• This topic has 82 replies, 34 voices, and was last updated 7 years ago by br.
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  • NHS consultant paid £375,000 in overtime
  • robdixon
    Free Member

    That chart up there shows tax paid by workers on an average salary.

    We already know that workers on average salaries in the UK make no net contribution to the running of the state – this is offset by relatively small number of individuals (300,000 people or so) who pay the bulk of the cost for running public services.

    So the debate should actually be – are people on average incomes willing to pay significantly more tax to improve the funding of the NHS?

    My hunch would be everyone agrees with the principle of raising NHS funding based on an assumption “others” will pay more – but the level of support for more spending disappears faster than a newly appointed member of the shadow cabinet when it becomes clear they personally need to pay more tax.

    ahwiles
    Free Member

    i’m on an entirely average salary, i’d be happy to pay more tax.

    although it would probably help if the NHS wasn’t being deliberately driven into the ground…

    anagallis_arvensis
    Full Member

    What is the average salary and what do you mean by average?

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    bencooper
    Free Member

    We already know that workers on average salaries in the UK make no net contribution to the running of the state – this is offset by relatively small number of individuals (300,000 people or so) who pay the bulk of the cost for running public services.

    Perhaps I’m not understanding, but are you really saying that most public services are paid for by only 300,000 very high earners? The rest of us contribute nothing? Isn’t it more that most of us pay our way on average, and those at the top end help out those at the bottom end?

    mikewsmith
    Free Member

    That chart up there shows tax paid by workers on an average salary.

    Partly it’s to show that the UK is still low tax for workers and it also goes back to my earlier point that a discussion about tax, spending etc should never be limited to income tax as it’s very subjective.

    gonefishin
    Free Member

    Perhaps I’m not understanding, but are you really saying that most public services are paid for by only 300,000 very high earners? The rest of us contribute nothing? Isn’t it more that most of us pay our way on average, and those at the top end help out those at the bottom end?

    It’s not quite the top 300,000 pay for everything but when looked at as a purely financial transaction (whether this is a good way of looking at things or not is another question) then something like the top 40% pay in more than they get out (subject to certain assumptions and averaging) whilst the rest get more out than they contribute. The cross over based on households gross income is around £35,000.

    http://www.telegraph.co.uk/finance/personalfinance/tax/10638283/How-much-we-give-the-state-in-tax-and-how-much-we-get-back.html

    FunkyDunc
    Free Member

    I’m sure that people enter the NHS to save lives and not to make money as a primary reason.

    There are definitely a small percentage who enter the NHS, with the aim of doing private practice. These numbers are small, and falling as the costs increase, plus the fact that to be come rich in private practice your literally have to work 7 days a week.

    Mrs FD is a surgeon, has no aspiration to do private work, but the way the government keep treating her profession like sh!t makes alternatives look more inviting.

    She showed me a job that she was offered in Corporate land. £100k a year 9-5 (relative compared to a doc), less responsibility etc etc. She would never go for it, but it was very demoralising to think that she works much harder for a lot less financial reward.

    Then there is moving abroad where you could get a much better work life balance, and get better paid for it.

    Quite a few docs are getting fed up of being kicked in the teeth and leaving 🙁

    br
    Free Member

    Also that chart ignores costs for some countries, for example in most of Europe our healthcare costs are deducted at source, whereas outside Europe they’re usually paid by the individual – so not really apples vs apples.

    jambalaya
    Free Member

    @convert I haven’t been to A&E since getting smacked in the head playing hockey in 1981. I and my immediate family have had a few NHS experiences in the last couple of years on which I base my comments. The NHS was setup to provide healthcare at start and end of life and to do emergency life threatening stuff. At many other things in between the service is really quite poor. This shouldn’t surprise anyone as we spend substnatially less on it than our European neighbours do. We can’t have a sensible conversation as it immediately descends into “privatise the nhs” rants. No where else in the world does health care as we do, there is a reason for that and its not a positive one for the UK.

    EDIT:

    As much as we like to think to the contrary, we don’t live in a particularly benevolent society and until we do the NHS will never be supported financially as much as we really should want it to be.

    As Inre-read your post I think we are agreeing. We don’t live in a society which is prepared to pay for the services we want. The average tax payer is of the view they are paying more than they get out and they are very much mistaken

    On taxes the top 1% pay 30% of income taxes collected, ie top 1% pay £50bn ie an average of £170,000 a head. Personally I think our spending on health provision ie a new NHS should rise from £130bn to more like £170bn – as you can see by the chart below you can’t realistically do that with income taxes as you can’t put them up enough. As noted VAT on food is 5% in France and 10% in Germany for example.

    jambalaya
    Free Member

    FD, Mrs FD should be able to earn a decent living in the UK and work sensible hours, we need to change our system and mind set to allow it. I have a few relatives who are dentists and doctors (not surgeons) in France, they make £500k plus as a result of their practices (they run businesses with multiple practitioners)

    Discussion on NHS is so skewed and emotional here its not possible to have a sensible conversation. So we carry on with the same old theme and the service is getting worse as health costs rise far faster than revenues not least due to an ageing population.

    jambalaya
    Free Member

    BTW see the Lyme Discease thread

    jambalaya
    Free Member

    @mike “selected” yes very 😀

    Fance would be above Belgium

    GrahamS
    Full Member

    Also that chart ignores costs for some countries, … so not really apples vs apples.

    this gets a bit closer to comparing your Bramleys to your Granny Smiths:


    http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-care-spending-compared

    And this is quite useful too if you want to explore further:

    http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014&locations=FR-GB-US-DE-DK-HU-AT-GR-NZ-IL-KR-MX&start=2014&view=bar

    robdixon
    Free Member

    FunkyDunc – if your wife is a surgeon and was offered £100K in the private sector she would very likely be taking a substantial pay cut when comparing her current overall remuneration (Pay, Holidays, Maternity Leave, Employers Pension contribution / value of the defined pension benefit) with that of a different role in the private sector that offers “headline” higher base pay.

    As I recall it employees in most private sector roles would need around 40-45% of their salary paid into a pension to get parity with NHS staff and their defined pension benefit.

    Although NHS staff sacrifice 10-15% of their salary the employers element is worth more than 25% of salary – compared to an average of 6% in the private sector. To make up the gap a typical private sector worker would need to sacrifice more than 35% of salary to get the same pension.

    Also factor in total job security compared to potentially very limited job security – the GMC / RCS find it extremely difficult to remove practising rights from doctors / surgeons with the result even the bad ones continue to be employed by the NHS.

    Also agree with Jamba above – we need Doctors / Surgeons to work reasonable hours to ensure they are not over tired and not making mistakes – as is the case with other safety critical professions.

    RichPenny
    Free Member

    So the debate should actually be – are people on average incomes willing to pay significantly more tax to improve the funding of the NHS?

    Alternatively, are the 300000 people who benefit the most from being part of our society prepared to pay an amount of tax which wouldn’t impact on their lifestyle, yet would allow the rest of society to live better lives?

    jambalaya
    Free Member

    Alternatively, are the 300000 people who benefit the most from being part of our society prepared to pay an amount of tax which wouldn’t impact on their lifestyle, yet would allow the rest of society to live better lives?

    They couldn’t pay enough more that anyone would notice. Thats one of my points, if we want the services we claim to want we all need to oay for them. The logic that it “wouldn’t impact their lifestyles” is a false one people are very sensitive to the 50% threshold as getting less than half is seen to be grossly unfair. Also in many cases these highly paid people could easily do exactly the same job elsewhere, certainly say Ireland or Switzerland.

    @rod yes my pension calcs would be the same, a private sector person would need to pay in approx 50% to try and match the pension and these days maybe even more as tax relief is limited and pension pot is heavily taxed above £1.2m (Jeremy Corbyn’s pension is worth £1.6m for example)

    bails
    Full Member

    maybe even more as tax relief is limited and pension pot is heavily taxed above £1.2m (Jeremy Corbyn’s pension is worth £1.6m for example)

    What’s that an example of?

    RichPenny
    Free Member

    They couldn’t pay enough more that anyone would notice. Thats one of my points

    So the top earners in society couldn’t pay enough, but the bottom earners could? If you look at the income splits your statement makes no sense.

    The logic that it “wouldn’t impact their lifestyles” is a false one people are very sensitive to the 50% threshold as getting less than half is seen to be grossly unfair

    You mean it’s fairer to increase taxes on the people who are getting the bus, rather than someone who might have to choose a 325i rather than a 330i? GTFO 🙂

    crankboy
    Free Member

    Jambalaya skipping back a bit what is your idea of a typical lawyer or barrister ? And do you understand the difference between charging out rate and salary ?

    jambalaya
    Free Member

    Yes I do appreciate that @crankboy. Typical: Employment lawyers, family lawyers for example. Top “magic circle” partner lawyers are £500-£1000 an hour assuming you are not talking about M&A or tax advice as thats much more expensive.

    You can make £150k running a local authority, £100k as a head teacher. I would wish surgeons and consultants to be able to make much more than that.

    Rich, well everyone in Germany and France manages fo pay more taxes, a lot more. I remember finding a list of the EU countries with VAT on food andnits most of them. Actually your car example makes a good point, by increasing taxes on the rich you reduce their spending and that impacts fhe wider economy, cheaper car means less revenue for car dealership, less profit for manufacturer etc. The top rate of tax/ni went from 41 to 52 (so a 26% increase) and they removed personal allowances. The top 1% pay an average of £170k in tax, the 99% pay £3,300 on average – now these figures don’t include NI but they are illustrative. My point is “tax the rich” is more a political battle cry than an effective financial policy.

    jamj1974
    Full Member

    500k ? A private doctor / surgeon could make multiples of that.

    Perhaps because when we have people still dying of hunger and exposure in the UK, it might almost seem immoral to earn that kind of money…

    irc
    Full Member

    Heard this discussed on R4 today. The doctors rep made the reasonable point that of the amount paid out in overtime the vast majority (from memory 3/4 or more) was covered by the number of salaries the NHS is saving by having large numbers of consultants posts unfilled.

    GrahamS
    Full Member

    Not to mention the money they save by not having to pay out huge fines for missing A&E waiting times and other quality measures.

    bonjye
    Free Member

    Firstly, hospitals are subject to a variety of incentives and penalties- so if you’re going to miss out on £2m for the sake of lacking consultant hours (and consultants to provide them) then paying your consultants handsomely for overtime makes perfect sense.

    Secondly, NHS hospitals must compete with private hospitals for consultant hours and pay accordingly. These numbers seem on the low side to me, given that spinal consultants locally (in the north east) can make 7 figure salaries and generate multiples more for the private hospitals they work for.

    There are also costs that come from working more – mainly professional indemnity insurance, which can be eye wateringly expensive for some specialties, so there’s a point where you’re not earning, just churning.

    RichPenny
    Free Member

    Actually your car example makes a good point, by increasing taxes on the rich you reduce their spending

    Or perhaps their saving. Poorer people by definition are less likely to save, because they have fewer choices.

    gonefishin
    Free Member

    You mean it’s fairer to increase taxes on the people who are getting the bus, rather than someone who might have to choose a 325i rather than a 330i?

    Whilst I’m not normally inclined to defend jambalaya (1. he’s more than capable of doing it himself and 2. I don’t necessarily agree with him on a lot of things) I think he is making a good point. Get rid of ideas of what is “fairer” as you’ll never get agreement on what this actually means. As far as raising tax is concerned what people generally consider fair is when taxes are raised on people who aren’t them (see also benefit cuts that they don’t receive). If you want to raise taxes to pay for the NHS then look at the best way of getting more money. I’ll wager that increasing the basic rate of tax by 1p in the pound would raise more than a 50p top rate of tax.

    Whether you consider this fair isn’t really the point, the point is how to raise the most cash.

    Oh and for reference I chose the 330i.

    mikewsmith
    Free Member

    I’ll wager that increasing the basic rate of tax by 1p in the pound would raise more than a 50p top rate of tax.

    Whether you consider this fair isn’t really the point, the point is how to raise the most cash.
    But you also have to assess the greater impact on society of those changes, adding 1% to the tax burden of people who probably have no spare income vs those who do.
    The real solution is to put it all on the table and look for a way to make tax work. Incentivse people to be in work and paying taxes.

    outofbreath
    Free Member

    “Incentivse people to be in work and paying taxes.”

    Welfare cuts.

    convert
    Full Member

    It would be interesting to know how far down the food chain most people think you should go before you find the first net financial contributor*. I’d like to think that it should be quite a way. You would hope all of us with the ability to make non essential purchases (shiny bikes for example) or put money away for a rainy day are also making a contribution beyond what we are costing over our lifetime.

    *appreciate this must be horribly complicated to work out and at best only an average. There are times in your life (when you are a child, when you are an OAP, when you are ill) when you are a huge taker and others when you cost the state very little. There are also some folk who stay healthy and cheap most of their lives and then drop down dead at 55 – the perfect member of the population in terms of ‘value for money’.

    mikewsmith
    Free Member

    outofbreath – Member
    “Incentivse people to be in work and paying taxes.”

    Welfare cuts.
    No, those are your words, making work pay, making sure that by working you don’t suddenly end up worse off by say paying another % on income tax.

    gonefishin
    Free Member

    It would be interesting to know how far down the food chain most people think you should go before you find the first net financial contributor*. I’d like to think that it should be quite a way

    It’s a lot higher up than you might imagine. Have a look at that Telegraph story I linked to but it’s around the £35k mark, based on household income.

    making sure that by working you don’t suddenly end up worse off by say paying another % on income tax

    When considered in isolation the increase in income tax never makes you worse off. The tapering rate of benefits on the other hand might.

    convert
    Full Member

    It’s a lot higher up than you might imagine. Have a look at that Telegraph story I linked to but it’s around the £35k mark, based on household income.

    I wasn’t really interested in where the line is currently but where people think ‘morally’ should be. At what point do people think they are comfortably enough off to feel that they should be contributing rather than just putting in what they get out. Judging on the recent EU referendum result that concept does seem quite alien to most now sadly.

    thecaptain
    Free Member

    The break-even point can’t be all that far from the average, ok the distribution isn’t symmetric and the very rich can pay a decent whack more (as they do) but the vast bulk of people must pay in roughly what they get out.

    Though this is of course ignoring the importance of borrowing against future generations, but that is again only a modest amount (per year: it adds up over time).

    gonefishin
    Free Member

    I wasn’t really interested in where the line is currently but where people think ‘morally’ should be.

    I suspect that would be “above what I currently earn”.

    I wasn’t really interested in where the line is currently but where people think ‘morally’ should be.

    Sadly I think you are correct.

    kimbers
    Full Member

    The 35k line says more about our low wage economy, the average household income is only 22k.
    Most people have never left the recession, austerity has been a crushing disaster

    https://www.theguardian.com/money/2016/jul/27/uk-joins-greece-at-bottom-of-wage-growth-league-tuc-oecd

    br
    Free Member

    Now pulling the post back from the tangent it went off on, when it seemed no one was at all interested in what I thought the issue was 🙂

    This is the kinda issue I could see:

    Possible fraud, certainly incompetence and bad management.

    http://www.bbc.co.uk/news/uk-england-36922039

    anagallis_arvensis
    Full Member

    The 35k line says more about our low wage economy, the average household income is only 22k.

    22k would be mode not mean wouldnt it? I would imagine the mean wage is much, much higher due to Branson and his mates.

    teamhurtmore
    Free Member

    In eonomic stats, average such as average wages are generally arithmetic mean averages

    anagallis_arvensis
    Full Member

    Indeed when people say average most people assume mean but 22k seems too low to be the mean wage. I remember my old style student loan needed paying back when I earned 2/3rds of the nat mean wage and that was around 22k about 15 years ago.

    anagallis_arvensis
    Full Member

    Also the poster seems to be mixing wage with household income which I presume includes those on benefits

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