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Old 24th May 2020, 11:00   #31
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Originally Posted by Avulon View Post
If you are trying to suggest that NHS treatment FOC at point of delivery, the whole premis of the NHS isn't possible, then I'd suggest you take another look at public finance. The truth is that successive governments would rather spend tax-payers money on the 'defence' budget and run down the NHS. And that this, up until now has been supported by the active electorate and accepted by the inactive electorate. It takes an active electorate with a will to make things happen any differently. The truth is, it is possible. Just that there's a lack of will to support it. Perhaps in future things might change...
The point of the discussion is that our UK health service is not free, all citizens have to contribute to the NHS pot (sort of "from cradle to grave" - but paid into over +5 decades of their working/earning/contributing lives). Some choose not to use the service (prefer private, separately funded healthcare) but regardless they still significantly/fairly contribute to the NHS (thus viewed as a 'closed' circulating system of health needs and care for all).
Anyone (without distinction other than being an adult of working age) not fitting the closed system profile should anticipate/expect some sort of 'catch-up' payment/surchage (whether it's a 100% or a proportional contribution can be debated but the principal remains) should they subsequently have need to access benefit of the NHS (or alternatively provide private insurance cover for any personal health eventuality meantime).
You are quite correct to point out the wider choice governments must make where national healthcare is concerned but that is a very different more long term question of policy and political will - for all the best reasons the UK made it's decision in 1946 and adjustments (rightly or wrongly) have been made in the interim. Crass decisions in the meantime don't make things better and that's one such situation that we are discussing here.
Maybe it's a subject not specifically appropriate to this Forum but it's an interesting, eye opening response...
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Old 24th May 2020, 16:34   #32
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Originally Posted by rab60bit View Post
The point of the discussion is that our UK health service is not free, all citizens have to contribute to the NHS pot (sort of "from cradle to grave" - but paid into over +5 decades of their working/earning/contributing lives). Some choose not to use the service (prefer private, separately funded healthcare) but regardless they still significantly/fairly contribute to the NHS (thus viewed as a 'closed' circulating system of health needs and care for all).
Anyone (without distinction other than being an adult of working age) not fitting the closed system profile should anticipate/expect some sort of 'catch-up' payment/surchage (whether it's a 100% or a proportional contribution can be debated but the principal remains) should they subsequently have need to access benefit of the NHS (or alternatively provide private insurance cover for any personal health eventuality meantime).
You are quite correct to point out the wider choice governments must make where national healthcare is concerned but that is a very different more long term question of policy and political will - for all the best reasons the UK made it's decision in 1946 and adjustments (rightly or wrongly) have been made in the interim. Crass decisions in the meantime don't make things better and that's one such situation that we are discussing here.
Maybe it's a subject not specifically appropriate to this Forum but it's an interesting, eye opening response...



No-one is claiming the NHS is 'Free' but 'Free of charge at point of delivery'. UK taxpayers pay for the NHS, notice I said 'taxpayers'. There are many UK citizens who are not tax payers that benefit from the NHS - should all these also be being charged in your view? How many generations of UK citizens should I count as my ancestors before I qualify in your view?



What decision(s) are you labelling as 'Crass' (stupid and insensitive)?
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Old 24th May 2020, 18:31   #33
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No-one is claiming the NHS is 'Free' but 'Free of charge at point of delivery'. UK taxpayers pay for the NHS, notice I said 'taxpayers'. There are many UK citizens who are not tax payers that benefit from the NHS - should all these also be being charged in your view? How many generations of UK citizens should I count as my ancestors before I qualify in your view?


What decision(s) are you labelling as 'Crass' (stupid and insensitive)?
Semantics - the arguments recognise citizen funding and no, you don't open your wallet each time you leave the doctors surgery or hospital.
The NHS is treated/considered and abused by many as a 'free service' ie not valued - as one example just look at the number of missed GP appointments alone (and the attributed costs that some bean counter has used to illustrate the financial waste to the system) proof of attitudinal disregard of the 'no cost (to me)' service; administrational cost would not support the idea but if there were to be a refundable £15/appointment fee we'd soon see a huge increase in appoinment take-up (conversely, probably a significant drop in appointment numbers requested .....win win NHS, less pressure on the system, more time for treating genuine ailments).
As already mentioned, +5 decades funded by every citizen (taxpaying citizens if you insist), each to their means. True not all contribute and that fact was part of the equation for the original funding formula but the model was supposed to follow a right cone (wide funding base, relatively smaller usage frustrum) and not the trend to an inverse shape that has been allowed to develop through crass decisions and muddled thinking by successive administrations/dogmas.
Within the model, contributions by preceding generations essentially fund the future infrastructure/user. Once the model is unduly influenced from outside the system it starts to break down (inverted cone sydrome..).
Final word from me 'cos we can't solve anything; new joiners of the NHS club from 'outside' should contribute via a surcharge - it's a contribution and not full compensation for what they haven't paid (by comparison with a contemporary as I attempted to illustrate in an earlier post) - it's not perfect but it is logical and fair.
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Old 24th May 2020, 22:17   #34
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It is not often I am in both camps, but this is where I find myself.

I think it prudent to fill vacancies in the NHS in the most prudent fashion in the short term, and that includes the employment of foreign medical staff where necessary.

In the long term, there should be value placed upon vocational training to encourage the next generation of home grown medical professionals, to reduce reliance on imported labour, note the use of reduction, not eradication, as I strongly believe there to be many merits in diversity in all walks of life, and the enrichment it brings.

However back to the thread title, NHS surcharge, any foreign national irrespective of their employer or employment status, or indeed any ex pat UK national should be required to pay this nominal charge, and it should be looked upon as an insurance payment, in the same manner as a National Insurance contribution is levied upon other UK taxpayers.

I have been in receipt of superlative care from the NHS in the past, and I am in awe of what is achieved by the tireless work of the staff employed in this fantastic organisation, but to say that certain sections of the population who are aliens as far as nationality is concerned should be exempted from paying simply because of who their employer happens to be, is patently wrong, and unfair to other individuals who have chosen to live and work in the UK, who are not exempted.

The NHS as an organisation has evolved from the vision of Aneurin Bevan, of a reactive service to treat ill people, into one where proactive care is more prevalent and people's expectations of treatment they might receive is much higher.

This of course puts an ever growing financial strain on what is effectively a publicly funded enterprise.

So in my view this is not an unfair charge, unless it is levied differently upon some immigrant workers based solely upon their employer, and as such should not be abolished.

Brian
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Old 24th May 2020, 22:36   #35
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I totally agree with the Brian. The problem is that some professionals are being turned away due to the extremely high costs of bringing their skills to the UK. As a result they are going to Canada, Auz, NZ and even S.America. Even getting paid to do so in some cases. many companies are now paying large parts of the immigration fees to lure these skills to the UK.

I suppose one solution that would level the playing field is to pay the people in the medical skills shortage rolls, extra and then everyone pays the surcharge.
Remembering of course that all this is to accommodate EU workers from next year, as commonwealth workers on visa's are already paying this and and accepting that it is value for money.

As a bit of an aside, I think one has to have lived in a non-EU country to completely appreciate the value and service that the NHS offers, as much as people in the UK complain about it. Many are used to paying as much for medical aids/insurance as they do for their monthly housing costs, this on top of high taxes.









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Originally Posted by marinabrian View Post
It is not often I am in both camps, but this is where I find myself.

I think it prudent to fill vacancies in the NHS in the most prudent fashion in the short term, and that includes the employment of foreign medical staff where necessary.

In the long term, there should be value placed upon vocational training to encourage the next generation of home grown medical professionals, to reduce reliance on imported labour, note the use of reduction, not eradication, as I strongly believe there to be many merits in diversity in all walks of life, and the enrichment it brings.

However back to the thread title, NHS surcharge, any foreign national irrespective of their employer or employment status, or indeed any ex pat UK national should be required to pay this nominal charge, and it should be looked upon as an insurance payment, in the same manner as a National Insurance contribution is levied upon other UK taxpayers.

I have been in receipt of superlative care from the NHS in the past, and I am in awe of what is achieved by the tireless work of the staff employed in this fantastic organisation, but to say that certain sections of the population who are aliens as far as nationality is concerned should be exempted from paying simply because of who their employer happens to be, is patently wrong, and unfair to other individuals who have chosen to live and work in the UK, who are not exempted.

The NHS as an organisation has evolved from the vision of Aneurin Bevan, of a reactive service to treat ill people, into one where proactive care is more prevalent and people's expectations of treatment they might receive is much higher.

This of course puts an ever growing financial strain on what is effectively a publicly funded enterprise.

So in my view this is not an unfair charge, unless it is levied differently upon some immigrant workers based solely upon their employer, and as such should not be abolished.

Brian
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Old 24th May 2020, 23:58   #36
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Originally Posted by rab60bit View Post
Semantics - the arguments recognise citizen funding and no, you don't open your wallet each time you leave the doctors surgery or hospital.
The NHS is treated/considered and abused by many as a 'free service' ie not valued - as one example just look at the number of missed GP appointments alone (and the attributed costs that some bean counter has used to illustrate the financial waste to the system) proof of attitudinal disregard of the 'no cost (to me)' service; administrational cost would not support the idea but if there were to be a refundable £15/appointment fee we'd soon see a huge increase in appoinment take-up (conversely, probably a significant drop in appointment numbers requested .....win win NHS, less pressure on the system, more time for treating genuine ailments).
As already mentioned, +5 decades funded by every citizen (taxpaying citizens if you insist), each to their means. True not all contribute and that fact was part of the equation for the original funding formula but the model was supposed to follow a right cone (wide funding base, relatively smaller usage frustrum) and not the trend to an inverse shape that has been allowed to develop through crass decisions and muddled thinking by successive administrations/dogmas.
Within the model, contributions by preceding generations essentially fund the future infrastructure/user. Once the model is unduly influenced from outside the system it starts to break down (inverted cone sydrome..).
Final word from me 'cos we can't solve anything; new joiners of the NHS club from 'outside' should contribute via a surcharge - it's a contribution and not full compensation for what they haven't paid (by comparison with a contemporary as I attempted to illustrate in an earlier post) - it's not perfect but it is logical and fair.

So by your reckoning then everyone that comes of age should be made to pay the surcharge then? There's absolutely no difference. Turn 18 just starting work: new joiner, pay the surcharge for 5 or 10 years. Come to the country to work and pay taxes - just like our fictional 18year old: new joiner, pay a surcharge. Only difference being those people coming to work in the NHS already trained - will earn more than the 18yo and pay more taxes from the off. Not only have they come to work in Britain, but in the NHS itself. Ironic isn't it that they could be asked to pay an extra tax for the privilege Health cover while at the same time saving the NHS a shed load of training costs... But there you go suggesting just that. Next you'll be trying to suggest that the NHS should make a profit. Keep your cones and your frustrums - They're pyramids anyway - the whole social contract is a pyramid scheme - and would continue to function if money wasn't being constantly syphoned off.
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Old 25th May 2020, 13:17   #37
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So by your reckoning then everyone that comes of age should be made to pay the surcharge then? There's absolutely no difference. Turn 18 just starting work: new joiner, pay the surcharge for 5 or 10 years. Come to the country to work and pay taxes - just like our fictional 18year old: new joiner, pay a surcharge. Only difference being those people coming to work in the NHS already trained - will earn more than the 18yo and pay more taxes from the off. Not only have they come to work in Britain, but in the NHS itself. Ironic isn't it that they could be asked to pay an extra tax for the privilege Health cover while at the same time saving the NHS a shed load of training costs... But there you go suggesting just that. Next you'll be trying to suggest that the NHS should make a profit. Keep your cones and your frustrums - They're pyramids anyway - the whole social contract is a pyramid scheme - and would continue to function if money wasn't being constantly syphoned off.
I didn't suggest anything of the sort. In simple terms, we leave school/college/university (these days = 18-23 YOA..) get jobs, start earning, pay income tax and NI (ie start supporting the system) and yup, not everyone follows this route but the significant majority do.
I suppose the lower/est paid (lets say untrained/unskilled and probably unqualified) foreign health worker could arrive at 18 yoa and start off on a contribution par with our home grown 18 yoa youth - except our youth has a line of forebears that have already contributed/paid into the pot, supported the infrastructure etc. - and that's a tangible difference in the theory.
The same logic applies should we compare more skilled/qualified better remunerated young adults from within and outwith the system (there is little difference in the age at which they reach this status), and, if any of these hypothetical examples has need of the NHS they all are treated the same.
Surcharging (or compulsory personal health insurance) for a foreign worker arriving here specifically to work in the NHS is emotive but as I stated previously, like any other job, our foreign worker arrives having accepted the T&C's of their offer; evidently many found the offer attractive - even more attractive now it appears they may avoid the surchage altogether (crass decisions....)
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Old 25th May 2020, 14:05   #38
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Perhaps they could be a little more efficient in how they spend our money.

No surcharge required then.

Last edited by Borg Warner; 25th May 2020 at 14:11..
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Old 25th May 2020, 21:21   #39
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Perhaps they could be a little more efficient in how they spend our money.

No surcharge required then.
Brave comment.
The waste in the NHS is colossal and there is much scope to improve. Whistleblowers get suppressed, and there are no serious active incentives to reduce waste. The NHS pays out billions in damages due to botched operations and substandard care. Plenty of scope for improvement but in practice this is difficult to achieve.
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Old 26th May 2020, 08:49   #40
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Brave comment.
The waste in the NHS is colossal and there is much scope to improve. Whistleblowers get suppressed, and there are no serious active incentives to reduce waste. The NHS pays out billions in damages due to botched operations and substandard care. Plenty of scope for improvement but in practice this is difficult to achieve.
Sadly, as a nation and society, we can't have a rational discussion about the future of the NHS without someone screaming privatisation. Until we can it's not going to improve anytime soon.

Similar is occurring on the continent I see.
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