NHS whats happened?

[Ntv]

oyster said:

pavarotti1980 said:

Ntv said:

Higher tax in part due to huge cost of COVID response - a policy to protect the elderly primarily.

I don't get your last sentence. The point is that income tax, in effect (not quite, but close), is comprised of Income Tax plus NICs. And the latter are not paid by those who are retired. Meaning a working person earning £50k pays far more "income tax" than a retired person with pension income of £50k.

Can you explain why you think this is fair?

Has you tax gone up (%) since 2019/20 and COVID?

Its fair because they have paid for the previous generation of pensioners whilst of working age. The current generation who now have to work longer before state pension age will pay for this generation.

But the model you're siggesting isn't sustainable is it?
We have increased NHS spending, increased taxes on working people, increased deficit and increased debt.
Where next?

Why is there this belief that pensioners are impoverished, having worked a life of toil and contribution and should be granted all benefits for however long they live and however much service they consume, all whilst contributing far less to the pot they take most from?

0.5% annual levy on all net assets would solve the imbalance right away, even if you kept NIC rules as now. Own a £1m home with no mortgage and another £300k in the bank (as most retired folk round me do) - annual levy of £6,500.
If you're genuinely impoverished and own no assets - annual levy £0.

It's worse that most people realise, as the employed pay (in economic terms) employer NICs too.

[Brave Fart]

oyster said:

<edited for brevity>
0.5% annual levy on all net assets would solve the imbalance right away, even if you kept NIC rules as now. Own a £1m home with no mortgage and another £300k in the bank (as most retired folk round me do) - annual levy of £6,500.
If you're genuinely impoverished and own no assets - annual levy £0.

I completely disagree with your wealth tax idea, for several reasons, including the following:

• wealth tax is double taxation. Someone who has bought and maintained their own home out of taxed income should not be taxed on that amount again.
• wealth tax is very difficult to apply to assets such as defined benefit pensions, shares in unlisted businesses and so on.
• wealth tax as you describe can only be a one off. It is illogical to tax wealth annually; it would be taxing the balance sheet not the P&L.
• wealth tax penalises the thrifty. Why bother improving your home and paying off a mortgage? The good citizen who does so pays wealth tax, while the spendthrift who's blown the money pays nothing. That can't be right.
• many older folk are asset rich but cash poor and would be unable to pay the tax.
• neither of the main parties are proposing this - Labour's Rachel Reeves confirmed that this week. Aiming a tax at those who have worked hard to own their home and/or paid into their pension fund is political suicide.

[Ntv]

Brave Fart said:

oyster said:

<edited for brevity>
0.5% annual levy on all net assets would solve the imbalance right away, even if you kept NIC rules as now. Own a £1m home with no mortgage and another £300k in the bank (as most retired folk round me do) - annual levy of £6,500.
If you're genuinely impoverished and own no assets - annual levy £0.

I completely disagree with your wealth tax idea, for several reasons, including the following:

• wealth tax is double taxation. Someone who has bought and maintained their own home out of taxed income should not be taxed on that amount again.
• wealth tax is very difficult to apply to assets such as defined benefit pensions, shares in unlisted businesses and so on.
• wealth tax as you describe can only be a one off. It is illogical to tax wealth annually; it would be taxing the balance sheet not the P&L.
• wealth tax penalises the thrifty. Why bother improving your home and paying off a mortgage? The good citizen who does so pays wealth tax, while the spendthrift who's blown the money pays nothing. That can't be right.
• many older folk are asset rich but cash poor and would be unable to pay the tax.
• neither of the main parties are proposing this - Labour's Rachel Reeves confirmed that this week. Aiming a tax at those who have worked hard to own their home and/or paid into their pension fund is political suicide.

Being in Govt. is political suicide these days!

I would like to seem them look at:

- NICs for the retired
- Inheritance tax - where is the tax take optimised
- Further windfall taxes

Most of all we need to grow the ste economy we have.

I agree there are big issues with a wealth tax. Though note that much income is taxed multiple times (e.g. take saving for and then buying a house and passing it on ... income tax, tax on investment returns (arguably), stamp duty, inheritance tax).

Agree the distortion impacts to overcome are significant.

[Freakuk]

Personally I don't think the NHS needs any more money, it's the way it's being spent that's the issue. There's a hell of a lot of rinse and repeat within the NHS and a lot of inefficiencies which ultimately are costing them money.

You only have to look a few years ago back to 2017 when they were hit by a ransomware attack on Windows 7 and Windows XP machines!!! If the IT systems are that old, can you imagine what they must be paying to 3rd parties to maintain support, broaden that across the whole organisation and it'll be a huge scale of mis-investment or lack of investment to incur such technical debt.

https://www.england.nhs.uk/wp-content/uploads/2018...

I read certain practices had completely changed the way they were working to get through their backlog a few weeks ago and now some practices don't have waiting list for operations/procedures, if they can do it the rest surely can?

The chicken and egg though is recruitment, if you were at school/college and you saw the constant news about how bad the NHS is would you want to go to Uni and then apply for a job that runs you into the ground, doesn't pay that well?

[Mr Whippy]

pavarotti1980 said:

Mr Whippy said:

Diabetics who are overweight?
Overweight fine, diabetic fine, but both? Should we pay to cover idiocy?

Heart disease, fine, but on top of being unhealthy for years on end? No.

Very clearly by providing help these people don’t learn a lesson and carry on being a burden.
Now if we lived in a super rich society with infinite resources, fine, but we don’t, so we shouldn’t enable people to abuse their bodies at societies cost.

Sports injuries? Getting less clear now. No one plays or partakes in sports knowing they’ll be injured.
Maybe if a doctor or gp has advised for years after many visits that the activity isn’t wise, then fair play… say they’ll not be covered and need insuring.

RTC, no one plans on crashing. This is exactly what the NHS is there for… the out of the blue life-threatening accidents.

Or there for people whose bodies just fail.



It’s very clear where the lines are in my view.

Just it seems no one is willing to be harsh about it.

People won’t learn and change while we have a system that enables them to be the way they are.
The NHS and government are enablers. They’re as bad as the people being the burden.

basically charge drunks as that will solve the NHS crisis...

Edited by pavarotti1980 on Friday 13th January 12:30

Nope.

Charge those who abuse their bodies despite being asked/advised not to.

Being obese with chronic illnesses is utterly daft for any sensible person, yet they keep doing it because they’re idiots and society are enablers!

Financial cost might motivate them to change their minds.

If we don’t do it this way, it’ll be done when it’s all privatised any way.

[ant1973]

The basic problem is financial. I dare say there are efficiency gains to be made, but the idea that we can run a champagne service on lemonade money is pretty unlikely. If that was the case everyone else would be doing it all around the world. Within margins of error, you get what you pay for. Most other comparator countries spend more than we do overall (and have done for longer). Few, however, commit as much public expenditure to health as we do. The balance is made up of private money. Even if that provided better outcomes overall, it is regarded as a politically unacceptable solution. The Tories can't do it because whatever the truth of the matter, they will be labelled as "evil". Nor can Labour - the left see the NHS as the last untouched socialist totem.

No right thinking person could regard the NHS as being the envy of the world. It's just another silly example of British exceptionalism that has no basis in fact.

The issue is really who pays. Most higher earners have a tax burden broadly comparable to most European "social democratic" countries. There is not enough of them to wring anymore out of them. Lower and middle earners pay considerably less, but the politics of the UK mean that everyone has to commit to not altering basic rate of income tax, NIC and VAT. Those are the big tax levers and they are politically static.

When Corporation Tax rises to 25% we will have close to the highest effective rate of corporate tax in comparator countries. So not much left there. Social contributions from companies could rise a little, but not enough to make a difference.

So we are stuck. By stealth, taxes are rising through fiscal drag. But the process is slow. Those who can afford private treatment simply get on with it. But given that it is politically unacceptable to contemplate using the private option (see this week's PMQ's), it is clearly not a viable solution at present. Equally, no one is prepared to commit more public money to the NHS. The right believe that efficiency gains are a complete answer and the left find the idea of profit and healthcare are abhorrent. Both are wrong but the consequence is stalemate.

Also, most of the public don't want to pay more in tax. That means a majority of the electorate want someone else to pay. But there is little more to be gained from high earners. More borrowing is out for obvious reasons.

When it breaks it will get fixed.

But not before.

[oyster]

pavarotti1980 said:

Ntv said:

Pleased your tax hasn't changed over the past 3 years. That is quite remarkable given the various changes to rates and thresholds. 99.9X% of people will have a different level of tax. Most people are paying more tax, sadly.

Tax to GDP has essentially been heading upwards in the UK for about 30 years, with a very sharp pick up in the last two years. On top of what's counted as tax, the state, in the broadest sense, I suspect takes more of our money in fines/charges than it used to.

Edited by Ntv on Friday 13th January 14:57

% rate has remained the same

I dont compare my contributions with GDP, sorry I don't earn that much

That's quite astonishing, if true.

Personal allowance has gone up 0.56% from £12,500 to £12,570
Allowance withdrawal has gone up 0% from £100,000 to £100,000

Higher tax rate threshold has gone up 0.54% from £50,000 to £50,270
Additional tax rate threshold up 0%

Class 4 NICs up from 9% to 9.73% (and from 2% to 2.73% above the upper limit)

So unless you have had less than a 0.54% pay rise over the last 3 years, you will be paying more income tax as a percentage of your income.


Oh and presumably you pay utilities and motor fuels. So you'll be paying a lot more VAT on those, unless your salary has gone up by an equivalent amount? Oh hang on, if it has then you're paying more income tax.

[oyster]

Freakuk said:

Personally I don't think the NHS needs any more money, it's the way it's being spent that's the issue. There's a hell of a lot of rinse and repeat within the NHS and a lot of inefficiencies which ultimately are costing them money.

You only have to look a few years ago back to 2017 when they were hit by a ransomware attack on Windows 7 and Windows XP machines!!! If the IT systems are that old, can you imagine what they must be paying to 3rd parties to maintain support, broaden that across the whole organisation and it'll be a huge scale of mis-investment or lack of investment to incur such technical debt.

https://www.england.nhs.uk/wp-content/uploads/2018...

I read certain practices had completely changed the way they were working to get through their backlog a few weeks ago and now some practices don't have waiting list for operations/procedures, if they can do it the rest surely can?

The chicken and egg though is recruitment, if you were at school/college and you saw the constant news about how bad the NHS is would you want to go to Uni and then apply for a job that runs you into the ground, doesn't pay that well?

I'd be inclined to agree with your viewpoint when, or if, the UK matches other countries for spend per head on health. Until that point, it's hard to argue it's got enough money.

[Brave Fart]

Ntv said:

Being in Govt. is political suicide these days!

I would like to seem them look at:

- NICs for the retired
- Inheritance tax - where is the tax take optimised
- Further windfall taxes

Most of all we need to grow the ste economy we have.

I agree there are big issues with a wealth tax. Though note that much income is taxed multiple times (e.g. take saving for and then buying a house and passing it on ... income tax, tax on investment returns (arguably), stamp duty, inheritance tax).

Agree the distortion impacts to overcome are significant.

When you say "NICs for the retired", do you mean applying NI deductions to their state pension, their earnings, or both? The former makes no sense because the typical state pension is below the NI threshold, and many retired folk have no employment earnings anyway (and no employer, obviously). I am not clear to what income you'd be applying NIC's.

By the way, I regard Inheritance Tax as a wealth tax and believe it should be abolished - probably a minority view I suspect. It only brings in around £6 billion p.a. anyway, so isn't a game changer.

I concur with your comment about growing the economy. That is the real answer to our problems, yet none of our politicians seem able to address it. Well, Truss and Kwarteng had a go, but the less said about that, the better!

[oyster]

Brave Fart said:

oyster said:

<edited for brevity>
0.5% annual levy on all net assets would solve the imbalance right away, even if you kept NIC rules as now. Own a £1m home with no mortgage and another £300k in the bank (as most retired folk round me do) - annual levy of £6,500.
If you're genuinely impoverished and own no assets - annual levy £0.

I completely disagree with your wealth tax idea, for several reasons, including the following:

• wealth tax is double taxation. Someone who has bought and maintained their own home out of taxed income should not be taxed on that amount again.
• wealth tax is very difficult to apply to assets such as defined benefit pensions, shares in unlisted businesses and so on.
• wealth tax as you describe can only be a one off. It is illogical to tax wealth annually; it would be taxing the balance sheet not the P&L.
• wealth tax penalises the thrifty. Why bother improving your home and paying off a mortgage? The good citizen who does so pays wealth tax, while the spendthrift who's blown the money pays nothing. That can't be right.
• many older folk are asset rich but cash poor and would be unable to pay the tax.
• neither of the main parties are proposing this - Labour's Rachel Reeves confirmed that this week. Aiming a tax at those who have worked hard to own their home and/or paid into their pension fund is political suicide.

Some good points there.
The last one is the biggest hurdle of course. Having said that, the current government have gone from 80 seat majority to almost certain landslide loss in a single parliament, so political suicide hasn't stopped policy changes recently!
Already taxed income. Yes but stamp duty, VAT, APD, IPT, IHT blah blah blah - already taken from taxed income.
Pensions have a separate tax treatment already, so would likely be excluded.
One off or ongoing? Council tax is ongoing, based on a form of wealth. Besides, it's a tax, when has logic come into it?!
Thrifty versus spendaholic - the spendaholic is likely to contribute a lot more VAT, duty etc
Asset rich, cash poor. Just like any other tax, if you know it's coming you plan for it.

[Brave Fart]

oyster said:

Some good points there.
The last one is the biggest hurdle of course. Having said that, the current government have gone from 80 seat majority to almost certain landslide loss in a single parliament, so political suicide hasn't stopped policy changes recently!
Already taxed income. Yes but stamp duty, VAT, APD, IPT, IHT blah blah blah - already taken from taxed income.
Pensions have a separate tax treatment already, so would likely be excluded.
One off or ongoing? Council tax is ongoing, based on a form of wealth. Besides, it's a tax, when has logic come into it?!
Thrifty versus spendaholic - the spendaholic is likely to contribute a lot more VAT, duty etc
Asset rich, cash poor. Just like any other tax, if you know it's coming you plan for it.

Likewise, in that you also make some good points. The pension one is interesting, in that many people have a modest home but have a fantastic defined benefit pension, perhaps as a result of public sector service. My mother has drawn an index linked pension from the age of 50-ish (she was a school teacher). She's 88 years young now, bless her; the capital you'd need to fund that arrangement would be huge, I imagine. One might wonder why a house would be taxed while a pension wouldn't.

There's also the issue of who would value one's wealth. We'd need an army of public servants visiting people's houses - assuming they were allowed in, which they might not be. Then there'd be endless appeals disputing the valuation. It'd be an administrative nightmare. People would move liquid assets offshore to avoid tax.

Those other taxes you mention are either discretionary (such as APD) or are part of receiving some benefit - yes one suffers VAT but one is receiving goods or services in return. Ditto council tax. A wealth tax would be handing money to Jeremy Hunt (yay!) with no direct benefit. As I mentioned in another post, I would abolish IHT.

[petop]

The other half has just gone back to the NHS after time away. Prior to starting she goes in to give her uniform sizes and couple weeks later she goes back to pick up. 2 of the tunic tops things are definitely 2nd hand and trousers done fit. Now you would think that in this well funded billion pound entity in the health clean environment she is in, they could not issue new uniform? In the end she got right sizes and new tunics.
Starts her work on the ward and night shifts are mentioned during recruitment stages. Turns out though that there is bit of a clique and nightshifts are taken up with agency (£££) workers..."good luck getting a night shift", she was told.
The staff meetings are the most dis-organised things she has attended. They all moan about each other, no actual decisions are made and woe betide anyone come up with a better easier idea.

[pavarotti1980]

oyster said:

That's quite astonishing, if true.

Personal allowance has gone up 0.56% from £12,500 to £12,570
Allowance withdrawal has gone up 0% from £100,000 to £100,000

Higher tax rate threshold has gone up 0.54% from £50,000 to £50,270
Additional tax rate threshold up 0%

Class 4 NICs up from 9% to 9.73% (and from 2% to 2.73% above the upper limit)

So unless you have had less than a 0.54% pay rise over the last 3 years, you will be paying more income tax as a percentage of your income.


Oh and presumably you pay utilities and motor fuels. So you'll be paying a lot more VAT on those, unless your salary has gone up by an equivalent amount? Oh hang on, if it has then you're paying more income tax.

So it's not 20%/40% tax at PAYE?

[Spare tyre]

Sadly this time last year I was told I had cancer and needed treatment

Got the diagnosis then nothing for weeks and weeks, kept ringing and chasing up was really weird

It wasn’t until I became a pest I finally got the name of the surgeons PA and eventually got squeezed in - even on the day it was not certain if I’d get my op, my life was kind of on hold and wife in bits etc


The cynical part of me thinks it’s the tories making it such a bad service that only privatisation will seem like the next steps, so they can divide the best bits up to line their pockets

I will take my foil hat off now

[Electro1980]

Freakuk said:

Personally I don't think the NHS needs any more money, it's the way it's being spent that's the issue. There's a hell of a lot of rinse and repeat within the NHS and a lot of inefficiencies which ultimately are costing them money.

You only have to look a few years ago back to 2017 when they were hit by a ransomware attack on Windows 7 and Windows XP machines!!! If the IT systems are that old, can you imagine what they must be paying to 3rd parties to maintain support, broaden that across the whole organisation and it'll be a huge scale of mis-investment or lack of investment to incur such technical debt.

Why do you think they were using Win 7 and XP machines? Because there was no money to upgrade and replace all of the critical applications. Lack of funding for critical infrastructure, like updating critical applications, is one of the issues.

[gazza285]

Spare tyre said:

The cynical part of me thinks it’s the tories making it such a bad service that only privatisation will seem like the next steps, so they can divide the best bits up to line their pockets

I have never understood this viewpoint, as this would be a massive vote loser for them.

[pquinn]

Spare tyre said:

Sadly this time last year I was told I had cancer and needed treatment

Got the diagnosis then nothing for weeks and weeks, kept ringing and chasing up was really weird

It wasn’t until I became a pest I finally got the name of the surgeons PA and eventually got squeezed in - even on the day it was not certain if I’d get my op, my life was kind of on hold and wife in bits etc


The cynical part of me thinks it’s the tories making it such a bad service that only privatisation will seem like the next steps, so they can divide the best bits up to line their pockets

I will take my foil hat off now

So the staff don't perform, yet the politicians *who don't even run it* are the ones to blame and not the organisation or the people in it?

No wonder the NHS gets away with being so crap.



As for the 'more money' argument some people seem to favour, please point out where any of the previous substantial lumps of cash have made any noticeable difference.

[XCP]

Retired people do pay NIC. I have an occupational pension, and payed NI on my part time earnings.

[wisbech]

pquinn said:

So the staff don't perform, yet the politicians *who don't even run it* are the ones to blame and not the organisation or the people in it?

No wonder the NHS gets away with being so crap.



As for the 'more money' argument some people seem to favour, please point out where any of the previous substantial lumps of cash have made any noticeable difference.

This was fairly noticeable

[djc206]

Ntv said:

Being in Govt. is political suicide these days!

I would like to seem them look at:

- NICs for the retired
- Inheritance tax - where is the tax take optimised
- Further windfall taxes

Most of all we need to grow the ste economy we have.

I agree there are big issues with a wealth tax. Though note that much income is taxed multiple times (e.g. take saving for and then buying a house and passing it on ... income tax, tax on investment returns (arguably), stamp duty, inheritance tax).

Agree the distortion impacts to overcome are significant.

The simplest route is the abolition of National Insurance, just roll it into income tax and apply the qualifying years principle to that. The older generations as a collective categorically have not paid their fair share, not their fault, they simply weren’t expected to live as long as they have and there was little predicting just how good modern medicine would be at keeping people ticking. That being said they should be putting their hands in their pockets not those of the working population to support their peers.

Inheritance tax is quite lenient in its application, a lot of us avoid it by gifting, maybe tightening those rules would be a start. You could probably make a reasonable argument for treating any inherited money above a certain figure as income to be taxed accordingly but I’ve not given it much thought.

Yep, multiple layers of taxation are abundant so that doesn’t form an argument against a wealth tax. Personally I’d like to see a move to a % property tax to replace council tax, set locally to reflect local earnings and house values such that the “average” household pays no more than at present. If the owner can’t pay immediately a charge could be levied against the asset to be paid upon its disposal with an appropriate level of interest applied.

As for the NHS. I think we need to look at the more successful systems around and reform the NHS to look more like them. That and we need to teach the British public that free at the point of use doesn’t equal free and that they shouldn’t be abusing it to the degree they are. fk off with your prescription paracetamol, going to your GP with a verruca or visiting A&E because your GP surgery has correctly triaged your complaint as non urgent/non existent. But yeah mostly it’s the fact that the Tories have driven the whole thing into the ground, just like every other public service.