If you work in the NHS, how would you fix it?

[startingitallagain]

Or AIBU to think it can't be fixed and we're gradually slipping down the slope of eventually not having an NHS?

I do absolutely understand how many staff within the NHS are struggling to cope under the pressure, with many leaving due to their own mental/physical health issues that the job has caused.

This has been inspired by another thread where the poster can't get a GP appt for their father who has terminal cancer and can't keep food down (and hasn't been able to for a number of weeks). www.mumsnet.com/talk/am_i_being_unreasonable/4708090-to-wonder-what-my-gp-surgery-is-actually-doing?page=1

With elderly parents myself and having to occasionally battle for them to get care, I find the prospect of getting older in this country quite terrifying, so much so I think I'd rather plan for euthanasia if I was facing end of life and no care!

Is it funding? Is it lack of staff? Would more money solve the issue? WWYD?
(As an aside I remember watching the documentary 'Can Gerry Robinson Fix the NHS?' a number of years back - made interesting viewing about the issues then!)

The trouble is, those millionaires and billionaires aren’t going to take too kindly to paying the kinds of additional taxes that you’re talking about. So the majority will either avoid it, seeing as they can pay some very clever specialist people to do so, or just move their liability to a lower tax regime, and we’ll lose out in even more income, making the whole situation worse.

The reason they squeezed middle is the squeezed middle is not just that they are the easiest option for Chancellors of the Exchequer to increase the tax gain. For the vast majority of the time, they are the only real option. Except that sponge is wrung dry at the moment, and for the foreseeable future.

Well, we've been swallowing that line for decades now and its wearing thin.
You can't move property and where are these lower tax regimes that they wouldn't already be using?

CGT in UK is significantly lower than Italy France Germany and Spain & they already charge tax on investment income.......

As for moving, there isn't any really evidence for that, sure you'll get rock stars and F1 drivers but they already live abroad and its not just for tax but live style.

Are you really saying that we can't close loopholes? but other countries can?

There’s a lot of cash in hand work going on ime. It’s not the super wealthy but if every other builder or plumber does it mounts up. Also subletting hA property.

it costs money to check these things so they don’t get done.

I’m not saying I don't agree, but it’s the same cyclic argument. To increase spending, where the money is going to come from- a look around this site alone will show just how many are struggling to keep their heads just above water as it is.

It is tricky I agree, to get a German system you would need to pay 20% of your gross wage like they do and the employers another 20% on top of that. So Germans pay for their system, like we do, they just pay more for it. You are quite right though, people are going to struggle to pay more for any type of system, when absolutely everything else people need to pay for, has shot up in price.

Nothing like enough to make in roads into health funding plus undeclared income gets spent in their local economy.

48% of the official HMRC "tax gap" is due to small business mistakes/evasion.

Only 5% of the "tax gap" relates to the wealthy.

So that clearly shows where the problem lies. Cash in hand work, not registering for VAT, not declaring income, over-declaring expenses, etc. , duty-free sales etc.

www.gov.uk/government/statistics/measuring-tax-gaps/1-tax-gaps-summary

Millions of people engaging in low level tax evasion is a much bigger number than a few ultra-wealthy using tax havens or loopholes.

The trouble is, those millionaires and billionaires aren’t going to take too kindly to paying the kinds of additional taxes that you’re talking about. So the majority will either avoid it, seeing as they can pay some very clever specialist people to do so, or just move their liability to a lower tax regime, and we’ll lose out in even more income, making the whole situation worse
Yes, the richer they are the greater their ability to avoid paying their fair share.
Those of us without money and power are taxed because we are low hanging fruit ....it's easy to get money out of us because we don't have the power to stop them.

The strong are protected and the weak get a kicking, dog eat dog, the law of the jungle, might is right
That is not what I call a civilised society 🤬

I think the problem is not so much tax evasion by the wealthy and more the fact that the system is setup to benefit the wealthy so that they get richer and richer at the expense of the rest of us.... The ones who do the real work that keeps them in lamborghinis and swimming pools and mansions
The ones with wealth and power make the rules and they make them to favour themselves.

a good thing I saw recently at Harlow An E was at the triage they had the ability to send you over to a GP based across the ( new fancy pants ) hall rather than admit you to A n E for eg a twisted ankle or minor injury

Harlow hospital itself just wants bull dozing selling to the highest bidder to build houses etc and use the proceeds to build a brand new hospital just outside the town

It just seems a bottomless pit the NHS , it is beyond me we pay train drivers what we do and Nurses that we all clapped for a pittance in comparison

Social care is a whole other issue on its own but one that cannot be ignored

Talk about missing the point!!

Yes under the current tax system but as i pointed out, we have taxes that favour the wealthy.... how many on here benefit from 0% tax on investment income or the very low 20% CGT ?

UK had 740k millionaires in 2015... it now has 2.4m... so the tax system clearly is not stopping many people becoming extremely rich.

To sort out health/nhs and social care.. we are talking 100s of billions over many years.

UK had 740k millionaires in 2015... it now has 2.4m... so the tax system clearly is not stopping many people becoming extremely rich
Exactly!
the proper function of the tax system is to fairly redistribute wealth, otherwise it just rises to the top even though it's the people at the bottom who do the work that creates the wealth.

Money does not trickle down
Money whooshes UP

The reason that the wealthy are not breaking tax laws is that the laws are made by them to favour them!

@Alexandra2001

Yes under the current tax system but as i pointed out, we have taxes that favour the wealthy.... how many on here benefit from 0% tax on investment income or the very low 20% CGT ?

But millionaires don't benefit from the £12.5k annual tax free income allowance.

They don't benefit from the £1k interest zero rate band.

Not sure why you think there's a O% "investment income" tax rate - there isn't!

The CGT annual exemption is being halved and halved again over the next couple of years, which is something that hits the wealthy more than the poor.

The vast majority of the UK tax revenue is paid by the wealthiest few percent. I don't have the exact numbers to hand, but the piretto principle applies, i.e. something like less the top 20% of earners will be paying over 80% of the total tax raised.

You really can't keep screwing those earning more than average. The ultra wealthy will just use tax havens. Such as Lewis Hamilton buying his private jet via the Isle of Man to avoid paying VAT on it! How are you going to "persuade" a tax haven island to stop being a tax haven - bomb it?

I’ve got a friend VERY successful building company self made left school with nothing

lives millionaire lifestyle I could only dream of
yes he’s very rich pays more tax in a few months than I earn a year
don’t see what crime he’s committed by being rich

As I said, he hasn't broken any laws because laws are setup to favour the rich.
You said that he is self made? Who did all the work that he profited from?
I'm not saying he hasn't worked hard but most of the hard work is done by the people who work for him, he didn't lay every brick himself.
Only fools and horses work.

Good start. I'd add walk in centres and cottage hospitals for recuperation to community hospitals.
And self referral to in person counselling - not everyone wants online. People need a human connection

@user1497207191

Yes there is, all you have to do is txfer your investment income into a ISA (20k p.a pp) you can then draw it out tax free.

CGT is still UK - 20%, in France 34% Germany 27%.

The reason the wealthy pay more tax as a % is because the rest of us earn so little, which has benefited the wealthy, as i ve shown with the increases in millionaires.

What you ve not addressed is the alternative, which is either no NHS or a failed NHS.

@Pianofar

Where will you get the staff from for these desirable outcomes?

The UK has worse labour shortages than almost any other European country.

Wow
he’s very hands on worked and worked . Pays staff well as they stay loyal and people queuing up to work for his company

pays an astronomical amount of tax .there child privately educated they have private health care they literally contribute but take hardly anything out of they system
what more would you expect people like him to do .
between top rate tax and ni contribution he’ll be already give us just under 1/2 of what he earns

If people were given a choice between paying a bit more tax for decent public services, and the amount we'd have to contribute for private healthcare, I think most would choose the former. But the Tories would prefer the latter, because it helps them get rich.

I do also think that pensioners who are asset rich shouldn't get everything given to them for free, paid for by many who will never own a home. I know ultimately they can be made to sell homes to pay for care, but it seems like a long road to get to that point. I know people will say they worked hard all their lives etc etc, but honestly, both my grandmothers were housewives after they had children- they gave up work younger than I am now, and never really returned to it. Their husbands were not that wealthy, either.

Joining up social care and the NHS surely only makes sense- you would then, presumably, get joined up thinking to allow people to return home in stages, rather than bed blocking, with the knock on impacts that has.

But anyway, austerity, austerity and more austerity is not the answer.

This thread started off well with some excellent and insightful suggestions. It's been diverted into the usual political arguments.
Most threads on the NHS descend into blame. We can all fling blame around but that doesn't solve anything.
We need cross party willingness to construct a long term plan. Without that no party will risk votes and look forward more than 4 years.

@Postapocalypticcowgirl No they wouldn't, people vote for parties that promise lower taxation AND austerity.

@snowsilver the NHS is politics, it was formed under a Labour Govt and opposed by the Tory one.

Both main parties have fundamentally different views on the NHS, this cannot be papered over, no matter how we wish it were different.
Probably why we have such a poor health service compared to European counttries.

15 years ago, we did not have 200people a week dying in the back of ambulances or at home waiting for medical help or 7m on waiting lists, we've had 13 years of the tories, so yes there is blame.

I do also think that pensioners who are asset rich shouldn't get everything given to them for free, paid for by many who will never own a home. I know ultimately they can be made to sell homes to pay for care, but it seems like a long road to get to that point. I know people will say they worked hard all their lives etc etc, but honestly, both my grandmothers were housewives after they had children- they gave up work younger than I am now, and never really returned to it. Their husbands were not that wealthy, either.

The majority of women who have retired more recently or are due to retire in future years will have worked for most of their lives. How will owning a home allow someone to say pay for prescriptions or a bus pass which is about all that pensioners get for ‘free’ unless they are on benefits (note that prescriptions are currently free from 60 and state pension age is currently 66/67? Are you suggesting that people have to release equity from their homes?

Should the same apply to younger disabled people? Should children have to pay for their prescriptions?

That sort of approach will do nothing to sort of the current NHS and social care issues and in fact could make matters worse due to people not taking the medication they need to keep them as healthy as possible and then requiring greater intervention.

pays an astronomical amount of tax .there child privately educated they have private health care they literally contribute but take hardly anything out of they system
all his employees have been educated by taxpayer money, he benefits from the fact we have a police force, roads, healthcare so that his employees dont die of minor illnesses. Of course the wealthy benefit from the system @rwalker
He earns what he does in part because of the publicly funded infrastructure which supports his business.
None of us is an island @rwalker

@Postapocalypticcowgirl

Joining up social care and the NHS surely only makes sense

They'd have to "join up" the NHS itself first. It's horrendously fragmented and dysfunctional with huge numbers of different trusts, the artificial internal market, etc.

Yes as I said he pays about half of his income
What % of there income do you think they should pay isn’t 50% enough for u