NHS whats happened?

[Ntv]

pavarotti1980 said:

Ntv said:

Paid for a smaller state and smaller health service.

Taxes have gone up generally, though have gone up less for the retired population than rest of the population, despite them being the big consumers of the services that increased revenue is needed for.

Why should there be a huge (effective) income tax reduction on retirement?

I do agree it needs to be phased in, as the differential is so vast.

Larger state currently paying for larger health service

Income tax reduction due to income reduction dropping them below taxation thresholds. Same as a working person receiving the lower levels of income.

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?

[BabySharkDD]

Getragdogleg said:

Locally the care used to be spread around multiple hospitals.

We had a town a and e, a maternity hospital, a respite hospital many satellite clinics.

All gone, now its all at the main city hospital and they can't cope.

They were supposed to improve the main hospitals to ‘super hospital’ status. Instead it seems that smaller units were shut and no improvements were made.

Cottage hospitals would be a huge help right now.

[worsy]

rdjohn said:

<snip>

We asked her why nurses were working 16-hour shifts, its because it suits them, they rack up a lot of hours in 3-days and then get 4-days off.

</snip>

Bonkers.

[TCX]

All through summer regularly saw upto 18 ambulances sitting with patients in Southend hospital car park,all day,since then most of the contracts dealing with backlog surgery have been cancelled,making space for winter bed requirements and allowing for nurses strike,so backlog just going to get bigger

[Olivera]

fat80b said:

Why should someone who takes a year or so to die of cancer be fully funded but someone who takes a year to die of dementia has to pay for it all themselves?

I personally think there is something wrong here with the current implementation that Boris was attempting to fix - it wasn’t about preserving inheritances…

So the two scenarios are:

A) Person pays for dementia care out of their own estate, albeit equivalent long term NHS illness care might be paid for by the state
B) Person pays for some dementia care out of their own estate (capped at 86k), the public purse picks up the remaining amount (possibly a lot higher than 86k) so that an inheritance is preserved for beneficiaries, and people of working age pay additional social care NI which current elderly tory cohorts are exempt from

I'm not sure how you can possibly argue that B is fairer.

[TwistingMyMelon]

BabySharkDD said:

Getragdogleg said:

Locally the care used to be spread around multiple hospitals.

We had a town a and e, a maternity hospital, a respite hospital many satellite clinics.

All gone, now its all at the main city hospital and they can't cope.

They were supposed to improve the main hospitals to ‘super hospital’ status. Instead it seems that smaller units were shut and no improvements were made.

Cottage hospitals would be a huge help right now.

They might, but you will need the people to staff them

People seem to get fixated with the buildings when its the staff to work in them when it is more the staff to work in them is more the issue

[pavarotti1980]

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.

[fat80b]

Olivera said:

So the two scenarios are:

A) Person pays for dementia care out of their own estate, albeit equivalent long term NHS illness care might be paid for by the state
B) Person pays for some dementia care out of their own estate (capped at 86k), the public purse picks up the remaining amount (possibly a lot higher than 86k) so that an inheritance is preserved for beneficiaries, and people of working age pay additional social care NI which current elderly tory cohorts are exempt from

I'm not sure how you can possibly argue that B is fairer.

I’m not arguing that point - I’m merely pointing out that there are other inequalities in the current system that are also considered “unfair” way before you get to an argument around the pros and cons of inheritances, tax, and benefits etc when it comes to social care funding.

When considering what an a actual “fair” approach is, I think you need to think about all of these unequal pieces and not just the single issue of “inheritances innit - the rich should pay more” as the only unfairness that needs fixing.

[pavarotti1980]

worsy said:

Bonkers.

Also seems like a load of bks to do 3 x 16 hours as the NHS working week averages as 37.5 hours so doing long days is normally 12 hour shifts and then one short day to make up the shortfall of 6 hours.

[JagLover]

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?

Because NI is not actually supposed to be a tax but rather a national insurance scheme the vast majority of which goes to fund the basic state pension. Therefore once you are actually drawing a pension you are in receipt of the insurance benefit for which you have been paying.

There is a valid debate to be sure about how much it has become just another tax with the erosion of contributory benefits and the end to the earnings related element of the state pension, but that is the justification.

[Olivera]

fat80b said:

When considering what an a actual “fair” approach is, I think you need to think about all of these unequal pieces and not just the single issue of “inheritances innit - the rich should pay more” as the only unfairness that needs fixing.

The ironic thing is that Boris' plan started from a premise which is the exact reverse of your statement: "inheritances innit - the rich should pay less”. The core component of this policy was a politically motivated starting point of preserving inheritances (preventing them from being eaten up by social care costs), then working back from there to everything else.

[chemistry]

Olivera said:

So the two scenarios are:

A) Person pays for dementia care out of their own estate, albeit equivalent long term NHS illness care might be paid for by the state
B) Person pays for some dementia care out of their own estate (capped at 86k), the public purse picks up the remaining amount (possibly a lot higher than 86k) so that an inheritance is preserved for beneficiaries, and people of working age pay additional social care NI which current elderly tory cohorts are exempt from

I'm not sure how you can possibly argue that B is fairer.

Arguably both are unfair; there are so many different scenarios in which the would be winners and losers. For example, option B is 'unfair' when considered in context of someone who has never had a job in their life versus someone who has worked hard, paid taxes and built up a moderate inheritance...why should the latter person be unable to pass on any money, whilst the former has everything paid for (again)?

I think the only way to deal with rising healthcare costs, regardless of the state/future of the NHS, is for everyone to pay more, albeit under a progressive tax system. Wealth taxes etc. won't work, only delay the inevitable (once the wealth has been taxed away, or fled, what then?) so if we each want the NHS to look after us using ever more expensive treatments and for longer and longer lives, we each have to fund a good chunk of that ourselves.

[BobToc]

BabySharkDD said:

Getragdogleg said:

Locally the care used to be spread around multiple hospitals.

We had a town a and e, a maternity hospital, a respite hospital many satellite clinics.

All gone, now its all at the main city hospital and they can't cope.

They were supposed to improve the main hospitals to ‘super hospital’ status. Instead it seems that smaller units were shut and no improvements were made.

Cottage hospitals would be a huge help right now.

Cottage hospitals is just another term for social care capacity. As another person has replied, that’s primarily a question of staffing (the oft quoted statistic of there now being 50% less district nurses is a relevant one).

As for concentrating care geographically, it’s generally improved outcomes (if and when I need cardiac surgery I want the busiest surgeon around, and if I have a stroke then the family has been briefed to do everything they can to make sure I get to a stroke centre).

[Murph7355]

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?

It's best not to bring "fair" into it as life isn't.

They should have rolled NI into Income Tax a long time ago. But govts since time began have become well versed in having two bites at the cherry.

[pquinn]

bigandclever said:

Klippie said:

The problem is with GP's...its widly reported that tyring to get a GP appointment is along the same odd's as winning the lottery, people can't get to see a doctor the next port of call is a hospital.

These stuck up cretins need to be taken down a peg or two, they are hired to provide a service not to dictate why they should not be seeing patients, they are no different to any other employee and should be treated no differently.

Not sure if that's satire or not, but the BMA and the European Union of General Practitioners say a safe number of patient contacts per day is 25. Across the board GPs deal with getting on with double that. Fundamentally we need more GPs not an attitude readjustment (well, maybe the great unwashed could start taking some responsibility).

Well apart from your little dig at the 'customer' being the problem, have you any data on what the professional regulator has to say about good practice as opposed to the unions whose primary goal seems to be the benefit of the members (aka minimum work for maximum pay). I know who I trust to keep GPs doing safe things and it definitely isn't the BMA.


Someone might also like to look at what has pushed so many GPs to be part timers, and maybe sort that. And not necessarily in a nice way.

[Murph7355]

chemistry said:

Arguably both are unfair; there are so many different scenarios in which the would be winners and losers. For example, option B is 'unfair' when considered in context of someone who has never had a job in their life versus someone who has worked hard, paid taxes and built up a moderate inheritance...why should the latter person be unable to pass on any money, whilst the former has everything paid for (again)?

I think the only way to deal with rising healthcare costs, regardless of the state/future of the NHS, is for everyone to pay more, albeit under a progressive tax system. Wealth taxes etc. won't work, only delay the inevitable (once the wealth has been taxed away, or fled, what then?) so if we each want the NHS to look after us using ever more expensive treatments and for longer and longer lives, we each have to fund a good chunk of that ourselves.

There are loads of ways it could be done to be "fair" (as noted, nothing really is)...

Where elderly care is concerned, they could provide a basic level of provision for anyone who needs it. State funded, but basic.

If you want better care, you get a credit note for the amount the state care would have cost, and you can spend it, plus top up, with whomever you want (direct payment to nominated care provider... Have to be registered etc). But the state's obligation during that time is done.

If you run out of cash, you can fall back into the basic level of care and your credit note stops.

[chemistry]

Murph7355 said:

There are loads of ways it could be done to be "fair" (as noted, nothing really is)...

Where elderly care is concerned, they could provide a basic level of provision for anyone who needs it. State funded, but basic.

If you want better care, you get a credit note for the amount the state care would have cost, and you can spend it, plus top up, with whomever you want (direct payment to nominated care provider... Have to be registered etc). But the state's obligation during that time is done.

If you run out of cash, you can fall back into the basic level of care and your credit note stops.

I agree. Rightly or wrongly, I think that NHS/social care is going to become increasingly basic, with people who can afford it having the option to pay more if they choose to.

[Ntv]

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.

Yes, my tax certainly has gone up, through various reductions in allowances, due payment times, freezing of thresholds etc. It's gone up quite a bit (making the necessary assumption that income was level).

Ah I see your position, it's fair because it was done in the past.

Not a great argument irrespective of the underlying subject matter, but I sense you are stuck in that way of thinking.

[Mr Whippy]

pavarotti1980 said:

Mr Whippy said:

So pensioners need to pay NI.

Then build pensioner hospitals which can clear out hospitals for accidents/body faults sorts of stuff.

NI based on BMI.

Stop providing free care for heavily drunk people.

What about free care for:
diabetics due to excess weight?
heart disease to unhealthy lifestyle?
sports injuries?
RTC injuries (free at the point of care but insurance pays up eventually)

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.

[Earthdweller]

pavarotti1980 said:

worsy said:

Bonkers.

Also seems like a load of bks to do 3 x 16 hours as the NHS working week averages as 37.5 hours so doing long days is normally 12 hour shifts and then one short day to make up the shortfall of 6 hours.

Well there’d be no 16 hour shifts rostered that’s for sure

My wife’s a nurse and she worked 12hr days or 13hr shifts on nights in ICU .. sometimes like any job she might not get off on time though

She would do either three or four nights in a row which with the way they rostered the shifts she could often have 6 or 7 days off, sometimes more with time owed and an odd annual leave day chucked in

She really liked it and the time off was amazing .. certainly the work was hard, very draining but very rewarding