I don’t think people should need to fund their own care. They are in care because they are ill, i.e. having dementia is an illness and needs caring for just as any other medical conditions does. Should all be within NHS.

So that argument initially seems to make sense, but:

– not everyone in a care home has dementia
– not everyone with dementia ends up in a care home
– whether they are in a care home or their own house there are costs for the building, heating, lighting, food etc. Why should the state be covering those basic costs for some people whilst others have to pay their own?
– is it reasonable for a single mum of two earning £28K a year, living in a rented house with no assets to pay more tax to fund the care of someone with £300K in the bank/shares, a £30k a year pension and a £250K house – so that the elderly person’s children will inherit £0.5M when the time comes?

Eh? Makes no sense.

If you tell people that there is going to be a wealth tax calculation in 3 years time (for instance) you give some folk the head start they need to minimize their exposure. So a one off wealth tax needs to be announced and then either quickly assessed or (more likely) the assessment date is in the past…ie what was your wealth on “x” date.

You can have all the mitigation you may need to acct for “asset rich and cash poor” and deferred or installment payment etc set up within the mechanism.

“i.e. having dementia” means for example.

Full social care means that people have care in their own home via health service just as those in a care home would be. It is all care and should all be part of the health service.

– is it reasonable for a single mum of two earning £28K a year, living in a rented house with no assets to pay more tax to fund the care of someone with £300K in the bank/shares, a £30k a year pension and a £250K house – so that the elderly person’s children will inherit £0.5M when the time comes?

Yes, that is reasonable just as she is paying NI/tax today. That is how the NHS works and is funded. The rich elderly person gets exactly the same care and treatment.

If you think the rich elderly person should be made less rich then great, do that via taxes that impact them and not the single mum, i.e. very high inheritance tax, high taxes on their shares

whether they are in a care home or their own house there are costs for the building, heating, lighting, food etc. Why should the state be covering those basic costs for some people whilst others have to pay their own?

the same applies if you go to hospital – should people in hospital pay for the lighting, heating etc when some other healthy people do not?

– is it reasonable for a single mum of two earning £28K a year, living in a rented house with no assets to pay more tax to fund the care of someone with £300K in the bank/shares, a £30k a year pension and a £250K house – so that the elderly person’s children will inherit £0.5M when the time comes?

yes, they’re paying more tax now, but the person with a 30k pension has paid more tax whilst accumulating their pension. THe single mum will also get a load of benefits the old person won’t.

but the person with a 30k pension has paid more tax whilst accumulating their pension

Not on their pension they didn’t! Also that’s not how it works. It doesn’t matter how much you’ve paid in the past that money is spent. Might net being spent now needs to be raised now (ish).

If yoyu want free care homes for all then you need a big tax increase – and I really do not see why my taxes should be used so middle class children get to inherit.

So you are using care home payment as a means of stopping middle class children (More like 50 years olds) having any inheritance. Clearly that only impacts those that require care and those dying of other things don’t have their inheritance affected as their treatment is covered by NHS. Odd way of looking at things.

If people require health care of any kind it should be covered by the NHS.
If you don’t want people to inherit large amount then increase inheritance tax which would be a consistent and fair way of handling it.

Social care costs are huge – dwarfing anything else. Are you prepared for a 20% rise in taxation to pay for all care to be free at the point of use when the only difference it makes is not to the people in care but their children who inherit?

Taxpayers money being used to allow the rich to inherit?

I don’t think many of you realise the sums needed.

If you think the rich elderly person should be made less rich then great

I don’t think the old lady should be less rich, but certainly the children that inherit should or could be, as they’ve done little or nothing to earn the wealth.

Social care costs are huge

And are only going to get bigger. Those above working age/retirement is set to be something like 20% of the population in the coming decades…we need some way of paying for it.

At current rates all social care including home care etc if fully taxpayer funded would add something like 20 billion to the spending

NHS is 180 billion or so. In comparison. Its a lot of money to find and will only increase with the aging population

Apologies. I listened again to ‘more or less’ and I need to correct my statement. We tax above the average of the oecd countries.

Still, if you think we are a low taxation country you agree with Sajid javid who claimed the same on Today the other day, so there’s that. 👍

The piece begins at about 8 mins 30s in.

At current rates all social care including home care etc if fully taxpayer funded would add something like 20 billion to the spending

NHS is 180 billion or so.

Serious question: Could there be cost savings by having them both run by the same organisation? I mean, if care could be integrated across both hospitals and care homes?

but the person with a 30k pension has paid more tax whilst accumulating their pension

Not on their pension they didn’t!

Doesn’t matter, they still paid more, unless they put all the extra 2k into pension, which they probably didn’t.

Serious question: Could there be cost savings by having them both run by the same organisation? I mean, if care could be integrated across both hospitals and care homes?

Hospitals suck up too much resource of the NHS already and arguably (from a primary and community care perspective) are already badly and inefficiently run. They can barely cope now. Adding Social care to their portfolio would be a recipe for disaster IMO.  I think I’d cut it all to pieces, separate out Mental Health, pretty much all children’s services, pretty much all outpatient care, and leave only acute/emergency and planned surgery care with hospitals. All chronic conditions and elderly care looked after by separate arm.

About the only bit the works anything like it should is primary care.

My wife works in social care. Her employer is NHS Scotland.

don’t think the old lady should be less rich, but certainly the children that inherit should or could be, as they’ve done little or nothing to earn the wealth.

Well 100% inheritance tax (which severe penalties for dodging it) would get my vote.
That should find the 20 billion (TJ figure) which in the big scheme of things is not very much anyway

Serious question: Could there be cost savings by having them both run by the same organisation? I mean, if care could be integrated across both hospitals and care homes?

Nope

Indeed integrating it into the NHS would increase costs massively because 60+% of the cost is staff costs and NHS employees are paid about 50% more ( if you include holidays and pensions) than care home workers and home care workers.

Nickc – really?

and leave only acute/emergency and planned surgery care with hospitals.

What about rehab? what about imaging? what about diagnostics like catheter labs / MRI scans etc

Where are you going to do outpatients? remember that outpatient consultants will also be working in the hospitals on the same day they are in OPD. making staff move locations several times a day is unutterably daft.

BTW – as is well proven UK hospitals are amongst the most efficient in the world – even in england where admins costs are twice Scotland because of the stupid fake internal market.

 as is well proven UK hospitals are amongst the most efficient in the world

yep, don’t disagree, and they still suck up huuuuge amounts of cash just to run them. There’s really no reason why outpatient stuff like audiology or ophthalmology should be in the hospital. There’s no reason why cataracts aren’t being done at all the (largely) unused ops rooms in most of the lift buildings that also house 2 GP surgeries and dentists. I ran a very successful cataract community ops pilot that saw 16 people every day working from essentially a GP surgery with no adverse side effects at all.

the Dutch have long separated their medical needs into Acute and Chronic and Mental Health, and it’s high time we stopped thinking that we can’t learn from places like Spain who’ve had some success devolving their care to regional “total care” packages. Even the US have things to teach us about getting the pat and doc together in the most effective and cheapest way (as they do with Medi-care and Medi-aid)

making staff move locations several times a day is unutterably daft.

But making them move in locality once a day isn’t really that daft, lets move the fewest people, and that’s always going to be the docs and nurses. We spent huge amounts of cash in the nighties and naughties building tremendously capacious and capable buildings in every town, let’s use them properly.

Oh dear.

A senior registrar or a consultant will be working 7 30 – 5 usually. OPD is usually 2x 3 hr sessions. You really want to waste their highly valuable time moving locations 3 or 4 times a day?

Even the US have things to teach us about getting the pat and doc together in the most effective and cheapest way (as they do with Medi-care and Medi-aid)

twice as expensive as the UK

Cateract ops in the way you describe are much more expensive than done in hospitals and require far more equipment as each piece of equi[pment has to be duplicated multiple times for reach clinic

the only way you could do it is because the fake market in england is totally distorted in favour of private providers

so under your plan for OPD we would be having the senior medical staff having to change locations 3 or 4 times a day wasting valuable time

they would be working in the hospital – then have to leave to other premises, then return to the hospital, then return to opd, then return to the hospital wasting maybe 15% of their time that day

also sometimes the OPD doc is also on the crash team

absurd

Indeed integrating it into the NHS would increase costs massively because 60+% of the cost is staff costs and NHS employees are paid about 50% more ( if you include holidays and pensions) than care home workers and home care workers.

An interesting angle.

It’s only a matter of time until euthanasia shall be a health care option

An interesting angle.

Its something many people do not understand. the privatisation of elderly care under thatcher was for one reason only – to enable the employers to be able to pay less than NHS or council staff.

Of course I would want everyone working in care to be properly paid – but is just an aspect that many folk will not realise. to bring all elder care into the NHS would have a huge cost because of the utterly wretched pay terms and conditions that the privatised workforce have and to bring them up to NHS standards would add significantly to costs

You really want to waste their highly valuable time moving locations 3 or 4 times a day?

That’s not what I said, go back and read it properly. There’s no reason why they can’t gp to a different location once a day, is there?

so under your plan for OPD we would be having the senior medical staff having to change locations 3 or 4 times a day wasting valuable time

Not what I said. stop making shit up just because you can’t read properly

twice as expensive as the UK

some of the insurance companies running medi-care in some states are very very efficient at getting patients and docs together as cheaply as possible, their profit-margin depends on it!

Nickc – if you are moving senior doctors out of hospitals for OPD then thats what would happen – at the moment they work in the hospital outside OPD for a part of the day and in opd for a part of the day – doing what you suggest would mean them moving sites 3 or 4 times a day.

“That’s not what I said, go back and read it properly. There’s no reason why they can’t gp to a different location once a day, is there?

Yes – because thats not how they work. the docs are doing ward work before. after and in between OPD sessions.

At the moment the senior docs will be doing ward work before and after OPD sessions. so taking OPD out of hospitals means they would be moving between units 3 or 4 times a day and wasting hours a day doing so

so yes – your idea is absurd, would waste huge amounts of time, reduce the amount of patient contact the doctors have

Once again you show your total lack of understanding of how hospitals work

As for the idea that american systems are cheaper – laughable

Cateract ops in the way you describe are much more expensive than done in hospitals and require far more equipment as each piece of equi[pment has to be duplicated multiple times for reach clinic

Oh, you really have no idea. Cataract ops costs the same rate regardless of where they’re carried out, the only difference is the overheads which are always more expensive in the big white building filled with expensive staff, and not the partially empty building with just GPs in it.

You may have been a good ward nurse, but you’ve no idea what you’re talking about.

doing what you suggest would mean them moving sites 3 or 4 times a day.

Again go back and look at what I said:There’s no reason why they can’t do to another location ONCE a day, jeasus pointless discussing this with you if you’re just going to ignore what I wrote

Shame for you that is categorically not true

Lots of research showing that hospitals are much cheaper

yes NHS commissioners pay the same amount – but the actual costs are much higher done the way you suggest. gpo check the kings fund reserarch. Up to twice as much per op

Once again you show your total lack of understanding of how hospitals work

Expensively and ineffceintly.

As for the idea that american systems are cheaper – laughable

do you know anything about the American insurance and Medicare market place after Obamacare?

Don’t dismiss things just because they don’t fit with you view or ideology, it’s very narrow minded and shows that you’re resistant to new ideas. The US system is some of the best healthcare in the world (IF you can afford it) but their system for incentivising fast and direct access is also worth looking at as companies are incentivised to make saving by making sure that pats. see the right care at the right time. it’s the profit motive….I’m not saying we have to have profit as a motive, but we can look at their systems of how they do that.

There’s no reason why they can’t do to another location ONCE a day

yes there is
1) currently they do other hospital based work before after and between OPD sessions
2) they need to be on the hospital site every day so cannot do a whole day in OPD

So thats 4 movements of staff daily at a minimum

then there are all the other issues. want an urgent MRI as a result of the OPD exam – now its ” just go down the corridor” Under your plan thats not possible

Want a second opinion as the doc is not sure – now you can just bleep the other doc to come down – under your system that could not happen

etc etc etc

You call me out for ideology? Jeepers!

Unlike you I actually understand how hospitals work.

arggh…you see the big white building as the only answer…you do know there’s literally thousands of docs working up and down the country that don’t need to run down a corridor to get a second opinion, right?  I mean, you do know that GPS don’t do this as a matter of course…?

And this works in Spain right now, This is literally how their healthcare systems works; Consultants go to the pats, not the other way around, are you saying that Spanish healthcare doesn’t exist?

I mean, you do know that GPS don’t do this as a matter of course…?

Actually they do. One of the advantages of multi gp practices. common practice

that big white building is the most efficent way to do it as weverything from expertise to equipment is all in one place available 24/7/365

consultants in spain have a very different role

Your ideas also mean huge duplication of equipment as every place would need all the equpmet

i really suggest you go read the research on costs. Hospitals are always significantly cheaper in actul costs that private clinic

is it reasonable for a single mum of two earning £28K a year, living in a rented house with no assets to pay more tax to fund the care of someone with £300K in the bank/shares, a £30k a year pension and a £250K house – so that the elderly person’s children will inherit £0.5M when the time comes?

yes, they’re paying more tax now, but the person with a 30k pension has paid more tax whilst accumulating their pension. THe single mum will also get a load of benefits the old person won’t.

A person with a £28k income will get **** all in benefits

While we are talking about funding the NHS and social care in the here and now, I see no reason why we can’t have a small fee payable for GP appointments. As a minimum wage worker I would be happy to pay a nominal £10 (or other small fee) per appointment, or if numerous appointments over a period are needed then maybe £25 to cover them. It works for NHS dentists. I would also charge for missed appointments as these are a huge drain on time and resource. All payments should go straight into the “pot” for the overall NHS budget.

Someone a few pages back (CBA to find the comment) knocked back my point about taxing bonuses and share options saying theirs were taxed. They are not taxed the same as base pay was my point. If they were then executive renumeration would not be so bonus heavy (with bonuses guaranteed regardless of performance) in some cases. Share options are shamelessly offered as a way of avoiding tax and increasing “wealth”. Any profit from selling these in the future should be taxed as if it was part of the employee’s income, not “capital gains”. Yes this would upset the high earners, but it would simply be closing a loophole by which they currently avoid paying due income tax, not hammering them with extra tax for being supposed “high achievers”. I’ll be honest… it pisses me off when execs get paid a huge bonus for making a load of people unemployed due to the company they run losing a load of money. If they are running it badly they don’t deserve a bonus surely?

If the bonus is in cash it will taxable the same as other pay. FWIW I exceeded all my targets despite being new in the job and doing so durimg the pandemic. I was due a 10% bonus (i actually significantly increased the pay of my whole team and hired people), didn’t get any bonus, same for everyone else including the Exec team, despite the business dojng a lot better than expected due to Covid. The general feeling was it wouldn’t be appropriate to be paying bonuses whilst we were taking government money with staff on furlough.

It works for NHS dentists.

might work for the dentists, doesn’t work for the patients, unless you want to push people into paying for private care so they can actually get treatment.

While we are talking about funding the NHS and social care in the here and now, I see no reason why we can’t have a small fee payable for GP appointments.

Because it puts people off going to the doctor making their illnesses worse and costing the country more in the long run

one small cost cutting I would like to see is no more prescriptions for cheap over the counter meds. Want paracetamol? Buy it – its literally pennies

one small cost cutting I would like to see is no more prescriptions for cheap over the counter meds. Want paracetamol? Buy it – its literally pennies

I thought that was already the case?