The UK Politics & Brexit Thread

[Alfie]

1% on taxes should be a start.

Its not about funding it more, its about removing the abject squandering of money on such things as rubber gloves at £13 a pair, diversity officers and chaplains on stupid salaries. And, dare I say it hundreds of thousands on map data rather than tens of thousands by cutting out the middle 'preferred' supplier. If the NHS was run as a business (im not suggesting its privatised) it would be far far more cost effective and then if it needed more money at least we would know that the existing money is well spent and not wasted. The whole system is being abused and instead of being there for the genuine needy its there for all and sundry. If employers were obliged to offer all employee's who are in the higher rate tax band, private health care, this might reduce the foot fall through the doors.

 

[leef44]

1% on taxes should be a start.

but this is how N.I. started. Politicians then decide this is a good tool to supplement their incompetence or political gains. It's difficult to segregate a tax and over the years it ends up going into the same one big pot which gets dished out from the red brief case.

 

[leef44]

Its not about funding it more, its about removing the abject squandering of money on such things as rubber gloves at £13 a pair, diversity officers and chaplains on stupid salaries. And, dare I say it hundreds of thousands on map data rather than tens of thousands by cutting out the middle 'preferred' supplier. If the NHS was run as a business (im not suggesting its privatised) it would be far far more cost effective and then if it needed more money at least we would know that the existing money is well spent and not wasted. The whole system is being abused and instead of being there for the genuine needy its there for all and sundry. If employers were obliged to offer all employee's who are in the higher rate tax band, private health care, this might reduce the foot fall through the doors.

This is always the challenge. It doesn't matter which party is in power, a government is run by political will and not by the same strategy as a business. The result is that a public run serviced can never be as efficient as a private business.

 

[Deleted member 6183]

Its not about funding it more, its about removing the abject squandering of money on such things as rubber gloves at £13 a pair, diversity officers and chaplains on stupid salaries. And, dare I say it hundreds of thousands on map data rather than tens of thousands by cutting out the middle 'preferred' supplier. If the NHS was run as a business (im not suggesting its privatised) it would be far far more cost effective and then if it needed more money at least we would know that the existing money is well spent and not wasted. The whole system is being abused and instead of being there for the genuine needy its there for all and sundry. If employers were obliged to offer all employee's who are in the higher rate tax band, private health care, this might reduce the foot fall through the doors.

I thought that the NHS had been subject to the work of business improvement people for years?

 

[artyman]

I wonder what people feel about spending on drug addicts which is totally self inflicted, should we spend anything at all on this. Also smoking related, when the NHS is under such pressure should it carry the cost of peoples foolish actions.

 

[Deleted member 6183]

I wonder what people feel about spending on drug addicts which is totally self inflicted, should we spend anything at all on this. Also smoking related, when the NHS is under such pressure should it carry the cost of peoples foolish actions.

Where do you draw the line though?

Should rugby players be treated for injuries suffered on the pitch?

I was going to ask about football players but that would be silly.

 

[Alfie]

Where do you draw the line though?

Should rugby players be treated for injuries suffered on the pitch?

I was going to ask about football players but that would be silly.

I would ask any smoker which brand they smoked and then the NHS should send a bill to that company for the treatment ;-) The invoices would mount up very quickly and I suspect the companies concerned would stop marketting and selling their poison here.

Laughed at the footballers reference. Of course they never actually get hurt and given their salaries shouldnt be using the NHS anyway!

 

[Deleted96908]

I definately think everyone should pay more except children. The NHS has come a long way from it's starting point of helping sick people to the point where just about every organ can be transplanted.
How about a weekly NHS surcharge of 0.5% on wages, pensions and benefits. That'll raise a few bob

Not sure what that would equate to in real terms, but it does raise the prospect of individual services being able to independently levy taxes. Which might sound a daft idea, until we remember that for a long time publicly owned utilities did just that via council collected rates and then direct billing. Not to mention BT which held us all over a barrel for years.

So maybe some services (NHS, Policing, Education etc) could be compulsory and collected independent of the Treasury, via income tax , or monthly billing as water and gas is now. And perhaps others could be optional, just like our garden waste collection scheme that costs £75 a year. Although the opt in - opt out model does beg the question of whether services you can't use, or won't use, should be excluded from compulsory taxation. For example, should a childless couple pay education taxes. Or should those with private health insurance be excluded from NHS levies?

It's a bit of a can of worms, but I can see benefits arising through accountability. So if an elected Chief Constable runs a tight shop in Wiltshire, should he expect to be reelected? Probably yes I guess. Incidentally, in case you haven't seen it, municipal accountability through elected officials was covered brilliantly in The Wire - which apart from its principle theme of police trying to keep Baltimore's drug market under control, dealt with the shenanigans of officials trying to keep within budget whilst keeping the electorate happy.

1% on taxes should be a start.

I was trying to find what the 1% would amount to and came across an article in the FT - Lib Dems propose 1 per cent tax increase to fund NHS. Which states that the Liberal Democrats have attempted to reinvigorate their election campaign with a promise to invest an extra £6bn a year in the NHS through a 1 per cent rise in income tax.

Apparently next year's intended spend on the NHS amounts to £122Bn - so the £6Bn increase might not make too much difference. Especially as @Alfie points out, in a service with so much waste. But there's no doubting $6Bn is a huge sum, as long as it can be used wisely.

Its not about funding it more, its about removing the abject squandering of money on such things as rubber gloves at £13 a pair, diversity officers and chaplains on stupid salaries. And, dare I say it hundreds of thousands on map data rather than tens of thousands by cutting out the middle 'preferred' supplier. If the NHS was run as a business (im not suggesting its privatised) it would be far far more cost effective and then if it needed more money at least we would know that the existing money is well spent and not wasted. The whole system is being abused and instead of being there for the genuine needy its there for all and sundry. If employers were obliged to offer all employee's who are in the higher rate tax band, private health care, this might reduce the foot fall through the doors.

The problem I have with running any public serving facility as a business is the obvious battle between profit and caring. So I am thinking here of the manager who is incentivised to keep costs low and in doing so chooses not to fund something which results in suffering or worse.

But if we do go that route, and many would argue that the NHS is already managed as a business, what with targets and performance related pay, then we'd need to do a better job than we currently do. Even cherry picking a so called perfect candidate (Carney for example) doesn't always lead to perfect execution.

But going back to @Harrythedog's comment above, direction taxation by a business unit, run by an elected official might work. Although (borrowing from some of @DrFeelgood's occasional dark humour), I'm tempted to comment that dead people can't vote - but then their relatives can - so maybe it would work after all.

 

[renault12ts]

It could be run as a type of non profit business. Provide the services, don't incentivise cost cutting...but do incentivise waste control.

Question the cost of things. All hospitals have a purchase dept...start there. Ask people to use their common sense.

 

[Deleted member 6183]

It could be run as a type of non profit business.

I thought that they they already were?

 

[renault12ts]

I thought that they they already were?

I mean run it like a private business (which it isn't) but without the profit motive. A private business is unlikely to pay £13 for a pair of rubber gloves.

 

[Deleted96908]

Maybe it's time to ramp them all up a little? Smokers, drinkers, legal cannabis, fast food, NI, NI for the self employed, income taxes and encouraging private healthcare (maybe by offering tax breaks on premiums) could all pay more and shouldn't have an in-proportionate effect on all.

I guess, given the propensity of governments to snoop on everything, it's not beyond the realms of possibility to monitor individuals' consumption of products that have been marked by the govt. as dangerous to health and then add a surcharge to a patient's care bill, should they end up in hospital for lung cancer etc. Although, even as I write this, I'm imagining huge court battles with patients claiming that smoking didn't cause their lung cancer - and who can prove that it did?

but this is how N.I. started. Politicians then decide this is a good tool to supplement their incompetence or political gains. It's difficult to segregate a tax and over the years it ends up going into the same one big pot which gets dished out from the red brief case.

Another reason for public service business units to collect their own fees (taxes) and spend them directly - presumably with one of more elected officials at the helm? Seems to work for NYC.

This is always the challenge. It doesn't matter which party is in power, a government is run by political will and not by the same strategy as a business.

I forget the actual quote, but when Eisenhower was instructing his generals during the last weeks of WW2, he told them their job was to prevent the enemy from obstructing the political will of the United States. Frightening that so much blood was lost during that conflict - and one wonders how many people truly supported that political will on either side. Certainly not the Germans, at least not by 1940 - even if they did buy into Hitler's militarism in the 30s. And we saw what happened to Churchill at the end of the war. Thanks mate. Off you go.

I suppose recalling MPs is a start, but there's still no accounting for bad government, which generally executes its 4-5 year mandate with little or no adherence to its election manifesto (Cameron and the Referendum being a notable exception). There was a time when the press or commentators held them to account - alas, neither make much of a splash these days and certainly not enough to divert the actions of government.

I wonder what people feel about spending on drug addicts which is totally self inflicted, should we spend anything at all on this. Also smoking related, when the NHS is under such pressure should it carry the cost of peoples foolish actions.

I get that and it makes me angry too. But thinking here of myself, I am a very fit guy with a double garage dedicated to intensive cardio and weights. I don't smoke or touch drugs and haven't drunk for getting on for 10 years. Yet still I find myself needing medical attention, mostly through my obsession with appearance and feeling good (edit: sports injuries). Should the NHS penalise my vanity? - even though by most measures I live a perfectly healthy life - apart from Pret Bakewells

 

[190]

I wouldn't much like the American model where health car costs are extortionate. Privatisation doesn't seem to work there. I have a view that whenever money is thrown at a service or where it is funded via insurance, then costs escalate. Look at car insurance, I wouldn't call that efficient with all the fraud and very high repair bills. When health care in the UK is funded by BUPA the hourly consultation fees charged would make MB's service charges look positively cheap. We recently had an example of what happened when the government allowed substantial increases in university fees. The bosses paid themselves huge salaries. Privatising rail services didn't seem to work either judging by consistently above inflation fare increases. I can't afford to travel by train even though I'm still subsidising it. Privatisation only works when there is real completion in the market place and a risk of the service provider going bankrupt.

Public services may be far from perfect but if they could be properly managed then gross profiteering might be better controlled.

 

[Alfie]

It could be run as a type of non profit business. Provide the services, don't incentivise cost cutting...but do incentivise waste control.

Question the cost of things. All hospitals have a purchase dept...start there. Ask people to use their common sense.

Exactly. The purchasing departments should be dispensed with and centralised into a single body that negotiates on a national level for the best deal. So if a hospital wants gloves, they request them from the central body and they are sent. This central body is carefully audited every year to ensure they are getting good/best deals for the NHS and there are no 'preferred' suppliers creaming off huge profits and no 'incentives' for purchasing depts to use particular suppliers.

 

[Deleted member 6183]

As I understand it there is already a substantial amount of governance and oversight within the NHS, remember all those headlines bemoaning the number of bean counters and their inflated salaries which could pay for thousands of nurses?

I suspect that there's a fierce resistance to change within the NHS and that the only solution is for more funding and getting the public to leave them alone with their petty illnesses and injuries.

 

[Deleted96908]

I suspect that there's a fierce resistance to change within the NHS .

Same for any corporation, especially those that are given a budget, rather then working within the confines of P&L.

I can't afford to travel by train even though I'm still subsidising it.

One of the most thought provoking comments I've read on this forum.

 

[Alfie]

As I understand it there is already a substantial amount of governance and oversight within the NHS, remember all those headlines bemoaning the number of bean counters and their inflated salaries which could pay for thousands of nurses?

I suspect that there's a fierce resistance to change within the NHS and that the only solution is for more funding and getting the public to leave them alone with their petty illnesses and injuries.

There is widespread ripping off of the NHS by suppliers and those who place orders need to be much more closely scrutinised.

 

[190]

I work in a secondary school which is now an academy i.e. in full control of how it's funds are spent. Prior to that we were under local authority control at county level. The NHS purchasing practices sound similar because I can tell you that county didn't have the faintest idea how to buy anything at a competitive price. Everything was tied up in contracts and miles of red tape which seemed to make them happy regardless of value for money. In theory we were supposed to buy our computers through them but the prices were ridiculous when they actually should have been cheaper due to economy of scale. You need flexibility and a little "street sense" to purchase efficiently not red tape.

 

[leef44]

As I understand it there is already a substantial amount of governance and oversight within the NHS, remember all those headlines bemoaning the number of bean counters and their inflated salaries which could pay for thousands of nurses?

I suspect that there's a fierce resistance to change within the NHS and that the only solution is for more funding and getting the public to leave them alone with their petty illnesses and injuries.

This is my thought process. this is the same as a national/global company would run its procurement department. Currently ward sisters have to order stuff directly from designated suppliers. They have no feel of costs, they only have a feel of how much stuff they need to make sure they can monitor/diagnose and save patients i.e. doing their job.

A designated nationwide procurement department would cost several millions in salaries and overhead costs. Setting up a "just-n-time" supply process with approved suppliers (which are re-evaluated every three years) including guarantees and obsolescence cost of stock (NHS would have to bear some of this cost from the supplier agreement) would cost hundreds of millions or maybe into a billion or two (stock obsolescence, delivery from nationwide depots on this scale, and still government organisation). So all in, we are talking maybe up to £2-£3 billion p.a. The savings would run over £10 billion. The net savings is bigger than the net amount of money we spend on the EU!

 

[gr1nch]

These centralised burearacracies seem to enable otherwise competent people to create playground for themselves where they can be incompetent at our, eventual, expense. An example from my home county today.

West Lindsey District Council spends over £2m on a hotel... in Yorkshire

At best they are getting a 3.8% return, but what of the time, effort and expense of setting it up and running it, which eats into that £90k.

1. The council should be investing in its local area of accepted care and responsibility.

2. They should be investing in local businesses, to encourage local growth and locally spent profits - not national multiples or chains.

3. They should focus on their core area of expertise. That is not running hotels. Not being a commercial landlord. Not playing at being business people. Their remit is providing local services

It is a trap that organisations call into by remaining in the comfort zone of awarding contracts to (or generally doing business with) the same or larger sized entities.

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