NHS winter 'crisis'
- Thread starter Damien
- Start date
NHS crisis fuelled by closure of 1,000 care homes housing more than 30,000 pensioners
http://www.telegraph.co.uk/news/201...ure-1000-care-homes-housing-30000-pensioners/
Maybe it depends on what we mean by NHS managers, as they are some of the very people enacting questionable expenditures, rationing of treatments and determining recruitment policy at a hospital. The person(s) calling on the public to be more personally responsible ought to have some distance from that type of decision making IMO.
http://www.telegraph.co.uk/news/201...ure-1000-care-homes-housing-30000-pensioners/
Clarification accepted.
Maybe it depends on what we mean by NHS managers, as they are some of the very people enacting questionable expenditures, rationing of treatments and determining recruitment policy at a hospital. The person(s) calling on the public to be more personally responsible ought to have some distance from that type of decision making IMO.
By Tory design. As mentioned earlier they set funding too low to pay for everyone and have others implement the cuts
The Government Needs to Reverse a Thirty Year Policy and Start Increasing the Number of Hospital Beds
http://iaindale.com/posts/2018/01/1...-start-increasing-the-number-of-hospital-beds
And then factor in a population increase of 7 million between 1995-2015, a significantly faster rate of growth than the decade which preceded it.
http://iaindale.com/posts/2018/01/1...-start-increasing-the-number-of-hospital-beds
And then factor in a population increase of 7 million between 1995-2015, a significantly faster rate of growth than the decade which preceded it.
Until there is proper competition in the providing of healthcare the service will continue to deteriorate, irrespective of the ever-increasing funds being pumped into it. There's a reason we have anti-monopoly laws and it's because a lack of competition and consumer choice results in poor service, because there is no incentive for the service to be better.
This can be done comfortably within the current free at the point of use model (although in my view this isn't sustainable either), which would result in patient choice causing poor hospitals to close down and good hospitals to expand, open more hospitals and replicate their successful model ala any other innovative and successful enterprise. Managerial pay in this sector should also be linked to success which would further incentivise providing a good service.
I'd also be interested in exploring a country wide incentive for not using the NHS over a 12 month period. After reading about the economics involved I'm confident that even something like a £50 cash-back would save billions more than it would cost. Almost like a reverse excess. I believe the statistics involved in respect of the amount of people that use the service solely because it's available for free, rather than because of actual need; compared with other countries where that isn't the case suggests a massive but unnecessary pressure. You couldn't set this incentive too high for fear of people putting their own health at risk just to achieve the "cash-back", but at a level of say £50 I believe it would relieve a large amount of pressure and cost without any detriment.
This can be done comfortably within the current free at the point of use model (although in my view this isn't sustainable either), which would result in patient choice causing poor hospitals to close down and good hospitals to expand, open more hospitals and replicate their successful model ala any other innovative and successful enterprise. Managerial pay in this sector should also be linked to success which would further incentivise providing a good service.
I'd also be interested in exploring a country wide incentive for not using the NHS over a 12 month period. After reading about the economics involved I'm confident that even something like a £50 cash-back would save billions more than it would cost. Almost like a reverse excess. I believe the statistics involved in respect of the amount of people that use the service solely because it's available for free, rather than because of actual need; compared with other countries where that isn't the case suggests a massive but unnecessary pressure. You couldn't set this incentive too high for fear of people putting their own health at risk just to achieve the "cash-back", but at a level of say £50 I believe it would relieve a large amount of pressure and cost without any detriment.
Whats your source on these economics? Very frequently the administration costs outweigh the savings for such schemes. Further, are you not going to treat people in A&E who refuse to provide ID?
A better idea (often stated) would probably be for the goverment to stop closing GP walk ins and making increasing availability over the weekend. People end up at A&E because there's no where to go. I'v heard plenty of co-workers say they go to A&E because they can't be seen by a GP for X days.
I think everyone needs to show some form of identification in truth. Even from a data collection point of view any good company needs to know the demographics of it's users/customers in order to improve its service. Of course this doesn't mean if you've forgotten your drivers licence you're left to bleed out in the back of an ambulance.
I'll have another look in terms of the data but it was a while ago that I read about it - the article I do remember from the Freakonomics blog as below is slightly similar which I think would be better than the current system but could be drastically improved upon.
http://freakonomics.com/2014/05/19/...-to-help-the-british-national-health-service/
You're saying this as if it's something that can be done in a day or two without long, drawn-out complex processes. If a hospital suddenly closes down then there's a good chance that a lot of the people working within it can end up unemployed and without work. 'Opening' hospitals isn't something that can be done overnight but which would instead take years if it involves building them, staffing them etc. Especially when hospital closures would likely be met with lots of protests from residents who'd (rightfully) be sceptical as to whether a hospital is being closed for genuine reasons or as an excuse to mask further cuts. Additionally new hospitals being built would potentially face challenges depending on where it's built, how that impacts residents in that area etc.
Finneh is a right wing economics fanatic
Those are the same problems that face every growing company; with creative solutions being found regularly to meet the demands of its customers/users and increasing in size. If the population at large had the ability to go to (or transfer to) any Doctors or Hospital at a moments notice and without copious amounts of arduous paperwork then you'd soon see the hospitals with shorter waiting times, better doctors/nurses, cheaper parking and/or better infrastructure becoming more popular and the worst hospitals becoming less popular. You'd also see new hospitals being built where only poor hospitals currently existed to provide competition. If Government had a set fee that they paid each hospital/GP practice based on each individual appointment/procedure you'd soon see the best establishments making a healthy "profit" that they'd reinvest in expansion and the worst hospitals being unable to stay open. The best doctors, nurses etc would get large pay rises as their salaries wouldn't be set by central Government, but would be set by supply and demand and naturally there would be competition for their services.
Obviously this doesn't happen overnight but it would have a positive effect almost instantly because it would curtail the complacency in NHS management. The problem with the Health sector is there are few creative or dynamic solutions being put forward, because there is no incentive for this to happen. If I'm a hospital boss - why would I risk putting forward a potentially good idea when there would be absolutely no benefit to myself in implementing it. My salary wouldn't change so why would I risk something that might not work? Likewise why would I risk using another supplier who is 15% cheaper, when again it doesn't benefit me one iota and the new supplier has the potential to be less reliable? Same applies with undertaking any kind of extensive review that might mean working 70 hours a week for a few months?
These are all risks that successful companies take on an ongoing basis in the adapt or die private sector environment. No politician will ever put forward privatising the NHS to any great degree as it would be political suicide; but surely looking at replicating the key reasons for success in the private sector: incentives and competition; wouldn't be a political own goal.
At the moment every single governmental department merely says "need more cash". Education, Police, Health, Prisons, Defence, Housing, Pensions, Benefits... They all want more money and talk about the "crises" they will be under if they don't receive it. Naturally though this doesn't make sense. In terms of taxation to GDP ratio we're extracting more than ever before out of the economy, whilst also outspending revenue; yet still every department wants more and more money.
It won't happen though as politicians are as cowardly as these managers. Why risk millions of votes with an innovative idea when you can kick the political football down the road another few years by borrowing another £10b and sticking this plaster over the problem, whilst continuing to leave the elephant in the room to the next government.
Like I said
The problem is though that highlighting the 'incentive' for profit as something that's inherently good is a one-sided, biased view. And it also presumes all hospital's are working under the same set of conditions - a public hospital in a poor area with higher levels of obesity, alcoholism, smoking-related problems etc is going to inherently face more problems than one in an affluent area where people are living longer and live in better conditions. That strikes me as a basic fact - your system though would inherently favour the latter type of hospital because of course you're going to see better hospital results in an area where certain health problems aren't as prevalent.
There are a ton of private companies which are just as inefficient and as poorly-run as the NHS. Giving people incentives to earn money doesn't necessarily mean they're going to do a better job for the company; all it means is they'll try to use shortcuts to earn more money for themselves. The idea that the private sector operates on a basis of people getting more money than someone else because they're inherently better at their job is a bit of a fallacy; like everything in life plenty of well-connected people who suck up to the right bosses will get prioritised over people who are perhaps more deserving but don't play the system as well. And the private sector is (again) rife with bosses who're ultimately out to increase their own wage without any real concern for the service they're running. Which is a problem when it comes to healthcare.
Ultimately I feel you can't really try to introduce 'competition' into hospitals because if it's still going to be public that competition is ultimately all artificial - unless you support complete privatisation (which clearly isn't the way to go) then you're still going to be favouring that public sector industry and therefore it's not really competition. Your solution also ignores the inevitability of protests, discontent which would come with certain hospitals closing. Or with the idea that this would be done on a merit-based system - a powerful politician, say the PM, would likely have a lot more sway in keeping their hospital open than an unknown backbench MP would have in an area that no one's all too bothered about. Hospitals shouldn't be treated like a normal business because they aren't one; you're not selling stuff to someone but fundamentally aiming to keep them in good health and keeping them alive. You can't just shut down a hospital without unrest because while people can make a slightly irritating travel to their next nearest supermarket after their local one closes down, having to go to a hospital that's further away is a potentially life or death situation.
The reason we have to put more money into the NHS is because we have an ageing population who're living longer because of the success of the NHS. That's just a consequence of the system. If we're not willing to pay more for it then we don't get to have it. And, yes, there's plenty of bureaucracy and the like within the NHS which likely needs cut down (although I can't claim to be an expert on it) but it's still a fantastic system and one of the best healthcare systems in the world. It may be strained but the service it gives to patients is still fantastic and the vast majority of staff who work within it are highly-dedicated and skilled at what they do in spite of the fact they're overworked and underpaid, something which rightfully frustrates them when the government can easily find money for things it genuinely wants to spend on whenever they feel like it.
You can privatise up to a point, however there are local guarantees of provision which ought to be maintained and such ideals are not really compatible with the practice of competition. Maybe you could implement it for minor operations or surgery which sees you leave hospital on the same day...although we coudl work that into the current framework were there electoral support.
Those in upper management aside, the costs associated with procurement seemed to be a shared gripe for staff and critics alike.
Those in upper management aside, the costs associated with procurement seemed to be a shared gripe for staff and critics alike.
What sort of interaction have you ahd with private healthcare in the UK, if any? Was your only impression that they were all two-legged leeches in white coats? In many instances, they either have worked for the NHS in the past or are employed by both.
I'd aruge that the NHS already does this.
I'm not suggesting at all that the people working within the private sector are bad doctors or that they don't care about their parents - I'm sure the vast majority are incredibly hard-working and incredibly skilled and do a great job.
What I'm suggesting is that the idea that the private sector will necessitate doctors/nurses coming up with better ideas, doing better work etc isn't true...they may be incentivised to earn more, but the quickest path to earning more money isn't necessarily always going to be what's best for the patient at-hand. And that's not the case to say that it isn't at all, or that there aren't going to be any advantages of the private sector compared to the public sector, but I was taking reservation to the extreme view on offer of literally anything to do with the private sector involving people working harder to come up with better ideas etc when I don't agree it's necessarily the case.
Bit of unfortunate timing for @finneh really, with Carillion and that. I take Cheesy's point, if I've understood it correctly, that the vaunted incentive for private company owners is in reality purely to make money for themselves, which may be good for the user or taxpayer, but then again may not.
It's up to finneh to give examples of countries with something like his proposed system to see if it is more efficient really. I'd advise not the US, but feel free.
It's up to finneh to give examples of countries with something like his proposed system to see if it is more efficient really. I'd advise not the US, but feel free.
I think Singapore has been used (maybe on redcafe itself) but right off it strikes me as a bit ridiculous to compare a rich city-state with a full country.
Yeah, pretty much it. I'm not saying that the private sector is inherently evil or awful - just that this idea that it automatically incentivises people or encourages to 'work harder' and come up with better ideas tends to be a bit of a fallacy. Ultimately like with any industry - private or public - people will cut corners for their own self-gain, and will be promoted (thus earning more money) because they know the right people etc while people doing a better job are ignored. Again - all this will happen in the public sector to an extent and I know that, but the idea that the private sector is an automatic solution doesn't work for me.
Obviously private companies should aim to meet the needs of their patients because if they don't that's bad for business...but then not all big private companies are well-run. Across a number of sectors there's plenty of examples of companies who've been run shockingly in recent years, whether it be due to over-estimating profits, treating customers poorly, treating staff poorly, bad advertising/marketing or a whole range of other things. It's easy to say that people can then just stop using these services and go to better ones instead but so many of them are powerful to the point where they have a stranglehold on the market to the point where they're so dominant they can afford to run inefficiently and still do fine. And obviously, yeah, some will hit a breaking point where their service becomes redundant and they do die out, but it can take a long time.
Healthcare to me is fundamentally different insofar as while there are a lot of issues currently, we can still hold the government to account because it's a public service. If we don't like what's being done we can vote in someone else who'll do it better. We can't really do that with private industries. In most cases it's fine, of course, because I'll survive if I get crap customer service from a big retailer or whatever...but if my healthcare is privatised and not very good, whether that be down to cost or something else, then I'm potentially fecked if I don't have enough money to go elsewhere. And it's easy to say the market balances that out in the long-term, but that's not really good enough on a short-term basis.
Of course, I know the argument I originally responded to wasn't suggesting full-scale private healthcare, but if we've got public healthcare with a dose of privatisation then we're still going to have the same problems we do within the public sector due to the fact it's still going to be a public service. And the fact is that many people will justly be unwilling to accept elements of privatisation within the NHS because it'll inevitably be cited as a way to introduce more privatisation into it...which is fair enough when most of the people suggesting it are right-wingers who like more private industry and smaller government and thus probably don't mind the idea of privatised healthcare.
Yeah, it's an inherently different situation. Singapore's economy largely relies on things like immigration for key sectors to a level that's just not the case in Britain at all. And while there's plenty to like about Singapore it's still got plenty of income inequality.
And with the geographical constraints, what you'd probably end up with is something analogous to railway privatisation rather than...telecoms for example.
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It's not necessarily just the incentive for profit, it's an incentive full stop. The ability for a manager to grow his hospital if it performs well is an incentive. The ability for a manager to replicate his success in another location is another incentive. The reward of knowing replicating his success is helping more people is an incentive.
In terms of hospitals in poor area's having more users I agree; which is a problem with the current system. My proposal would be to pay hospitals based on the procedures and care they carry out (adjusted for local population density), so hospitals who have more procedures to carry out due to a poor standard of living would get greater funds than hospitals who were comfortable. Therefore my system would do the opposite of what you suggest: it would financially favour hospitals in poorer area's who carry out more care, over the affluent ones who carry out less. This alone would be a positive change.
Of course their are inefficient private companies. However in the medium and long term these companies will dissolve, as other companies provide better service for a cheaper price. That's the reason Netflix is doing very well and Blockbuster has dissolved. In terms of people essentially "blagging" their way into high up positions it does happen, particularly for reasons such as nepotism. However this is generally the exception to the rule, rather than the rule. My salary for example is based off my departments profitability; so I am always going to be aggressive in getting the best people for the job, for a selfish reason. If I promote based on any other factors my own salary is negatively affected. The second my salary has nothing to do with the success of my business is the second that I'll stop working 60 hour weeks in favour of a standard 8-5, I'll stop being aggressive in getting the best staff and I'll stop managing poor staff out of the business. It would be far too much grief for no incentive, which is where NHS bosses find themselves.
It is artificial competition, but the people in charge of individual hospitals couldn't see it that way. Their careers, salary, pensions etc would all depend on their success. In terms of hospitals closing down there would then be plenty of "customers" that other hospitals would then expand to cater for. In fact the successful hospitals would already have expanded and taken customers from the poor hospital, which would be the reason for it closing down. Like any private company - when a competitor is clearly struggling, it's the perfect time to invest in order to compete.
The aging population is of course a key point, but this is offset by the incredible savings brought about by technology and likewise future key savings it can bring about. The NHS though is so far behind the private sector in investing on technology... Because there is no incentive for them to do so. Why would an NHS boss risk investing in a £500k piece of technology which would save £200k in bureaucracy per year, but that of course would take 30 months to pay for itself? He wouldn't - it's far easier and less risky to spend that £200k on expensive agency staff for short term relief; then after the 30 month period complain about a £200k shortfall in his budget.
In terms of healthcare systems the NHS is nowhere near one of the best in the world. Look at the OECD outcomes for cancer, cardiovascular or just life expectancy; we're miles behind some other countries. The likes of Japan, South Korea, Singapore, Canada, Norway, Iceland, Sweden, Australia, Denmark, Switzerland are way ahead and in many instances we're closer to the likes of worst performers than the best. Naturally the fact that we have a greater than average OECD expenditure on healthcare per capita, compared with a much worse than average level of doctors, nurses and beds is a key problem; which highlights the inefficiencies - where's the money going if not on key things like doctors, nurses and beds?
Carillion are a fantastic example of my point - a terrible company that has now dissolved as a result of their inefficiencies and bad practices. Their work will be picked up by a much better and more efficient company who won't run themselves into the ground. The problem with UK Healthcare is that we have dozens and dozens of Carillion's spread across the UK; the problem is that instead of letting these hospitals and doctors practices rightfully close down, we continue to pump vast sums of money into them.
Can you imagine the uproar if the Government announced that it was pumping £5b extra into Carillion to keep it affloat? That's exactly what has been done with the NHS because they hasn't been able to hit their own targets and expectations. But instead of people revolting against this extra money and saying it's down to poor management so should have to find it's own solutions (as they would have done with Carillion), they're saying we should give them more.
Absolutely and I agree it would have to be looked at in terms of coming up with a "Barnett formula" for healthcare in comparison to the population density of the area. Naturally you couldn't give a hospital in the Scottish highlands the same per procedure as a hospital in Central London.
As a whole though the UK (particularly England) benefits hugely from it's population density. We regularly hear that France or Germany invest more per capita than the UK and this is used as a stick to beat the Government with. However what they don't say is that the UK and particularly England have a substantially greater population density and so should need to invest far less to achieve the same outcomes.
Surgeons - the programme on BBC - is incredible. Watching this failing NHS achieve miracles like the ones in that series is amazing.
Fund it properly already.
I’ll be working every day in my job from Boxing Day through to March again this year.
Fund it properly already.
I’ll be working every day in my job from Boxing Day through to March again this year.
Paying people based on the number of procedures they do incentives them to keep people sick, keeping them coming to hospital means you make more money
I was gonna go for a detailed reply but that sums it up better than I could've. Private companies ultimately aim for a profit and what makes them a profit isn't always what's best for the customer. Healthcare's something where the customer not getting care that's as good as it should be can have much more dire consequences.
Screwing over your customers is the absolute worst way to try and run a successful business and is absolutely the quickest way to lose customers, decrease your income and ultimately close down; not vice versa.
If in my business I sold faulty goods or provided a crap service or incomplete advice in order for my customer to keep coming back to purchase the product again and again... Guess what... They'd be going to a competitor for the product or service straight away. Have you seen the uproar with Apple phones due to them intentionally releasing updates that slow down older models in order for customers to have to buy new ones? They have had that much poor publicity that they're now having to apologise and replace batteries free of charge, knowing that otherwise people will start buying Android phones instead. Their attempt to gain extra profit has backfired and instead will cost them profit. The same is the case with VW and the emissions scandal.
The hospitals employing these practices would quickly get found out; whether it be by journalists, patients, staff, whistle-blowers or statistics showing that they carry out 250% more hysterectomies per patient than the average UK hospital which would trigger an investigation. This investigation would have serious criminal ramifications as it isn't merely someone selling you a dodgy phone, it would be someone intentionally harming (or not properly treating) you. Plus it would take an absolutely sociopathic cartel of doctors, nurses and managers (breaking their hypocratic oath) to carry out such a revolting practice, so to expect this to go ahead unnoticed is naive in the extreme. That's before even thinking about the fines that would be in place which would make even attempting this practice a complete false economy.
Either way it won't happen and we'll continue to go down the asinine route of mindlessly borrowing billions of pounds from foreign investors in order to pump more and more money into a non-viable system, simply because no political party or cross party group have the gonads to be honest with the public. Naturally though the public will end up being be the ones paying for this, either through increased VAT (which has already been increased to 20%), through increased NI Contributions causing further wage stagnation (being proposed at the moment), or merely through the back door taxation of quantitative easing.
The people in charge don't give a shit. These practices can carry on for years whilst they pocket dividends and wages, when shit hit fan clawing back the millions isn't likely.
Pretending that the market is such a wonderful and benign self regulator is a bit stupid in this week. Thousands of subcontracters to Corrilian are about to be screwed, you make it sound oh so painless. Imagine that's when you are dealing with someones actual body to whom harm as been done chasing an extra buck
Thankfully people have some sense and realise that fanatical right wingers are chatting shite so will riot if they ever try to pull their shite
The people in charge don't give a shit about keeping their jobs and making money in the medium to long term? I'm not sure what businesses you're talking about but the vast majority of business operate to make profits on a consistent and long term basis. The exception to that rule, such as Carillion, will soon collapse (just as terrible hospitals would) and this business goes to their well run competitors instead.
Without the incentive of money and the disincentive of being out of a job if things go badly there is literally no reason to be more efficient.
I'm not talking about self regulation - government have a vital role in being the referee throughout business, but it would particularly be the case with this model of public healthcare. Turnover to debt ratio's would have to be analysed regularly. Management salary in comparison to performance of hospitals likewise.
The signs of Carillion failing were apparent long, long ago. For example 7 years ago they approached my company about being added to their key supplier agreement with a view to placing six figure contracts with us on a semi-regular basis. Their first requirement was a 120 day credit facility whereby January deliveries were paid for on June 1st. Our comment to them was that they would be paying a lot more for the product as we wouldn't be their bank for free. Likewise they said that they wanted to procure a lot of their product from India as it was more cost effective and so would need us to add a "temporary" product to our pricelist as on most of their contracts they would need a large quantity of these whilst awaiting the cheaper product from India. We again made the point that the cost of the temporary product plus the cost of the Indian product (including fitting both) was more than the cost of the UK product that would be delivered on time. Their response was that we should price based on their requirements.
We declined in the end as if it looks like a duck (a badly run company), swims like a duck and quacks like a duck, then it's probably a duck - so for some of the subcontractors they've creamed off Carillion's poor practices for years and I'm sure like ourselves knew it was a bubble that would inevitably burst. Well run subcontractors would ensure minimum exposure to this kind of company - particularly after their numerous profit warnings over the last 18 months.
People will riot if government puts up taxes, borrow and print money in order to prop up a poorly run NHS? Considering this has been happening for years and people are actively happy about the situation I'd disagree. In fact I'd go further and say they are not only happy with the situation but are unhappy that we aren't borrowing more or putting up taxes in order to prop up the ever larger black hole that is the NHS.
People will keep arguing that more and more money needs to be spent on the NHS and politicians will keep cowardly avoiding the real issue and giving it to them at the expense of other departments (or by borrowing more money from the exchequer in the form of larger interest payments). People will realise there's no point having an NHS in the current form with other equally important area's being devastated at its expense.
I just hope people and politicians realise this before other departments are truly screwed over just to prop up a Carillion-like NHS.
When you have millions being paid into your account, the long term health of the company isn't that important as even if it collapses, you are immune to the consequences.
You want big bad government to monitor and regulate business? I thought the point was to set the hospitals free and allow innovative solutions to consumer demand?
Please stop writing essays in response to every post, your story was overlong and I think you wrote it in an attempt to look clever
Nope, people will riot if they try to pull your bullshit right wing ideas
It is also an open question whether the "healthcare market" will move fast enough (I guess this is an information problem and an elasticity problem) that bad service is indeed rewarded with closure.
Interestingly this is one of the areas where rail privatisation fell down. Privately-owned companies were supposed to bring in exactly those innovative solutions but were then so heavily regulated that they were highly limited as to what they could actually do. And regulated by a right-wing Tory government, I might add.
Government can be great when it's concentrating on being a good referee, rather than a terrible player. Hong Kong are the ultimate illustration of that (prior to Chinese re-influence), a government focused enough to regulate but smart enough not to be an active participant in the free markets.
Right wing? A liberal economic model is absolutely nothing to do with right wing politics.
The current government is worse than Tony Blair's labour party in terms of unnecessary interference and a failure to keep focused when it comes to regulatory good practices.
Don't confuse seeing the innovations and successes of the past 2-3 decades in terms of private enterprise and how it has benefit the country and people on the one hand; compared with the abject failures of successes governments of all colours on the other and making a simple and obvious correlation as "Right wing".
That's one of the reasons in my view the left aren't in power... A tendency to scream "right wing" at anything one doesn't agree with.
Hong Kong grew rich by being competently run in an area of the world with massive populations to supply. It's also a city state which is no way equivalent to the UK
You act like any private sector success is independent of the public sector. Public health, education and infrastructure are the back bones on which the private sector thrive.
Never forget the defence of property, intellectual property, and contracts.
Hong Kong's light-touch housing regulation has worked great!
Also, I don't get how a city-state run almost solely as a finance and logistics hub (since its own manufacturing industry vanished) can be a model for a bigger nation.
Also, I don't get how a city-state run almost solely as a finance and logistics hub (since its own manufacturing industry vanished) can be a model for a bigger nation.
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The state of the NHS actually made the dutch news as one of the top headlines with a top manager in London's University Hospital being interviewed, he was dutch.
He basically said 'The people dont want to pay for good health services'
And he's right.
He basically said 'The people dont want to pay for good health services'
And he's right.
Actually people will pay for good health, unfortunately we have the Tories in charge who are opposed to raising taxes
The Tories cut income tax, but raised various indirect ones, such as VAT.
I'd pay an extra penny on income tax if that additional money was ring-fenced for the NHS, but it won't be. Plus I'm thankfully at a stage where I can afford it- plenty can't after a decade of stagnant wage growth and spiralling house prices.
Tories love an indirect tax, insurance tax has really stung
Nobody voted for more tax and thats why you have the govt you have. Live with it or vote differently.