Page 3 | If everyone was taxed an extra pound, would that save the NHS?

EddyF · 2022-12-22T11:49:51+00:00

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.

Fadedpicture · 22/12/2022 12:54

I was talking to a friend who's a middle manager in the NHS. She works crazy hours, 12 hours days plus at least one day at the weekend. I'm all sympathetic thinking that's no way to live and no one should be working like that, but no, she does it by choice, for the money because she's saving to move house. She gets paid enhanced overtime rates for every hour she does and turns up regardless of whether there's an operational need or not.

Now, I'm not in favour of anyone doing unpaid work, but I don't know any manager in the private sector who gets overtime for additional hours and lower ranked staff who do get additional pay will only get those hours when there a genuine and pre approved need.

This case is probably extreme, but how many excess hours are being paid because people fancy a bit of extra cash and how many are genuinely needed?

Lostinalibrary · 22/12/2022 12:56

Also, procurement in the public sector is an absolute con. Procurement managers paid an absolute fortune to source basic components from “approved suppliers” which also cost a fortune. All that needs sorting first.

vivainsomnia · 22/12/2022 12:56

DH was working as an external consultant with the NHS for years. He has recently pulled out as he can't cope any longer
At the same time, you do have consultants, who were let off from NHS roles for incompetence, who redesign themselves as consultants, demands massive amount of pay (one got close to 2 millions for less than 3 years), who come with made up ideas of how the organisation's can improved, things that had already been tested and failed, bully staff to change their ways in unfavourable ways, leading to chaos, at which point, they go and start again elsewhere whilst making a fortune. Not all, of course, but sadly too many who are in it just for the money.

scaredoff · 22/12/2022 12:57

The basic idea behind this is sound: that the government could, if it wanted to, increase the overall tax burden and spend it on fixing the NHS. However (1) as pp have pointed out, £1 per UK tax payer per year wouldn't raise nearly enough. (Personally I'd be willing to pay considerably more than that, but then you enter into a much more difficult political argument). And (2) given the huge and increasing inequality of UK society and the proximity of many lower paid people to the breadline already, there's no reason why such an increased burden should be a flat tax such as £1 per person. The money that has disappeared from public services over the last 12 years has gone somewhere - that is, there are sections of society that have gotten wealthier as everyone else has gotten poorer. I'd rather see the government reverse that process.

LexMitior · 22/12/2022 12:57

Personal responsibility is a huge aspect of NHS care. In other public health systems this is explicitly dealt with and you can expect to have to deal with lifestyle issues. That is the implicit deal.

My prediction is that lifestyle issues, relative to say, obesity, smoking, alcohol, drugs, sport, will increasingly be contracted out. You will be expected to deal with these issues yourself in terms of healthy eating, giving up vaping or smoking, receiving physio etc.

It is an obvious way to reduce the service without not providing critical or acute care.

strawberriesarenot · 22/12/2022 12:58

How do other countries with comparable economies manage? France, or Germany?
How do they deal with care of the very elderly, who can't manage independantly?

Badbadbunny · 22/12/2022 12:58

@vivainsomnia

The biggest cost to the NHS is diabetes and associated health issues. We are talking about one billion pounds a year, close to half of the full costs of the NHS.

Your figures are wrong. One billion pounds isn't anywhere near half the full costs of the NHS! A quick google suggests it costs 10 billion which is less than 10 percent of the costs of the NHS. Still a lot, but nothing like half!

Fadedpicture · 22/12/2022 12:58

vivainsomnia · 22/12/2022 12:52

DH had a long period of illness before his death, multiple hospital appointments, a letter sent to confirm each one, at a cost of what, £1 each for just the stationery and stamps, let alone the time. Now, people working in the system will tell me why it can't support any electronic communication, but it should
Posts like this make me laugh. It shows how the average person in this country has absolutely no clue how the NHS is run, the issues it faces, and the scale of these.

The biggest cost to the NHS is diabetes and associated health issues. We are talking about one billion pounds a year, close to half of the full costs of the NHS. And you mention a £1 letter!
To clarify, many efficiencies have been introduced such as reducing letters when appropriate except that this sadly leads to more appointments missed and a higher cost. This still is nothing compared to the savings the NHS made if we tackled the obesity crisis, something that the majority of people could manage themselves.

No, I mention what I imagine are several million £1 letters every year. And it's just one example of one inefficiency. Plus, it's not £1, it's £1 plus the staff costs of sending them out.

But I have also said people taking responsibility for their own health is a bigger issue.

vivainsomnia · 22/12/2022 12:59

This case is probably extreme, but how many excess hours are being paid because people fancy a bit of extra cash and how many are genuinely needed?
And again, what utter rubbish. Only staff band 7 and below get extra money for extra hours. They are not top managers! They usually only do so when their staff levels are low and the service is making a saving from the reduced staff level anyway!

Fadedpicture · 22/12/2022 13:00

vivainsomnia · 22/12/2022 12:59

This case is probably extreme, but how many excess hours are being paid because people fancy a bit of extra cash and how many are genuinely needed?
And again, what utter rubbish. Only staff band 7 and below get extra money for extra hours. They are not top managers! They usually only do so when their staff levels are low and the service is making a saving from the reduced staff level anyway!

I didn't say top managers....

LlynTegid · 22/12/2022 13:00

Start with windfall taxes at a proper level for oil companies, and then large tech companies paying a reasonable share of tax.

EngTech · 22/12/2022 13:00

Any extra revenue raised would be lost into a general coffer plus admin charges would dilute any additional funding to the NHS 😔😳

Badbadbunny · 22/12/2022 13:00

LexMitior · 22/12/2022 12:57

Personal responsibility is a huge aspect of NHS care. In other public health systems this is explicitly dealt with and you can expect to have to deal with lifestyle issues. That is the implicit deal.

My prediction is that lifestyle issues, relative to say, obesity, smoking, alcohol, drugs, sport, will increasingly be contracted out. You will be expected to deal with these issues yourself in terms of healthy eating, giving up vaping or smoking, receiving physio etc.

It is an obvious way to reduce the service without not providing critical or acute care.

I fully agree, especially in terms of telling people with lifestyle related health issues to do something about it themselves. Unfortunately, as we regularly see in the media, people complain when a doctor or nurse points out that they are overweight and suggests healthy lifestyle choices! So many healthcare professionals either don't mention the blindingly obvious or pussyfoot around skirting the issue. Some hard truths need to be told and if the patient doesn't like what they're being told, then tough!

LexMitior · 22/12/2022 13:02

The other thing is the medicalisation of being old. Our bodies do fail. The NHS is not social care, and you can see the drift back to what used to happen, which is care of the old by the family except in cases of severe demantia.

Delectable · 22/12/2022 13:02

The fact is the RF and more particularly Charles and William own the largest amount of land in this country. They not only don't need it as all their expenses are fully paid for for life; they don't pay any taxes. Yet the government not only keeps going after the commoner trying to make a living, they pitch us against eachother, distract us and program us using the media, asking for higher taxes. Tenants are fighting landlords, socialists want everyone on the same pay etc. We're all paying them and now they say Charles is refusing a slimmed down coronation. Ofcourse he is. This is a man who can't put toothpaste on his toothbrush nor move paper away from his desk. He has servants who dress him, drive him, cook, clean etc. Yet he needs more to be spent on him but we can't afford to pay nurses or heat our homes!

LikeTearsInRain · 22/12/2022 13:03

Boris could have started by using that 350m per week ‘saved’ from the EU to increase the NHS budget…

oh wait…

XingMing · 22/12/2022 13:04

Not sure you are on the right thread @Delectable .

Anotherbloomingchristmas · 22/12/2022 13:05

They should make early retirees pay NI until state pension age. ( This would apply to me).
If you can afford to retire early you can afford NI.
Also free prescriptions should be means tested.
And eye tests.

Unicorn34 · 22/12/2022 13:05

Kendodd · 22/12/2022 11:59

Might help if richer people paid the same rate of National insurance as poorer people.

www.gov.uk/national-insurance/how-much-you-pay

I didn't know that - WTF?

Badbadbunny · 22/12/2022 13:06

Fadedpicture · 22/12/2022 12:58

No, I mention what I imagine are several million £1 letters every year. And it's just one example of one inefficiency. Plus, it's not £1, it's £1 plus the staff costs of sending them out.

But I have also said people taking responsibility for their own health is a bigger issue.

Show quote history

Indeed, millions of "small" inefficiencies add up to millions, if not billions of pounds. I appreciate that individual staff won't appreciate their part in the NHS waste scandal, as they'll just see the few pounds that they put into the bin each day, and won't really extrapolate that out among all the other staff too.

I've had a few ECGs over the years and have been amazed every time that they open a new pack of "connectors" - those clips with a sticky back they put on your chest. There's about 8 or 10 clips in the pack, and I've only ever had 4 or 5 attached to me, and the nurse just throws the others in the bin. Why not leave the pack and use the unused ones for the next patient? Even better, why don't they buy packs with only 4 or 5 in? Once the nurse attached me and threw away the unused in their pack, only for a couple of the sticky things to come loose, so she opened yet another pack to get two new ones and threw the rest of that pack away too! Yes, I know each pack won't cost too much, but if thousands of packs are being used across the NHS daily, that'll be thousands of pounds wasted on just one "consumable".

Badbadbunny · 22/12/2022 13:08

Anotherbloomingchristmas · 22/12/2022 13:05

They should make early retirees pay NI until state pension age. ( This would apply to me).
If you can afford to retire early you can afford NI.
Also free prescriptions should be means tested.
And eye tests.

Even better, just scrap NIC and raise income tax instead. That way, everyone will pay which is fairer, not just the "workers" shouldering the tax rises yet again. Lots of pensioners have incomes in excess of workers, yet don't pay NIC. Same with landlords, those living on investment portfolios, those living on foreign income etc. NIC is antiquated and needs scrapping. Just tax everyone on the same basis.

NeverDropYourMooncup · 22/12/2022 13:08

Badbadbunny · 22/12/2022 12:33

@CinnamonJellyBeans

I believe the main way we can ease the burden is by healthy people looking after our bodies as best we can and not getting complacent about the fact that abusing the gift of health will automatically get us new knees, livers, cancer treatments, metformin, BP tablets, mobility scooters, gastric bypasses. We take the NHS for granted. Everyone should receive a virtual bill when they leave, that lets them know how much their treatment would have cost if they had paid.

Yes, indeed, far too many people don't care about the damage they do their bodies and don't lead a healthy lifestyle at all. I don't think they intentionally do it because they expect the NHS to "cure" them, but they just don't think of the consequences. I really don't think many people will think "stuff it, I'm going to smoke like a chimney because the NHS will provide me with an oxygen mask". I think it's more that people just don't think of consequences any more, i.e. re health, dangerous sports, dangerous driving, etc. No sane person would intentionally damage themselves just because treatment was available.

As for a virtual bill, I'd be against that kind of thing as it just creates more layers of bureaucracy and there'll be doubts as to the reliability of the figures as there are different ways of working out costs, i.e. marginal costing, absorption costing, etc. We already have crazy figures for things like calling out a fire engine which aren't transparent as to what's included, and the old "lie" about raising a purchase order costing £40 when in reality the marginal cost is just a couple of pounds, but using absorbtion costing (inc the building, admin, management, equipment, etc it's much more). The general public can't understand the nuances of cost accounting.

If they started issuing virtual bills, they'd be using software used in, say the US, countries where there is no universal healthcare.

How long would it be after introducing billing software (which would also need a fully integrated universal computer system for all providers, which would make a private contractor an unfathomable amount of money at the prices they would charge for it) to introduce actually billing people? I'd give it a couple of years.

YooniqueMe · 22/12/2022 13:09

I would pay it if it would work, but I don't believe it would work.

I asked a nurse recently if every job vacancy was filled and money was no issue, would everything be fine. They said no (although obviously would help) because of the lack of social care and the attitude/health of society in general (eg taking no responsibility for being obese, not completing courses of antibiotics so their problem reoccurs etc).

I would support a fee at point of contact. It's been shown that if a gym is free people value it less than if they have to pay even a nominal amount.

XingMing · 22/12/2022 13:10

Free prescriptions should not start until retirement age, instead of at 60. Pre-payment certificates are quite reasonable if people under retirement age need a lot of meds. Dental or sight tests aren't free for pensioners, as far as I know, but I am only a few months over 66, so they haven't come around yet.

MrsDanversGlidesAgain · 22/12/2022 13:10

They should make early retirees pay NI until state pension age

NI is payable until state pension age.