A smoking ban?

[Spectric]

but unfortunately the next one will be worse.

Take a look at Stammer, I now realise where I have seen similar facial expressions and that was from being a kid watching Doctor Who.

 

[Jacob]

Take a look at Stammer, I now realise where I have seen similar facial expressions and that was from being a kid watching Doctor Who.


View attachment 167817

Keith doesn't do facial expressions very well. When he tries to smile he looks like he's trying to control a large fahhrt. His heart just isn't in it.

 

[Phil Pascoe]

So it should be if we want better public services. Still low tax compared to comparable countries. Top rates lower than they were even under Thatcher.

You also looking forward for a continuing decline in the quality of health services?

It's labour's lovechild - they'll throw money at it no matter what the outcome.
Still low tax compared to comparable countries?
Here are the top 10 highest taxed countries:

• Portugal: 64%
• United Kingdom: 63.25%
• Switzerland: 59.7%
• Aruba: 58.95%
• Estonia: 58.4%
• Denmark: 57.11%
• Japan: 55%
• Austria: 55%

 

[Jacob]

It's labour's lovechild - they'll throw money at it no matter what the outcome.
Still low tax compared to comparable countries?
Here are the top 10 highest taxed countries:

• Portugal: 64%
• United Kingdom: 63.25%
• Switzerland: 59.7%
• Aruba: 58.95%
• Estonia: 58.4%
• Denmark: 57.11%
• Japan: 55%
• Austria: 55%

You've got your figures wrong. Where did you find them, The Daily Mail?
We are well down the list of tax/GDP, with a lot of catching up to do.
Why are you so keen on protecting the wealth of the already very rich?
https://en.wikipedia.org/wiki/List_of_sovereign_states_by_tax_revenue_to_GDP_ratio

 

[Phil Pascoe]

Of course they're wrong. They must be, you disagree with them.

If you had your way there wouldn't be any rich left to tax.

 

[Jacob]

Of course they're wrong. They must be, you disagree with them.

Where did you find them? On the back of an envelope in a golf club perhaps?
Do a bit of googling?
https://wisevoter.com/country-rankings/highest-taxed-countries/#tax-rates-by-country

 

[Terry - Somerset]

The key issue is the quality of outcomes delivered by a health system.

Research across countries similar to the UK (size, economic level, population, etc) show UK health spend close to the average, outcomes overall close to average, and assessed as fairly efficient.

There are outliers - the US overall produces average outcomes but at a high cost - I suspect the wealthy get high performance but the economically marginalised do poorly.

It seems to make little difference how health services are funded - whether an NHS model free at the point of use, with patient contributions, with state run insurance schemes. But public health care should be fundamental to any civilised society.

The major problem with the debate over health services in the UK is the extent to which arguments are driven by dogma, ignoring the fundamental - delivering the best quality outcomes.

• change is too often seen as a threat not an opportunity delaying and sometimes derailing necessary changes. The NHS has been very slow in (for instance) properly embracing technological and IT change
• creation of financial silos leaves coordination of primary, hospital and social care unbalanced and inefficient - an issue which was apparent over 20 years ago
• the lack of a workforce plan in an organisation with over 1m employees is incomprehensible - now being resolved but a deficiency covering decades (and several changes of government)
• assuming the NHS is supreme in the delivery of health services is arrogant. Innovation and ideas are not the preserve of the NHS - input from the private sector should be both encouraged and supported
• debates over policy using skewed and selective data, far from improving outcomes, acts to deny optimal solutions
• more healthcare costs money. Either taxes increase or other public services reduced. The capability to provide healthcare is all but infinite, the capacity to provide it is limited. A very honest and uncomfortable debate is required rather than continually avoiding the issue.

 

[Phil Pascoe]

Where did you find them? On the back of an envelope in a golf club perhaps?
Do a bit of googling?
https://wisevoter.com/country-rankings/highest-taxed-countries/#tax-rates-by-country

https://worldpopulationreview.com/country-rankings/highest-taxed-countries
I did a bit of googling.

 

[Phil Pascoe]

more healthcare costs money.

Yes. So spend it on healthcare and not multiple tiers of management.

I saw my consultant (with whom I still converse occasionally) with an idea that could save his hospital probably £100,000s per annum. He listened, putting his head in his hands saying oh, god, that's so obvious, isn't it? I'll bring it up at the next managemant meeting .............. where it'll get kicked into touch because it I'm only a consultant, my views don't matter.

 

[paulrbarnard]

Yes. So spend it on healthcare and not multiple tiers of management.

I saw my consultant (with whom I still converse occasionally) with an idea that could save his hospital probably £100,000s per annum. He listened, putting his head in his hands saying oh, god, that's so obvious, isn't it? I'll bring it up at the next managemant meeting .............. where it'll get kicked into touch because it I'm only a consultant, my views don't matter.

The multiple tiers of management often gets stated but you need to take in to account the number of employees. A typical management structure is one manager to ten sub ordinates. There is of course large variation to that but it is a reasonable expectation. More problematic than the tiers of management is the creation of non clinical roles that have no direct or in some cases no indirect impact on patients.

 

[Jacob]

The multiple tiers of management often gets stated but you need to take in to account the number of employees. A typical management structure is one manager to ten sub ordinates. There is of course large variation to that but it is a reasonable expectation. More problematic than the tiers of management is the creation of non clinical roles that have no direct or in some cases no indirect impact on patients.

As far as I recall more management was brought in to improve "efficiency" from 1979 on, to an organisation which was previously world renowned for high cost effectiveness and low management costs. It was the start of the wind down and denigration of the NHS but even Thatcher didn't contemplate privatisation - she just wanted it cheaper.

https://worldpopulationreview.com/country-rankings/highest-taxed-countries
I did a bit of googling.

Well done!
It shows UK with high "marginal" rate, which means that some (individuals I presume) are paying high rates, but nevertheless the overall UK tax burden is low compared to many. You've cherry picked the wrong column of figures. Easily done - keep googling but do try to look more closely!

 

[Jacob]

Just wondering.
Why do some people leap to the defence of the very rich against the predations of the tax man, and argue for reduction of public services and selling out?
Is it because they are mega rich themselves and/or hope to be shareholders in various dodgy health/public service businesses? Or even managers paying themselves enormous bonuses?
Or are they just very confused and bewildered?
Thought for the day!

 

[Terry - Somerset]

Just wondering.
Why do some people leap to the defence of the very rich against the predations of the tax man, and argue for reduction of public services and selling out?
Is it because they are mega rich themselves and/or hope to be shareholders in various dodgy health/public service businesses? Or even managers paying themselves enormous bonuses?
Or are they just very confused and bewildered?
Thought for the day!

Those you describe as confused and bewildered see themselves rather differently:

• hard work and entrepreneurial effort should be rewarded
• people not government are best able to decide how their money is spent
• high taxation encourages avoidance and evasion, not innovation and investment
• allowing aspiration is is fundamental to a thriving society

Most tread a middle path and recognise there are some things which government either needs, or has a moral and practical obligation to provide to society - eg: healthcare, education, law and order, defence. Beyond a basic level there is rightly a debate.

Were voting intentions determined solely by income, Tory voters would likely include many on below median incomes. In the 2019 election 42% voted Tory and 32% Labour - other votes went to SNP, LibDems etc. Support for right of centre extends to the whole of society not just "fat cats".

It is unclear how you define as "mega rich":

• the Sunday Times rich list has 171 billionaires residing in the UK. Wealth at this level means they can live wherever they choose and hire the very best lawyers and tax advisors.
• Incomes - 10% earn more than £60k pa, 1% earn over £200k pa. £200k is a very comfortable income to my mind but hardly mega rich.

Soaking the rich has some clear limits - there just aren't enough of them. Reality - better health, education etc means that those on average and below average will need to contribute more.

Conclusion - hard though it may be to accept, you may be confused and bewildered - unable to comprehend how and why the views of others may differ to your own.

 

[Jacob]

Those you describe as confused and bewildered see themselves rather differently:

• hard work and entrepreneurial effort should be rewarded

• people not government are best able to decide how their money is spent
• high taxation encourages avoidance and evasion, not innovation and investment

Higher taxation gets invested by the state into public services and also into innovation, education, research & development, support for businesses too. It's the biggest single driver of the economy.
About 46% of our GDP is in the public sector.

• allowing aspiration is is fundamental to a thriving society

Most tread a middle path and recognise there are some things which government either needs, or has a moral and practical obligation to provide to society - eg: healthcare, education, law and order, defence. Beyond a basic level there is rightly a debate.

Were voting intentions determined solely by income, Tory voters would likely include many on below median incomes. In the 2019 election 42% voted Tory and 32% Labour - other votes went to SNP, LibDems etc. Support for right of centre extends to the whole of society not just "fat cats".

It is unclear how you define as "mega rich":

• the Sunday Times rich list has 171 billionaires residing in the UK. Wealth at this level means they can live wherever they choose and hire the very best lawyers and tax advisors.
• Incomes - 10% earn more than £60k pa, 1% earn over £200k pa. £200k is a very comfortable income to my mind but hardly mega rich.

Soaking the rich has some clear limits - there just aren't enough of them. Reality - better health, education etc means that those on average and below average will need to contribute more.

Conclusion - hard though it may be to accept, you may be confused and bewildered - unable to comprehend how and why the views of others may differ to your own.

I see you are one of the defenders of the wealthy! I hope they are grateful.
There's more of them about than you think, you shouldn't believe what they are telling you!

https://gala.gre.ac.uk/id/eprint/42714/9/42714_TIPPET_The_good_life_at_the_top.pdf
https://gala.gre.ac.uk/id/eprint/33...a_Progressive_Annual_Wealth_Tax_(2021)_v2.pdf
You seem a bit bewildered?

 

[John Brown]

The problem for the NHS is it can do more things for more people for more years than was ever envisaged at its inception.
It now needs someone to have the guts to say that's all we can do with what is available, anything above 'x' you'll have to pay for. Used to be if you were over 70 then good luck getting any major ops, weren't deemed a worthwhile use of resources but who'd dare say that now?

I guess these days it's a question of can you get a major op in time, regardless of age. The govt would probably call that levelling up

We already pay for it.

 

[Fergie 307]

I thought, this thread seems to have taken off. So I had a look and once again find a thread that has largely been taken over by Jacob. Becoming quite boring now. Shan't bother looking again.

 

[whereistheceilidh]

At the end of the day it really does not mater who runs the NHS, we think it is free but tax payers fund it so only free to those not paying tax. Look at what happened to all the other huge nationalised industries such as the shipyards and railways, in essence they delivered but not efficiently because of the workforce culture of just turn up and it's a job for life. The NHS is an example of an inefficient nationalised industry that is big and bloated with too many bosses and not enough doers. The only other industry like this is nuclear decommissioning which again has the mentality of employing ten people to change a light bulb and that is on a good day.

Look at the NHS as an engineering problem, do not re-invent the wheel but look around and see how others are delivering better services to the people and follow suit, nothing wrong with a little plagiarism.

You have been reading the mail again haven't you Roy!
You are making simplistic political points which do not stand up to analysis. It is sad to see an important debate demeened by such ill informed, polarised oppinions....... on both sides. For example shipbuilding was lost for a range of reasons & deffinitely not all labour related. Lack of investment & political support at a crucial point played their part. Other countries have managed better ....some with higher rates of labour problems.
Just because something is nationalised does not mean it does not work well...or turns a profit. It seems to work in other counties.
The NHS is not inefficient...again compare it to a range of other countries in terms of cost per treatment....& be glad you are not in the privatised healthcare that is the USA.
I think I will stick to the woodwork side of this forum. It is rather better informed & less black & white.

 

[NickDReed]

The NHS is not inefficient

I work in it and can assure you it is.

If you talk to anyone working in the NHS who says it is efficient, they are part of the problem.

 

[flying haggis]

Of course the NHS in inefficient. Take yesterday for example . Mrs FH had to have knee X - ray, appt 1510 arrive at 1445 , two receptionists, one person in waiting room (actually just waiting for his wife) Mrs books in and is taken straight in, out in 10 mins. People in waiting room waiting as we leave, one! The dept is so underworked it could easily do two or three times as as many appts in a day.
And she had to wait SEVEN weeks to get the appt she did. With that level of workload the dept should be just turn up with doctor's letter in hand and we will see you! As it was a few years back when I needed an x-ray from the same dept.

 

[Jacob]

Of course the NHS in inefficient. Take yesterday for example . Mrs FH had to have knee X - ray, appt 1510 arrive at 1445 , two receptionists, one person in waiting room (actually just waiting for his wife) Mrs books in and is taken straight in, out in 10 mins. People in waiting room waiting as we leave, one! The dept is so underworked it could easily do two or three times as as many appts in a day.
And she had to wait SEVEN weeks to get the appt she did. With that level of workload the dept should be just turn up with doctor's letter in hand and we will see you! As it was a few years back when I needed an x-ray from the same dept.

Some confusion here - sounds like a model of efficiency; in and out promptly on time, only one person waiting at a time. What are you complaining about?
You might complain if there were dozens waiting for hours, or if there was nobody waiting and the staff were just hanging about doing nothing, but what you describe sounds like a well oiled machine!