NHS Crisis. Are you willing to pay more in tax?

[MajesticWhine]

The Patient's association says the NHS is now in crisis. Almost two thirds of health executives think the Government needs to raise taxes to pay for the NHS (link here).

In a poll of the public 62% supported the idea of increasing NHS spending but only 30% supported the idea the public should pay more tax to maintain NHS care and services. Unsurprisingly there is a disconnect between wanting more money to be spent, and actually being prepared to pay for it. There was also some public support for the idea of charging patients for some services (39%).

I am interested to know what mumsnetters think. Are we willing to pay more tax to maintain the level of service provided by the NHS? Or would we accept paying for some services?

It's not how much you put IN yo the system but what you get OUT that counts.

How do we know it needs more money? have we considered that it actually gets sufficient money but chooses to spend it unwisely on things like agency fees for bank nurses, flying in GOs from other countries for weekend shifts, failed computer systems, ridiculous specimens of modern art (or clock that no one can read in the new Southmead hospital)

No, I don't want to give more in tax to perpetuate nonsense like that.

And if it does indeed need more money then we should use the £1.7 billion additional money we are giving to the EU or the £1.6 billion that we send to countries that have space programs or the £17 million we give to South Africa so I can spend £16.5 million on its presidential palace.

We need to scrutinise and prioritise our spending

For the NHS, yes. It is very much underfunded, there are some efficiencies that could be made, certainly in terms of allowing private companies to profit from it, but not enough to bring it up to bring it up to adequate funding.

I'd rather see the NHS run efficiently than just throw more money without sorting the problems that are (very obviously) there. I'd also like to see a re distribution of tax revenue.

If I thought for one minute that chucking another £1billion or £10 billion at the NHS would fix it then I would 100% support that no problems at all.

However let's be honest with ourselves. What would REALLY happen?

Well I'm old enough to remember back when the NHS during the Thatcher years. It did it's job. Of course back then you heard all about the fact the NHS was underfunded, it was in crisis and Tony Blair famously in 1997 declared there was only 24 hours left to save the NHS.

Under Labour NHS budgets TREBLED by 2008. We even threw £46 BILLION at a new IT system. The results of which I can't really see....can you? I mean I can book an appointment online now. Woo! That's value then!

So....after tripling the NHS budget what do we now have? Oh yes. Cries of our NHS is in crisis, it's underfunded etc etc. Sounds familiar?

The NHS needs to do better with the money it has. That means less bureaucracy, less managers, less targets (which need bureaucrats to administer) and someone desperately needs to sort out the PFI scandal.

Otherwise all we're doing is throwing good money into a deep black hole.

Of course this narrative doesn't fit into soundbites most people need it distilled into so it's simpler and sounds politically better to just say "Vote for me and I'll spend more money on the NHS!"

That's a soundbite that's a votewinner. I mean the public love it and NHS staff love it too as it means more money with no condition.

Sorry the reality doesn't work like that.

happy to pay similar to, say, france

but how about we cut back on other stuff first?

nhs as a top priority

nhs was shit in the 80s

Part of the problem is just the sheer size of the NHS and the pots of funding which means each department just cares about their own budgets and no one else's just as long as it doesn't impact on them. It results in lots of inefficiencies and waste including referring patients to endless specialities even if the problem is quite simple.

I've recently left the NHS because I couldn't stand seeing the sheer waste, incompetence and mismanagement that I witnessed on a daily basis.

Throwing more money at it won't solve the problems.

Nope. I work for the NHS, have done for 24 years. The amount of waste and incompetence is staggering - a whole corridor of Change and Innovation Managers for example, on senior manager salaries - so until they make it more efficient and accountable then no, I wouldn't be happy to pay any more into it.

another story on this today - £2billion more needed for the NHS next year

I guess the consensus here (small sample) is that throwing more money at it isn't the answer. But I don't know what is. Unfortunately politicians, especially labour, hold up increased spending on the NHS as such a glorious aim, when it seems it is only likely to go to waste. It's as if increased spending is morally irrefutable. Perhaps it is also a guaranteed vote winner. Whereas any attempt to reform the NHS and make it more efficient is criticised, especially by unions. As for anyone trying to tackle the fundamentals of the NHS and saying we can't go on like this, we have to pay for some services as we use them, it seems that would be unspeakable.

I was coming on to say what WetAugust has said. I would be prepared to pay more if the shocking waste of money in the nhs is curbed. Its out of control and nobody seems to know what to do.

I've posted before about being asked to purchase some plastic boxes for the ward stockroom. The sort of stuff which is £3 in Wilkos is £55 from nhs purchasing.

No. They will hire more managers. They need to address the waste and cost of medication, and this will help to free up some cash for frontline staff. I know of one hospital that spent 50k on self watering plant tubs, which were outside and uncovered It's things like this which need addressing.

If we want top quality state care (schools/nurseries/NHS/elderly care etc) we need to pay more taxes. Lots more tax. And I for one don't have an issue with that.

The tax doesn't go where it should though, ItsAllGoingToBeFine. I worked in the NHS and the prescription bill, the waste bill, the fees to external agencies etc is shocking. The NHS is a cash cow for a lot of different places and this impacts on frontline services as they can't afford to hire new staff.

I remember watching a programme on the TV (could have been on BBC news) where they use trays of instruments for simple operations, most of which they don't actually use. These instruments have to be replaced, checked, sterilised and someone has to take them to the theatre. They are not used but they are checked and sterilised again and again. It's basic things like this when added to 50K plant pots and whatnot which turn it into a financial wreck. If the NHS was a private company it would have gone bankrupt by now.

Pretty much agree with what everyone else has said.

It needs to be managed properly and ironically that means less managers.
There needs to be less waste.
Less money wasted on agency staff and overseas doctors etc.
Any health executive who spends riduculous amounts of money on unnecessary items such as paintings and clocks as mentioned above needs to be sacked.
They need to utilise their massive purchasing power. Properly.
And I think some services could be charged for.

All in all though I think the NHS is fantastic. Just very big and unwieldly and catering for millions more than it ever was designed for. And badly managed.

The pharmaceuticals take up a hell of a lot of the budget. I know a lot of time and resources go into creating the drugs, but some of the medications cost thousands per patient per year. Interferon is 24k a year, just for one patient. I do think the companies milk the NHS for all they can get, and this is the tip of the iceberg.

Unlike private businesses the NHS does seem to have an endless pot of money which comes every 5 years when politicians need to buy votes

Privatise it ASAP

The Health budget is estimated to have risen by more 4% in real terms in 2015-16 from the level it was in 2010-2011. It is currently under demographic pressure of course (which is going to get worse) so this raises the question whether it is just poorly run through the current system of governance or whether the entire model is flawed and the demographic shift in the general population is going to expose it further.

Coming late to the party, but I really don't understand how anyone can think privatization is the answer. In theory private companies are run for the benefit of profit and shareholders, not the public (private inefficiency and ineffectiveness was well-known 150 years ago when the public sector was being set up, in contrast to the ideology of our own times). In practice we have the sterling example of tbe USof A hanging over our shoulders.

I am not actually in the UK at the moment but I too would in principle pay more to keep the NHS, especially after living with Belgium's inefficient and ineffective public/ private partnership. The care is good but the admin is appalling - you ain't seen nothing in the UK.

But there is still the point about top-heavy wasteful admin, management, and yes, god help the public sector the IT. Why is pubic sector ALWAYS ripped off on IT.

Are any of you familiar with John Seddon, Vanguard and the systems thinking approach? He essentially says what any front-liner could tell you about any public service but does it in language closer to the managements own (he also still complains that they just don't listen). Namely that the services have all been run from a top-down perspective for far too long and are now not fit for purpose because they are no longer designed against the NEED. I'm a big fan, as an ex-front liner, he just said exactly what I'd always thought and with the facts and figures to back it. Here try this: www.systemsthinking.co.uk/6-news-0.asp

Why is public sector ALWAYS ripped off on IT.

I can try to answer this one. There's multiple reasons.

Firstly government's aren't very good at defining their requirements. In short they don't know what they really want. Politician's get elected on the promise of spending money and doing 'something'. But nailing that down into a contract they're piss poor at. Then they run a hugely complicated tender process that even the multinationals run scared of.

Because companies know it'll be horribly complex they load it full of extra costs which the govt then sign. Later it'll all come out that things are more complicated than first thought so they'll want to make changes.....except the company will want more money to analyse the changes they want, the impact it will have and throw even more people at it.

The minister in charge is usually just some elected numpty with no experience of managing a multi billion pound contract and whose sole priority is to get re-elected, not make the system work. In fact chances are they won't even be in the job by the time the system gets put in. So it becomes SEP. Somebody Else's Problem. Remember, most of our elected politicians nowadays are career politicians who have never had to make a profit before. They're trained in media spin but not how to make widgets.

Secondly multinational companies load the projects up with as many people as they can get away with. Each 'consultant' is charged at say...£1000+ a day. The more consultants you can shoehorn into the project the more money your company earns. If/when the govt wants to do something not in the terms of the contract....KERCHING!

To make matters worse the govt dept then hire a team of identical IT staff to manage the supplier. So back when I was working on a project for the DWP, I had a counterpart who was employed by the DWP to work with me. In effect we had two people doing the same job. Same with the project manager. We had ours....they had theirs.... Usually for commercial customers they let us get on with it and nail us if we fail.

Lastly the UK is at that awkward size where we're not so big that we NEED to have lots of separate IT systems like they would do in America but we're pretty big to make any IT system a big challenge to scale up and make robust.

Dominic Cummings' blog makes some thoughtful points about why large projects (eg public sector IT) so often fail: not least of which is the fact that such projects are often run by people with experience only of trying to get elected and zero experience of specifying, running and delivering multi-billion pound projects. There is little incentive within the public sector - especially government - to develop proper project management skills. So these projects go tits up, again and again and again, and waste billions in the process.

In answer to the question: no, I wouldn't want to pay loads more in tax to fund the NHS. I think it's a bottomless pit and just throwing more money at it isn't going to solve the problem of waste and mismanagement.

Well I'm totally against privatisation and would like to see the last 20 years worth of PFI 'outsourcing' privatisation reversed.

My reasons are simple, profit motive and monopoly. On the one hand thank god the days when a local doctor had a free hand to charge whatever he liked. Medical emergencies are both time critical and essential for the recipient and their family. Nye Bevan had a simple solution to the medical profession's resistance. "I will stuff their mouths shut with gold".

It strikes me that the modern NHS, or which I'll happily admit to knowing little about, has a real problem with change. On the one hand all medical practitioners are required by their profession to maintain their skills up to date, change is built into the very nature of the business as drugs and techniques improve. This is quite enough for any profession, and as someone who works in the constantly changing IT industry I'll vouch for it first hand.

Hence I suspect if you added political meddling to my industry the results would be shocking. I'm sure most people are aware of instances without in depth knowledge however it was roughly explained earlier in the thread. If you ask for a house to be built, then ask for changes once it is finished, you'll be paying through the nose for them.

Apply this to the NHS where pointless politicians who have never managed a welk stall decide that they need x % reduction in y by May 2015... The results must be easy to predict. Add in constant reorganisations forced by the politicians which are barely finished before the next begins and I think I can see nothing but problems with no easy solutions.

Frankly we need to take control of the NHS away from these shysters, and their lackeys in middle management.

Bear in mind that every time the government increases taxes they bring in far less revenue than they expect. This is only logically because we are way past the peak of the laffer curve. Increasing taxes for the NHS is a noble aim, but I suspect the beneficiaries are not the nurses but the corporations. Some time ago I was rather shocked to hear that despite their purchasing power drugs cost more to the NHS than they did on the open market. Instead of being an economy of scale the drug companies had realised that they had to buy, and increased their rates accordingly.

I don't think I've written anything contentious, however I realise that I haven't proposed any solutions.

Frankly other than directly electing people who are licenced by the BMA ( as in doctors and nurses) to oversee the NHS and stating their priorities and direction in manifestos I can't think of any. So we would either have to have parliament stuffed with doctors or something separate would have to be set up.

One thing is for sure though, I trust the medical staff. I just think their problem lies in Westminster.

Agree with others saying the NHS is horrendously inefficient. Parts are being outsourced to private companies who (in some cases) are doing it cheaper and getting better clinical margins, while still making a margin - just shows what waste there is. And the purchasing is ridiculous. So no, I don't want to throw more money into a bottomless pit for zero benefit.

Can't believe anyone thinks privatisation would do anything except stuff the pockets of the corporations picking up the contracts. Plus add yet another layer or dozen to deal with!

Re: government IT, basically what others have said. There's a government dept actually doing tendering well now - GDS. Managing to do projects internally at a fraction of the cost of going out to the usual private corporations who get the contracts.

If they stopped pissing money away on let projects then the NHS would be fine.

They wasted £3bn reorganising the NHS but what has happened? They've fucked it up. They could have stopped that shit and put the money back in as it has done nothing good.