There is nothing special about the nhs

newatc

After 70 years with very little need of the NHS, over the last year I seem to have spent most of time concerned with health problems.
I still believe in the principles of the NHS but now regard as a broken second-rate system. Inefficiencies, poor communication, poor attitudes are rife. I wish I know how to to fix it but it's beyond me; I do believe is that it does need better funding but that alone won't do.

lisyloo

Carl31 wrote: »

i think an easy solution here is just bring the prescription charge forward. Most people, if truly ill, must have an expectation they will come away with a prescription which they will have to pay for, so know they will be paying later that day

Make that charge the fee. Those who expect to pay it are no worse off, those that dont expect to pay anything may think twice about whether they do need that appointment

Of course, not all GP trips result in a prescription, so its not perfect, but might relieve some pressure on doctors

I’m comfortably off but I don’t pay for prescriptions.
Does that mean it’s free for people who don’t pay for prescriptions? (Including the old?)

I don’t disagree with some element of charging but there are practical issues e.g. pushing people to free emergency debts, and you’re a long way from nailing it.

If it was simple don’t you think it would have been sone already.

For example start charging for travel vaccines (relatively uncontencious I think as a cost of travel) then people in the uk start spreading cholera and thyphoid??

These schemes need thinking through as there are consequences if you disincentives people from getting healthcare.

Andy_L

Carl31 wrote: »

i think an easy solution here is just bring the prescription charge forward. Most people, if truly ill, must have an expectation they will come away with a prescription which they will have to pay for, so know they will be paying later that day

Make that charge the fee. Those who expect to pay it are no worse off, those that dont expect to pay anything may think twice about whether they do need that appointment

Of course, not all GP trips result in a prescription, so its not perfect, but might relieve some pressure on doctors

IIRC ~90% of prescriptions are dispensed for free, unless you change the criteria for free prescriptions I doubt it would change much

peterbaker

lisyloo wrote: »

I agree and I've just had an Aunt (96) die and I have a MIL living a sad life in a nursing home.
We accept that if you found a dog that couldn't eat or stand and was in pain you'd put it down.

Famliies would agree with you on this.
However the difficulty is how do you deal with medically well people?


Believe me we wouldn't want to be like that and understand the issue but how and crucially when would you end their life?


People seeem to know with pets, but noone Ive met could make the decision with a human famliy member.

There are perhaps growing numbers employed by NHS who make decisions like that daily. Pneumonia makes it easy.

I defy you to tell us where you'd draw the line and who (safely) decides when life is not worth living. Believe me I'm not motivated to keep these people alive but I have first hand experience so I can see the difficulty.

"These people"?? I think Mistermeaner saw comments like that coming! Sounds more like Logan's Run than any of the other comments in this thread! Did you mean it to? I note you have also decided that your MIL is "living a sad life in a nursing home". It is indeed sad that so many elderly suffer dementia or related problems, but at £50,000 to £80,000 a year for proper care surely the lives the patients lead are maintained at a level above sadness or anxiety? What price happiness? Personally I believe in much higher personal taxes and highly monitored state care for this kind of health need. Forget about NI contributions ... those are like a useless appendix in the system. I am talking about doubling income tax for all and halving personal allowance.

Obviously the lowest wages would have to double but that is easy if you choose to believe it can be done instead of poo-pooing it, and instead using all your energy to argue for Brexit like turkeys voting for Christmas. We buy tonnes of supermarket flowers to give to our elderly relatives, don't we? It makes them happy and cuts through their sadness and ours for a few minutes. Yet the wages paid to those who grow the flowers in Kenya are in UK terms non-existent and living conditions awful, yet shiney multi-billion dollar aircraft are used to bring the bloody things to Tesco daily! Oh and the Kenyan workers love that they have their "jobs" so they can pay their children's school fees. It's wrong! And so is our stupid low wage / low tax economy. We are developing backwards!

In my experience, UK private nursing homes/car homes are wheezes used by get rich quick merchants who of course pay stupidly low tax. The fees they cream off from dementia sufferers could provide at least twice the capacity if those same fees were employed in state-owned care facilities of equal care quality.

actually theres a cap on care fees coming in April 2020, so it's not as bad as peeople think.

HOW SURE ABOUT THAT ARE YOU? Has here been any further news on the subject or is it all hidden behind the Brexit smokescreen and the perceived need for £160,000 halfwit Tory Party members to ensure that the Tory Party survives at all costs? Why do we tolerate our stalled democracy now being so overtly "fixed" in ways worse than a Russian Presidential election and by types who could never swing a starting handle on a simple machine to get it running again or who would know their black from red even with a set of jump leads?

lisyloo

peterbaker wrote: »

"These people"?? I think Mistermeaner saw comments like that coming! Sounds more like Logan's Run than any of the other comments in this thread! Did you mean it to?

I don’t understand the reference (not familiar with the film).
What’s wrong with saying “these” referring to a category with similar traits?

I note you have also decided that your MIL is "living a sad life in a nursing home". It is indeed sad that so many elderly suffer dementia or related problems, but at £50,000 to £80,000 a year for proper care surely the lives the patients lead are maintained at a level above sadness or anxiety?

Some local authority homes are dreadful. Do you really believe all of “these people” I.e. dementia patients are all receiving expert care?
The nursing home I go to have 2 pairs of carers and they are generally fully engaged with toileting (which with immobile patients needing hoisting into wheelchairs is a little involved).
I can tell you from personal experience they are not.
We have a good family and we try to do as much as we can but there are still periods of 48 hours when MIL might not see a family face. That’s a long time to twiddle your thumbs.

What price happiness? Personally I believe in much higher personal taxes and highly monitored state care for this kind of health need. Forget about NI contributions ... those are like a useless appendix in the system. I am talking about doubling income tax for all and halving personal allowance.

My guess is you wouldn’t get voted in on that manifesto.

In my experience, private nursing homes/car homes are wheezes used by get rich quick merchants who of course pay stupidly low tax. The fees they cream off from dementia sufferers could provide at least twice the capacity if those same fees were employed in state-owned care facilities of equal care quality.

What’s your evidence for this.
My MIL pays £925 per week, which is £132 per day.
For all food, 24/7 care and entertainment I think that’s pretty good.
Obviously there is a variation, but no I don’t think it’s a cash cow.
If you do you should be running one or at least investing.

HOW SURE ABOUT THAT ARE YOU?

I am sure I was incorrect (read something old).
It has since been pulled or at least not progressed.
So there is no cap coming currently.
Thanks for point it out ( I don’t want to spread incorrect info).


I have no issue with my MIL paying for care as I think she should pay rather than younger tax payers as she no longer needs her own home.

peterbaker

lisyloo wrote: »

I don’t understand the reference (not familiar with the film).
What’s wrong with saying “these” referring to a category with similar traits?

You make these people sound like you have identified them as having a problem. THe problem is a UK societal problem and as such I offer that you should be talking of "us" rather than "them", but I can see you won't vote for that.

Some local authority homes are dreadful. Do you really believe all of “these people” I.e. dementia patients are all receiving expert care?
The nursing home I go to have 2 pairs of carers and they are generally fully engaged with toileting (which with immobile patients needing hoisting into wheelchairs is a little involved).
I can tell you from personal experience they are not.

I am sure I agree with you. Why do "we" tolerate it?

We have a good family and we try to do as much as we can but there are still periods of 48 hours when MIL might not see a family face. That’s a long time to twiddle your thumbs.

I understand perfectly.

My guess is you wouldn’t get voted in on that manifesto.

Yes in the UK you would be right. We are a pretty gormless lot, aren't we? Just as bad as Americans thesedays.

What’s your evidence for this.

Same as yours I guess - I'm having to deal with it constantly in my family too and when I look behind the company names that are opening handfuls of new private care homes and see how they charge enormous sums yet avoid CQC inspections for at least a year, then get scored as "Requires Improvement" and allowed to continue, I think I can see that money is beeing diverted to the wrong pockets. More and more I hear "We don't have any local authority contracts. We're private" as if that's a feather in their cap, and then I get quoted £1,250 a week and more and see where the money goes - a lot of it on show in the owner's car park space. So I think I am not far from deducing the truth. Ask a private sector home what happens when the patient's money runs out.

My MIL pays £925 per week, which is £132 per day.
For all food, 24/7 care and entertainment I think that’s pretty good.

Is that local authority? A year ago I was quoted just £800pw for local authority dementia care. The home was however old and has since closed. Don't know where they shipped all the existing residents to ...

Obviously there is a variation, but no I don’t think it’s a cash cow.

Don't you now?

If you do you should be running one or at least investing.

Why should inevitable care needs for the elderly be sold out to the private sector? So the unscrupulous can get double digit returns?

I am sure I was incorrect (read something old).
It has since been pulled or at least not progressed.
So there is no cap coming currently.
Thanks for point it out ( I don’t want to spread incorrect info).

That's ok - we all miss these things sometimes. So what do you think of the fact the Tories have reneged on it?

I have no issue with my MIL paying for care as I think she should pay rather than younger tax payers as she no longer needs her own home.

What makes the younger taxpayers immune from the cost of inevitable elderly care?? Why do you prefer the "luck of the draw" type burden on the unlucky families and individuals? Isn't that very much like the stupid message given to prospective English undergraduates that they may never pay for their uni educations because they won't earn enough? Is that any way to run a railway?

Don't you believe in collective responsibility and societal risk-sharing? Didn't I once read you worked in insurance? And you don't believe in the many pooling contributions to help the few unfortunates who get burdened based on the luck of the draw?

What's wrong with everyone paying much higher tax, and the four or five million in work who don't pay any income tax, being included in how our country pays for itself?

Yes the lowest paid will need a massive wages hike to go with doubled marginal rates of tax, but what's wrong with that? Might it mean a few "businesses" are no longer viable? You bet. THey were only viable by exploiting the ability to pay stupid low wages in the first place. That's why I mentioned the Kenyan flower industry example. Should Brits be thankful if they hold jobs, wages and accommodation like those Kenyan workers? They aren't Brits? Why does that make any difference? Exploitation happens on a scale of tolerance.

We are groomed to tolerate salaries that are far too low and alongside that, we are groomed to repeat Tory mantra that low tax is good. It's all evidence of a gormless society that doesn't know how to truly stand together and stand up for itself to fix things and instead just blindly elects leaders on the strength of ignorant hunches.

Then we we don't even notice when they renege upon serious promises because they manipulate the media daily to divert our attention to something completely unrelated.

So again, why is low taxation good?

lisyloo

peterbaker wrote: »

You make these people sound like you have identified them as having a problem.

err yes, people who cant see, hear, are in pain, have lost mental capacity have a problem. I didnt say they were a problem.

THe problem is a UK societal problem
and as such I offer that you should be talking of "us" rather than "them", but I can see you won't vote for that.

You are making massive assumptions about my views.
I personally will vote for tax increases.
Its a fact that in general it's not a vote winner - but you incorrectly extrapolate my person views from that plain fact.

Is that local authority?

The £925 is the self-funding residential rate.
The LA rate for exactly the same is £825.

So what do you think of the fact the Tories have reneged on it?

I am not bothered about my MIL using her own money to pay for her care.
I think brexit has been a huge distraction plus the Tories have failed to be decisive. I am ashamed to have voted Tory and won't be voting for them next time.

What makes the younger taxpayers immune from inevitable elderly care??

I don't think just about managing people on the breadline should subsidise the wealthy, so they can pass on an inheritance (this is against my own person vested interest).

Why do you prefer the "luck of the draw" type burden on the unlucky families and individuals?

Not sure what you mean.
Unlucky families get LA funded care so it's all paid for.
That care should be better - sure.

Don't you believe in collective responsibility and societal risk-sharing?

Not for the wealthy no.
I believe in means testing.

Didn't I once read you worked in insurance?

Nope. Never.

And you don't believe in the many pooling contributions to help the few unfortunates who get burdened based on the luck of the draw?

Unfortunates yes and people do get free care if they have no money.

What's wrong with everyone paying much higher tax, and the four or five million in work who don't pay any income tax, being included in how our country pays for itself?

Many of those are visiting food banks and struggling to make ends meet.
If you want more tax and I agree with that then you need to take it higher up the income scale, not from people going to food banks.

So again, why is low taxation good?

There are pros and cons.
We want a low tax environment to encourage businesses e.g. car makers to this country.
The tories have gone too far with austerity and become totally uncompassionate.
I agree with higher taxes but not from ordinary working people.
Either raise Corp Tax or income tax at higher levels or as a minimum don't keep increasing the thresholds.

peterbaker

I'm sorry I mistook you for someone else who used to write about insurance matters, but haven't completely got your personal views wrong, have I? Why should "ordinary working people" not pay tax at a doubled marginal rate? Yes I know they can't suddenly afford it whilst on a low wage, but why must ordinary working people have to endure low wages at all?


Do "ordinary working people" have to worry about selling our labour cheap and thus argue the pros and cons on behalf of the manipulators and speculators who employ us?

We have been steadily reconverted into a nation of cowed individuals. Labour is not organised and there are those who love that.

So given that the UK business environment is so great for unscrupulous spivs to exploit, why are you arguing that it is fair that your MIL's assets should be spent instead of taxpayers' funds - taxpayers who excuse themselves from the burdens of society until they get hit and can ultimately leave nothing for the extended family ?

At the rate we are going, ordinary working Millennials will never be given the same opportunity their ordinary working grandparents had of accumulating wealth if they were thrifty (as many WW2 younger generation were).

Why is it fair that the lottery of the approximate 7:1 odds against dementia in old age be funded only by those who suffer it? It's surely a nonsense to argue that they should self fund and then go forth into the dreadful LA care home system and multiply unless they really have lived charmed tax free lives up to that point and do not deserve their wealth? I am sure you don't think that in general, the WW2 generation were mostly spivs who avoided tax and did not deserve to accumulate any funds which they could gift to their grandchildren and great grandchildren, for example?

Are you perhaps arguing against the North / South divide? Do you feel pensioners' houses in the South may have raced ahead in value compared to the North and you are worried that a northerner's family may not inherit much anyway whereas a southerner's family may still inherit even after the costs of dementia care have been shelled out?

I am clutching at straws here because I am trying to understand where you are coming from in trying to administer fairness across society with these inevitable costs. It sounds as if you want to level the playing field completely for families across the whole country - literally. Abolish inheritance for all ordinary working families. Let all their offspring start at the bottom with no help from above? Unless that is, they are lucky and avoid the need for elderly care ... are ordinary working elderly who avoid the need for much elderly care therefore excused from gifting or leaving inheritance?

Trying to understand where you want to draw the line, or why you are even trying to draw a line... My solution - much higher tax, is a much fairer start point (I reckon!).

lisyloo

peterbaker wrote: »

but haven't completely got your personal views wrong, have I? Why should "ordinary working people" not pay tax at a doubled marginal rate?

It’s my view from where we are at the moment that the wealthier elements (people and businesses) could give a bit more.
We have been more unequal.
There are some rich people in the US saying they would like to contribute more.
We’ve had quite a few corp tax cuts. I don’t think we should be cutting taxes for the wealthy.
Perhaps we have to agree to disagree on the exact way tax should be distributed which is fine, but my view is we’re unequal in favour of the better off at the moment.

why are you arguing that it is fair that your MIL's assets should be spent instead of taxpayers' funds

Because she’s massively wealthier than those going to food banks.

taxpayers who excuse themselves from the burdens of society

They are not excusing themselves, they are just paying lower rates as they have less wealth.

Why is it fair that the lottery of the approximate 7:1 odds against dementia in old age be funded only by those who suffer it?

Is it fair that those who drop dead at 60 of a heart attack get no pension when they’ve paid in all their life?
Life isn’t fair.
It’s only those who are lucky enough to live long enough (in general) who have the long term care issue, so in once sense they are the lucky ones.
I can’t help with nature’s lottery I’m afraid.

Are you suggesting that millionaires should get free care at the expense of just about managing families.
And also that they cannot choose to have a nicer facility if they want? That’s nonsense. If they choose to go into a home (rather than waiting until fall which is when the LA will pay) and want to go somewhere nicer they should certainly be able to with their own money.
I’m guessing you haven’t been to many LA funded care homes.
Some are not where you’d want to leave your parents,t?

I am clutching at straws here because I am trying to understand where you are coming from in trying to administer fairness across society with these inevitable costs.

People who no longer need a home (and btw aren’t capable of maintaining it), should sell it to fund their care (as of now).

It seems fairer to me that they pay (above a 5 figure threshold) than you ask just about managing families to subsidise them whilst they have probably 6 figure sums from a property.

Abolish inheritance for all ordinary working families.

You’re making stuff up.
The majority of people do not go into residential/nursing care

Trying to understand where you want to draw the line, or why you are even trying to draw a line... My solution - much higher tax, is a much fairer start point (I reckon!).

The line is currently £23,500 (or thereabouts).
I’m happy with that.

No I don’t agree with you that poorer people should subsidise the wealthy.
Well just have to agree to disagree.

Btw - the happiest countries (the Scandinavian ones) are where there is less financial inequality.
That is fact not an opinion.
People don’t stop being ambitious or running companies in these countries so people are still motivated to strive with higher tax levels.

We agree on more tax, we just don’t agree on who should pay it.

peterbaker

lisyloo wrote: »

The line is currently £23,500 (or thereabouts).
I’m happy with that.

No I don’t agree with you that poorer people should subsidise the wealthy.
Well just have to agree to disagree.

Btw - the happiest countries (the Scandinavian ones) are where there is less financial inequality.
That is fact not an opinion.
People don’t stop being ambitious or running companies in these countries so people are still motivated to strive with higher tax levels.

Thank you for troubling to respond - I had wondered if I was a bit too pushy with my last!

I absolutely do not wish to subsidise the wealthy by taxing the poor. I merelý believe that the tax system should include almost everybody with its burden, and of course with its major benefits like proper elderly care without having to bankrupt yourself. I am NOT arguing at all for any kind of flat tax amount for everyone wealthy or poor. But I do think it does the spirit of our citizens no good whatsoever to ever feel that they are too poor to pay tax. It basically means they have very little investment in the way tax is spent. So I am sorry to say I think you may be terribly mixed up like most of the UK electorate. Is your MIL really "fabulously wealthy"? What is her net worth currently? My MIL's net worth is around £150,000 cash + £250,000 equity in the house. That will last 6 years and then she will be effectively bankrupt. Although she is 90, it is likely she will survive those 6 years - then what?

We agree on more tax, we just don’t agree on who should pay it.

True, because you perhaps do not understand or appreciate the psychological value of all workers being included in income tax payments so they are actually taking part in providing the budget for how their country works.

By the way, I understand the Scandinavian model quite well because I am part of it too! It is why I mentioned the 37% marginal rate of tax (which applies to everyone with annual income above the equivalent of approx £7,000pa. That includes university students whose free grant of some £700 per month is taxable alongside any part-time earnings they may receive).

That's novel isn't it? University students get free tuition and a free grant but they rapidly find themselves paying 37% tax on some of their income which includes their free grant! Of course if they work part-time like many do, they don't get paid a piffling £6 per hour as teenage shelf stackers at Tescos - it's around twice that to start in Scandinavia even for a teenager!

It's not a perfect system, but as you say, perhaps it leads to a happier and more equal population.

By the way, I have visited local authority elderly care homes in UK and was appalled at one, marginally satisfied at another (where my two ninety something aunt and uncle had been dumped separately following a fall, plus one more which was poor as it was such an old building and seemed to be staffed by minimum wage staff. I have visited four private ones where other relatives are housed. Does that give me a valid input?

Also, what is this silly idea you have that "most" do not end up in residential care? How can that be proper even if true? Average life expectancy is close to 90. Tell me how many 90 year olds can safely survive totally independently if they haven't dropped dead at an independent age 60 thus forgoing most final salary pensions which actually are rarer than hens teeth thesedays for the under 70s

State pensions are so low as to be almost insignificant whether you live to take them or not.

Other private pensions for under 70s now leave an awful lot to be desired cf final salary pensions which "many but not most" 90 year olds of ten years ago might have retired on - many will have then paid a widows pension or have been payable for 5 years irrespective of death at 60. Since pension reform 2015 and even earlier, there will most likely have been money not yet drawn down from private pensions which could be partly transferred as inheritance. Either way however, none of these pensions were ever intended to pay out £65,000pa for ordinary working people. My MIL nets about £15,000 a year but is probably an exception.

No, the real problem is the cost of elderly care compared to ordinary working people's average earnings.

A total rebalance is necessary and that DOES require something as drastic as doubling the lowest wages at a stroke and doubling the 20% marginal rate of tax, and halving the £12,500 personal allowance.

Do what you like also to the highest earners and corporations, but do please include the lowest paid in the tax system so they can begin to see how the system is supposed to work and appreciate how their tax money is spent - then they might actually have a proper purpose in mind when they go and vote instead of blowing with the prevailing populist wind and hot air, and thereby selling their votes on the suggestion they will pay less tax!