Our NHS needs money!

Vince has been talking about how we can properly fund the NHS in England and Wales.

 

The full LIb Dem plan is here. It includes five steps for rescuing health and social care services, with the long-term goal being to integrate health and social care into one seamless service with pooled budgets.

  1. An immediate 1p rise on the basic, higher and additional rates of Income Tax to raise £6 billion additional revenue which would be ringfenced to be spent only on NHS and social care services.
  2. Direct this additional investment to the following priority areas in the health and care system: social care, primary care (and other out-of-hospital care), mental health and public health.
  3. In the longer term and as a replacement for the 1p Income Tax rise, commission the development of a dedicated Health and Care Tax on the basis of wide consultation, possibly based on a reform of National Insurance contributions, which will bring together spending on both services into a collective budget.
  4. Establish a cross-party health and social care convention, bringing together stakeholders from all political parties, patients groups, the public, and professionals from within the health and social care system to carry out a comprehensive review of the longer-term sustainability of the health and social care finances and workforce, and the practicalities of greater integration.
  5. Introduce a statutory independent budget monitoring agency for health and care, similar to the Office for Budget Responsibility. This would report every three years on how much money the system needs to deliver safe and sustainable treatment and care, and how much is needed to meet the costs of projected increases in demand and any new initiatives – to ensure any changes in services are properly costed and affordable.
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80 Comments

  • Lorenzo Cherin 25th Jan '18 - 1:44pm

    This is very good and an answer to those who think the party talks about anything but Brexit.

    The sad fact is the party barely gets any coverage when it does talk about anything but Brexit.

    The two do connect.

    And it is, Labour , whether they have policies as good, worse , or better, get coverage on the health service related issues.

    What is both necessary and vital, is very dramatic or action packed changes to the way we do things in this country on health care.

    One thing not mentioned much is training and recruitment and then retention.

    We have to see that as the Brexit situation is already making the NHS lose staff, it also reveals the defeatist attitude to providing the jobs needed for the patients who need them, as well as the benefits to the UK workforce being a skilled and productive one.

    It is shameful that people who could be providing the essential services within this country , are not available in numbers needed, compared with most countries.

    British jobs for British workers, was meaningless , from Brown, because he did not even get the government to phase in the accession of new countries into the EU, nor did any government play by the same strict but sensible rules on freedom of labour movement, not the same thing as the mythical free movement referred to often, most countries enforce them, and claim the money for their patients from the host country, but this country does not.

    Money that is available not claimed, added to training and recruitment that is not implemented, as well as retention of workers not happening , a demoralised staff, a disastrous situation.

    This is without even staring on the flaws in the whole structure and attitude , in delivery and care, in general.

    The social care element added, only adds to the problem identified above, if the money and changes are not made.

    Big private monopoly contracts are no more the answer than big government management led ones, if none of the real issues are addressed, these contractual ones, are a sideshow.

  • John Marriott 25th Jan '18 - 1:54pm

    Absolutely SPOT ON! Now comes the hard bit. Stop banging on so much about Brexit and start promoting the Health Plan. Lib Dem supporters are anxious for the party to gain the public’s attention (and presumably votes). Surely here is that opportunity. But KEEP IT SIMPLE!

  • Lorenzo Cherin 25th Jan '18 - 2:14pm

    John

    Yes , keep it simple, and simple me should have said , doesn’t talk about anything but Brexit!

    We are staring regularly at the same terrible problems in our health care delivery in our country.

    The keep it simple, can only gain impact if we talk as a party prepared to say not just the popular things, but the less, popular.

    There is waste , private sector or public, in the service, bad practices and good, and too little attention to satisfaction for patients as well as the professional staff.

    A simple approach is this: It is immoral to ot prioritise health.

  • Lorenzo Cherin 25th Jan '18 - 2:17pm

    Another typo, meant to say, it is immoral to not prioritise health!

    I am convinced my typing is behind misunderstanding on here which never happens when I speak !

    It is no wonder I am developing the notion of a you tube presence to start up soon…!

  • Brexit is costing the public finances £15 billion a year (OBR figures). Let’s stop Brexit and fund the NHS instead!

  • Neil Sandison 25th Jan '18 - 2:27pm

    Completely agree with John Marriott .Tired like most of the public of Labour weaponising the NHS .Support cross party moves not only to adequately fund the current Health and Social Care needs through taxation but to come forward with a sustainable package going forward for the next 10 years . I recognise as someone who has recently spent time in hospital in acute services waiting for a bed to become available that our major trauma units have become little better than war time field hospitals and not the centers of excellence promised under the Major, Blair ,Brown PFI contracts .The buildings are deteriorating and the staff are stretched beyond what is reasonable and perhaps safe too many external contractors not keeping pace with demand leaving nursing and medical staff having to bypass them to get things done so patents get a least a reasonable level of care .It frightening to note that we will soon have a million people over the age of 75 with complex medical problems yet we are still in the foothills in terms of primary ,acute and social care discharge practices.

  • William Fowler 25th Jan '18 - 2:33pm

    A new land value tax, increase in income tax and an expanded role for the government in people’s lives (I guess) is not going to add up to any new seats in the next election…

  • John Marriott 25th Jan '18 - 2:52pm

    I’m not saying that savings still can’t be made but, clearly, more cash is needed if we are to maintain let alone increase the kind of health cover we seem to expect. Currently our spending on health as a percentage of GDP is, I believe, around 2% less than Germany or France, for example, although, admittedly, these countries operate a different system of health cover.
    One other aspect needs eventually to be tackled, if not immediately then at least in the short to medium term, namely the lack of homegrown doctors, nurses and care workers and our reliance on foreign trained health and care professionals. I would seriously consider offering bursaries only on condition that the recipients, once qualified, would agree to work exclusively within the NHS and be directed to where was the greatest need for, say, at least four years before being allowed to work in the private sector or abroad. Failure to comply would mean that they would be legally obliged to pay back the public funds their training had cost.

  • OnceALibDem 25th Jan '18 - 3:26pm

    @William Fowler. Slightly awkward fact but since 1992, Lib Dem seat increases at general elections have only come when the party had a manifesto commitment to raising one of the income tax rates. You may not have realised as you were busy supporting the Tories then of course……

    Though had the 2010-15 government increased NHS funding at the historic average of the 79-97 Tory governemnt the NHS budget would today be higher by more than the £6bn Vince is talking about.

  • A welcome shift of emphasis by Sir Vincent – but- I’m afraid a penny on income tax is a tired old slogan well past its sell buy date. It lost its resonance in Charlie Kennedy’s day when it was for education.

    Unfortunately, there’s a legacy which impacts on credibility. According to the I.F.S. “spending growth under the coalition government was the lowest five-year average since records began”. (UK health spending, pub. by The Institute for Fiscal Studies, ISBN 978-1-911102-46-5.

    There is also the Lansley reforms (supported by ??? ) which handed over profits from GP surgeries to such as Branson, and the cuts to local government spending which reduced the opportunity for joint working with the NHS in England.

    I’m not sure what Neil Sandison means by “Labour weaponising the NHS”. It sounds like a trite remark from a Tory backbencher. We need an opposition doing its job – exposing the scandalous state of the NHS where people die in ambulances waiting for admission – which Mr. Corbyn certainly did yesterday. We also need a future Government that will do something about it. If that’s ‘weaponising the NHS’, then tough.

    Where the 12 Lib Dems will come into it, and where they will spend a penny, is a mystery wrapped in an enigma for the moment.

  • Jayne mansfield 25th Jan '18 - 5:56pm

    @ David Raw,
    I am afraid hat the rot set in under Blair. The marketisation of the NHS, PFI, the disastrous GP contract.

    I think that l Oliver Letwin’s dreams must have come true with the the Health and Social Care Act. But may I say, you haven’t seen anything yet. Wait for the Accountable Care Organisations.

    I don’t know whether you are familiar with the work of Professor Allyson Pollock, but I am impressed with her work. Her earlier work has sadly become an accurate prediction of what would happen to the NHS under privatisation.

  • Peter Martin 25th Jan '18 - 6:06pm

    How do you know that increasing income tax by 1p will raise £6 billion?

  • @ Jayne Mansfield Yes quite right. It started under Major but was championed by Blair and Brown. Edinburgh Royal Infirmary is a classic case.

    Yes, I have heard of Allyson Pollock at Newcastle. Her paper with Mark Hellowell to the Scottish Government should be compulsory reading for Liberal Democrats. (10 January 2008, Written evidence to the Finance Committee of the Scottish Parliament with regards to its inquiry into the funding of capital investment, Scottish Parliament.)

    They showed that the £5.2 billion of PFI investment in Scotland has created a public sector cash liability of £22.3bn. This cash liability is ‘off balance-sheet’ and does not show up on government statistics such as the Public Sector Borrowing Requirement (PSBR). I do wish Vince Cable, Alex Cole-Hamilton and Willie Rennie would talk to them –
    and I hope Corbyn can deliver a change of direction.

  • Not sure that the great British public have any great appetite for an extra 1% on income tax. The great attraction of Labour’s offer is that it will be someone else (probably one of those nasty banker types) who will be paying. Fundamentally the problem is that people want Scandinavian welfare and American taxes and politicians haven’t the pluck to tell them that it can’t be done. Certainly we need more money spent on the NHS. Problem is we also need more on defence, education isn’t looking too good, I could go on.
    Countries like France spend a good 10-15% more of GDP on healthcare. Perhaps we should just indulge in a little comparative social policy ?

  • @ David Raw @ Chris Cory

    The situation was that at the end of the Labour Government overall public spending was some £100 billion a year more than income – clearly an unsustainable position. Health (and education) spending was safeguarded by the coalition.

    I think that the British public are not fools and they know that if you want extra spending on the NHS then it has to come from somewhere. A large number do support 1p on income tax because they know that if they don’t pay it in taxes then they have to pay it in either private health insurance or private treatment or having a full A&E when they need it

  • Peter Martin 25th Jan '18 - 7:22pm

    @ Micheal,

    “The situation was that at the end of the Labour Government overall public spending was some £100 billion a year more than income”

    Money is the creation of government. It can’t get back more in taxes than it has created in the first instance. It’s arithmetically impossible.

    “I think that the British public are not fools and they know that if you want extra spending on the NHS then it has to come from somewhere.”

    They aren’t fools, but neither are they helped in their understanding of macroeconomic theory, when the budget of a government is continually compared to a household budget when those making that comparison, politicians and TV pundits etc, know very well that is a false comparison.

  • Tony Greaves 25th Jan '18 - 7:35pm

    I don’t think Mr Corbyn will “deliver” anything. The whole Corbyn thing is an enormous diversion which will be ultimately very damaging to progressive/radical politics. Just wait and see.

  • John Marriott 25th Jan '18 - 7:36pm

    Chris Cory,
    Nobody likes to pay taxes. Most please support higher taxation provided that someone else pays. As I have said on several occasions, in LDV and elsewhere, people here expect Scandinavian levels of public services on American levels of taxation. Although I don’t hold the copyright on the analogy, i’m pleased that you appear to agree. Continuing to pander to self interest, as the Tories have done for years, may have worked in the past and may work in the future; but, one day, people just might wake up to the fact that you usually get what you pay for. If you want Rolls Royce services, I’m afraid you need to pay near to Rolls Royce prices. You know what they say about Tories? They know the cost of everything and the value of nothing.

  • People may well vote for their own self interest, but when the prospect of having no services out weighs the value of a few more pennies in their pockets their self interest changes. I think we are rapidly reaching that point, especially if the majority of people think the majority of money will be raised off the rich of which they are not a part.

  • Peter Martin 26th Jan '18 - 10:09am

    No-one seemed particularly interested in my question of how anyone can say that an increase of 1p on income tax will raise £6 billion. That was a bit disappointing. It probably wouldn’t. The increase in tax rates will just depress the economy and reduce tax revenue generally.

    The correct way to look at the question, is to say that an increase in spending of £6 billion, by the normal process of new money creation, on the NHS will come back as taxation unless someone saves it along the way. If the extra spending in the economy causes an undesirable rise in inflationary pressure then an increase in the rate of income tax is one measure that may need to be considered.

    I can’t see what is hard about looking at the economy in this way. Like it or not, this is how it works and anyone who is interested in politics shouldn’t pretend otherwise.

  • Laurence Cox 26th Jan '18 - 10:30am

    @Peter Martin
    Read the IFS Green Budget for 2015: https://www.ifs.org.uk/uploads/gb/gb2015/ch10_gb2015.pdf

    Their figure is £5.5 billion, so it would be slightly higher now. £6 billion is a reasonable rounding of the estimate.

  • @Chris Cory
    “Not sure that the great British public have any great appetite for an extra 1% on income tax.”

    and
    @John Marriott
    “people here expect Scandinavian levels of public services on American levels of taxation.”

    In an opinion poll by Ipsos Mori – 66% of people agreed with statement “I would be willing to pay more taxes in order to maintain the level of spending needed ”

    https://www.kingsfund.org.uk/publications/what-does-public-think-about-nhs

    The key word here being “I”. Now I appreciate there may be a gap between an opinion poll and voting but it does suggest a strong strand of opinion supporting more taxation for the NHS.

  • Can anyone remember a time when there was not a crisis in the NHS, especially in the winter ?

  • In an opinion poll by Ipsos Mori – 66% of people agreed with statement “I would be willing to pay more taxes in order to maintain the level of spending needed ”

    They may say that, but that doesn’t mean they will actually do it when push comes to shove.

    According to the web page, this was a face-to-face survey about the NHS. I’m actually surprised 33% of people were willing to look someone in the eye and say they weren’t willing to pay more taxes for the NHS, something which in our national debate, where the NHS is basically the national religion, is akin to screaming ‘I want to murder children and kick puppies!’ at the top of your voice.

  • Neil Sandison 26th Jan '18 - 11:43am

    Micheal .The policy we are advocating clearly has high levels of public support .The public do understand that there is choice is stark funding by largess with each political party trying to out bid the other and a lack of transparency as to how the income /tax /revenue is to be raised on a 5 year parliamentary cycle on uncosted general election promises .Or a viable funding stream based on the requirements of the service that can only be achieved through general taxation with everyone contributing their fair share .Agree with Tony Greaves be it Corbyn or Johnson its about their personal ambition to get into number 10 not the practical politics of delivering a sustainable service that when you or a member of your family has a health or social care crisis . i do not really care if you call in a tax ,a fund or an national insurance contribution .provided the public can see it has clearly been ring fenced for our health care needs.

  • You know what they say about Tories? They know the cost of everything and the value of nothing

    Actually, that’s the definition of a cynic, according to Lord Darlington in Lady Windemere’s Fan. Nothing to do with Tories.

  • Tony Greaves 25th Jan ’18 – 7:35pm…………I don’t think Mr Corbyn will “deliver” anything. The whole Corbyn thing is an enormous diversion which will be ultimately very damaging to progressive/radical politics. Just wait and see…………

    Well, as LibDems have absolutely no chance of becoming a majority government, the alternative is a Tory administration…For the last 7 years we have seen what THAT means…Still, nice to know where you stand, Tony…

  • expats. I think you are mistaken with your comment on Tony Greaves. We all know where Tony stands and it is against Tory and Labour and for Liberalism. I don’t think any of us should have a problem with that.

  • Lorenzo Cherin 26th Jan '18 - 1:25pm

    Chris Cory correctly alludes, as do many often, to countries like France spending much more, but that includes into and with private sector involvement too.

    Our top down , centralised system is unique and suffers in comparison to most developed countries.

    When governments here address it they do so in a completely lop sided way.

    They do not see that replacing a monopoly that is public, with one that is private, does little to improve it and, if the monopoly is profit driven and part of a big corporation based abroad, skews things further.

    The answer is to ask the right questions first.

    The centre left has rarely asked them.

    Why are we powerless? We were when we waited in long queues and only for public run treatment, we are when in the same length of queues, and for privately run contracts.

    The system has not been expanded or broadened lately, but replaced and fragmented.

    We need to ditch the ludicrous waste in fees to contractors in failed bids and legal suits, like Virgin, and yet not ignore that public and private, can and, as in Europe at large, must be involved in the delivery, not in a false way, in reality, as there is capacity worth harmonising.

    We, in common with music, need harmony, not ideology.

    The private , public debate is sterile, as the private contractors main point of criticism should be their monopoly , at the basis of a contract, the criticism is rarely that.

    We could very easily combine the expertise of all comers in health care , without this illiberal monopolistic tendency, and the corporate dominance, private or public, and emphasis in top down, rather than individual rights.

  • Peter Martin 26th Jan '18 - 2:26pm

    @ Laurence Cox,

    Yes the IFS do say that “a 1 percentage point rise in all rates of income tax would raise £5.5 billion”.

    This is nonsense. The IFS are simply assuming that everything else in the economy will remain the same if income taxes are increased. It won’t. The economy will become more depressed. Revenue generally will fall. It is the same type of thinking which dictates that VAT can be raised to 20% and the extra revenue used to “balance the budget”. It doesn’t work like that as Richard Murphy tries to explain here:

    “But let’s also be clear the premise of their (the IFS) report is nonsensical because there is no need for any government to balance a budget. What is more, technically it is simply not possible for a government to choose to do so. In that case the IFS are just peddling fear whilst recycling government propaganda that a balanced budget is necessary.”

    My emphasis.

    http://www.taxresearch.org.uk/Blog/2017/02/07/the-ifs-is-taking-nonsense-there-is-no-need-for-a-balanced-budget/

  • Phil Beesley 26th Jan '18 - 3:33pm

    @Peter Martin: “No-one seemed particularly interested in my question of how anyone can say that an increase of 1p on income tax will raise £6 billion. That was a bit disappointing. It probably wouldn’t. The increase in tax rates will just depress the economy and reduce tax revenue generally.”

    It’s like the national minimum wage. It’s probably enough to swallow without causing significant harm or discontent. It helps some people. The NMW is accepted UK economic policy — or “pay people something like they are worth”, in the vernacular.

    I’m agin 1p in the pound tax for health care because it is a hypothecation tax. Why does health care have to cost more money each year? I know IT and I know cobblers, but why are we expected to pay more for health care each year? How much are we expected to pay for health care in the future? Assume that I am not a Daily Mail writer: Are we being ripped off?

    The thing about hypothecation is that we just accept things as they are. We accept that there is a way to deliver health care without considering whether it is the right thing.

  • Peter Hirst 26th Jan '18 - 3:40pm

    It makes no sense to allow people to harm their bodies and then spend a fortune healing it. You either invest in sensible life styles or apportion the cost according to the degree of personal involvement in the disease. Otherwise, costs will continue to spiral and we all will become less healthy.

  • @ Tony Greaves “I don’t think Mr Corbyn will “deliver” anything”. Just wait and see.”
    An uncharacteristically Asquithian response, Tony.

    I don’t know any more than you do whether Mr Corbyn will deliver or not …. I just hope he does. What I do know is that we have a government of incompetent rascals and I want to see them replaced PDQ.

    I also know (indeed can remember) that in 1948 the Attlee Government introduced the NHS in the teeth of opposition from Churchill & the Tories……….. despite (@: Michael) the appalling state of Government finances post World War 11. Where there’s a will…..

    As to “wait and see”, like you Tony, I’ve been waiting and seeing for a Liberal Government since 1961 and I don’t think either of us have much time left to see the reality of that, and what I saw in 2010-15 was hardly a compelling advertisement for “progressive/radical politics”.

  • Richard Underhill 26th Jan '18 - 4:44pm

    David Raw 26th Jan ’18 – 3:52pm: and the BMA.

  • Lorenzo Cherin 26th Jan '18 - 4:51pm

    David Raw

    David, do you think an alliance with Labour, one which could be realistic, we pull back in several seats, they in some, and then a genuine coalition of the centre left, would be possible with the current leadership, of each.

    Also, would be interested to know if you understand Tony Greaves view here ?

  • The details of the Commonwealth fund report on health care systems of 11 developed economies make interesting reading – http://www.commonwealthfund.org/~/media/files/publications/fund-report/2017/jul/schneider_mirror_mirror_2017.pdf

    On “Had serious problems paying or was unable to pay medical bills”. It reports that for France this was the case for 41% of people for people on below average income (and even 7% for those on above average incomes) against 3% (and 0%) in the UK.

    On the other had we do have (slightly) worse survival rates for cancers, heart attacks and strokes. Against which this has been improving faster than in other countries. looked at.

  • David Evans 26th Jan '18 - 5:22pm

    Lorenzo, I’m afraid having fought against Jeremy Corbyn and his type of Labour at local council level, the one thing I can say is that he isn’t anything like Centre Left. That is why he is totally against EU membership.

    In that regard, I see (to partially quote David Raw) “a government of incompetent rascals *and an opposition of incompetent rascals* and I want to see them replaced PDQ.” The problem is, I was pinning my hopes on the Lib Dems replacing them by showing what it could do in coalition to tame the extremes but sadly Nick had a different vision and so all we did was look like the Tories.

  • @ Lorenzo Cherin You must ask Tony to explain his views. All I know is that radical young Liberals of my generation thought the Labour Party was too right wing and authoritarian.

    Compass are campaigning for what you suggest. I guess a lot of people individually will decide to vote tactically depending on local circumstances for whoever can beat the Tory.

    Many radical Liberal M.P.’s of pre First War joined the Labour Party in the 1920’s. Indeed the first M.P. to use the slogan, “For the Many Not the Few” was the Liberal M.P. for my home town, Charles Trevelyan, in 1910. He resigned from the Libs in the War and became Education Minister in the first two Labour Governments. As a wealthy man, he donated to the great Nye Bevan when the NHS was founded.

    @ Richard Underhill : ‘and the BMA’ – yes – but Nye “stuffed their mouths with gold”.

  • John Marriott 26th Jan '18 - 6:03pm

    From the reaction of the ‘Question Time’ audience last night it was clear that the majority of them were heartily fed up with politicians, particularly Tory and Labour, trying to use the NHS against one another. That’s what is so refreshing about the Lib Dem proposals for a cross party ‘health and social care convention’. Sadly, like the SNP initiative on Brexit, it is unlikely to succeed, while the Labour Party thinks that it alone has all the answers.
    And, ‘Dav’, thanks for putting me right regarding my ‘definition’ of a Tory. You obviously know your Oscar Wilde. Actually, I was aware that he was defining the cynic; but I still feel that this could equally apply to Tories in general.

  • Lorenzo Cherin 26th Jan '18 - 11:53pm

    Thanks to our two Davids.

    Very good to read such different views from you on this.

    My view on the positioning of Corbyn is with David Evans. I tend the think of the recent direction of his followers as far left or left not centre left or centre which I am.

    I tend to understand David Raw though on the need for a replacement in government of the Tories, but that in the near impossible chance of the Liberal tendency in politics doing it , I despair at worst, fret, at best.

    I often say if we were in the USA we would all be in the same party, with Anna Soubry, Heidi Allen, Corbyn, Abbot, and all Liberal Democrats!

  • @ Chris Cory

    If my memory is correct even in 1992 when I think we had the 1p on Income Tax for education policy there were members who said the public wouldn’t support it. When implemented by Brown as 1p on National Insurance it was accepted. I can’t see any reason why 1p on Income Tax would not be acceptable now especially as the basic rate of income tax is much lower today. I note that Michael has posted an opinion poll which suggests there is public support for this measure.

    We could ensure that the poorest are not affected by reducing the Universal Credit and Tax Credit tappers by 1p.

    @ Michael

    History does not support your claim, in the past 300 years economic growth has always taken care of huge deficits.

    @ Peter Martin

    It depends what the government does with the £5.5 billion. If the government spends the money on employing more people this is likely to generate growth as these people spend their money in the economy. There will also be an increase in taxation and so more than £5.5 billion might be generated. I don’t know how much of £5.5 billion spent on the NHS and Social Care will grow the economy by, but I expect it would grow the economy not depress it.

    Of course if the money instead of being spent was used to reduce the deficit this would depress the economy.

    @ Peter Hirst

    How are you going to force people to live “sensible life styles”? How are you going to penalise them if they fail to live according to government diktats? Do you value some one’s life as not worth saving because they failed to live your “sensible life styles”?

  • @ Michael BG The penny on income tax is a plucked from the air slogan which bears no resemblance to the needs of the NHS. An evidence based party would examined the needs of the NHS and then produce a budget to match. It’s a tired old slogan.

    @ Lorenzo Cherin How do you describe a Liberal Party ?

    Back in the sixties I remember my old friends Nick Fogg and Michael Steed describing it as “Anarcho-syndicalism with Trotskyite leanings”. I think Tony G. thought it had something to do with pavements and the philosophies of Hegel and T.H. Green. I’ll let you work that one out. A lot of them have now gone to Labour – the latest yesterday being Chris Foote-Wood in County Durham.

  • @ Michael BG Sensible life styles : persons with a chronic alcohol problem have to prove that they have been dry for at least six months before becoming eligible for a liver transplant. Chronic obesity also quite rightly imposes limits on eligibility for certain forms of surgery.

  • Nonconformistradical 27th Jan '18 - 9:30am

    @Phil Beesley
    “Why does health care have to cost more money each year? I know IT and I know cobblers, but why are we expected to pay more for health care each year? How much are we expected to pay for health care in the future? Assume that I am not a Daily Mail writer: Are we being ripped off?”
    Aside from possible rip-off reasons – other possible reasons might be that modern medecine and surgery techniques can do much more than previously and the public has come to expect access to such modern treatments?

  • nvelope2003 26th Jan ’18 – 11:16am………….Can anyone remember a time when there was not a crisis in the NHS, especially in the winter?……..

    May I add,”Can anyone remember a time when the Tory party believed in an NHS?”

    Just prior to the winter of 2016-7 Theresa May, secure in her In infallibility, stated that there was no extra money and that the NHS should “learn from the painful cuts to the Home Office and Ministry of Defence budgets that she and Philip Hammond, the chancellor, had overseen when they were in charge of those departments”; and that shortfalls should be made up by ‘efficiency savings’ …

    Anyone listening to her non-answers at PMQs will know that her concern for the NHS is confined to slogans, “Safe in our hands”, etc…The only party that can change things is Corbyn’s Labour; I’d love to say LibDems but with just ‘a man and his dog’ representing us in parliament that is not going to happen…

  • @David Raw

    There is a good argument that when people need treatment due to a “lifestyle” choice – smoking, obesity, alcohol – pressure is put on them to improve it and support is given (and arguably that needs to be radically improved in the NHS). And more needs to be done on preventative medicine so that it does not get to that point. Interestingly people are (much) more likely to be successful at dieting if it was triggered by a medical incident.

    But I don’t think it should be used to deny people treatment – are we going to bar A&E to speeders? Or unsuccessful suicides? Or not rescue mountain climbers?

    And on consuming public finances – smokers, drinkers, the obese are arguably much better than the slim, fit and sensible as they contribute more in taxes and die earlier costing much less in state pension payments. Someone living to 100 is going to cost the state around £250,000 more in pension payments compared to someone dying at 70!

  • @Nonconformistradical

    “Why does health care have to cost more money each year?

    A significant part of the reason is that health care per person is very much more expensive for older people – 40% of the NHS budget is spend on over-65s – and as a population we are getting older.

    https://www.theguardian.com/society/2016/feb/01/ageing-britain-two-fifths-nhs-budget-spent-over-65s

  • @ Michael ” But I don’t think it should be used to deny people treatment – are we going to bar A&E to speeders? Or unsuccessful suicides? Or not rescue mountain climbers?”

    Whether you like it or not, I can assure you that what I said about transplants is correct and is current practice….. and so it should be. The gift of an organ is precious, there is a waiting list and demand exceeds supply. Why should a precious organ be wasted on a person incapable of making the best possible use of that gift when other people in the queue are better placed to make a success of it ?

  • Phil Beesley 27th Jan '18 - 3:37pm

    @Nonconformist radical: “Aside from possible rip-off reasons – other possible reasons might be that modern medecine and surgery techniques can do much more than previously and the public has come to expect access to such modern treatments?”

    And when you do things more often or develop better techniques, in other aspects of life, costs fall.

    Thank you “Michael” for the reminder that how we measure the cost of the NHS should be measured according to the needs of patients.

  • @ David Raw

    A penny on Income Tax for the NHS and Social Care is an easily remembered slogan which might get through to the public. I wouldn’t be against it being 1p for the NHS and 1p for Social Care. Underneath this headline policy there is a policy which states we need to discover how much we as a nation think should go towards the NHS and Social Care and then provide taxes to provide it. However, it is the headline slogan which will get through if anything gets through.

    There is a difference between denying all treatment to those who the government states don’t have “sensible life styles” and choosing people who will benefit the most from limited transplants or not operating on a person until they have lost weight so their survival rate increases. However, the NHS should provide support to those who don’t have “sensible life styles” to get them into a position where treatment can be successful, not just leave them to their own devises and possibly an early death. As liberals we can’t have policies which value one person more than another.

  • Ed Shepherd 28th Jan '18 - 8:10am

    When the LibDems had their extra penny in tax policy in the past it got the LibDem party a lot of positive coverage. But over the decades, the press has scared political parties into being scared of being realistic about the need to raise taxation. The result has been the obfuscations of Tony Blair, the replacement of progressive direct taxes by regressive indirect taxes and silly media storms about the so called: mansion tax, pasty tax, stealth taxes and dementia tax. Worst of all is when a political party is accused of the crime of being taxandspend. All governments tax and spend. It might be good to see politicians retun to being realistic about tax and spending now that the power of the popular press is in decline.

  • Peter Martin 28th Jan '18 - 8:34am

    All governments tax and spend

    Actually they spend and tax. Where does money come from in the first instance, before it is available to be collected as taxes? It is first spent into the economy by the government.

    So, logically, the spending has to come first! The taxes follow later to create a demand for the currency and thereby give it a value.

    It may seem a minor quibble, but difficult economic problems can only be properly tackled if we have the correct economic understanding.

  • Michael, I too would be happy for a penny for the NHS and a penny for social care, but Ed is also right that the media has pressured political parties into hiding or deferring tax rises, and going along with the notion that they aren’t required.

    I also think it’s legitimate to require that certain medical procedures are only used where there is a good chance of success, and that patients are supported to take-up the healthier lifestyles that will help them with that. Whether it’s quitting drinking before a liver transplant, or stopping smoking before a lung-transplant, or losing an appropriate amount of weight before certain, relevant surgeries. The latter scenario is always going to be trickier to implement, but so long as it’s done to secure medical success, and not sneaky rationing, then it’s legitimate.

  • Peter Martin 30th Jan '18 - 10:12am

    @ Expats,

    You ask:

    “Can anyone remember a time when there was not a crisis in the NHS, especially in the winter?……..”

    Er, well, yes I can !

  • Peter Martin: Perhaps you would like to say when that was. I was not criticising the NHS but just trying to take a grown up view of our institutions. Nothing in this world is perfect and there will always be mistakes and too many people wanting to use a service at certain times. Things are not busy everywhere in the NHS – a friend who is not ill was asked to come in for a check up recently.

  • expats: It is not just Mrs May and the Conservatives who parrot slogans. Mr Corbyn stated that he would buy 8,000 empty homes for the rough sleepers “immediately”. I would be very interested to know how he proposes to do that.

  • Peter Martin 30th Jan '18 - 3:15pm

    @nvelope 2003.

    I haven’t studied the figures in detail but the NHS seemed to be functioning reasonably well up until about 2010 but has progressively worsened since. Sure the NHS was always busy but it wasn’t in crisis. Just when we use that word is a matter of some subjectivity but I would say it is in crisis now whereas it wasn’t then.

    From conversations I have had with NHS staff the main problem now is that the work can be so stressful, especially in some A&E depts, that staff are burnt out after a few years and have to be replaced. If we could get it back on a proper footing staff would last longer and some who may well have left to do other things may well even return. A decent pay rise wouldn’t go amiss either!

  • Peter Martin 30th Jan '18 - 3:25pm

    @nvelope2003

    ‘Mr Corbyn stated that he would buy 8,000 empty homes for the rough sleepers “immediately”. I would be very interested to know how he proposes to do that.’

    It’s just a balance sheet excercise for Govt. The government swaps cash for real assets like real estate. There’s no real cost.

    I’m not sure that I favour Nationalisation without fair compensation but, if there were a real cost to Government, when things like this occur I could be persuaded to change my mind!

    http://metro.co.uk/2017/04/16/every-flat-in-new-london-estate-has-been-sold-to-foreign-investors-6577715/

  • Peter Martin 30th Jan ’18 – 10:12am………………[email protected] Expats, You ask:“Can anyone remember a time when there was not a crisis in the NHS, especially in the winter?……..”
    Er, well, yes I can !……………
    Actually, I didn’t ask; it was nvelope2003 26th Jan ’18 – 11:16am…………My question was regarding the Tory support fro the NHS

  • nvelope2003 30th Jan '18 - 6:07pm

    Peter Martin: Oh dear. I was not referring to the cost or the effect on the Government’s balance sheet which I am sure can be dealt with. It is the practicality of acquiring 8,000 homes “immediately”. You cannot buy property “immediately” as transactions have to be in writing and there will be all sorts of legal formalities to go through.

    It is the same with everything politicians say. No wonder many people have lost all faith in them although a few simple trusting souls still seem to exist.

  • @ nvelop2003 Have you ever been elected as a member of a local authority Mr/Ms nvelop ?

    If you had you would know local authorities keep a register of empty properties and of homeless people. If national government provided the powers and the funds it could be done relatively quickly and at much less cost than the existing homelessness arrangements in bed and breakfast..

    The number of empty homes in the UK is at its highest level for 20 years.

    Analysis of Government figures shows that there are more than one million additional homes above those required for households in the UK. This “housing surplus” nearly doubled from 800,000 spare homes in 1996 to 1.4million homes at any one time in 2014.

  • I think the NHS was not in crisis up until at least 1992 and was in crisis from about at least 1996 to 2000. It then returned to crisis after 2004 clearly being in crisis by the 2010 general election. At what general election was Blair questioned by a voter about the difficulty of getting appointments with her GP? If it was 2001 then the NHS was at near crisis point then.

  • I see today that Capita has issued a profits warning. If they go down after Carillion the whole PFI thing will collapse like a pack of cards.

    Who next ? Serco, G4S ?

  • Capita shares hit 15-year low after shock profits warning – business live
    Major UK outsourcing group stuns City with profits warning, as new CEO admits the company is too complex and freezes its shareholder dividend

    Latest from the Guardian :

    10.30am: Shares down 42% at 15-year low : Newsflash: Capita profits warning :
    New CEO says company must change : Capita wants to raise £700m from shareholders
    Worries over £381m pensions deficit : Labour: Privatisation is failing
    Capita’s major government contracts

    Not a peep from the Lib Dems yet !!!! C’mon you lot – wake up.

  • David Raw: Does the figure of 1,4 million surplus homes include second homes and holiday homes ? Second homes might include homes used from Sunday/ Monday night to Thursday/Friday night by people working away from the family home who do not wish or are unable to commute. A holiday home for 2 or 3 weeks in the year might be hard to justify but people are allowed to do as they please with their own money. Some people do rent them out. I was concerned that 2 houses might be empty but on checking they were actually found to be occupied.

    Some empty homes might be subject to probate or unfit for use because the owner does not have the money to repair them at the moment but does not want to sell – for example they might plan to move home when they retire or change jobs. Many homes owned or rented by the Government and local authorities have been left empty for years while they decide what to do with them. Many other properties also stand empty because no attempt has been made to sell them or no one wants to buy.

    I agree that something has to be done urgently about homelessness but the use of the word “immediately” was inappropriate as that is simply not possible and gives people false hope.

  • Re Capita: The whole economy is on the verge of failing because of uncertainty and neither the present Government or the Labour party can do anything to stop it because their proposed solutions would not work or would make things worse. It is time to wake up.

  • @ Councillor Shaw And if Capita go down don’t you, as a Councillor, think it will have a profound affect on outsourcing and PFI ?

    I’m happy to agree with Dr Cable who (four hours later) has just put out a statement,

    Huffington Post ‘Lib Dem leader and former business secretary, Vince Cable, said: “Coming only a couple of weeks after Carillion’s collapse, this profit warning highlights concerns over handing outsourcing contracts to just a few big companies, though we note there is a turnaround plan in place. We need a proper government review of the outsourcing model and assurances from ministers that they are factoring in any risk on Capita projects.”

    Let’s hope things stay hunky dory in Southport. Odd that Sir Vincent mentions Carillion, and unlike you, appears to think there is clear linkage between outsourcing and PFI.

  • Simon Shaw 31st Jan ’18 – 12:46pm…………………Except that I don’t reckon Capita do PFI……………

    Well they certainly did! I suggest you have a word with the Evening Standard…

    Evening Standard july 2002..CAPITA, the biggest of the stock market’s Private Finance Initiative specialists, gave a much-needed boost to the sector today when it quashed market rumours that it would be the latest company to announce accounting revisions…

  • PFI : Outsourcing – Both causes for concern – both attempting to make profits from the public sector. That’s my thinking…….

    …….and neither gives much confidence in the accountancy profession either, Mr Shaw. “Carillion collapse could spark competition probe into accounting Big Four (PWC). (Daily Telegraph yesterday.)

    See also . “Capita is not Carillion 2.0 but it’s swimming against … – The Independent
    http://www.independent.co.uk/…/capita-carillion-public-contracts-government-pfi-profit-wa...

    4 hours ago – Hot on the heels of Carillion’s collapse, Capita has stepped up to give ministers more of a fright than watching Hereditary in a haunted house (it’s reputedly the scariest horror film of all time). The outsourcer has won more than 10 times the number of public sector contracts operated by its deceased peer …”

    I’ve said my bit and I’m sure you’ve got ward business to attend to, so that’s ‘End Of’ this conversation from me.

  • Simon Shaw 31st Jan ’18 – 3:49pm……@expats……..But I don’t think that means that they “do PFIs”. As I said above Capita certainly do provide management consultancy support to local authorities in connection with intended PFI projects, but that is something different….

    Really? They manage Army recruiting and have been roundly criticised for their disastrous RAF Recruiting Partnership Project with the UK MoD….If that ongoing Public Private Contract is not a PFI then I don’t know what is…

  • Jayne mansfield 31st Jan '18 - 5:50pm

    @ David Raw,
    If you tap, ‘GP surgeries and Capita’ into Google you will be able to access some of some of the concerns that have been expressed in the past relating to Capita.

    And now GPs are concerned about the 40% share drop.

    ‘BMA seeks reassurance over ‘shambolic’ Capita following share price drop ‘, in today’s Pulse magazine which can also be accessed online.

  • @ expats I don’t know why your Southport Councillor correspondent seems to imply that outsourcing to Capita is a good thing when his own Lib Dem group decided to support a move to end a contract with Capita and bring services back in house.

    Sefton Council confirms plan to tear up a £65m contract outsourcing …
    http://www.liverpoolecho.co.uk › News › Liverpool News › Sefton Council December, 2011.

    Lib-Dem deputy leader Iain Brodie-Browne said with no major projects in the pipeline and the council having to plug a £38m budget black hole, the contract no longer seemed “value for money”. He said: “Financial circumstances have changed since the contract was signed and going forward there really is not the work for Capita to do. Bringing it in-house makes sense.”

    Pity about the Coalition cuts too.

    @ Jayne Thanks for that. One of my daughters was affected by that very issue a week after giving birth – but charitably decided not to take it further because she had enough to cope with..

  • Liberal Democrats need to keep pushing this policy of an extra 1p on tax to fund the NHS
    According to a recent survey
    https://www.mirror.co.uk/news/uk-news/three-quarters-brits-would-pay-11955709
    63% said they will happily pay an extra 1% tax. It would raise an extra £5.5billion and cost those on the average wage of £27,600 just £3.50 a week.
    73% would give up an £1 a week to keep the NHS free and out of the clutches of the private health firms That would bring in £2.75billion a year.
    More than half said they would part with £2 a week
    A third would pay £5, raising £13.75billion

    Raising taxes to fund our NHS is clearly a policy that would by and large be supported by the electorate, as long as the money was ring fenced for funding of the NHS.

    This really is an area that Liberal Democrats should get their teeth into and pledge at the same time that access to mental health treatment would receive parity of esteem when it comes to funding and services

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