NHS breaking point?

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dyqik
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Re: NHS breaking point?

Post by dyqik » Sun Jul 24, 2022 5:53 pm

WFJ wrote:
Sun Jul 24, 2022 1:06 pm
dyqik wrote:
Sun Jul 24, 2022 12:52 pm
Woodchopper wrote:
Sat Jul 23, 2022 11:37 pm
So, tom p is making a point about macroeconomic policy and not about quality of healthcare. Whereas lpm is making a point about quality of healthcare and not about macroeconomic policy.
LPM is glossing over some basic economics to hide the point being argued by deliberately not using quantitative adjectives.

The fundamental thing here is that fragmented private for profit healthcare needs to be significantly less inefficient than national public healthcare to provide the same value to users.
How does the NHS's value compare quantitatively to the health systems of Germany, France, Netherlands, Belgium, Switzerland or many other European countries without comprehensive national public healthcare? It's not clear to me that public ownership is required for efficiency or value, and that overall funding is a more important factor in quality of care.
I don't know, and in some senses that is also a subjective measure. I'm not talking about just cost, but also the difficulties in navigating the system.

There's value associated with all insurances being accepted at every provider, and single payer. There's value associated with a uniform booking system, and a uniform records system. The costs of that address largely borne by users in indirect costs, like time and effort in finding providers and making sure that records are up to date

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Re: NHS breaking point?

Post by Millennie Al » Mon Jul 25, 2022 1:24 am

Sciolus wrote:
Sun Jul 24, 2022 5:40 pm
Increasingly, they are owned by huge corporations, often multinational, based in tax havens, owned by private equity funds, highly leveraged, and generally set up to ensure as little money as possible remains locally and as much money as possible gets sucked out of reach of HMRC.
Perhaps you could be more specific in relating the above points to your examples:
We have seen how
Southern Cross Healthcare - what tax haven? which private equity? how is the money sucked out of reach of HMRC and how much?
Paywalled - please give an alternative citation.
Four Seasons Health Care - what tax haven? which private equity? how is the money sucked out of reach of HMRC and how much?
works for users and taxpayers.
That's an article which says that care homes are struggling financially and hints that the profit margin might be 1%. Explain how that allows for significant profits to be made and how they are sucked out of the reach of HMRC.

And as for leverage, that's just debt and the public sector has huge debt - just owed by the nation and not by the individual sections (though they may also have localised debts).

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Re: NHS breaking point?

Post by shpalman » Mon Jul 25, 2022 10:09 am

Worst NHS staffing crisis in its history
The NHS is facing “the greatest workforce crisis” in its history which is putting patients at serious risk of harm, an influential group of MPs warns today.

In its report, the cross-party Commons health and social care select committee slams the “absence of a credible government strategy” on NHS-wide understaffing and criticises ministers for delaying a blueprint it says is urgently needed to address critical gaps in almost every area of care.

The hard-hitting report includes evidence showing that the staffing crisis in the NHS in England is even worse than official figures suggest. NHS Digital figures suggest that the service has vacancies for 38,972 nurses and 8,016 doctors. However, the real figures could be as high as 50,000 and 12,000 respectively, according to estimates the Nuffield Trust prepared for the MPs.

The trust’s analysis accords with the view of many frontline doctors and managers that some posts are not advertised, and thus not picked up by the statistical agency, because hospitals cannot afford to fill them, even if suitable doctors or nurses are identified.
molto tricky

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Re: NHS breaking point?

Post by shpalman » Mon Jul 25, 2022 10:11 am

Charge for hospital stays to help fund NHS, says ex-health boss
Patients would be charged £8 a day when in hospital under proposals from a former health service boss to raise more money for the NHS.

Prof Stephen Smith is also urging ministers to bring in charges of £4 to £8 to help cover the costs of medical equipment that patients need, such as hearing aids and walking devices.
People should pay a fee of £8 for every day they are in hospital receiving medical care or undergoing rehabilitation, up to a maximum of 28 days a year, added Smith, who said his idea was based on the system in Germany, where patients are charged €10 a night.

More money could also be raised for the NHS through financial penalties for abusing the NHS by repeatedly missing appointments, a hypothecated tax to bring in extra income for the NHS and social care, and tax breaks for high earners who take out private medical insurance.

However, Dr John Puntis, the co-chair of the campaign group Keep Our NHS Public, accused Smith of advancing “harebrained ideas” and “zombie policies” which would end the basis on which the service has operated since its creation in 1948, including that it is paid for by general taxation.

“Charging people to cover part of the cost of a hospital stay would be a fundamental departure from the founding principles of the NHS and show that the longstanding consensus on a tax-funded public service model of healthcare has been truly abandoned,” said Puntis.
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Re: NHS breaking point?

Post by EACLucifer » Mon Jul 25, 2022 10:28 am

shpalman wrote:
Mon Jul 25, 2022 10:11 am
Charge for hospital stays to help fund NHS, says ex-health boss
Patients would be charged £8 a day when in hospital under proposals from a former health service boss to raise more money for the NHS.

Prof Stephen Smith is also urging ministers to bring in charges of £4 to £8 to help cover the costs of medical equipment that patients need, such as hearing aids and walking devices.
People should pay a fee of £8 for every day they are in hospital receiving medical care or undergoing rehabilitation, up to a maximum of 28 days a year, added Smith, who said his idea was based on the system in Germany, where patients are charged €10 a night.

More money could also be raised for the NHS through financial penalties for abusing the NHS by repeatedly missing appointments, a hypothecated tax to bring in extra income for the NHS and social care, and tax breaks for high earners who take out private medical insurance.

However, Dr John Puntis, the co-chair of the campaign group Keep Our NHS Public, accused Smith of advancing “harebrained ideas” and “zombie policies” which would end the basis on which the service has operated since its creation in 1948, including that it is paid for by general taxation.

“Charging people to cover part of the cost of a hospital stay would be a fundamental departure from the founding principles of the NHS and show that the longstanding consensus on a tax-funded public service model of healthcare has been truly abandoned,” said Puntis.
Small charges for things, aside from harming poor people for getting hell, are going to be exceptionally efficient. Hoe much of that four to eight pounds is going to go on the infrastructure required to charge four to eight pounds? It can hardly be cash upfront - people sometimes turn up unconscious or raced in via ambulance without time to pick up their wallet. So how much will it cost to chase people down? And if they don't pay, do you then in future let them die over an unpaid £8?

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Re: NHS breaking point?

Post by Lew Dolby » Mon Jul 25, 2022 11:00 am

and looks to me suspiciously like the thin end of a wedge. It opens the door to future (tory) governments jacking the charges way up.
WOULD CUSTOMERS PLEASE REFRAIN FROM SITTING ON THE COUNTER BY THE BACON SLICER - AS WE'RE GETTING A LITTLE BEHIND IN OUR ORDERS.

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Re: NHS breaking point?

Post by discovolante » Mon Jul 25, 2022 12:02 pm

Financial penalties for repeatedly missing health appointments strikes me as something that would largely impact people with chronic health issues. Good one.
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Re: NHS breaking point?

Post by lpm » Mon Jul 25, 2022 1:50 pm

No, it would largely impact people with chronic health issues who repeatedly miss health appointments.

Anything "free" has a powerful impact on human psychology. For example, it leads to people not valuing things they got for free, even if they are actually valuable. For anyone with a chronic health issue, presumably an appointment is worth a great deal to them, leading to a reduction in pain or even extra years of life. Yet because it is free that person might treat the appointment as a casual thing.

We are long long way from 1948. The idea that "the founding principles of the NHS" are sacred isn't really based on anything except tradition. We are a hugely richer people now, able to enjoy unbelievable luxuries like cars and foreign holidays. And we are an older population - now 13 million people over 65 (19%), compared to 5.5 million (11%) in 1950.

For some people these extra charges would go unnoticed, for many they would be inconvenient, for a few they would be catastrophic - so simply link it to the benefits system to give refunds to those who would be harmed. Administration is easy - nearly everyone has an NHS number and a credit card. Get your bill, tap your card on the reader. It's not much harder than a restaurant.

We need this thin end of a wedge and we need to jack the charges way up in the future. If ever I stay overnight in an NHS hospital, Bupa pays me as part of my employer-provided insurance. The system is totally mad. The NHS is desperate for extra funding, there are millions of people who are willing and able to pay extra, yet ideologues refuse their money because of the beliefs and needs of an ancient people who invented a gospel back in 1948.
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Re: NHS breaking point?

Post by Lew Dolby » Mon Jul 25, 2022 2:08 pm

refunds for people who can't afford the initial costs are no answer at all.
WOULD CUSTOMERS PLEASE REFRAIN FROM SITTING ON THE COUNTER BY THE BACON SLICER - AS WE'RE GETTING A LITTLE BEHIND IN OUR ORDERS.

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Re: NHS breaking point?

Post by lpm » Mon Jul 25, 2022 2:26 pm

What you could do for people who can't afford the initial costs would be the things discussed on this thread:

- require 187 phone calls to get through to a GP
- bring in an 8 month waiting list for dementia service
- remove child mental health services
- make patients wait 2 weeks for a phone appointment with a GP because some of them will get better in this time
- let them die on a trolley in A&E

All these methods used today, from just the first few posts of this thread, would also work in the future to prevent poorer people from incurring costs.

Or we could actually provide healthcare and introduce easy ways to make sure poorer people don't have to pay a penny.
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Re: NHS breaking point?

Post by bjn » Mon Jul 25, 2022 2:41 pm

Would charging actually fix any of that, or would the Tories reduce public funding in line with revenue from charging for access, in which case you’d get sh.t service and be paying for it.

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Re: NHS breaking point?

Post by lpm » Mon Jul 25, 2022 3:05 pm

Boris Johnson attempted to raise a 1.25% health and social care levy. The extra tax was incredibly unpopular with press and public. But Johnson has a popularist instinct and knows better funding for health and social care is a vote winner.

The answer is obvious. Avoid the tax, deliver the extra funding. If one falls off one's polo pony and breaks an arm in the UK treatment is free. Even in Norway it costs £50. Starmer simply has to state some basic truths. Making people contribute to their health appointments will turn out to be popular.
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Re: NHS breaking point?

Post by EACLucifer » Mon Jul 25, 2022 3:21 pm

lpm wrote:
Mon Jul 25, 2022 1:50 pm
No, it would largely impact people with chronic health issues who repeatedly miss health appointments.
Which is frequently a consequence of having a chronic health condition you reactionary arse.

Booking a wheelchair taxi can be nearly impossible. Even if one can be booked, sometimes the taxi firm sends a conventional taxi, at which point you are f.cked. And yes, the NHS do hold it against you if you had a taxi booked and despite the booking clearly indicating a wheelchair cab - as acknowledged by the taxi firm after the inevitable complaint - the taxi firm sends a cab a wheelchair user can't get into.

Likewise carers can be unreliable. That gets held against the patient too.

And chronic health conditions harm people's ability to function normally in all areas of life, potentially, especially in a society that just isn't set up for us. You might take it for granted that you can catch a bus. I don't really like talking in terms of privilege in this area, but relative to someone with mobility problems, the average person is very privileged, to the point they just aren't aware of the obstacles others face. Most people don't realise that wheelchair users, for example, are still frequently prevented from getting on buses. Yes, it's illegal, but that doesn't mean it doesn't happen. And even when the driver abides by the law, there's only ever space for one wheelchair at a time. And even if you can get the bus, are there dropped kerbs? There's been regulations about those for decades, but as a society, we've decided it's ok to just ignore them because it only hurts a small minority that face serious barriers to advocating for themselves - you know, the same minority you are so f.cking patronisingly ignorant about as you gleefully seize upon an idea to make the least well off in every sense of the word pay.

And I really mean it when I say able bodied people just don't see the obstacles. I've known some very right on people who have all said the right things about access, and yet when they've travelled with me, there's just so many things they've never even thought of that they see - and I'm right at the top end of function for wheelchair users, with a chair that is specifically built to overcome the obstacles left in place by an ableist society.

And no, the patient transport service is not fit for purpose. It isn't meant to be. It's meant to be so unpleasant people don't use it.

So yes, it does come down to taxi or carer. And those aren't reliable either, so if they fall through, you miss the appointment. A humane service, a service that actually understood its legal obligations towards people with disabilities, would seek to mitigate the effects of that, not to compound them to spare the better off a tiny bit of tax.

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Re: NHS breaking point?

Post by EACLucifer » Mon Jul 25, 2022 3:22 pm

Lew Dolby wrote:
Mon Jul 25, 2022 2:08 pm
refunds for people who can't afford the initial costs are no answer at all.
This. And organisations are very good at making refunds hard to claim.

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Re: NHS breaking point?

Post by lpm » Mon Jul 25, 2022 3:31 pm

I've got an easy answer to all that EACL. Ration health appointments for people with chronic health conditions. Then they will have fewer hassles with taxis and buses.

Which is what the NHS is currently doing to great effect.
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Re: NHS breaking point?

Post by monkey » Mon Jul 25, 2022 3:44 pm

Exempting people from the charge should be easy enough, they already do it with prescriptions.

Still a bad idea.

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Re: NHS breaking point?

Post by EACLucifer » Mon Jul 25, 2022 3:58 pm

lpm wrote:
Mon Jul 25, 2022 3:31 pm
I've got an easy answer to all that EACL. Ration health appointments for people with chronic health conditions. Then they will have fewer hassles with taxis and buses.

Which is what the NHS is currently doing to great effect.
This is not an appropriate subject on which to troll.

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Re: NHS breaking point?

Post by dyqik » Mon Jul 25, 2022 3:59 pm

lpm wrote:
Mon Jul 25, 2022 1:50 pm
No, it would largely impact people with chronic health issues who repeatedly miss health appointments.
Like those that rely on public transport to get to appointments, because their health condition means they can no longer drive themselves, or because they can't afford to run a car.

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Re: NHS breaking point?

Post by lpm » Mon Jul 25, 2022 4:01 pm

I'm a bit fed up of you Daily Mail readers, desperate to dreg up any conceivable reason to prevent increased funding for the NHS.

Why are you so resistant? Why so against a functioning service? Is it because you are devoted followers of the Mail's political ideology? Hate ill people? Want to keep the money in your own pockets?

The NHS is no longer resourced enough to deliver the basics. Why is this so welcome to you? Do you really value ideological purity so much you'll let people suffer and die?
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Re: NHS breaking point?

Post by monkey » Mon Jul 25, 2022 4:17 pm

lpm wrote:
Mon Jul 25, 2022 4:01 pm
I'm a bit fed up of you Daily Mail readers, desperate to dreg up any conceivable reason to prevent increased funding for the NHS.

Why are you so resistant? Why so against a functioning service? Is it because you are devoted followers of the Mail's political ideology? Hate ill people? Want to keep the money in your own pockets?

The NHS is no longer resourced enough to deliver the basics. Why is this so welcome to you? Do you really value ideological purity so much you'll let people suffer and die?
I don't think people are against funding it, just not funding it in this way.

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Re: NHS breaking point?

Post by EACLucifer » Mon Jul 25, 2022 4:23 pm

lpm wrote:
Mon Jul 25, 2022 4:01 pm
I'm a bit fed up of you Daily Mail readers, desperate to dreg up any conceivable reason to prevent increased funding for the NHS.

Why are you so resistant? Why so against a functioning service? Is it because you are devoted followers of the Mail's political ideology? Hate ill people? Want to keep the money in your own pockets?

The NHS is no longer resourced enough to deliver the basics. Why is this so welcome to you? Do you really value ideological purity so much you'll let people suffer and die?
We're objecting to you a) wanting that money to come directly from ill people, and b) when it was pointed out that this would disproportionaly affect those most vulnerable, you latched onto that, enthusiastically extolling the virtues of punishing people for the consequences because apparently you think the reason people with chronic illnesses sometimes miss appointments is because they treat them casually, rather than because a) having a chronic illness directly affects ones ability to function and that can include getting to appointments, and b) society is not set up for people with disabilities and puts in place various obstacles to us that make it hard to do things like reliably attend appointments.

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Re: NHS breaking point?

Post by lpm » Mon Jul 25, 2022 4:35 pm

monkey wrote:
Mon Jul 25, 2022 4:17 pm
I don't think people are against funding it, just not funding it in this way.
The attitude is: fund it through general taxation or nothing.

You get nothing.

It's the worst kind of sh.tty Corbynism there is. Privileged lefties playing their little political games. More important that the Gospel of St Bevan is obeyed than disadvantaged citizens get functioning healthcare.

And the shocking disrespect for the NHS. Buses and taxis and patient transport services are crap, therefore it's fine if that makes the NHS waste its resources. Come on. Put the NHS and its resources number one, don't treat it with contempt because it's free and other stuff doesn't work.

Since this thread started, the Prime Minister and Chancellor who attempted to increase funding through general taxation have paid the penalty. One is fired, with his unpopular levy forming the backdrop to his disgrace. The other lost his reputation partly over it and won't win the leadership as a result. Voters only want to pay in claps, not in taxes.

Make the choice. Increased funding is not going to be coming from general taxation. So it's nothing. Or find a new way. Every single little whine you make about new ways reinforces that it's going to be nothing. And that means more and more rationing of healthcare for everybody - well, everybody except for the top earners who have private healthcare.
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Re: NHS breaking point?

Post by dyqik » Mon Jul 25, 2022 4:41 pm

lpm wrote:
Mon Jul 25, 2022 4:01 pm
I'm a bit fed up of you Daily Mail readers, desperate to dreg up any conceivable reason to prevent increased funding for the NHS.

Why are you so resistant? Why so against a functioning service? Is it because you are devoted followers of the Mail's political ideology? Hate ill people? Want to keep the money in your own pockets?

The NHS is no longer resourced enough to deliver the basics. Why is this so welcome to you? Do you really value ideological purity so much you'll let people suffer and die?
It's your position here that is the Tory voter and Daily Mail's position - a health service only available to deserving people who can afford it, and no new taxes to support the undeserving poor.

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Re: NHS breaking point?

Post by lpm » Mon Jul 25, 2022 4:50 pm

Wrong. Mine is the left wing position. It's others on here who are adopting the Tory voter and Daily Mail position of not wanting to do anything to stop the collapse of the NHS.
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Re: NHS breaking point?

Post by monkey » Mon Jul 25, 2022 4:57 pm

lpm wrote:
Mon Jul 25, 2022 4:35 pm
monkey wrote:
Mon Jul 25, 2022 4:17 pm
I don't think people are against funding it, just not funding it in this way.
The attitude is: fund it through general taxation or nothing.

You get nothing.

It's the worst kind of sh.tty Corbynism there is. Privileged lefties playing their little political games. More important that the Gospel of St Bevan is obeyed than disadvantaged citizens get functioning healthcare.

And the shocking disrespect for the NHS. Buses and taxis and patient transport services are crap, therefore it's fine if that makes the NHS waste its resources. Come on. Put the NHS and its resources number one, don't treat it with contempt because it's free and other stuff doesn't work.

Since this thread started, the Prime Minister and Chancellor who attempted to increase funding through general taxation have paid the penalty. One is fired, with his unpopular levy forming the backdrop to his disgrace. The other lost his reputation partly over it and won't win the leadership as a result. Voters only want to pay in claps, not in taxes.

Make the choice. Increased funding is not going to be coming from general taxation. So it's nothing. Or find a new way. Every single little whine you make about new ways reinforces that it's going to be nothing. And that means more and more rationing of healthcare for everybody - well, everybody except for the top earners who have private healthcare.
Ah, piss off with your false dichotomies.

The tax rise was unpopular* because Johnson promised not to raise taxes, and because it was seen as regressive. In general, raising tax to fund the NHS has support, but you have to do it in the right way (i.e. make the rich pay more), and not come across as a hypocrite when you do it. Raise the tax in the right way and it'll get support, no matter how much the Daily Mail complains about it.

*and it wasn't that unpopular when announced, A snap YouGov poll had ~50% support, IRC).

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