoveeCakes

Well, if there are no suitable people at all, then it is what it is.After all, we are on an inverted population curve now - increasing olds and decreasing working age people. Add in increasing energy costs = everything gets harder, more scarce and more expensive.

There is a lack of suitable people due to pay, hours and conditions. Deal with those, and combine with training, and you begin to arrive at a solution.... but it's a solution that involves more money, which is what you recognise above...

@ScrappyMoggy

I have far too many letters, there are too many steps, and too many managers. there needs to be systems reform, and far better, focused spending at point of contact care.

How do you achieve that focus and efficiency, when you're removing the very people who would be needed to make that happen?

Medical schools are grossly oversubscribed. There’s no shortage of people with the right qualifications applying for far too few places.

The Australian system has more than a basic public hospital system with inpatients, outpatients, therapists, investigations, emergency departments.

There is a private system working along side it, with overlaps. Some people will see consultant X for their endocrine problem publicly and consultant y for cardiology service.

The big misunderstanding about it is that you need private health insurance to access it, but you don’t. Private cover is largely for inpatient stays at private hospitals.

There’s a whole heap of private services - speech, OT, physio, psychology, medical specialists. You don’t need private cover to see them.

It works because the government pays each private provider a fee, then they charge on top. You pay the “gap”. My daughter saw a dermatologist privately, she cost $300ish and we were out of pocket 120. Follow ups are much cheaper.

If you have a low income or a chronic condition everything is cheaper. Private Therapy including psychology can be no cost, if you have a chronic medical condition/disorder and are on the National Disability Insurance Scheme. You don’t have to see a private consultant, ever, if you don’t want to. Some people without a lot of spare cash choose to see a specialist privately so they can see the same person every time.

GPs are private, although in most places you can find one who doesn’t charge beyond their government fee (bulk billed, no cost to patient). Most private lab tests are bulk billed (no cost), most basic radiology is. An MRI scan at our best local provider will have you out of pocket 150 dollars, if you choose to “go private” for this.

Without government funding this hybrid public/private service wouldn’t work, it would be crazily expensive.

I also don’t think it would work because culturally, people in the UK don’t want to pay anything at all.

Here, if you had a 7 year old child with ASD/aDHD and some delays you could see a paediatrician publicly (no cost), have fortnightly “private” speech, OT, physio, psychology through the government funded NDIS (no cost), see a bulk billing GP (no cost), have private bloods done to check for iron deficiency (no cost), private X-rays after a fall (no cost) and go to public ED for acute serious illnesses (no cost).

However, there is a cost to medications, the government subsidises medications and this subsidy is set irrespective of whether they are prescribed by the GP, private specialist of hospital. A child with a chronic condition or a low earning household will have meds cheaper; the cost of long acting stimulants
will be around $7/month.

A typical MN response to all of this is: “I can’t believe that I’d have to pay 2-3 pounds a month for this. I would have to go without food. I’ll stick with our wonderful NHS, thanks”.

I rhink it’s a cultural thing in the UK, most are not prepared to pay anything at all for health care.

So what?

Funny, when people want to extol the virtues of the free market, they usually reject criticism of how much fat cat CEOs and directors get paid because it's necessary to "attract the best people". So what makes you think something as large, complex and important as the NHS could function just as well with second rate managers? I've no idea how much a 100K NHS manager could earn in the private sector but presumably they wouldn't be offering that much if they didn't think it was necessary.

Or to put it another way: the existence of managers earning over 100K a year is supposed to be evidence that the NHS is wasteful, right? And therefore it should be replaced by some kind of private or semi-private system, right?

I wonder: How much do you think the managers in that private system will get paid? How much are the senior managers of large American health insurance firms paid? Less than 100GBP a year? I doubt it.

So will the existence of highly paid managers in private insurance firms equally be evidence that private health insurance is wasteful? And will people be coming on here sounding off about how terrible it is, that they have to pay inflated premiums for such indulgent business practices, and that clearly it all needs to be nationalised to get rid of such waste?

PAYE can be a bit hit and miss when it comes to low incomes, because HMRC need to consider the whole picture of an individual's income before working out where the tax free allowance fits in, and they can only do that with the information they have. For example, for some years I had two part time jobs of which one earnt just under the allowance and the other over. It took some years of adjustments, estimates, rebates, communications and money back and forth before they finally sorted it, with the lower salary coming through untaxed.

They may be imposing a provisional tax code because they're waiting for confirmation you have no other source of income, for example, and you may be eligible for a rebate at the end of the year. Or something like that. Obviously I don't know your whole situation but the figures you say on face value don't sound right.

It’s expensive to run and eats money left right and centre. Only better management can save it. And leadership comes from top down. They need to do basic things like triage on door and not treat everyone no matter what. Get x-ray in one room, fast track elderly and pay out for public health campaigns so people with sick bugs don’t keep turning up!!

I think an extra £1 would help, actually.

@user1497207191

I don't think the poster was referring to doctors - they tend to get more than £27k per annum!

@Theeyeballsinthesky

However, the money was not ring fenced and because local authority funding has been decimated, there is hardly any money to do any proper public health education or interventions.

You are incorrect on that. Public Heath Grant to local authorities most definitely remains ring-fenced.

£1 a day for every individual in the country would be close to the £25 billion mark and would make a good difference. £1 a year from income tax payers would raise something like £35 million and wouldn’t make a noticeable difference.

You're all looking at this from the wrong angle. The problem with the NHS is the way it is managed and structured. Throwing money at it doesn't fix the issues, it papers the cracks.

The hierarchy of staff is completely broken, too many managers with no accountability.

Structure is top top heavy.

Also the NHS is abused for what it is, too many bellends taking themselves to a doctor or A and E with a sniffle.

"Your first grand or so a month should be subject to no tax as it's below the personal allowance. You're basically being taxed 50% on the remainder which should be basic rate"

it pains me to see how many people do not know the rate of taxation in this country, anything over your personal allowance as a basic rate tax payer is taxed at 20%. National insurance is 12%.

Ergo 32% and not 50%...

@user1497207191
Again, who will train them? you know why they don't train more, there simply isn't the space and staff in hospitals for their placements.
Where do these students who don't get in to med school go on to do? who will fill these jobs if we extend med school places?

What about all the nurses and AHPs the NHS is short of?

Then there is retention in both sectors.

what i see on this & on other NHS threads is simplistic solutions with no thought to the realities or the issues.

@Setyoufree has it. There was money enough to throw at conservative party cronies for undelivered PPE, but the NHS is not properly funded.

That said, a mixture of reforms would help. France and Germany both have compulsory employer health insurance schemes in addition to state insurance, so nothing is "free" but everything is "covered". I think it's actually unhelpful to perceive the NHS as free; people need to understand that health care is expensive so they don't miss appointments or make them for frivolous things. We should be aware that time wasting or anti social behaviour in medical settings is stealing.

In addition, @CulturePigeon is right that we expect far too much. There has to be prioritisation. Cancer pathways are supposed to be only weeks long for a reason. NICE has imo some weird ideas about what it's reasonable to fund. Puberty blockers or opposite sex hormones for under 18s should never be a question; they simply compromise health too far.

And @Fadedpicture's point about social responsibility and @upfucked's about the impact of poverty are also important. It is not the NHS which is responsible for Aawab Ishak's death; it is a lack of accountability for health standards in housing. Traffic pollution, food poverty, lack of educational opportunity have an impact on health and cost the NHS.

And yes, it's also poorly organised and its inefficiencies are expensive.

For a start GPs are private businesses.

We need to end them being the gatekeepers of the NHS.

We need far more self referrals.

It would be far more efficient to have people going direct to specialists.

Why don't kids here have paediatricians?

Why don't women have an OBGYN?

I don't think GPs should be doing these pieces of work. It would free up their time if they didn't.

I was shocked when I went for physio (for severe mobility issues) and I was in an open ward type room where everyone else was being seen for sports type issues I think they should be paying for privately rather than using the NHS. I can't believe people in pain, who struggle with basic movement/ functioning have to wait in NHS queue for physio behind someone actually complaining about only being able to run a half marathon not a full one or only play 20 mins of tennis not two hours.

I don't think we should be paying for fertility treatment either, unless it's something exceptional like post cancer.

More like £122.5 billion!!

A number of problems here. The NHS is having to do far more than it was established to do, one only has to read comments here where someone is, in reality, a bit fed up but the suggestion is to 'see your doctor'. 'The provision os social care was never part of the NHS remit, nor was dealing with a multitude of addictions, things like being too lazy to keep one's house clean is now classed, conveniently, as an illness and is dumped on the NHS.
Taxing £1 will only be paid by those who pay tax, a lot of people will escape it.

Loads of issues on this thread (not surprising). The NHS as someone said is cheaper than most alternatives. It is about 20% of people's income tax a year. So if as someone said above it costs each working person about £9500 a year in tax (£47, 500 income tax per person I suppose) some are paying just about nothing if they get a single person tax allowance (not everyone does these days) of about £12,500 and some are paying huge sums into it. I call me 2 NHS GP appointments in the last 15 years my £100k a time appointments given what I pay into an NHS I never need so far just about. I am very very lucky not to be ill (not all luck but mostly luck) and paying all that tax to help others is something I can accept as I would much rather be well than needing healthcare.

However it is getting very expensive and there are too many bells and whistles provided. We are moving as a nation from the richest best nation on earth down the pecking order which is fine but comes with many things being worse and we need to prepare for that.

I agree with those saying we do;'t need a single diversity manager in the NHS.

However I would look at where most of the money goes and try to cut from that. Eg we could legislate so no one can sue the NHS for negligence. "The overall cost of clinical negligence in England rose from £582 million in 2006 to 2007 to £2.2 billion in 2020 to 2021, representing a significant burden on the NHS. For all claims, legal costs have increased more than fourfold to £433 million since 2006 to 2007."

"In 2020/21 the Department for Health and Social Care spent £192 billion." "In 2019 the UK spent 10.2 per cent of GDP on health, which is in line with the average among comparable countries. The provisional estimate for 2020 is that this has risen to 12.8 per cent due to the increased funding allocated to tackling the Covid-19 pandemic."

"The NHS is one of the world’s largest employers with around 1.2 million full-time equivalent staff in England, as of June 2021. Consequently, the wage bill for the NHS makes up a substantial proportion of its budget. In 2019/20, the total cost of NHS staff was £56.1 billion which amounted to 46.6 per cent of the NHS budget. These statistics don’t include salaries for GPs or..." www.kingsfund.org.uk/audio-video/key-facts-figures-nhs

So about half is wages. If we are going into a massive recession with few jobs available due to the huge debts we took on because of furlough payments making changes like requiring all NHS staff to work full time only and no private work or other jobs ever and retirement at 67 for all and no employer provided pension other than auto enrolment and also no sick pay other than SSP I bet that would save an absolutely fortune.

NHS staff will just leave the only thing remotely attractive about it is the now reduced pension , sick pay , enhancements , annual leave and maternity leave. Private companies pay a lot more money . Also it's easy to get a job abroad with the qualifications other western countries who pay more are crying out for staff. You can't tell the staff not to take private work , they will be off as that's subsidising their NHS wages.

To stop staff leaving to go private/ agency/ abroad we could make NHS degrees free and require those not working in the NHS to pay back their full fees (not just the £9k pa).