"Health and Social Care levy", or is it just another tax??

[keith_d]

OK, time to get your political opinions out and talk some complete bull.

Is the planned Health and Social care levy going to make any difference or is it just another tax?

The idea of a 1.25% tax which is ring fenced for health care sounds great. But in practice the government is spending almost 40% of tax revenue on the NHS at the moment. So it would be easy for them to simply remove a chunk of that funding and replace it with the Health and Social care levy. So, do we think that this levy will actually make a difference, or is the government cynically using the current outpouring of support for the NHS to justify a increase in taxes?


I will mention that this directly breaks one of the government's manifesto promises, but apparently this is a special case because... um... err....it distracts from some parties or something.

I'll also mention that the car tax was originally ring fenced for the roads system, but now just goes into general taxation. Similarly, National Insurance now just goes into general taxation instead of health and pensions. So governments do have some form.

Your thoughts??

[Craig380]

The plain fact is, if we want to have proper universal health services that are free at the point of access, that can cope with an ageing population with increasingly complex health needs, we need to pay more tax.

The systematic erosion of state social care provision over the past decade has magnified pressure on the NHS because often there's nowhere for elderly patients to be discharged to. Coupled with the loss of 50% of the NHS' bed capacity in England since 1990 and the loss of front-line staff, that's why the NHS is currently in crisis.

I lived in Denmark for 5 years, where the health and social care system is amazing - paid for by high taxation. And taxes needed to be high because of the small working population relative to the overall population.

Over here, I've benefited from fantastic, immediate treatment for my advanced cancer -- all at no direct cost to me.

So to my mind, we need to make a simple decision. Do we want to fund the NHS properly? Or do we want private healthcare as in the U.S., where insurers can decide to stop funding your treatment on a whim (as has happened to two good friends of mine, who would both have lost children if it wasn't for Obamacare)?

However, given the bunch of f*cking spivs and chancers currently in government, I doubt very much whether the H&SC levy will be ringfenced. But the NHS is not, and has not for some time, being adequately funded to deal with the demands we as a nation make of it.

[Bibio]

who remembers the big hooha about scotland having tax raising powers...

give the gov an inch and they will take a mile... they will take the tax then spend the same. give them nothing and tell them to stop giving billions to their mates. why cant they just admit that they have feked up and the public have to bail them out and income tax will be going up and the threshold lowered... jeezz we already have a minimum wage system AND top ups so no wonder the gov has no money as they keep giving it away.

[Ruffy]

IMHO, just more smoke and mirrors really. As has been said, ring-fencing makes no difference when only applied to part of the funding arrangements because they can just 'adjust' outside the fence to suit ideology and other factors.

There's two fundamental funding approaches for the public sector incl. NHS:

1. Top down - allocate a chunk of the expected tax revenue and see how far it goes - 'cut cloth accordingly' on service delivery
2. Bottom up - define a required service level criteria for each healthcare area, cost-load it and see how much total funding is required to be provided

Unfortunately, we have a bad blend of both, all dealt with in a politically charged environment. Free at the point of delivery creates an ignorant public with no idea of the costs involved who just expect infinite bottom-up service provision. This is pitted against politicians who want to manage the total amount in a way that wins and keeps votes.

Neither deals well with the reality and risks of providing the service, especially bearing in mind how medical science has progressed and population has grown/changed over the years. We'll only start making progress when everyone accepts that there is a limit on service. We can then talk sensibly and more empirically about where the limit should be and what compromises that means in other areas.

At the minute, both public and politicians' expectations on service are often unrealistic - they don't accept (public) or admit (politicians) that however much NHS funding we provide, it will still run out at some point. So NHS will always be susceptible to being characterised by some as "struggling".

The issues are further obscured by the challenges of having to deal with variable, unpredictable demand. To illustrate the flip side of the coin: Who wants to pay for empty hospitals with doctors/nurses/treatments on the payroll excess to requirements but there 'just in case'? And then, of course, we need to weave in the debate about organisational efficiency, productivity and waste - should that be first or later?

This isn't necessarily a public vs private thing either. Balancing the books applies to both - public/private just changes the order of priority for pulling the control levers, especially relevant if the risk due to uncertainty hasn't been pre-allocated clearly and well.

[keith_d]

I've just found an interesting report on pre-Covid healthcare spending from the ONS:

https://www.ons.gov.uk/peoplepopulat...ies/2019-08-29

Before Covid we were spending about 9.6% of GDP on healthcare, compared to about 10.6% in Denmark which one of the other posters highlighted as having a great healthcare system. So we're some way behind, but not as far as you might think from the media coverage.

Assuming 1.5% levy was actually spent on the NHS that would get us to 10% of GDP spent on healthcare which is about average for the rich countries of the world. But in practice we might still see money being syphoned out of the NHS by cuts in other areas, just to reduce the government borrowing which has been completely out of control during the pandemic.

Am I being overly cynical??

[svenrico]

There is never going to be enough money for the NHS when they keep wasting millions/billions like they have done with their Covid related spending.

[embee]

I often watch some of the numerous emergency service documentaries on TV. I'm always staggered at the way consumables are used in the NHS/hospital type programmes. I don't know how much these make up regarding total spend, probably not that much in reality compared to staff costs, but I bet those bandages and tape etc cost a fortune when supplied to the NHS. I'm sure someone did an exercise once where the prices were put on the shelves in the stock rooms and usage went down.
My other bugbear is that hospitals seem to be designed specifically for people to walk about, long corridors etc. Industry design processes to avoid people walking about, while they are walking they are not doing the job. I'm sure it's not easy but I bet something could be done more efficiently.
I know someone who is a commercial buyer from industry and worked on contract in a Police Constabulary purchasing department. He was horrified at the waste, the excessive prices paid for stuff compared to what he was used to in industry. The argument was that they used limited lists of approved suppliers so paid whatever they asked for (mates rates??). Whenever there's big money sloshing about in public services where they don't actually need to "earn" the money (I mean the institution, not the front line workers), there will be excessive pricing, military is probably the worst.
The big picture needs to be seen, joined up thinking. Hospitals can't discharge vulnerable folk because of lack of community care services, and ambulances line up for hours outside hospitals waiting to pass on patients. Bonkers, and it's not just due to "unforseen" peak demand, it's all the time now.
It won't get better, it never has. There'll just be re-organisation, rearrange the deckchairs, carry on (nurse). This government seems to have a standard response, "We have a plan, we'll spend £5 Bn more". That's not a plan, it's an invoice.

[Bibio]

its not the NHS its the cowboys running things. too many bosses getting paid huge sums of money for doing nothing. then you have asswipe companies like Virgin who sue the NHS add too that the public wanting EVERYTHING.

i know someone who was going to sue the NHS due to a "stopper" coming out after an angiogram till i said go private and dont phone the NHS next time your is having a heart attack if your not happy. BTW i had the exact same thing happen too me after an angiogram. did i moan.. nope, thats life.

[svenrico]

Originally Posted by Bibio

its not the NHS its the cowboys running things. too many bosses getting paid huge sums of money for doing nothing. then you have asswipe companies like Virgin who sue the NHS add too that the public wanting EVERYTHING.

i know someone who was going to sue the NHS due to a "stopper" coming out after an angiogram till i said go private and dont phone the NHS next time your is having a heart attack if your not happy. BTW i had the exact same thing happen too me after an angiogram. did i moan.. nope, thats life.

Funny you should mention that and an angiogram specifically. At one time I was in a private health care scheme part paid for by the company I worked for at the time. After an ECG scare I was told I needed an angiogram and there would be some wait on the NHS so I contacted the private health care company. They put me off by saying I should bear in mind that if I went private the NHS could be a bit 'sniffy' if I needed any follow up treatment on the NHS in the future ! I waited and had it done on the NHS.

[ethariel]

Originally Posted by svenrico

They put me off by saying I should bear in mind that if I went private the NHS could be a bit 'sniffy' if I needed any follow up treatment on the NHS in the future ! I waited and had it done on the NHS.

They don't want to have to use thier resources for the low price your company negotiated thier contract for.

The NHS generally does not 'Sniff' at the use of private healthcare but actually picks up the pieces when private ***** up which happens a lot more than people realise. A full on private hospital can cope with most eventualities but it's easier to pawn someone off in a private ambulance to A&E when it goes tits up rather than the liability of dealing with it (private 'Clinics' are much worse as they are usually woefully underequipped to deal with any mishaps at all).

That said the NHS pays a huge premium farming out services such as MRI scanning to a 'private Hospital' that has slots available as they dont have any capacity left themselves.

Oh back on topic - It's just another stealth tax. it's a 'Ringfenced' buffer that will let NHS funding by general taxation be reduced/not increased by as much and will 'help hide this from the general population'.