Reply to: Doctors read my mind

[Mailman]

If you don't work - there's no reason why you can't get a daytime appointment.

Apart from the fact that you cant get in anyways because all the other poor sick scum are stinking up the system!

Mailman

[Old Greg]

It is well known that NHS managers and clinicians are gaming the target system to make waiting times, etc, look better.

Sure, two patients with simple ops see an improvement, but the difficult cancer patient shunted aside for them might not. And all of a sudden we stopped being able to book GP appointments more than 48 hours in advance, so now it looks like everyone is seen within 48 hours!

There certainly is gaming, but waiting times have still dropped considerably for surgery - therer simply aren't masses of people waiting for 2 years + for surgery. Cancer and suspected cancer patients don't, in my experience get shunted around for simple ops (not saying it has never happenned) and cancer is one area where there is very little gaming (I've never known of any) simply because the DH will come down like a ton of bricks for any breach of cancer waits and a hundredfold for a cover-up of it.

The 48 hour business for GPs is a different kettle of fish in that it was a very poorly implemented project ('Advanced Access'), which was intended to give everyone the opprotunity of booking within 48 hours (I remember when I lived in London and couldn't get a routine GP appointment for 2 weeks). But it got badly mangled in implementation as as you say, has caused a whole load of problems.

[Rantor]

It is well known that NHS managers and clinicians are gaming the target system to make waiting times, etc, look better.

Sure, two patients with simple ops see an improvement, but the difficult cancer patient shunted aside for them might not. And all of a sudden we stopped being able to book GP appointments more than 48 hours in advance, so now it looks like everyone is seen within 48 hours!

Absolutely, its only human nature.

The recent mega-investments in the nhs that have shown such uneven, and often marginal, improvements seem to indicate that the basic model is not fit for purpose.

I can't see how things can change as the nhs is nearly a state religon (there is a good original quote on this.) I have members of my family who work in the nhs who will seriously say that taxes should be set at whatever level necessary to pour in however much money it takes.

More realistically, many people are afraid of us going to the other extreme (American style.) Given that debates on controversial subjects in Britain ain't always that nuanced this is not an unreasonable poistion.

It only took a year of living in a country with a wellstructured healthcare system to see the difference in terms of quality, choice, speed and affordability.

I can't see anything really changing too much for the better in the near future for the biggest employer in europe.

[wendigo100]

It is well known that NHS managers and clinicians are gaming the target system to make waiting times, etc, look better.

Sure, two patients with simple ops see an improvement, but the difficult cancer patient shunted aside for them might not. And all of a sudden we stopped being able to book GP appointments more than 48 hours in advance, so now it looks like everyone is seen within 48 hours!

[vetran]

Most employed people would happily take doctor appointments during the day if they could book it in advance. Unfortunately you have to get up early and soft soap the receptionist to get an appointment for Tomorrow. You normally get 'well we only have one at 2:30 today'. Yet a third of appointments aren't attended. So have a 2 strikes and you are out policy miss 2 appointments in a 2 year period and it costs you £10 each.

There is no preference given to working people for 8am or 5pm appointments so it disrupts employers / small businesses.

Not sure why I should pay more for a service that twice as much of my tax money has been poured into to pay for £10,000 works of art and shiny boardroom tables not clean instruments or medical staff who can speak english.

[Old Greg]

[QUOTE=IR35 Avoider]

Correct me if I'm wrong, but I suspect by "middle-earner" you mean people earning something like 30-60K per year.

A quick Google led me to a government statistics web page that indicated that median individual income for women in 2003/2004 was £163 per week and for men £303, so I calculate "middle income" should mean roughly 52*(£163+£303)/2 = 12K.

Anyway, half of all government income from income tax and NI comes from the top 10% of earners, so broadly speaking I would disagree that top-earners are under-taxed.

One document I've Googled indicates that in 2002 a single person with no children would have been in the top 10% of the population for income if they had an after-tax (including after council tax) income of £1700 a month. I know this is not quite the same thing as individual taxable income, but it was the best statistic I could find quickly that would illustrate what it would mean to be so "rich" that you fell in top 10% and therefore were one of those carrying a disproportionate share of the tax burden.

I'm not in a position to dispute any of your figures. But the really rich manage to live in tax havens and seem to pay next to nothing.

[IR35 Avoider]

[QUOTE=gingerjedi]

Its pretty obvious to most that the 'middle earner' pays more than their fair share of tax whilst the top end earners are left well alone, I agree with the assumption that its better to have them paying some tax than have them live somewhere else and pay none.

So no they don't pay their fair share but what can you do.

Correct me if I'm wrong, but I suspect by "middle-earner" you mean people earning something like 30-60K per year.

A quick Google led me to a government statistics web page that indicated that median individual income for women in 2003/2004 was £163 per week and for men £303, so I calculate "middle income" should mean roughly 52*(£163+£303)/2 = 12K.

Anyway, half of all government income from income tax and NI comes from the top 10% of earners, so broadly speaking I would disagree that top-earners are under-taxed.

One document I've Googled indicates that in 2002 a single person with no children would have been in the top 10% of the population for income if they had an after-tax (including after council tax) income of £1700 a month. I know this is not quite the same thing as individual taxable income, but it was the best statistic I could find quickly that would illustrate what it would mean to be so "rich" that you fell in top 10% and therefore were one of those carrying a disproportionate share of the tax burden.

[Stan]

How can it continue to be free? We have so many immigrants arriving n the country that any money we invest is instantly consumed by immigrants and health tourists that are not paying any money in.

Watch out you've got drool on yer chin

The stealth privatisation of the NHS continues. Follow it to it's conclusion and if you work then you will have to pay for all treatment and if you are unemployed you get all treatment free.

[Old Greg]

How is this an issue? What is the difference between a foreign doctor's family using the NHS and a British doctors family using the NHS? Both families have a bread winner who contributes to Taxes/NI and therefore the NHS.

Why should the immigrant family not be allowed to use the NHS when the british one can?

There's a fair chance that all those little immigrant children of doctors will grow up one day to be British doctors, paying taxes all of their own, and maybe even having their own little future taxpaying doctors one day.

As far as the NHS is concerned, kids are a bit of a side issue. The NHS does not spend money equaly on everyone, but expenditure instead disproportionately goes on a relatively small cohort of patients (mostly aged > 60) with multiple chronic health problems (e.g. heart conditions, breathing problems, diabetes, stroke history). Maybe some immigrants do bring elderly relatives with them but this is, I expect, a small minority (I have no figures to back this up, it's just a hunch). Most 'dependents' coming over are non-working spouses and children, I reckon.

[Ardesco]

And as for the doctor part, what the issue is is not that they don't get a new council house but more that they come over here as relatives (in some cases bloody loads of them) and then do not work, do not pay tax but still consume resources from NHS etc.

How is this an issue? What is the difference between a foreign doctor's family using the NHS and a British doctors family using the NHS? Both families have a bread winner who contributes to Taxes/NI and therefore the NHS.

Why should the immigrant family not be allowed to use the NHS when the british one can?

[Old Greg]

I guess not but we need to do something. We are chucking money into NHS and seeing no benefit as it gets swallowed up instantly....

Back to where we were a few posts ago! I've just come out of a long stint in the NHS, and I only half agree with you (and I don't agree that it's immigration swallowing the funding). Now I'm no fan of NL's appalling mismanagement of the NHS, but here are some areas where I think there have been some improvements (hence no benefits it's a bit harsh):

Decreased waiting times (I remember working on projects to reduce the maximum waiting time between Outpatients to Surgery from 2 years). The fact is waiting lists have massively decreased, even if there is still a hidden waiting list for patients waiting for diagnostics (which was always there). This has made a serious positive difference to the lives of a lot of patients, and is in my view one of the very few achievements of this government.

Improved facilites (especially in updating of the old mixed sex Nightingale Wards) - although there's been a disgraceful waste of money on PFI schemes.

We all know the litany of wasteful spending:

I mentioned PFI
Massive pay increases for all staff and GPs (it can be argued whether this has all been wasted, but it was not implemented with any robust views of the benefits).
Multiple restructuring of organisations.
Expenditure on management consultancy etc.

So it is a mess, but there have been some changes for the better.

[angusglover]

I guess not but we need to do something. We are chucking money into NHS and seeing no benefit as it gets swallowed up instantly....

[Rantor]

I move we go to an American system where we all pay for health cover. No pay, no cover.

You might (though I doubt it) want to look into this a bit further - the current system ain't that popular in the US.

[angusglover]

So I stand by original statement that most immigrants do pay thier way. As for doctors coming in and then bringing thier family over, this family is not going to get a nice new council house and a bunch of benefits as the doctor earns too much so it's not really the same thing.

I don't disagree that we have a problem with immigration, however I do dispute the fact that immigrants are the source of all our woes.

I think the statement trhat "most immigrants pay taxes" is very naive.

And as for the doctor part, what the issue is is not that they don't get a new council house but more that they come over here as relatives (in some cases bloody loads of them) and then do not work, do not pay tax but still consume resources from NHS etc.

I move we go to an American system where we all pay for health cover. No pay, no cover.

And just to quote, I did not say "immigrants are the source of our woes". I made the point that we cannot continue to give give give while people take take take.

[Ardesco]

Ok I admit my figures are way off (I belive I said that in my original post anyway).

I also do not disagree that the middle class have a greater tax burden than anybody else, however the immigrants that come into this country and work pay no less than our lower classes and many of the professional immigrants that come into this country come into the middle class bracket.

So I stand by original statement that most immigrants do pay thier way. As for doctors coming in and then bringing thier family over, this family is not going to get a nice new council house and a bunch of benefits as the doctor earns too much so it's not really the same thing.

I don't disagree that we have a problem with immigration, however I do dispute the fact that immigrants are the source of all our woes.