Do you want to discuss boring politics? (36 Viewers)

[shmmeee]

Some good news for you:

” For the 30 years up to 2011, the number of people dying in the UK was falling but that has changed as the people born during the boom in births following World War Two have grown old. Over the next decade, the number of deaths a year is expected to increase by 12%. “

Copied from:-

Assisted dying debate: The UK’s real problem with palliative care

The UK was once ranked the best country for end-of-life care - but, say experts, that has all changed

www.bbc.co.uk

Really annoying to me for two reasons, one being how much time, effort and money was sent in the early 2010s on developing community end of life care to facilitate people whose preference was to die at home. The second is that, having been unaware of the current situation described that, despite having being involved in all that work at the time, I personally didn’t have a huge desire to die at home. My preference is not to die at all, although my belief is that immortality as a stand alone concept is probably not all that great a prospect. Immortality and everlasting health would be the minimum requirement. As that personal preference isn’t going to happen, it is extremely upsetting to see how poor hospital end of life care is being reported to be.

I dread it. Would rather work until I drop dead than dribble away in a retirement home for decades. I wonder if everyone’s dread of it is part of what stops us actually tackling it. It’s why I’m pro assisted dying. I don’t want to be forced into a hospice or whatever if it comes to it. I want the option to go on my terms.

 

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[Mucca Mad Boys]

And this is a big part of the reason the NHS is fucked. The routine and profitable services are taken on by private healthcare companies who reap the rewards. The rest if left with the NHS to deal with but with increasingly less resources as the money is being spent elsewhere and the staff are poached by private providers.

I had a fun day at the hospital on Saturday and the person I saw was very scathing that I was only now seeing someone actually employed by the NHS despite first having gone to my GP in 2010. Bounced around from place to place with symptoms being patched up rather than anyone looking at the overall cause. Was told this happens all the time because nobody is looking outside the narrow band of whatever particular service they are being paid to provide.

If the government sees the private sector as the solution to shortages, it’s got to be much more intelligent with its policy making. If the NHS outsources NHS patients, it will just drive up the costs. As a short term measure, sure… the private sector in this country isn’t large enough to cope and it’s often the case that NHS and independent providers use the same staff. I am seeing the same consultant on the NHS and privately at the same time.

It’s won’t be popular but the government has to facilitate the growth of the private healthcare in this country. Without doing research, I believe the private sector has shrunk since 1997.

In my view, two policy areas the government should be looking at is:
- scrapping VAT on private healthcare insurance as it’s no longer a ‘luxury’ product since people are going private to skip NHS waiting lists
- tax relief for employers/self-employed who enroll their employees on private health insurance

These measures aren’t quick fixes but the government could do with making policy decisions that decrease demand on the NHS.

 

[Mucca Mad Boys]

This seems bonkers to me. Is the worry that they’ll all fuck off as soon as they’ve trained? Cant we golden handcuff them or something. We cut off supply of critical labour all over the shop it seems.

Well yeah because working conditions in the NHS are that bad, qualified people go abroad to earn more and better conditions in, ironically, privatised healthcare systems. This is why we’re in a position that we import many of our healthcare professionals from abroad.

I’d like to see the tax burden reduced on NHS staff so abolition of basic tax on frontline staff and the taxes on pensions. It could also be a good idea to allow NHS staff to opt-out of their 10% contributions.

 

[fernandopartridge]

Well yeah because working conditions in the NHS are that bad, qualified people go abroad to earn more and better conditions in, ironically, privatised healthcare systems. This is why we’re in a position that we import many of our healthcare professionals from abroad.

I’d like to see the tax burden reduced on NHS staff so abolition of basic tax on frontline staff and the taxes on pensions. It could also be a good idea to allow NHS staff to opt-out of their 10% contributions.

Why would you further complicate the tax system like that rather than just pay them more and create more roles so that the working conditions are improved?

 

[Mucca Mad Boys]

Why would you further complicate the tax system like that rather than just pay them more and create more roles so that the working conditions are improved?

More taxes? Yippee! That won’t exacerbate the situation with record amounts of millionaires leaving the country or an increasing tax burden on companies.

The criticism that we’re a healthcare system with a country attached becomes truer by the day. The NHS budget is forecasted to be around £192bn and at what point do we say ‘this is a bit much now?’

 

[fernandopartridge]

More taxes? Yippee! That won’t exacerbate the situation with record amounts of millionaires leaving the country or an increasing tax burden on companies.

The criticism that we’re a healthcare system with a country attached becomes truer by the day. The NHS budget is forecasted to be around £192bn and at what point do we say ‘this is a bit much now?’

The budget will continue to go up as the population ages, accept it.

 

[Brighton Sky Blue]

Well yeah because working conditions in the NHS are that bad, qualified people go abroad to earn more and better conditions in, ironically, privatised healthcare systems. This is why we’re in a position that we import many of our healthcare professionals from abroad.

I’d like to see the tax burden reduced on NHS staff so abolition of basic tax on frontline staff and the taxes on pensions. It could also be a good idea to allow NHS staff to opt-out of their 10% contributions.

Well, 14 years of Tory neglect have achieved that. Like you they would prefer it if people were charged for being ill and we had for-profit middlemen in the system, so it suited them to let it rot.

 

[Mucca Mad Boys]

The budget will continue to go up as the population ages, accept it.

I don’t think the electorate will accept it blindly. If the NHS is gobbling all this money and it’s months/years to get the procedures/checks people need, they probably would prefer it if we moved to an insurance based system.

In my experience, the people most likely to be anti-privatisation are people who have never suffered the pain of NHS waiting lists.

 

[Brighton Sky Blue]

I don’t think the electorate will accept it blindly. If the NHS is gobbling all this money and it’s months/years to get the procedures/checks people need, they probably would prefer it if we moved to an insurance based system.

In my experience, the people most likely to be anti-privatisation are people who have never suffered the pain of NHS waiting lists.

Gutted that the wife and I don’t live in the US to be charged £30k+ for having a baby.

 

[fernandopartridge]

I don’t think the electorate will accept it blindly. If the NHS is gobbling all this money and it’s months/years to get the procedures/checks people need, they probably would prefer it if we moved to an insurance based system.

In my experience, the people most likely to be anti-privatisation are people who have never suffered the pain of NHS waiting lists.

Who is an insurance based system going to be cheaper for? How is it going to be cheaper?

 

[Mucca Mad Boys]

Well, 14 years of Tory neglect have achieved that. Like you they would prefer it if people were charged for being ill and we had for-profit middlemen in the system, so it suited them to let it rot.

These NHS has pretty much always underperformed in health outcomes compared to similar countries.

The UK is not the only universal healthcare system and many others use universal insurance based systems which produce better health outcomes.

A sensible approach for the government would be to get as many people off the NHS and in the private sector so it can prioritise the most needy people.

 

[Mucca Mad Boys]

Gutted that the wife and I don’t live in the US to be charged £30k+ for having a baby.

Resorting to the US system as the example is why the country cannot have a sensible topic on the NHS. The US system is the polar opposite and has equally bad health outcomes.

Hypothetically, if a universal insurance-based system lead to better health outcomes, higher pay and better working conditions. Why would you be against that as a staunch trade unionist?

 

[Brighton Sky Blue]

These NHS has pretty much always underperformed in health outcomes compared to similar countries.

The UK is not the only universal healthcare system and many others use universal insurance based systems which produce better health outcomes.

A sensible approach for the government would be to get as many people off the NHS and in the private sector so it can prioritise the most needy people.

Getting it to underperform to justify eventually scrapping it has been part of the right wing playbook from 2010.

Provided the principle of free at the point of use is maintained though I don’t necessarily mind about the government running hospitals or directly employing staff. The issue I have is what we have seen in education with the privately run/publicly funded model. It introduces more waste and less consistency in the service.

 

[Brighton Sky Blue]

Resorting to the US system as the example is why the country cannot have a sensible topic on the NHS. The US system is the polar opposite and has equally bad health outcomes.

Hypothetically, if a universal insurance-based system lead to better health outcomes, higher pay and better working conditions. Why would you be against that as a staunch trade unionist?

See above, I don’t necessarily mind that provided it remains free to use.

 

[Mucca Mad Boys]

Who is an insurance based system going to be cheaper for? How is it going to be cheaper?

I never said anything about being cheaper. My argument was simply that the government should make private healthcare more accessible by introducing tax breaks.

My employer pays for private healthcare insurance, it is a sound idea if we encourage businesses to offer this to their workers. The more people going to independent providers, the less demand on the NHS and that’s inherently a good thing. It’s not undermining the NHS and probably allows it to focus their resources elsewhere. For example, increasing trainee positions or being able to bring privatised services back in house.

 

[Brighton Sky Blue]

I never said anything about being cheaper. My argument was simply that the government should make private healthcare more accessible by introducing tax breaks.

My employer pays for private healthcare insurance, it is a sound idea if we encourage businesses to offer this to their workers. The more people going to independent providers, the less demand on the NHS and that’s inherently a good thing. It’s not undermining the NHS and probably allows it to focus their resources elsewhere. For example, increasing trainee positions or being able to bring privatised services back in house.

Private healthcare is driven by the need to make a profit. That should not be the objective of any healthcare system.

 

[Mucca Mad Boys]

Getting it to underperform to justify eventually scrapping it has been part of the right wing playbook from 2010.

Provided the principle of free at the point of use is maintained though I don’t necessarily mind about the government running hospitals or directly employing staff. The issue I have is what we have seen in education with the privately run/publicly funded model. It introduces more waste and less consistency in the service.

See above, I don’t necessarily mind that provided it remains free to use.

Which, by the way, is more or less the norm in Europe and Australia. They also have a significantly larger private sector.

You reference 2010, the reason for New Labour NHS reforms were basically down to sustainability. For example, PFI is overall a failure, but was down to offset the larger upfront costs of building hospitals.

The issue we have is that everything is government funded, it’s reached a point where it’s just stretched far too thinly and the public probably isn’t willing pay the costs needed to bridge the funding gap.

 

[Mucca Mad Boys]

Private healthcare is driven by the need to make a profit. That should not be the objective of any healthcare system.

Well, that’s a naive notion. Profit motives drive innovation and leads to advancements in medicines, equipment, technologies that support healthcare systems.

Applying the logic to hospitals, they will tend to have the best; ‘customer service’, equipment and staff. The lack of choice we have in the NHS to choose healthcare providers is eye opening.

The primary objective of a healthcare system is delivering the best healthcare outcomes which the NHS has consistently punched below its weight there. The problems do not start in 2010.

 

[Brighton Sky Blue]

Which, by the way, is more or less the norm in Europe and Australia. They also have a significantly larger private sector.

You reference 2010, the reason for New Labour NHS reforms were basically down to sustainability. For example, PFI is overall a failure, but was down to offset the larger upfront costs of building hospitals.

The issue we have is that everything is government funded, it’s reached a point where it’s just stretched far too thinly and the public probably isn’t willing pay the costs needed to bridge the funding gap.

Then the question is in fact one of politicians making the argument that quality services aren’t cheap. As said above, look at what has happened to state education since we switched to academisation. I am not convinced allowing for-profit healthcare providers and insurers into the system is the right thing for the country.

It’s all well and good your employer paying your insurance, but this a) gives them leverage over your access to healthcare and b) leaves you in a sticky spot if you were to be laid off. It is in fact just transferring the burden of cost from the state onto someone else.

 

[Brighton Sky Blue]

Well, that’s a naive notion. Profit motives drive innovation and leads to advancements in medicines, equipment, technologies that support healthcare systems.

Applying the logic to hospitals, they will tend to have the best; ‘customer service’, equipment and staff. The lack of choice we have in the NHS to choose healthcare providers is eye opening.

The primary objective of a healthcare system is delivering the best healthcare outcomes which the NHS has consistently punched below its weight there. The problems do not start in 2010.

Treating patients like customers buying a new car has always struck me as an odd way to view medical treatment.

 

[Mucca Mad Boys]

Then the question is in fact one of politicians making the argument that quality services aren’t cheap. As said above, look at what has happened to state education since we switched to academisation. I am not convinced allowing for-profit healthcare providers and insurers into the system is the right thing for the country.

It’s all well and good your employer paying your insurance, but this a) gives them leverage over your access to healthcare and b) leaves you in a sticky spot if you were to be laid off. It is in fact just transferring the burden of cost from the state onto someone else.

It’s not introducing the private sector into the NHS, let’s be clear on what I’m arguing for here.

My argument is that it’s desirable to have a buoyant private sector to support the NHS indirectly. The vehicles for this is abolishing VAT on private healthcare and giving employers generous tax breaks on private health care insurance. Any tax not recouped is probably offset overtime - in a blue sky thinking.

The NHS backlogs is the biggest driver of inaccessible healthcare. It’s totally normal for people to know of someone on a NHS waiting list. I had a NHS appointment at the end of Jan (2025) and this was my ‘3 month follow up’ from Q3, 2023. It was actually really useful being able to be seen by a consultant privately 3 times in the meantime.

Trust me, as soon as you actually experience private healthcare, you’d 100% do it if you could. Don’t get me wrong, there are absolutely brutal stories from the USA and China where the worst excesses of completely privatised systems come to the fore.

 

[shmmeee]

Well yeah because working conditions in the NHS are that bad, qualified people go abroad to earn more and better conditions in, ironically, privatised healthcare systems. This is why we’re in a position that we import many of our healthcare professionals from abroad.

I’d like to see the tax burden reduced on NHS staff so abolition of basic tax on frontline staff and the taxes on pensions. It could also be a good idea to allow NHS staff to opt-out of their 10% contributions.

We could just pay the more. The net is the same and it makes the job feel more prestigious. Has the downside of angering up the blood of Daily Mail readers of course.

 

[Mucca Mad Boys]

We could just pay the more. The net is the same and it makes the job feel more prestigious. Has the downside of angering up the blood of Daily Mail readers of course.

No it’s not, because the money spent by insurers on treatments/medication isn’t offset by tax breaks, only the costs of the policies.

We are giving more and the service isn’t getting better. That’s only politically viable for so long before the public’s trust in the NHS is eroded and people call for reform. That was a shrewd observation from Tony Blair in 1997. So, the people who actually care about the institution of the NHS have to think of better solutions than ‘just pay more’.

We’re already taxed so heavily that you can earn a lot more in places like Dubai, USA, Australia and so on. Hence, only China has more millionaires exiting than we do globally.

 

[chiefdave]

it is extremely upsetting to see how poor hospital end of life care is being reported to be.

Probably still better than the absolute lottery of care homes. The NHS would not allow my dad to come home from hospital as they said it wasn’t safe, no other option than a care home. Except there was no places available so at one point, until someone local died and a place became vacant, there was talk of him going as far away as Manchester.

When he went in he was given 3 months, 6 months absolute max. When he outlived that the NHS refused to keep paying so now I’m paying a 4 figure sum for him to be somewhere he would hate with basically no option to move him anywhere else without spending far more.

In the time he’s been in there the care home has had multiple managers, multiple owners and had a period in special measures as they couldn’t recruit enough staff for it to be run safely.

 

[chiefdave]

This seems bonkers to me. Is the worry that they’ll all fuck off as soon as they’ve trained? Cant we golden handcuff them or something. We cut off supply of critical labour all over the shop it seems.

My ex worked for the NHS. They sent her to uni for 3 years, covered all the fees and continued to pay her salary. There was zero requirement for her to even work a single day after completing the course.

In face within a few months of her returning to work Cameron did his NHS reorganisation which resulted in budget cuts and the department she was in ceasing to exist. Most of the staff moved to private providers, many overseas, who couldn’t believe their luck at getting highly qualified staff without the need to fund any training

 

[Brighton Sky Blue]

It’s not introducing the private sector into the NHS, let’s be clear on what I’m arguing for here.

My argument is that it’s desirable to have a buoyant private sector to support the NHS indirectly. The vehicles for this is abolishing VAT on private healthcare and giving employers generous tax breaks on private health care insurance. Any tax not recouped is probably offset overtime - in a blue sky thinking.

The NHS backlogs is the biggest driver of inaccessible healthcare. It’s totally normal for people to know of someone on a NHS waiting list. I had a NHS appointment at the end of Jan (2025) and this was my ‘3 month follow up’ from Q3, 2023. It was actually really useful being able to be seen by a consultant privately 3 times in the meantime.

Trust me, as soon as you actually experience private healthcare, you’d 100% do it if you could. Don’t get me wrong, there are absolutely brutal stories from the USA and China where the worst excesses of completely privatised systems come to the fore.

We are currently experiencing the NHS through pregnancy and it’s been excellent so far. My concerns on relying on employers to pay for insurance are above.

I do not think many things should be state run as it happens. Education, health, and the armed forces being the big 3 and for good reason. Prisons and the emergency services not far behind. The point being that none should be treated as for-profit services.

 

[fernandopartridge]

I never said anything about being cheaper. My argument was simply that the government should make private healthcare more accessible by introducing tax breaks.

My employer pays for private healthcare insurance, it is a sound idea if we encourage businesses to offer this to their workers. The more people going to independent providers, the less demand on the NHS and that’s inherently a good thing. It’s not undermining the NHS and probably allows it to focus their resources elsewhere. For example, increasing trainee positions or being able to bring privatised services back in house.

The worst area of demand on the NHS is urgent / unplanned care which private provision of elective care does nothing to help. The poor old NHS hospital and ambulance still has to take on the patient e.g. where an elective private procedure goes wrong. The activity based payments for an NHS provider include contributions towards all the other related services it provides, stripping elective procedures out therefore doesn't really help all that much. Not to mention that the private providers employ the same consultants otherwise employed by the NHS.

 

[fernandopartridge]

Well, that’s a naive notion. Profit motives drive innovation and leads to advancements in medicines, equipment, technologies that support healthcare systems.

Applying the logic to hospitals, they will tend to have the best; ‘customer service’, equipment and staff. The lack of choice we have in the NHS to choose healthcare providers is eye opening.

The primary objective of a healthcare system is delivering the best healthcare outcomes which the NHS has consistently punched below its weight there. The problems do not start in 2010.

Do you have no right to choice in the NHS?

 

[CCFCSteve]

The care in the nhs is usually very good but there’s major issues with it and it’s not just funding

NHS productivity plunged after the pandemic, data shows

ONS figures ‘in development’ highlight challenge facing government in improving health service performance

www.ft.com

Productivity down significantly since the pandemic, there’s extra staff but waiting lists increasing and insufficient bed capacity (social care)

I still can’t understand why more of the recent cash injection wasnt focussed on social care. That would surely be the quickest win due to the amount of bed blocking that goes on. Clear some of that that and available capacity increases

Also, I’ve said a million times that until we as a nation start to look after ourselves better it won’t matter what is thrown at the nhs. With an ageing unhealthy population that has grown by around 7.5% in past 10 years or so and will continue to grow rapidly in the short term. Throw in the long term affects of the pandemic (thanks China) and it doesn’t look good

Ps If anyone thinks this is just a purely funding issue needs to look at Scotland nhs.

 

[shmmeee]

£5/delivery Uber Eats tax. Pay off the debt in no time.

 

[fernandopartridge]

The care in the nhs is usually very good but there’s major issues with it and it’s not just funding

NHS productivity plunged after the pandemic, data shows

ONS figures ‘in development’ highlight challenge facing government in improving health service performance

www.ft.com

Productivity down significantly since the pandemic, there’s extra staff but waiting lists increasing and insufficient bed capacity (social care)

I still can’t understand why more of the recent cash injection wasnt focussed on social care. That would surely be the quickest win due to the amount of bed blocking that goes on. Clear some of that that and free capacity increases

Also, I’ve said a million times that until we as a nation start to look after ourselves better it won’t matter what is thrown at the nhs. With an ageing unhealthy population that has grown by around 7.5% in past 10 years or so and will continue to grow rapidly in the short term, it doesn’t look good

Ps If anyone thinks this is just a purely funding issue needs to look at Scotland nhs.

Social care is paid for by local authorities not the NHS

 

[fernandopartridge]

I would love a government to recognise and tackle the wider determinants of health, agreed Steve. There have been lots of warm words about prevention rather than cure but the reality is that, like you say, general health levels are going in the wrong direction.

 

[CCFCSteve]

Social care is paid for by local authorities not the NHS

I know I was saying rather than direct all the new cash at the nhs, a proportion would’ve been better spent in social care to free up capacity

Ps it shouldn’t be by the way, it needs to be an integrated system

 

[fernandopartridge]

I had a look at the UHCW annual report earlier, I thought this was interesting:

 

[Brighton Sky Blue]

The care in the nhs is usually very good but there’s major issues with it and it’s not just funding

NHS productivity plunged after the pandemic, data shows

ONS figures ‘in development’ highlight challenge facing government in improving health service performance

www.ft.com

Productivity down significantly since the pandemic, there’s extra staff but waiting lists increasing and insufficient bed capacity (social care)

I still can’t understand why more of the recent cash injection wasnt focussed on social care. That would surely be the quickest win due to the amount of bed blocking that goes on. Clear some of that that and available capacity increases

Also, I’ve said a million times that until we as a nation start to look after ourselves better it won’t matter what is thrown at the nhs. With an ageing unhealthy population that has grown by around 7.5% in past 10 years or so and will continue to grow rapidly in the short term. Throw in the long term affects of the pandemic (thanks China) and it doesn’t look good

Ps If anyone thinks this is just a purely funding issue needs to look at Scotland nhs.

Genuine question, how is productivity quantified in the NHS?