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Wes Streeting (in the Times earlier this month via today's Guardian):
'We’ve got to identify a system of funding for healthcare that is more effective than the one we have currently got, and at the same time carries those who can’t afford to pay'.
To me this sounds like a;
a basic safety net for the poor;
a full spectrum, pay for use NHS for the bulk of the population; and
a quicker(?) private health care system for the rich?
This is not the NHS people want or voted for!
Did the people want the NHS for the 14years before the Labour Party got into Power, I am not sure they did, they kept voting Tory who did not want the NHS in the first place and who did want to privatise it all.
sure, that's a fair comment; of course, the Tories were operating a culture-war driven politics of distraction to encourage people to blame others for the travails of the NHS... but your point nonetheless stands!
I would take the last 14 years as evidence that people DO want the NHS. The Tories have never been able to campaign openly on a privatisation agenda.
Labour don't help by their pretence that efficiency or AI or PFI will keep the show on the road. Or internal markets or spurious competition.
@iaruffell I want an NHS. (And I very much do not want a health system that is anything like the one in the US.)
But can we have one? If so, on what terms? I don’t think we really have any idea because our expectations are set on notions of economic growth that are going away and not coming back.
But that’s electorally unpalatable
@urlyman @iaruffell @lyndamerry484
I've occasionally mooted a 'health Keynisanism' which would reflect the domination of health expenditure in the USA (and its economic contribution), while organising it a completely different socially directed way.... but your Q. is the one we need to ask, if only to explore how we can..... but also see @markhburton response suggesting proper progressive taxation is the answer!
@ChrisMayLA6 @urlyman @iaruffell @lyndamerry484
But in a context of either,
a) Managed contraction (degrowth)
b)Secular stagnation (stalled growth)
c)Deep recession (system collapse)
For these are the serious future options, despite the growthist fantasies of our 'leaders'.
For more on the detail of progressive taxation under a), see
https://gettingreal.org.uk/full-report/
@markhburton @ChrisMayLA6 @urlyman @lyndamerry484
In the meantime folk continue to be ill. So tax.
I am growth-agnostic myself, it is not an end in itself.
@urlyman @ChrisMayLA6 @lyndamerry484
Well, it is pretty palatable here in Scotland. It is UK Labour who have given up.
@iaruffell I’m not aware that Scotland have enacted a degrowth economy, or that there is any broad enthusiasm to do so?
Oh, I see the issues of progressive taxation and growth as distinct, with the former key.
@iaruffell as I understand it, progressive taxation manages money supply equitably – https://mastodon.social/@urlyman/113838189194999183 And that’s obviously a good thing.
But doesn’t in itself tell us what is plausible and sustainable in a stagnant economy that needs to become smaller and at some point will begin to do so, whether we want it to or not https://mastodon.social/@urlyman/113850195365641566
I don't have quite the same assumptions about the shape of the economy or politics.
For me, if we think that health is a basic requirement, we start from there. That may not be comfortable in the meantime, taxation is a start.
@iaruffell progressive taxation would certainly reduce inequity. Not much chance of that from Labour at present
@ChrisMayLA6 @lyndamerry484 Not entirely, as the constantly lied to the people about their true intentions.
They being the we always did hate the NHS Tories?
@lyndamerry484 @ChrisMayLA6 They being the Tories, yes.
Deliberately making the service so bad that people start asking about privatisation.
The Lib Dems defence of the NHS privatisation regulations doesn't stand up 2 scrutiny Lib Dems appear 2 be sending out variations on a stock response when questioned on the section 75 regulations Yet their response appears to contradict both expert legal opinion & the Lords own scrutiny committee not to mention leading health professionals practitioners & leading charities The party should be clear exactly what it is doing if its peers wave through these regulations
2013
@ChrisMayLA6 I’ve identified a way of funding the NHS fully. No need for health insurance or private health care. It’s called “Tax the super rich until their pips squeak. Make mega corps actually pay tax. Looking at you Amazon, Apple et al…”
@ChrisMayLA6 It is, however, the Labour Party that the chattering classes have promoted for 50 years, whilst extinguishing any electoral choice.
@ChrisMayLA6 yes, keep pushing privatisation by stealth. Of course, the best system to ensure that everyone can afford healthcare is to have it free...
@ChrisMayLA6 the most effective funding system is called taxation, it ensures everyone pays according to their ability to pay. Every other way is less effective, though social insurance, based on a fixed percentage of your income extracted at source, comes close as though it pays and independent body to fund the service, a bit like student loans, it is simply relabeled taxation, with an added profit/cost load applied.
It's the false mantra "Private good, Public bad" again, Police and Army next.
Yes, we're on the same page
@epistatacadam @ChrisMayLA6 have you noticed how it's never "we can't afford the army! Police is running at a loss!"?
@ehproque @epistatacadam @ChrisMayLA6 and roads. It's amazing how socialist right leaning voters suddenly become if it's suggested that roads should become toll roads, with road pricing proportional to road wear and tear.
@Pionir @ehproque @ChrisMayLA6 I'd like to see annual car tax based on mileage and kerb weight of vehicle. We already do it slightly as HGVs have higher tax on that basis so why not making it explicit. Since fuel duty is disappearing might be a useful way to fill the black hole....
@epistatacadam @ehproque @ChrisMayLA6
Yes, or the alternative is a tyre and brake pad tax. Easier to implement but probably less equitable and potentially harmful if it discourages people changing them when they get dangerous.
Also unlikely to happen because of the CycLisTs ShoUld PaY RoAd TaX lobby and the supposed war on motorists which doesn't exist
@ehproque @epistatacadam @ChrisMayLA6
The problem here is the mindset, isn't it? We don't expect roads to make a profit, but in a way, they do. A decent road infrastructure, well maintained, plays a part in businesses having their deliveries, and people travelling to places of work.
For the businesses, some of this is paid for by council rates, but effectively road building and maintenance is a part of keeping our society functioning.
Likewise with healthcare. If people fall ill, getting them sorted out is in the overall interests of the majority. They aren't claiming sickness benefit, and they're working, contributing to the economy and paying taxes. Those who are "economically inactive" also contribute to society, as carers, volunteers or other functions in society. None of us is worthless, except to a blinkered capitalist mindset.
I know, I'm a hopelessly naïve old fool.
@Fragarach @ehproque @ChrisMayLA6 I don't think you're hopelessly naïve!
The provision of good roads for communication & trade has been a public good since before Roman times. Both Marlborough and Wellington recognised the importance of logistics in war. Similarly, public health practice is not a trade, but a function of the state. (According to the judgements in European law, I understand)
So making money out of them is simply a way to raise taxes, on a user pays basis, or via another manner.
@ChrisMayLA6 no but it’s the system Streeting’s donors/sponsors/paymasters have paid him to deliver
@ChrisMayLA6 But how can we stop him?
good Q.; mass protest (see another conversation this morning).
@ChrisMayLA6 Start a "Save the NHS" party?
@PoliceStateUK @ChrisMayLA6 Thanks for that. That seems to be almost exactly what I had in mind. I'll look into it a bit more - beyond fielding a candidate for Liverpool Riverside in 2024 I'm not sure how active they currently are.
@ApAlun I don't think they've done as well as they possibly deserve... our electoral system makes it very difficult for new parties to break through without massive financial backing (like the UKIP/Brexit/Reform lot).
@ApAlun @ChrisMayLA6 The Greens are making noises on the NHS which are much more in line with what we want, although as mentioned elsewhere, it's hard for them to break through.
@ChrisMayLA6
It's called progressive taxation Wes. The principles behind it are 1) Fair distribution, 2) Risk pooling.
'We’ve got to identify a system of funding for healthcare that is more effective than the one we have currently got, and at the same time carries those who can’t afford to pay'.
#NHS
#tax
@ChrisMayLA6 Try a model like in DE where it all works.
@ChrisMayLA6 I never understood why they haven’t reintroduced a hypothecated tax as part of NI even, add a higher threshold above which you pay an extra 1-2%, say £70,000? Also, look at child health, bring back Sure Start or similar - reducing child poverty is a good way to reduce long term NHS demand, as healthy children become healthy adults. And fund primary and community care, sort out social care, and stop throwing money at big hospitals.
No Chancellor likes hypothecated taxes... tries their hands to much & means they cannot threaten the recipient dept.'s budget
@ChrisMayLA6 Or alternatively, we could simply read it as a desire to deal with the fact that - like all large government departments - the DoH is highly inefficient at rapidly moving funds from the Treasury to where they're actually needed.
But I realise that wouldn't involve the big scary P word, and we must always say that privatisation is happening even when there's no grounds on which to do so.
@RolloTreadway @ChrisMayLA6 except that everything has to be taken in the context of what that person and the government he represents has already said.
@UkeleleEric @ChrisMayLA6 What the Government have said? That they want to cut waiting lists, improve out-of-hospital care, have better communication between services and do better to ensure that the right care is given at the right location?
Because the Government haven't actually said anything that leads to privatisation.
@UkeleleEric @ChrisMayLA6 I really shouldn't have bothered replying. I do know by now that this is Mastodon, a place where the NHS's priority should be the appearance of ideological purity, and I'm very out of step in believing that we should help patients.
@RolloTreadway @ChrisMayLA6 no, I appreciate your reply. And patients is what we should be considering. There are varying models for health systems, but, if we believe that everyone has an equal right to health, we must think about the best and most efficient way of providing that. And, so far, Labour seems to be doing the same as the Tories did, which doesn't work.
Hmmm.... I'm not so sure about that; seems to me that the issue is actually a workforce issue, and that will not be resolved by partitioning the service, other than to move to further (quasi) rationing.... but that's not to say there are no inefficiencies in the NHS, but many (I think) are the result of bad staff management (and that reflects staff as a scarce resource)....
@ChrisMayLA6 There are huge staffing issues. Staffing is at the heart of everything. But I don't think it's possible to go from 'the DoH are trying to solve NHS problems without solving the staffing problem first' (which is probably true) to 'the DoH is planning to end the NHS as a free-at-the-point-of-use public service, even though doing so would likely guarantee defeat at the next election'.
I'm just so tired of imaginary privatisation being talked up instead of actual problems. There's probably nothing, save for another major inflation crisis, that will have more impact on whether or not Labour retain power in 2029 than whether the NHS is improving. And they absolutely know this. So I just don't buy this idea that there's a sneaky plan to lose the next election.
I agree they do see that need to improve the NHS, but the difference is the method.... but Streeting seems to see a larger role for the private sector, and so some of the 'new' money will flow to dividends (as must happen), unless your view (which it may be) is the private sector is so much more efficient it can profit & increase delivery; my view is they will cherry pick the regular stuff, use the NHS as an emergency backstop. But I accept this is not *full* privatisation!
@ChrisMayLA6 @RolloTreadway I would dispute that there are staffing issues in the NHS as a result of poor management (I would say that as a retired NHS manager!).
I feel that there are fundamental issues with the NHS that can't be solved *purely* by throwing money at it.
I support the long term view that prevention of ill health and having a healthy population is uppermost - but that has to be a 20 year plan.
But today - the NHS has become all things to all people with little focus on doing anything excellently. Mental health care, emergency services, and primary care are all beyond creaking at the seams.
I think in the short term the use of the private sector can't be avoided. The financial rules around procurement & disposal of capital equipment are looser in the private sector but the sector is parasitical on NHS training & expertise.
If parts of the NHS were ultimately given more financial freedo, reliance on private providers could be reduced.
Thanks for this; I of course am only observing & defer to your knowledge/experience - I was using 'management' in a wide sense, but I think the point you make about capital investment (and subsequent amortisation) is an interesting one - shifting the budgetary rules, would certainly (I imagine) shift some (high-level) management priorities.... however, I also infer from your answer that the 'staffing issues' have a different cause; I'm curious, if so what?
@ChrisMayLA6 @RolloTreadway
My feeling is - don't forget I'm 15 years retired - is that the removal of nursing bursaries and some of the changes in medical schools may have had serious knock-on effects on the numbers & calibre of entrants to health staffing.
Retention of staff appears to be a huge problem - this is related to, yes, management style, but if the 'system' (education, research, buildings, IT, social care & other support services) is not supporting the clinical staff (at the 'sharp end') then who can blame them for wanting to get out.
A lot of the systematic issues are finance related, but I question whether political interference is helping those with a grasp on the situation deal with those problems.
The NHS is a hugely complex organism - tinker with one bit and you'll never know what the effects will be!
and thanks for this continuation of your point, which dovetails with some of my observations (especially around terms & conditions & educative costs)... I know from my own retirement from university, that some things come into keener focus once one is out of the day-to-day fire-fighting
@ChrisMayLA6
As I am concerned about privatisation (including partial) by stealth, I don't take comfort from the fact that the government isn't openly talking about it. I can hear Sir Humphrey explaining it to Jim Hacker, "You can't say privatisation Minister, the voters won't like it. You say that you are going to leverage the efficiency of the NHS by having it work in partnership with additional health service providers. It means the same, but the voters won't realise it".
@ApAlun @ChrisMayLA6
Streeting is channelling Sir Humpy, isn't he?
@ApAlun @ChrisMayLA6 I think that, as usual, the necessity of the private sector is just being completely ignored. I know everyone likes to say 'get rid of all private contracts!', but private contracts in the NHS provide us with:
medicines, medical equipment, computers, software, cleaning supplies, latex gloves, bandages, thread, beds, chairs, sheets, soft furnishings, defibs, plumbing, tools, cables, vehicles, parts of vehicles, heating, lights, pacemakers, clothes, trolleys, air conditioning, paint, windows, syringes, drips, carpets, batteries, paper, pens, I could go on and on and on
It's not about 'the private sector being more efficient', it's that the NHS is not the same as other public services, you can't just say 'no more private contracts' because then IT WOULDN'T BLOODY WORK and the fact that my NHS laptop is from Hewlett Packard does not mean that Hewlett Packard own the NHS.
This is what drives me up the wall. It's the complete refusal to engage with what the NHS is - a vast, incredibly complex and fantastically technical healthcare system - and instead treat it like a bus service that's either run by the council or by some private company.
Yet every fucking time the Government talks about working with state-of-the-art manufacturers and developers (which are necessarily private), there's the same old cry of 'privatisation!' and it's not that at all. We need this equipment and this medicine and this software etc etc etc. It saves lives and it's amazing. And we should not be seeking to deny anyone the best treatment because we can't distinguish between an equipment manufacturer and contracting out of NHS primary care services.
@ApAlun @ChrisMayLA6 Also, and I've said this a lot of times but I don't think anyone bloody listens: my Trust has had to pay a lot of private ambulance services to do work that we should be able to do, but can't, because the previous Government didn't allow us enough staff and resources.
That, right there, that *is* privatisation.
And we should get rid of those private ambulances and we will, but it'll take years and years to be able to do so. And if we get rid of them a day too soon, then people will die.
This is what we have to deal with. Not ideological purity, not getting confused about what privatisation actually means. Patients, who need us, right now. These are not hypothetical questions. So every time we talk about 'is the privatisation? Is that privatisation?', I'd like you just to stop and ask yourself: if the NHS doesn't do this, right now, today, will anyone die?
You might start to realise that some things are more important than whether a particular choice of words sounds like secret privatisation.
see previous answer; which is also why part of the issue (as we agree0 is the funding settlement.... but, I hope, Rollo you and I are (really) on the same side for all our differences in emphasis...
@ChrisMayLA6 @ApAlun I'm just tired. Too many people are dying. Political chat is so hypothetical but these are real people.