What should we do with the NHS?

[Johnnyweetabix]

Maybe the NHS might be in a better place if there was a much more rounded way of dealing with obesity, alcohol, drug and smoking issues. Quick look on the internet and the total costs of supporting these is over $20b per year.

 

[HolgateCorner]

As I said before; a properly healthy, productive workforce pays for itself.

This is a point conveniently ignored by the Tories, private businesses benefit massively by not having the issue of millions of low paid workers needing health insurance or treatment and having to find the money for it. First port of call would be the employers, no doubt about that.

 

[Frozen Horse]

A more healthy population should pay for itself.

I can't accept that, much as I would like to believe it.
To a large extent, the NHS is a victim of its own success.

The first graph shows increasing life expectancy (Source: ONS). Clearly life expectency was increasing prior to 1945, but does anyone believe this trajectory would have continued as far as it did without the NHS?

The second graph is spending by age, which shows a sharp increase in spending over the age of 65.
A successful NHS makes people live longer, which in turn, increases the demands upon it.

So where am I going with this? Not, I assure you, towards a "let them die" position. I worked in the NHS for over a decade, and both of my parents are reaching their latter years. As a professional and a human, I can't support that conclusion.

More recent studies suggest life expectancy is plateauing: maybe 80 or so years is the most we can sustain in any circumstances, so I don't necessarily assume this viscous cycle continues.
I would consider increasing retirement age: retirement age was about the same in life expectancy in 1950, so are we really entitled to expect 15-20 years out of employment at the end of our lives? However, I have no idea how reduced pensions/increased tax revenue could compare to the funds needed by the NHS.

 

[sherlock]

Maybe the NHS might be in a better place if there was a much more rounded way of dealing with obesity, alcohol, drug and smoking issues. Quick look on the internet and the total costs of supporting these is over $20b per year.

£23 billion in tax take just from tobacco and alcohol last year. That's without things like the sugar tax etc.

There's no political will to tackle this sadly.

 

[sherlock]

I can't accept that, much as I would like to believe it.
To a large extent, the NHS is a victim of its own success.

The first graph shows increasing life expectancy (Source: ONS). Clearly life expectency was increasing prior to 1945, but does anyone believe this trajectory would have continued as far as it did without the NHS?

The second graph is spending by age, which shows a sharp increase in spending over the age of 65.
A successful NHS makes people live longer, which in turn, increases the demands upon it.

So where am I going with this? Not, I assure you, towards a "let them die" position. I worked in the NHS for over a decade, and both of my parents are reaching their latter years. As a professional and a human, I can't support that conclusion.

More recent studies suggest life expectancy is plateauing: maybe 80 or so years is the most we can sustain in any circumstances, so I don't necessarily assume this viscous cycle continues.
I would consider increasing retirement age: retirement age was about the same in life expectancy in 1950, so are we really entitled to expect 15-20 years out of employment at the end of our lives? However, I have no idea how reduced pensions/increased tax revenue could compare to the funds needed by the NHS.

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Retirement age is already heading to 68. It's nonsense to suggest this goes higher for a multitude of reasons. It should come back down if anything.

 

[Johnnyweetabix]

£23 billion in tax take just from tobacco and alcohol last year. That's without things like the sugar tax etc.

There's no political will to tackle this sadly.

there is the evil conundrum !

 

[Frozen Horse]

Retirement age is already heading to 68. It's nonsense to suggest this goes higher for a multitude of reasons. It should come back down if anything.

Please expand.
I can see that any economic benefits could be negated by saturation of the job market, and if that's the case, there's little point in doing it, but I'm not an economist so I'm speculating, and I'm happy to be educated on this.
However, I don't agree that as a matter of principle we're entitled to more than a decade of retirement.

 

[h_m_boro]

A lot of the NHS is not particularly efficient, but a lot of this is down to underfunding, 12 years of neglect, reduced staffing and the ridiculous refusal to look at the big picture - which includes incorporating social care. This is a massive undertaking, which the current government clearly does give one solitary sh*t about.
Throwing money at it isn't going to fix it, but looking at best practice, what works (and what works but has been sacked off), doesn't work needs looking at, and ultimately a cohesive system implemented. Not going to be a quick fix over one parliamentary term.

Massive job......have the current incumbent shysters or shysters in waiting got the bollox to do this? Probably not.

 

[sherlock]

Please expand.
I can see that any economic benefits could be negated by saturation of the job market, and if that's the case, there's little point in doing it, but I'm not an economist so I'm speculating.
However, I don't agree that as a matter of principle we're entitled to more than a decade of retirement.

- loss of individual productivity as people age
- some jobs are simply impossible to do at that age
- increased welfare spend on younger people unable to secure employment as older people aren't leaving the jobs
- increases in child care costs and associated public spending as natural child carers eg grandparents are taken out of the equation by being required to stay at work
- age discrimination from employers - older people who lose a job have much less chance of being taken on again - so the welfare spend on them is still there, it's just in unemployment costs rather than pensions
- we already have a ridiculously low state pension compared to every other European country - any complaint about pension spend is just nonsense when this is considered
- increased absenteeism from work as guess what, older people get sicker more often

And that's just off the top of my head.

 

[Colgates_shaving_foam]

Please expand.
I can see that any economic benefits could be negated by saturation of the job market, and if that's the case, there's little point in doing it, but I'm not an economist so I'm speculating, and I'm happy to be educated on this.
However, I don't agree that as a matter of principle we're entitled to more than a decade of retirement.

How are people going to work on building sites etc at 70+?

Would you have different retirement ages for white collar and blue collar workers?

 

[SuperStu]

I'm coming around to thinking that if you can pay for treatment - you should - giving relief to people that need it and can't afford it - elderly, unemployed and low pay should all be exempt.

If you were going to start charging anyone for treatment why would you exempt the elderly? They're the ones using it most, and yet they're also the ones voting tory (so voting for the NHS's defunding and privatisation) in greatest numbers. They're the people who enjoyed all the benefits of the post war consensus and then decided to remove the lot for the next generation. People under 35 now are less likely to own their own homes than the elderly were at the same age, they're not getting final salary pensions, they're having to wait longer to retire.

If you're charging anyone, charge the oldies and give working age folks a bit of help for once.

 

[Nano]

I can't accept that, much as I would like to believe it.
To a large extent, the NHS is a victim of its own success.

The first graph shows increasing life expectancy (Source: ONS). Clearly life expectency was increasing prior to 1945, but does anyone believe this trajectory would have continued as far as it did without the NHS?

The second graph is spending by age, which shows a sharp increase in spending over the age of 65.
A successful NHS makes people live longer, which in turn, increases the demands upon it.

So where am I going with this? Not, I assure you, towards a "let them die" position. I worked in the NHS for over a decade, and both of my parents are reaching their latter years. As a professional and a human, I can't support that conclusion.

More recent studies suggest life expectancy is plateauing: maybe 80 or so years is the most we can sustain in any circumstances, so I don't necessarily assume this viscous cycle continues.
I would consider increasing retirement age: retirement age was about the same in life expectancy in 1950, so are we really entitled to expect 15-20 years out of employment at the end of our lives? However, I have no idea how reduced pensions/increased tax revenue could compare to the funds needed by the NHS.

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It's true that the increased chance of surviving a major issue later in life is a massive cost to the NHS. In the past, for most people the last time they go into hospital will be the most expensive (for the NHS) but we have got so good at keeping people alive that people go into hospital for something that would have been their final time in the past multiple times. Prolonging life is very expensive. The bulk of the costs are just from taking up space in hospitals. It is that expansion of capacity that is needed but that requires a lot of extra cost in terms of skilled people and infrastructure. The alternative is letting people die which avoids those costs but that obviously isn't an option.

Please expand.
I can see that any economic benefits could be negated by saturation of the job market, and if that's the case, there's little point in doing it, but I'm not an economist so I'm speculating, and happy to be educated on this.
However, I don't agree that as a matter of principle we're entitled to more than a decade of retirement.

It's already a stupid situation that we are in where we spend the majority of our time on this planet working just to afford enough to survive as comfortably as we can while feathering the nest of some billionaire. Surely at some point it makes sense that we get a break from it. To be honest, I would accept a higher working age like 70 if we could change to a 4 day work week now. I would rather have more time for myself, family and friends now while I'm still young enough to enjoy it than just having more time to watch bargain hunt when I'm older.

 

[exeterboro]

It's been undermined with intent over the last 12 years to get it to this point where we think it is broken, we need to fight this. It's obvious to even some Tory supporters that big business is circling it wanting to take parts of it over. The national insurance that pays for it is our money I don't want a multi billionaire making more billions out of it, or the US government insisting that as part of a trade agreement we open up the NHS, it is literally our money paid to make sure we get better healthcare not some bargaining chip.

 

[sherlock]

The alternative is letting people die which avoids those costs but that obviously isn't an option.

Seems to be exactly the option the current government are going with.

 

[gregorgregorovich]

If you were going to start charging anyone for treatment why would you exempt the elderly? They're the ones using it most, and yet they're also the ones voting tory (so voting for the NHS's defunding and privatisation) in greatest numbers. They're the people who enjoyed all the benefits of the post war consensus and then decided to remove the lot for the next generation. People under 35 now are less likely to own their own homes than the elderly were at the same age, they're not getting final salary pensions, they're having to wait longer to retire.

If you're charging anyone, charge the oldies and give working age folks a bit of help for once.

I've just turned 65 and I would find it hard to argue against any of that.

 

[Scrote]

Whilst tory policies, 12 years underfunding, brexit and removing nursing bursaries etc, have caused this to come to head. We as a country need to decide we want western european quality services, including health and social care, but we only want to pay american levels of tax. Quality services cost money and we pay less on the whole than pretty much every other western european country. This problem was always going to come to a head eventually as the country as a whole ages and pressure on social and health services. The tories have just accelerated the process.

We've already got the highest tax burden for 70 years. The problem isn't lack of tax take, the problem is what a corrupt, criminal government are doing with all of that money.

It's also the fact that tax take isn't directly related to goverment spending in the way it seems to be embedded in our collective consciousness.

We aren't medieval kings riding round the country collecting window taxes before we can pay our soldiers.

 

[h_m_boro]

Am I right in thinking in the USA you pay for Health Insurance - hundreds of dollars a month - but don't pay "direct" tax to the government (our income or NI contributions)?
But this country will be looking to move to a similar system......but we will pay both every month?

 

[Corcaigh_the_Cat]

I've experienced private health care living abroad. Employers were obliged to give you this as a part of your employment contract. I only needed to use it once or twice but it proved very effective without any waiting lists.

Not for me it didn't. And I had to fork out on top of the employer's insurance package. Poorer service than here.

 

[Andy_W]

I'm coming around to thinking that if you can pay for treatment - you should - giving relief to people that need it and can't afford it - elderly, unemployed and low pay should all be exempt.

First of it needs to be funded and caught back up to equivalent levels of what it was in 2010, which was probably 3% too low for every year from 2010, so 13 years, but as that compounds it probably needs a 50% bump.

Then factor inflation and then also factor in for the increase in the older population, covid/ long covid and overall it probably needs double the funding to get caught back up quickly, and then this could be reduced back down to a reasonable level, but still increasing 5% every year to counter the again population which isn't slowing down for the next 50 years at least.

Also need 20% more nurses and 10% more doctors, plus an additional amount to cover those who are going to leave or who we've destroyed with crap conditions.

This is all irrelevant if social care is not sorted out though. Can't get people out of beds if there's nowhere to put them (which isn't within NHS funding, it's local council funding). If you can't get people out of beds then you need more beds, which means more staff, and more funding.

The NHS also needs its own construction and maintenance company, which is ran by an army of competent workers, they will cost a lot to attract, but pay their cost back 100 fold. Same applies to the medical aspects they outsource, it needs to be in house, but also needs the best guys running it, and that costs top money.

At the minute NHS often use cost-plus-profit contracts, not fixed price. Basically no matter what the project costs, the company doing it still gets 2-10% on top or whatever. There's zero incentive to carry out projects on budget or on time, and the larger the project cost the higher the project figure to apply the profit margin too. If there's no suitably qualified project manager on the NHS side, looking after this, then things get out of hand, quickly. Instead, the contractor runs the project, effectively his own PM (yet with no risk), and the client (the NHS) pays the bill, and is easily talked round to why there's an increase in time/ cost, as it's rarely their speciality.

 

[Laughing]

Maybe the NHS might be in a better place if there was a much more rounded way of dealing with obesity, alcohol, drug and smoking issues. Quick look on the internet and the total costs of supporting these is over $20b per year.

Smoking is a net gain for the public coffers. Smokers die quicker and younger.

But I do know the answer to the question "What should we do with the NHS?" We should cherish it, invest in it and encourage all who work in ir.