NHS "Pay Rise" of 1% (real term pay cut)

[roger.mellie]

Murph7355 said:

roger.mellie said:

Yip and that leads to some very complicated and emotive questions on which treatments should be provided for free on the NHS. In a finite funding model it can't do everything. But, being slightly flippant, if the principal that fat bds and skinny joggers get free knee surgery is accepted then we should fund the level of resources required .

I'm very open to looking at alternative funding models e.g. I've seen how health care works in UK, IRL, US, Japan, Canada and Finland through personal and familial experience. I don't like how the conversation always leads to assuming the UK would adopt a US model (which I'd never support), but there are good reasons for thinking that would be our government's preference.

Different topic really, but I don't "accept" the principle of fat b*stards / skinny joggers. I think some very tough decisions need to be made. But unfortunately don't think they ever will be.

Funding models - agree with you that we should look at all options. I am not sure I agree on any pre-ordained view that this government might have.

What I' really like to see happen is a proper cross-party working group put together to look at the options for funding.

In terms of priorities/scope, I would then leave that to medical professionals. "You have £10bn and not a penny more for the next 5/10/15yrs. Decide what you prioritise the spend on with the only caveats being the treatments be open for everyone. And if medical data suggests postcode nuances are needed then it's one in, one out". Anything not on the list to be covered privately or not at all.

Long term financial planning and reviewing borrowing models would definitely be a good thing. Given the practicalities of government term limits and how funding is supplied the chances of a 10/15 year plan are unfortunately very limited.

[shed driver]

With drug therapies becoming more expensive, any long term funding program is liable to be derailed pretty quickly.

£1.79 million for one treatment.
BBC News - Spinal muscular atrophy: Gene therapy approved by NHS
https://www.bbc.co.uk/news/health-56315870

SD.

[turbobloke]

roger.mellie said:

Murph7355 said:

roger.mellie said:

Yip and that leads to some very complicated and emotive questions on which treatments should be provided for free on the NHS. In a finite funding model it can't do everything. But, being slightly flippant, if the principal that fat bds and skinny joggers get free knee surgery is accepted then we should fund the level of resources required .

I'm very open to looking at alternative funding models e.g. I've seen how health care works in UK, IRL, US, Japan, Canada and Finland through personal and familial experience. I don't like how the conversation always leads to assuming the UK would adopt a US model (which I'd never support), but there are good reasons for thinking that would be our government's preference.

Different topic really, but I don't "accept" the principle of fat b*stards / skinny joggers. I think some very tough decisions need to be made. But unfortunately don't think they ever will be.

Funding models - agree with you that we should look at all options. I am not sure I agree on any pre-ordained view that this government might have.

What I' really like to see happen is a proper cross-party working group put together to look at the options for funding.

In terms of priorities/scope, I would then leave that to medical professionals. "You have £10bn and not a penny more for the next 5/10/15yrs. Decide what you prioritise the spend on with the only caveats being the treatments be open for everyone. And if medical data suggests postcode nuances are needed then it's one in, one out". Anything not on the list to be covered privately or not at all.

Long term financial planning and reviewing borrowing models would definitely be a good thing. Given the practicalities of government term limits and how funding is supplied the chances of a 10/15 year plan are unfortunately very limited.

Currently ca £130bn / year (?) and there have been recent bailouts iirc.

[Murph7355]

roger.mellie said:

Long term financial planning and reviewing borrowing models would definitely be a good thing. Given the practicalities of government term limits and how funding is supplied the chances of a 10/15 year plan are unfortunately very limited.

If the cloth was cut according to what was viable to draw in via tax, I strongly suspect that not all current treatments could/should be provided free at the point of service...therefore "long term" wouldn't really have to need to be accounted for.

Long list of treatments with cumulative expected cost, ranked in terms of expected benefits by medical professionals...red line drawn where the current administrations funds run out and job done. If we all want more shovelled into the NHS, the next administration can pledge £xbn/x% more and the line just moves down the list. Job done.

shed driver said:

With drug therapies becoming more expensive, any long term funding program is liable to be derailed pretty quickly.

£1.79 million for one treatment.
BBC News - Spinal muscular atrophy: Gene therapy approved by NHS
https://www.bbc.co.uk/news/health-56315870

SD.

Cold as it may seem, then perhaps that treatment should stay below the red line mentioned above.

Medical science will keep on advancing. As will the costs associated with it. Unless there is an equal rise possible in income year on year (there isn't), something has to give.

[roger.mellie]

Murph7355 said:

roger.mellie said:

Long term financial planning and reviewing borrowing models would definitely be a good thing. Given the practicalities of government term limits and how funding is supplied the chances of a 10/15 year plan are unfortunately very limited.

If the cloth was cut according to what was viable to draw in via tax, I strongly suspect that not all current treatments could/should be provided free at the point of service...therefore "long term" wouldn't really have to need to be accounted for.

Long list of treatments with cumulative expected cost, ranked in terms of expected benefits by medical professionals...red line drawn where the current administrations funds run out and job done. If we all want more shovelled into the NHS, the next administration can pledge £xbn/x% more and the line just moves down the list. Job done..

I can't remember the exact stats but on the current trajectory the NI health budget will be 100% of the devolved budget within 20 years or something like that. There are huge inefficiencies in the NI health system. Pork barrel politics (e.g. no local politician will allow a local hospital closed to consolidate critical care elsewhere) continually contributes to those inefficiencies. Successive reviews have pointed out recommended savings and the political response has been "that's too hard, let's have another review".

I've less knowledge of the rest of the UK but I'm sure it also applies to some degree or other.

I'd be very supportive of any view that takes short term politics out of the longer view equation. We both know the accountability arguments against leaving things to experts rather than elected representatives though so it's not an easy ask.

ETA - found it - https://www.bbc.co.uk/news/uk-northern-ireland-485...
"We have enough money to run a world class health service, but we don't have enough money to run this health service."

Edited by roger.mellie on Monday 8th March 16:16

[anonymous-user]

Murph7355 said:

roger.mellie said:

Long term financial planning and reviewing borrowing models would definitely be a good thing. Given the practicalities of government term limits and how funding is supplied the chances of a 10/15 year plan are unfortunately very limited.

If the cloth was cut according to what was viable to draw in via tax, I strongly suspect that not all current treatments could/should be provided free at the point of service...therefore "long term" wouldn't really have to need to be accounted for.

Long list of treatments with cumulative expected cost, ranked in terms of expected benefits by medical professionals...red line drawn where the current administrations funds run out and job done. If we all want more shovelled into the NHS, the next administration can pledge £xbn/x% more and the line just moves down the list. Job done.

shed driver said:

With drug therapies becoming more expensive, any long term funding program is liable to be derailed pretty quickly.

£1.79 million for one treatment.
BBC News - Spinal muscular atrophy: Gene therapy approved by NHS
https://www.bbc.co.uk/news/health-56315870

SD.

Cold as it may seem, then perhaps that treatment should stay below the red line mentioned above.

Medical science will keep on advancing. As will the costs associated with it. Unless there is an equal rise possible in income year on year (there isn't), something has to give.

I’m sure you’d advocate that model admirably until it was you, your child or family who needed an urgent medical treatment that ‘fell below the line’.

Healthcare should not be something you need to worry about in a first world civilised country, irrespective of the cost. Yes perhaps there are elements that need to be reviewed in terms of how they are funded, obesity, alcohol / drugs related violence, injuries / treatment required as a result of criminal activities, etc.

The NHS needs to focus on efficiency of funds to increase its level of care not just shovel more money in.

My MIL had a stomach ache May 2019 thru Aug 2019, it was misdiagnosed by her GP, she had bowel cancer that spread to her ovaries, how can you plan for the unplanned? Or are you suggesting medical professionals need to assess a case based on age, cause and projected outcome and decide upon a persons right to live or their death?

[Captain Raymond Holt]

Douglas Quaid said:

I don’t understand why they’re complaining. Most of the year they’ve been quiet. They have guaranteed income. Millions of people have lost their jobs, NHS staff should count themselves lucky they have managed to keep theirs in my opinion.

This is an interesting post.

My wife an ITU medic and she (and her shift of nurses from last night) agree with you, most are pretty embarrassed about all the noise in the media. they get fed up of being told they’re poor, most aren’t.

For what you do you get paid pretty well, the progression is good, pension is good, job security is a case of ‘keep your PIN’ (you can make a mistake that kills someone and still keep it...).

A lot of people seem to love to get offended on their behalf.

[Wombat3]

Captain Raymond Holt said:

Douglas Quaid said:

I don’t understand why they’re complaining. Most of the year they’ve been quiet. They have guaranteed income. Millions of people have lost their jobs, NHS staff should count themselves lucky they have managed to keep theirs in my opinion.

This is an interesting post.

My wife an ITU medic and she (and her shift of nurses from last night) agree with you, most are pretty embarrassed about all the noise in the media. they get fed up of being told they’re poor, most aren’t.

For what you do you get paid pretty well, the progression is good, pension is good, job security is a case of ‘keep your PIN’ (you can make a mistake that kills someone and still keep it...).

A lot of people seem to love to get offended on their behalf.

NHS / Nurses being weaponised by the left for political gain - "plus ca change"

[ant1973]

roger.mellie said:

ant1973 said:

I think part of the problem is that there is no market mechanism in the UK for establishing nursing pay. The NHS is the 800lb gorilla that sets the scene. Presumably wages would rise naturally but for the NHS?

I doubt that anyone really grudges front line staff better pay and conditions. However, it's part of the wider question of how do we value work? Would you do a care home worker's job for £10 an hour? Are they worth more? Undoubtedly, yes. Same for other workers, too. People are more willing to value "work" based on its subjective value rather than its economic utility. Well, until you ask them to pay for it....

True, it's also hard to compare internationally as roles differ in different countries and averages don't take in the spread of how specialised the role may be. But when it's more free market driven such as in the US where health care is predominantly privatised the salaries do seem to be higher. However, countries like the UK & IRL also seem to have a net migration inwards when it comes to health care workers.

I remember at the start of the lockdowns many were expressing a view that it would cause some sort of reset on how we value the importance of certain roles. It's nice in theory but I suspect it will never happen in practice for the reasons you mention.

My aunt was a nurse who left the UK to work in the USA and the Middle East in the 1960s. She was very highly rewarded and rose to a senior managerial position. She definitely earned a lot more than would have been the case if she had stayed NHS. If there was no NHS and a privatised model, we would likely pay more (so a tax rise of sorts).

Edited by ant1973 on Monday 8th March 17:27

[Wombat3]

ant1973 said:

My aunt was a nurse who left the UK to work in the USA and the Middle East in the 1960s. She was very highly rewarded and rose to a senior managerial position. She definitely earned a lot more than would have been the case if she had stayed NHS. If there was no NHS and a privatised model, we would likely pay more (so a tax rise of sorts).

If we had a privatised model we would also probably find demand would be lower as well & in some cases (but not all) that would be a good thing.

Then again cost of treatments / prices would also certainly rise when you introduce a profit requirement.

Therefore on balance the model is probably the best one - but the outcomes & costs could be so much better if it was run better & not so wasteful and also if its customers/users didn't abuse it quite so much.

[LetsTryAgain]

Makes me laugh when the first response to (usually justified) criticism of the religion-of-the-NHS is - "Well, what do you want? The US version!?".
Like the only two countries which provide health care are the U.K and the US.

If the National Health Service could start being an actual health service, rather than National Illness Service, that'd be a good start.

[Wombat3]

anonymous said:

[redacted]

Yep externally, because too many people don't give a toss because "its free innit?". Therefore a massive program of education needed - which of course will simply confuse the hard of thinking, enrage the L'Oreal generation and probably then frighten large groups of the elderly.

Internally, too many vested interests, too much arse covering, too little accountability for outcomes and value is usually then the way with such vast organisations. - especially ones that know they will never be allowed to fail.

All the worst traits of British Leyland, British Steel, the GPO , the Gas Board, British rail & all those other marvelous 20th century nationalised industries rolled up together - but with a bulletproof coat on.

I have some sympathy for the people that have to try & run it - they are dealing with one of the top ten largest employers in the world with a customer base that thinks everything is free and systemic internal problems.Then, to compound things any push back in terms of the provision of services is automatically "inhumane" or weaponised for political gain.

[leef44]

LetsTryAgain said:

Makes me laugh when the first response to (usually justified) criticism of the religion-of-the-NHS is - "Well, what do you want? The US version!?".
Like the only two countries which provide health care are the U.K and the US.

If the National Health Service could start being an actual health service, rather than National Illness Service, that'd be a good start.

The challenge is to provide that service equally for both the wealthy and poor.

[Murph7355]

Lord.Vader said:

I’m sure you’d advocate that model admirably until it was you, your child or family who needed an urgent medical treatment that ‘fell below the line’.

Healthcare should not be something you need to worry about in a first world civilised country, irrespective of the cost. Yes perhaps there are elements that need to be reviewed in terms of how they are funded, obesity, alcohol / drugs related violence, injuries / treatment required as a result of criminal activities, etc.

The NHS needs to focus on efficiency of funds to increase its level of care not just shovel more money in.

My MIL had a stomach ache May 2019 thru Aug 2019, it was misdiagnosed by her GP, she had bowel cancer that spread to her ovaries, how can you plan for the unplanned? Or are you suggesting medical professionals need to assess a case based on age, cause and projected outcome and decide upon a persons right to live or their death?

This is why it shouldn't be left to an individual with no medical experience but an ill family to decide upon.

"Irrespective of the cost" is a nonsense. Everything is respective of the cost.

If my kids/family were ill I would do whatever it took to raise the funds to have them treated privately. Would I expect everyone else to foot a billion pound bill? No.

Nobody has a right to live forever. Nature sees to that.

Would you sooner one 69yr old has a billion spent on them to save that one life? Or 1,000 10yr olds have a million spent on them to save theirs? "Both" isn't a viable option unless one has the plan to ensure that both can be fully funded.

[johnboy1975]

Wombat3 said:

All the worst traits of British Leyland, British Steel, the GPO , the Gas Board, British rail & all those other marvelous 20th century nationalised industries rolled up together - but with a bulletproof coat on.

I have some sympathy for the people that have to try & run it - they are dealing with one of the top ten largest employers in the world with a customer base that thinks everything is free and systemic internal problems.Then, to compound things any push back in terms of the provision of services is automatically "inhumane" or weaponised for political gain.

Excellent post

[nikaiyo2]

monkfish1 said:

Why are they doing that. Surely no one is "forcing them " to do so?

Because the Public Sector is SO UNDER PAID that they need to match those ludicrously low salaries to attract staff.

[CrutyRammers]

LetsTryAgain said:

Makes me laugh when the first response to (usually justified) criticism of the religion-of-the-NHS is - "Well, what do you want? The US version!?".
Like the only two countries which provide health care are the U.K and the US.

Yes, they really are the two extremes at opposite ends, and many people can't see all the stuff in the middle. Germany? France? Sweden? Don't exist. It's either ALL nationalised or ALL privatised.

[Murph7355]

roger.mellie said:

I can't remember the exact stats but on the current trajectory the NI health budget will be 100% of the devolved budget within 20 years or something like that. There are huge inefficiencies in the NI health system. Pork barrel politics (e.g. no local politician will allow a local hospital closed to consolidate critical care elsewhere) continually contributes to those inefficiencies. Successive reviews have pointed out recommended savings and the political response has been "that's too hard, let's have another review".

I've less knowledge of the rest of the UK but I'm sure it also applies to some degree or other.

I'd be very supportive of any view that takes short term politics out of the longer view equation. We both know the accountability arguments against leaving things to experts rather than elected representatives though so it's not an easy ask.

ETA - found it - https://www.bbc.co.uk/news/uk-northern-ireland-485...
"We have enough money to run a world class health service, but we don't have enough money to run this health service."

Missed this yesterday Rog'.

Agree with you, and I would be shocked if GB wasn't in the same situation as NI.

Inefficiencies aren't really the only answer. I think I've read objective reports that suggest for what it is, the NHS actually isn't that inefficient. Can't recall where, and as a natural cynic I was....cynical. But some of the logic stood up. It's a huge organisation and the larger organisations get, the more friction/inefficiency you get really.

We appear to have both a very large leaky bucket and a tap that we keep turning on more and more and that has no stop. Like many of the problems we are suffering (e.g. taxation/spending) it's one that needs hitting from both ends. But politically that never seems to be the soup du jour.

Hey ho. My underlying belief is that one day we will have no choice. The wheels will fall off all the borrowing/squeezing the tax pips. At which point the whole system will collapse back and *only* be able to provide emergency care at best. At which point it won't be the "rich" that will suffer most. So it's in absolutely everyone's interests to take a far more grown up and pragmatic view on how the service should be taken forwards, what does and does not get paid for etc.

Will never happen

[Digga]

Murph7355 said:

Inefficiencies aren't really the only answer. I think I've read objective reports that suggest for what it is, the NHS actually isn't that inefficient. Can't recall where, and as a natural cynic I was....cynical. But some of the logic stood up. It's a huge organisation and the larger organisations get, the more friction/inefficiency you get really.

I don't bu that. There are bits of the NHS - as a good example I'd say the teams manning the X-Ray and scanning machines - that are hugely productive and efficient. then, like a lot of enclaves of the public sector, there are the backwaters of the idle, feckless, jobsworth, seat-shining, 35 minute working flexi-week.

I have to be careful what I say, but I have friends in NHS, civilian police, and EA who cite numerous examples of completely useless management and attitudes. These people themselves realise their 'every Wednesday afternoon off' flex schedule is part of the problem but are happy with the perks, despite the knowledge their absence often impacts on the delivery of 'something' to a member of the public, be that business or private.

To have the scale but so few of the benefits of it is an abject failure. NHS could probably learn a lot from McDonalds in many regards.