NHS under pressure across whole UK – how do we fund the health service we need?

StethoscopeA clinical commissioning group in South Warwickshire was heavily criticised last week for suggesting that it might charge patients for use of mobility aids like crutches, walking sticks and neck braces.  A rather hyperbolic Guardian column screamed that this was the “first painful step towards the dismantling of the NHS” which seems a bit strange given that they’ve been telling us for the past two years that the NHS had been all but privatised anyway.

The furore over this idea made me think, though. While you don’t and never should have to pay to see a doctor, there are some charges for NHS services. Although it’s capped, there are charges for going to the dentist that I certainly couldn’t afford to pay when I was a student a long time ago. It takes my breath away when I read that the prescription charge in England is now over £8. Per item. In Scotland and Wales, the prescription charge has been abolished.

While charging for walking aids would have an impact on people, it’s also completely impractical. You have just put someone in plaster from their thigh to their ankle. They say they can’t pay for the crutches that will enable them to get out of the room. What are you going to do? But you could argue that the prescription charge could be even more dangerous. If someone can’t afford that charge for their antibiotics, then the impact and cost of future treatment could be much greater.

The reality, of course, is that not everybody would have to pay. Those who use most drugs, the poorest, pensioners and children, were always exempt anyway. It rankles with me a wee bit that I get free prescriptions when I could afford to pay a small charge, even the £8 per item. For the price of a large glass of wine in an Edinburgh city centre pub every two months, I could have the daily medication I need. It’s affordable for me and for many other households with our level of income. Instead, I see £40 million (in Scotland) being spent on this policy while nursing levels are critically low, mental health provision is beyond abysmal and people are having to wait much longer than they should for vital treatment.

We might be protecting NHS funding, but we are far from providing the sort of service we need. It seems very difficult to have a calm and rational debate about what services the NHS should provide but it is essential that we do. Money is not unlimited so we have to make choices. Is it right that we prioritise cancer drugs (which seem to be untouchable) over addiction services, which are often non existent or insufficient? If we gave drug users the quality therapy that they need, then think of the consequences for them and the benefits to the whole of society.

The NHS is the right model of health service provision as far as I am concerned. Nobody should ever be denied care because of a lack of money. We need to be honest about where it’s failing though. If we want to make it more effective, we need to work out how best to spend its resources. If you spend more on one thing, you have to spend less on another unless you increase the income. A higher level of personal taxation within a progressive tax system sounds like a sensible way to do it to me. The problem is that any talk of raising income tax is greeted with shock and horror. The narrative that governments and politicians are incompetent and untrustworthy serves the interests of those who want the state to be smaller for entirely ideological reasons.

If our health service is going to keep up with medical advances while providing good quality care to our ageing population, it will need much more money in the future. We have to be able to debate and discuss this with reason and intelligence. Sadly, I won’t be holding my breath waiting for that to happen. The debate is wider than the health service, too. I’d be the first to suggest that many of our public services need improvement and cultural change within them, but a strong public sector is very important in protecting and enabling citizens. It’s time that we argued that case with pride and passion.

Update: it has been pointed out elsewhere, by Iain Donaldson who is a regular contributor on these pages that it’s due to the Liberal Democrats in government that any new NHS charges must be first approved by Parliament.

* Caron Lindsay is Editor of Liberal Democrat Voice and blogs at Caron's Musings

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41 Comments

  • It’s the dishonesty in this debate that irritates me. The state is abusing its position and acting like a dishonest trader.
    Where I live prescriptions are free, but the chemists are always changing the make (presumably to keep costs down) and this causes more problems than you think.
    Also where I live there are NO M&S dentists and I have to pay my former one £10/month subs now, plus costs of treatment (£60 for a tiny filling). I gave up years ago trying to find an NHS optician. I use a private podiatrist too, the nearest hospital being miles away.
    The state is taking my contribution for services it is not even trying to provide!

    On the original point, I can see why S Warks wanted to charge for equipment because no one takes crutches, etc back to the hospitals – it’s too much trouble! Much better surely for them to charge a realistic deposit ?

  • Chris Turner 21st Apr '14 - 11:56am

    While the general voting population sees drug addicts as scroungers and criminals,mental health issues as not real and cancer therapy about keeping their beloved (grand-)mother alive it’s clear that reprioritisation of health care resources will never be politically expedient.

  • Eddie Sammon 21st Apr '14 - 12:26pm

    I agree with a two pronged approach of more charges and higher taxation. However I would add two further points:

    1. We need to incorporate social responsibility more into NHS charges. People who act irresponsibly should sometimes be sent a bill.

    2. We should set up public services memberships. People could sign up become a member of the NHS, which doesn’t mean priority care, but it does mean a better funded health service, providing both a personal and a collective benefit. I submitted the idea to the manifesto group months ago.

  • Radical Liberal 21st Apr '14 - 1:25pm

    Caron writes ”The reality, of course, is that not everybody would have to pay. Those who use most drugs, the poorest, pensioners and children, were always exempt anyway.”

    I am one of those that are classed as exempt. But I continue to pay the full prescription because the form to fill in to get the exemption is confusing and long. There are many other’s like me out there although I suspect some of them just don’t take their medication at all. This is what happens when you means test. No doubt people will say ‘well fill the form in” but truth is you need to deal with people as they are – many of those who don’t fill in the forms and so can’t afford the medication will just get worse health and end up costing the NHS more when they have a stroke etc.

    There are however these people, not sure if you know about them, who basically have everything their own way. In fact, society – the economic system – has been structured in such a way as to benefit them most. They are called the rich. Make them pay for universal free healthcare.

  • Tony Greaves 21st Apr '14 - 1:31pm

    It seems the Labour Party thinking of creating a hypothecated fund by putting up NI charges. This is of course the wrong solution. If they want to raise more money from employed people and their employers they should increase income tax and corporation tax. But they could make top earners pay NI contributions on all their income.

    Tony

  • Radical Liberal 21st Apr '14 - 1:33pm

    Eddie Salmon – ”1. We need to incorporate social responsibility more into NHS charges. People who act irresponsibly should sometimes be sent a bill.”

    What would you consider irresponsible and why do you hold them responsible? Often people think of those who get drunk and have to get the stomach pumped etc in cases like this. So will you be sending the bill to the person who got drunk – even alcoholics? – or to the pubs that they went to? What about their families who have a ‘drink culture’. Should they be sent part of the bill for their responsibility? Apply the same to smokers etc.

  • Brave thread – it feels politically impossible to address these issues in Government as the NHS is such a political football. The only way I could see this changing is a Con-Lab coalition, or some form of cross-party commission where everyone signs up to the process in advance.

    The root of the problem is that inflation in the NHS is running at roughly 6% pa in real terms, so even the coalition protecting budgets (annual increases of 0.1%) is the equivalent of a substantial saving elsewhere. All the comments on prevention measures are valid but not enough. My proposal is quite radical and different. The NHS needs to start generating billions in income to survive. I’d create an investment portfolio ‘NHS Investments’ or similar, with all funds ring-fenced in the portfolio, and all dividends going straight into health funding. I’d have two main ways of getting funds in: 1- additional inheritance tax charge for those with a substantial estate who have received more than £xx of care on the NHS. 2 – encourage charitable donations (so all the same tax breaks) for those who want to give something back to the NHS, show gratitude about care of a loved one etc.

    Can I see anything like that happening? No, it’s just too politically difficult. But something is going to give sooner or later, and we need to know our approach as a party in case we are in power when it can’t be ducked any longer.

  • Jenny Barnes 21st Apr '14 - 2:42pm

    johnmc “no one takes crutches, etc back to the hospitals – it’s too much trouble! ”
    Wrong. I do.

  • “For the price of a large glass of wine in an Edinburgh city centre pub …”

    £8 may be the price of a glass of wine in a pub to you, but it’s the price of nearly three bottles of wine in an off-licence to me – and probably to quite a large proportion of your former supporters.

    If you don’t want to sound too much out of touch, perhaps you should try to think of a different way of making £8 sound cheap.

  • Andrew Martin 21st Apr '14 - 3:15pm

    I have a problem with the title of this – in particular the word ‘need’. We could always choose to change the amount we spend on healthcare, and ‘need’ is subjective. How much do we ‘need’ to spend on education, on defence or on law and order?

  • Current spending won’t keep the NHS as it is because of the costs of a rising elderly population, which is by far the biggest financial problem the NHS (and society) faces, so either the money comes from somewhere, cuts are made elsewhere, or both.

    In the long term certain other things can be done to reduce costs, such as to cut alcohol, tobacco and food consumption in the population – but many people oppose this. Social care can be integrated, and I think this has resulted in a political consensus that yes this must happen, minor disagreements over detail aside. This will help. But it won’t stop people ageing and it won’t make looking after them cost free.

    The NHS needs a lot more money just to stand still.

    Labour have one solution, which is to raise NI, Tony Greaves says this is wrong, it may be, but what is the Lib Dem alternative?

    Of course, there is a terrifying possibility which would dramatically reduce costs and cut the numbers and costs of diseases of ageing. Antibiotic resistance. If we don’t keep generating new antibiotics then all of the above arguments are moot.

    Most people will die of infection rather than disease of old age.

  • Eddie Sammon 21st Apr '14 - 6:53pm

    Radical Liberal, I think social responsibility charges have the dual benefit of raising revenue and reducing costs by encouraging more responsible behaviour. I would target reckless behaviour, rather than simply flawed acts.

    Reckless behaviour would include binge drinkers who need their stomach pumped, but special leeway would be given to alcoholics seeking help.

    I really don’t see any other alternatives to the drink and drug problem. Prohibition doesn’t really work and the NHS wouldn’t be able to cope with a literal “free for all”.

    Regards

    Regards

  • Little Jackie Paper 21st Apr '14 - 8:42pm

    OK – I’ll stick my head above the parapet.

    g – ‘The NHS needs a lot more money just to stand still.’

    Well, yes. But in many ways, this argument could be applied to many services – the NHS is just the stand-out example. Basically money is needed in quantities that do not reconcile with deficit reduction.

    This is the whole crunch on many services. If you look at how the young have been invited to contribute to extra funding for universities then you get some idea of the political costs here. And one reason that other things have been clobbered is the protection for the NHS. As a number of people on here have already said, it is far from clear that people are willing/able to pay more tax for the NHS.

    We have basically had the discussion about how to cut just about everything else (except, it should be noted, pensions). So is it time to start having a discussion about how best to cut the NHS?

  • Philip Rolle 21st Apr '14 - 10:19pm

    I would have thought that we are going to have to switch to an insurance based system in the end. A flat fee, per person or per family each year. Those who couldn’t pay would have their premium paid by the government.

  • jACKI

    g – ‘The NHS needs a lot more money just to stand still.’

    Well, yes. But in many ways, this argument could be applied to many services – the NHS is just the stand-out example. Basically money is needed in quantities that do not reconcile with deficit reduction.

    Well, the coalition have cut taxes, that too is incompatible with deficit reduction, or for that matter sustaining current spending on healthcare, let alone increasing it.

    Phillip Rolle

    I would have thought that we are going to have to switch to an insurance based system in the end. A flat fee, per person or per family each year. Those who couldn’t pay would have their premium paid by the government.

    Why? There’s nothing inherently wrong with insurance based systems, but they are not cheaper than the NHS when done well, e.g. France, Germany, etc, only comparable with it, and when done badly…

    It seems a hell of a risk to go from state funded healthcare to an insurance based system when it won’t actually save money.

  • Matthew Huntbach 22nd Apr '14 - 10:05am

    Consider this news. From 2003 to 2011, deaths from heart disease and strokes fell by 40%. So there has been this HUGE drop in the thing that kills most of us, and in particular kills people before they reach retirement age, and often kills us quickly so we don’t need a long period of expensive health care while it’s doing it.

    This ought to be THE biggest thing we are talking about in politics, because of the impact it has. With so many more people living longer and dying of things that kill you very slowly, the impact on health and welfare expenditure is bound to be huge. This ought to be OBVIOUS. It is something that should be so obvious that it doesn’t need to be mentioned. Yet it isn’t mentioned. Right-wing politicians and commentators like to drop hints (even though they know it isn’t true, or if they don’t know, they really are very thick) that rising health and welfare expenditure is all due to “scroungers” etc. They like to talk as if a fixed proportion of GDP going on state spending means no change in service levels, when it ought to be obvious to anyone who has the intelligence it takes (or should take) to be a politician or paid media commentator, that this huge demographic change is going to push up state expenditure massively so long as we have the rule that health care sufficient to do all that is needed to keep us alive and as healthy as can be should be provided free of charge at point of delivery.

    The failure of the political left to make this point and so challenge the right also says a lot. The political left in this country is useless. It lets the right win because of its uselessness. We need a serious debate on these issues, not moans about “the cuts” as if “the cuts” are just done because the right enjoys inflicting them.

    A proper democratic discussion is needed. If we want the NHS as it is, we will need to pay more taxes. If we aren’t willing to do that, then the discussion needs to be in dismantling the NHS. If we want a decent state pension for all, we need to pay for it with more taxes. If we aren’t willing to do that, we need to accept that the state pension will be run down and become a token amount. If we aren’t willing to pay the taxes needed for these things, we will still need to pay for them – more private medicine with all its costs, more private pensions. If that’s the way the people of this country want to go, well fine, but let’s have an HONEST discussion about it. When all major political parties are importing expensive ad-men to run their campaigns in the next general election, that won’t happen. Instead we’ll have this continuing everyone throwing mud at each other over the consequences of it happening while pretending it isn’t happening, and pretending their are easy-peasy solutions and it’s just the fault of “the other lot” that those solutions haven’t been put in place.

    On the right the easy-peasy solution is more competition. It drives up quality, you see, there’s this magic fairy dust called “private sector know-how” you can sprinkle of things to make them improve. The problem with the NHS, according to this theory, is that its workers are not under enough stress. You need to put them under more stress, fear they will lose their jobs, fear some competitor will beat them if they don’t accept wage cuts so the competitor wins the contract with a lower bid. That will improve service.

    Well, isn’t it remarkable that most Tories and judging by some of their rhetoric quite a few Liberal Democrats believe in that one?

    The easy-peasy solution on the left is that there are some rich people over there – waving hands vaguely – oh not you, not anyone you know, who might need to be taxed more. Plus, post-Blair, similar to the right-wing solution, only done in a nicer way, obviously.

    And on both sides “Government by us will be so wonderfully successful that the economy will grow massively, so we don’t need to worry about how we’ll pay for things”.

    By the way, “We’ll devolve power, so put the Health Service here under local control” is another easy-peasy solution proposed by some that quite obviously won’t work.

  • Andrew Colman 22nd Apr '14 - 5:29pm

    The average Briton spends about US $3000 pA on healthcare including taxes. The average American spends over $7000 for the same level of service on average. We Britisgh have been getting healthcare on the cheap for decades and don’ t realise how lucky we are.

    However, one can have too much of a good thing, the NHS is so underfunded, it is starting to crack. Adding bureaucracy and implementin g patina choice (a myth for most) has increased the cost of the NHS. The NHS is cheap because it is a “COLLECTIVE” service, it can negotiate the lowest prices for drugs and benefit from economies of scale. Many in the establishment hate this and would like to move to a system like in the USA wher patients can be ripped off for medicines when utterly desperate and sick..

  • Paul in Twickenham 22nd Apr '14 - 5:51pm

    At a conference in the USA a few years ago I heard the CEO of a very well known IT company encourage people to start businesses in the health care sector. He said “people will spend a lot of their personal wealth trying to stay alive”. Peerless capitalist sentiment but it makes a good point: the cost of health care will continue to increase as novel treatments look to recoup R&D costs while also turning a healthy profit. How do we respond? I really don’t know but it feels as though the current NHS model is not sustainable.

  • Andrew Colman 22nd Apr '14 - 5:53pm

    As for funding gap I suggest the following
    (1) The NHS should be for curing disabling or life threatening disease, not for lifestyle choice (eg fertility treatment)
    (2) Save public money by only sending dangerously violent criminals to prison, except in extreme cases
    (3) Raise more revenue via Land Value Tax, Tobin Tax, Mansion tax, abolishing tax relief, making it harder to use tax havens
    (4) NHS should pursue a 3rd party when responsible for sickness. Eg A bullying employer causing depression in a victim..

  • Andrew Colman
    I agree with much of what you say.
    Some of us do realise how lucky we are that during our lifetime the NHS has survived the worst of what the privatisers have tried to do to it.
    Health Care and government interventions to secure public health (keeping people out of hospitals in the first place) are far superior on this side of the Atlantic.

    It is worth pointing out that within the USA there are huge variations from state to state. Some states ( those which traditionally have elected right wing nutters) have a life expectancy and health care system far inferior to that of some much poorer Latin American states. Hence the potential for significant improvement in Obama’s limited federal scheme. Other states ( mainly in the north ) have had a sane system going back generations which reflects a more European approach.

    It remains true that in many parts of the USA public health is a very poor relation especially if for example some capitalist get rich quick multinational decides to start fracking your neighbourhood to destruction.

  • Matthew Huntbach 22nd Apr '14 - 6:20pm

    Andrew Colman

    (4) NHS should pursue a 3rd party when responsible for sickness. Eg A bullying employer causing depression in a victim..

    Sounds like a job creation scheme for lawyers.

  • Andrew Coleman
    (1) The NHS should be for curing disabling or life threatening disease, not for lifestyle choice (eg fertility treatment)

    I’m not entirely sure being infertile is a lifestyle choice…

    However, smoking is. Drinking is. Being overweight is. Or at least at first, before addiction, bad habits and psychological issues set in. Would you deprive cancer patients of treatment if they smoke/d? Would you deprive liver patients of dialysis if they drank? Would you deprive people of statins if they were overweight?

    Shall we abandon addicts, of all sorts, to their vices rather than offer treatment?

    What of those who injure themselves while doing a sport? Should they be refused treatment as it was their choice?

    Who decides?

  • Jayne Mansfield 22nd Apr '14 - 8:52pm

    @ Andrew Colman,
    I am not sure that the wish to have infertility treated is a ‘lifestyle choice’.

    Infertility is, as far as I am aware, the outcome of a biological problem that in some cases can be treated. Why should individuals with this particular problem be less entitled to treatment than individuals who are afflicted with other biological problems.

    My husband and I were fortunate enough to have the children that we correctly assumed that we would be able to have, but I can understand the horrendous mental anguish of those who are less fortunate, the strain that might put on a relationship, and the desperate longing that might tip a couple into depression.

    The decision to have a child or not might be termed a lifestyle choice, but in my opinion, being unable to reproduce without medical intervention is not.

  • Richard Dean 22nd Apr '14 - 10:08pm

    @Jayne Mansfield

    Surely the question is not whether it’s a lifestyle choice, but whether it’s something that those with that problem should have a right to expect those without it to pay for through taxation? Some people are not too happy about paying taxes for someone else’s cosmetic surgery, for example, but will accept paying taxes for someone else’s cancer treatment partly because they or a family member may need it in future.

    Where fertility treatment comes in the spectrum I don’t know, I suppose the right thing to do is ask the people who pay the taxes – voters. On the positive side it soothes a not-uncommon problem, and the research that supports it has many other applications that can benefit many other people too.

  • Matthew Huntbach

    I agree we need a sensible grown up discussion. I agree the success with heart disease and strokes has changed the shape of demand for health services. I’m not sure anyone considers the increasing demand for health due to “scroungers” anyone could see though a claim that bizarre.

    I think your choice between lots more funding or “dismantling” sounds rather vague. A lot would depend on what you mean by that latter option. I can think of countless unpleasant choices that would reduce the cost but would not remove the free at the point of use principal. Any alternative would be very significant and has to be a mature democratic discussion. There are still some basic savings that could be made.

    Regarding competition, the way in which competition in the private sector improves productivity is through allowing experimentation and then the successes are copied. Anyone hoping this will be the way it is promised in the NHS is living in a dreamland, the public appetite for the experimentation is not there. That is not to suggest that support services shouldn’t be provided on that basis.

    Andrew Colman

    “Many in the establishment hate this and would like to move to a system like in the USA wher patients can be ripped off for medicines when utterly desperate and sick.”

    Really? Above people were suggesting serious discussion but they you went off down your fantasy land. There is no massed numbers of the population who are salivating over inflicting suffering on their neighbours. People have beliefs in different ways of doing things, some I can understand why they think that some I can’t but I don’t assume they are “evil.”

    No one would look to copy the US system but they may want to see what they can take from other European models.

  • Malcolm Todd 22nd Apr '14 - 11:39pm

    Very well said, Richard Dean. Worth saying that infertility treatment probably isn’t a huge factor in the NHS budget — but the principles involved are no doubt applicable more widely, and it’s not an issue that is well served by dogmatic comments about “lifestyle choice” or “biological problem”.

  • Matthew Huntbach 23rd Apr '14 - 12:28am

    Psi

    I think your choice between lots more funding or “dismantling” sounds rather vague. A lot would depend on what you mean by that latter option.

    I don’t mean anything specific, and it’s certainly not a direction I would want the country to go down.

    All I’m saying is that there aren’t easy options. We can’t just not raise tax and yet keep the NHS providing the sort of health care we assume it should. Once this is accepted, we can have a proper debate in this country on just how we handle this dilemma. If the people of this country really wouldn’t pay the taxes, then it’s up to them to decide what they’ll do instead.

  • Jayne Mansfield 23rd Apr '14 - 8:27am

    @ Malcolm Todd,
    Actually I was responding to Andrew’s comment that infertility might be a life style choice, something that I would strongly argue against.

    Perhaps I lack a facility with language but what you call ‘dogmatic comments’ about biological problems’ is what I call the criteria set down by NICE, on whom should be eligible for infertility treatment.

    My husband and I have been fortunate to have had good health and need little intervention from the health services, even now my age related problem with eyesight does not lead to me being a burden on the NHS. I am starting to object very strongly to how we, the aging population are being used as an excuse for the implementation of changes in the implementation of health care and the way it is funded.

    Many of the ageing population will be working for longer and paying NI and taxes for longer. As a family, I would argue that we still pay more in tax than either my husband and I have drawn from the NHS.

    The NHS came into being when there were arguments about its affordability and there will always be arguments about its affordability. There has always been rationing and there will always be rationing. A current controversy being that NICE have not recommended the £90,000 cost of a drug to extend the life of women suffering a particularly aggressive form of breast cancer by up to six months. NICE recommendations are meaningless though if the Clinical Commissioning Groups choose not to fund some of their recommendations. Infertility treatment and other treatments are still subject to a post-code lottery whatever the evidence gathered by NICE, so I question whether we have ever had a ‘National’ health service, ever.

    On another thread, there is discussion on the growth of UKIP support in the polls. One of the arguments most often put forward by people who I overhear saying they intend to vote UKIP is the anger that the contributory link has been broken. People feel that they have paid into a system and others who have not done so, are receiving benefits to which they are not entitled. I have yet to hear a politicians mount a counter argument and would welcome one.

    I am happy for a health service that continues to be financed by NI and taxation. If we look to Europe, perhaps we should start with doctors salaries and if we decide on an NHS funded by taxation maybe we should look at ensuring that people pay their taxes and do not avoid or evade doing so.

  • Matthew Huntbach 23rd Apr '14 - 1:34pm

    Jayne Mansfield

    One of the arguments most often put forward by people who I overhear saying they intend to vote UKIP is the anger that the contributory link has been broken. People feel that they have paid into a system and others who have not done so, are receiving benefits to which they are not entitled. I have yet to hear a politicians mount a counter argument and would welcome one.

    But UKIP themselves are giving the counter-argument. They are mounting this big campaign about foreigners coming here and taking our jobs. I.e. the foreigners do the work and pay income tax, we Brits laze around unemployed being paid benefits from the proceeds of that income tax.

  • Jayne Mansfield

    “One of the arguments most often put forward by people who I overhear saying they intend to vote UKIP is the anger that the contributory link has been broken. People feel that they have paid into a system and others who have not done so, are receiving benefits to which they are not entitled. I have yet to hear a politicians mount a counter argument and would welcome one.”

    Perhaps the counter argument is not put because the argument is so weak as to be non-existent. On the odd couple of times I have ever heard anyone mention something to this effect it is answered if you ask (quite innocently) “in what way” or “what do you mean.”

    Most people don’t want some king of strict contribution testing and certainly don’t when they hear how badly the current system of “contribution” assessment works.

  • Jayne Mansfield 24th Apr '14 - 10:20am

    @ PSI
    Having looked it up on Wikipedia, I think I see what you mean, although I don’t think that I have understood the complex nature of the system enough to challenge someone on what they mean.

    Does the system have to be so complex? I agree that George Osborne or any other chancellor should try to simplify it but I am not against a redistributive element. What does it mean that he is considering simplifying the system but the options do not include pensions, dividends etc. ?

    I was supportive of the extra penny on the pound on tax for education in the 1990’s In my opinion, it is simple things like this that appeal to people. The NHS has been referred as almost a ‘religion’, if extra money comes from taxation but people like myself are more aware of where it it going and approve, it seems to me that this is the sort of message that cuts through. The alternative is for us to remain in ignorance ( how many people do you think would wade through the Wikipedia article), or to change votes to a party ( UKIP) , who give simple messages ( over-simple some would argue) that allows us to remain intellectually lazy and get on with our daily lives.

  • Matthew Huntbach 24th Apr '14 - 10:28am

    Jayne Mansfield

    Does the system have to be so complex?

    You are the one calling for health care to be provided only to those who have “contributed”, so to do that there needs to be records kept of contribution, and checks before care is given as to whether those it is being given to have contributed.

    Just providing people who are entitled to live in this country with health care paid for by general taxation is much less complex.

  • Matthew Huntbach 24th Apr '14 - 10:30am

    Jayne Mansfield

    Infertility treatment and other treatments are still subject to a post-code lottery

    “Post-code lottery” means local decision making. if you ask people they always say they want local decision making, they don’t want all decisions to be made by civil servants in Whitehall. If you have local decision making, then it is bound to be the case that in one area the people making the decisions decide to balance priorities one way, and in another area they balance it in a different way.

  • Matthew Huntbach 24th Apr '14 - 10:36am

    Just saw a glimpse of a newspaper headline today about a massive drop in deaths from cancer. Plus an article in another newspaper about a massive rise in the number of elderly people who do not have children who can help with care as they grow older and need it.

    All these things are BOUND to push up spending on health and care. They show how UTTERLY BOGUS are all those right-wingers who go on and on about keeping state pending at a fixed proportion of GDP and claim that means a steady state in terms of service. Next time you hear someone saying that sort of thing, remind yourself “He’s a conman”. Do not take ANYTHING he says seriously. Such people are menaces and should be shown up as such, they should be attacked and ridiculed and made to feel deeply ashamed of their conman trickery.

    There are people here reading this who know I mean them.

    An honest politician would be honest about the dilemma faced here and would talk openly about it in order to get a proper democratic debate and an informed decision. Are there any such politicians around?

  • Jayne Mansfield 24th Apr '14 - 11:52am

    @ Matther Huntbach,
    No Matthew, I said that I overhear people grumbling that they feel that people are benefitting from something that they
    have not contributed to. I did not say that I agree with them.

    As for your second post, to go back to the subject of language, I think that people understand the principle of ‘fairness’ rather than ‘localism’. They may have different notions of what is fair, but I think most people agree that it is a noble aim.

    If we are a united nation and we have a ‘National’ health service, is it really fair that people in one area of the country have access to funds for their condition when people in another part of the country don’t? You don’t have to agree with me, but you must as someone who has spent a lot of time campaigning for a political party understand that others have different ideas to your own or that of the party, or when push comes to shove, they change their ideas about what is fair.

    Localism seemed like a good idea to me until I understood how unfair ( according to my definition), it can sometimes be in practice, i.e the concrete as opposed to the abstract.

    I would also like to point out that there are several outcomes when it comes to a rise in the elderly population. It is not inevitable that in a wealthy country such as ours the elderly will become an intolerable burden on finances.
    1. The Compression of care
    2.Better care in childhood and through life to ensure better health in old age.

    There needs to be a change of attitude to the elderly, there is plenty of evidence that there is not as great a slowing down of cognitive function in old age as once thought. There is no reason why people should have to retire at a particular age, and again there is plenty of evidence that continuing to work helps delay some effects of the ageing process. Where people are in physical demanding jobs there should be opportunities to retrain and an environment that supports this. Having said that check out whether productivity on German production lines dropped when people were older. ( They didn’t).

    When people keep framing us as a problem, they should check out how much we contribute indirectly to the economy even after retirement in terms of voluntary social work and care etc. Try looking round any play area during school holidays and you will see them over run with grandparents like myself who care for our grandchildren so that our own children and daughter-in laws can work in the paid economy.

    Dementia, the great concern is not an inevitability, if the public are concerned about the effects of dementia they should be arguing for more research into its prevention.

    Developed economies have known for decades that we were going to be a low fertility, high longevity nation. That patterns of health were going to, and were changing from infectious type diseases to chronic diseases and it has been a failure of politics that we suddenly have this recognition of the need for preventative health from the cradle as opposed to waiting for problems to occur and then grumbling that there is a problem and it might prove expensive.

    If this is off topic, I too will be eligible for my ‘Dementia test’ at the GPs.

  • Jayne Mansfield 24th Apr '14 - 2:27pm

    @ Mattew Huntbach,
    Sorry, that should be,
    1. the ‘compression of morbidity’.

    I also forgot to mention keeping costs down by allowing people to function within their own homes for longer. We contribute to doing this for my 88 year old sister.

  • Jayne Mansfield

    Two points

    Firstly

    “Does the system have to be so complex”

    Probably not, it was not designed to be if you look at the original law, but that is what happens when policy hits reality, so we would be better off scrapping the contribution tests until someone can provide a really good justification on how they have found a system that will work. I’m not convinced anyone will.

    Secondly

    “Dementia, the great concern is not an inevitability, if the public are concerned about the effects of dementia they should be arguing for more research into its prevention.”

    Completely agree, one of our stored up problems is the lack of effort in to tackling the chronic conditions that would be far less of an issue now than if we had put more focus on them earlier.

    Also more research in to how life adjustments should be made as people come to ages that were previously retirement ages. Once it becomes the norm to gradually scale back rather than drop off a cliff the better. Too little value is placed on life experience.

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