Can the Tories be trusted with OUR National Health Service

Anyone in South Yorkshire?

inews.co.uk/nhs/staffing-shortage-forcing-drop-number-nhs-stroke-services/

The true scale of the planned hospital and service cuts in England is becoming clearer. This was, in part, what David Cameron was referring to when he referred to £22billion of "efficiency savings" during the last election campaign.
www.bbc.co.uk/news/health-39031546

TV and newspaper reports this morning say that the Kings Fund is advising the Govt. that, on the whole (some caveats) they should approve and support the STPs, on the basis that they will improve care.

Here's a link to the Kings Fund's actual response:

www.kingsfund.org.uk/blog/2017/02/what-next-sustainability-and-transformation-plans

Yes. it agrees that the changes should go ahead,

BUT (and it's a big BUT)

"Funds to invest in strengthening and redesigning care in the community – one of the top priorities in STPs – are in short supply, raising serious questions about the credibility of those plans that seek to reduce hospital capacity. Similar questions arise about proposals to prioritise prevention when public health budgets are being cut."

"The first is the need to adopt a realistic timescale for implementation of the plans that recognises how long it takes for innovations in care to become established and deliver results. The second is to create sufficient capacity to build on the foundations that have been laid already, when so much attention is being given to financial and operational pressures."

"In the immediate future, these challenges have to be addressed by using existing resources more effectively and setting aside planned increases in funding to support new care models. In the longer term, the need to find extra resources for social care is becoming ever more urgent, while the claims of the NHS will also require a response given the infinitesimal growth in its budget planned for 2018/19 and 2019/20. It is no longer credible for the government to argue that it has provided ‘the funding needed to deliver the NHS’s own plan’ when most of the additional funding identified in the 2015 Spending Review is being used to keep services afloat rather than to transform care."

In other words, closing acute services as a cost-cutting measure won't deliver improvement on their own. They need to be in tandem with changes and extra resources for community care and public funding, both of which have been cut drastically in the last six years.

*Oops I meant 'public education' not 'public funding' in the last paragraph.

All makes great sense. The issue, as always, is finding the money.

The money is there. It's just a question of wanting to spend it on the NHS.
ONS statistics say there was a big budget surplus in January, biggest since 2000.
I know it still means they are borrowing too much, but again it means they can decide where to spend our money.
There is no need for a £22 billion cut in the NHS if the chancellor changes his mind about making this country a tax haven by cutting corporation tax to 17%.
Why do we need the lowest corporation tax in the top 20 economies, whilst the NHS and social care is in crisis?

This was a question asked in parliament yesterday.

www.theyworkforyou.com/wrans/?id=2017-02-08.63569.h&s=NHS+Sustainable+Development

A written response says there is a £1.8 billion fund for STPs.
Where did that come from?

NHS England is also saying that the money which was supposed to fund STP changes has already been spent on plugging NHS deficits :-(.

What I fear will happen is that acute services will be cut without being replaced with community services and public health. This is what happened when the big mental hospitals were shut down. It also happened a couple of years ago when many people with learning difficulties were transferred from NHS to council care.

It's quite difficult to monitor what's going on, because so many organisations are involved, including NHS (different trusts), council and private providers. The councils don't correspond to the STP 'footprints', so everybody passes the buck.

Anybody remember who said "With the Conservatives there will be no more of the tiresome, meddlesome, top-down restructures that have dominated the last decade of the NHS" in 2009?

My councillors said that they didn't know about them! They might have been right at the time because there was some dispute about which footprint North Durham was in.

They know now!

Divide and pass the buck is Hunt's new mantra.

Your councillors are wallies! Anyway, the submission has been made for Northumberland, Tyne and Wear and North Durham and it's too late to give feedback.

Low corporation tax can be good. We have good growth and very low unemployment - increasing CT could compromise both, which is just what we don't want with Brexit on the horizon. Hammond looks like he will undershoot the latest borrowing estimate by 10bn or so which might help. But what about all the extra money we're told need for housing, transport, prisons, education, energy, not to mention social care the cost of which is ramping up hugely?

Errmm! Was this the wrong thread Fitzy? What does this have to do with the NHS?

Yup you can't do something like relocate maternity services to another NHS site without incurring lots of costs. Some of these changes are no doubt backed by evidence (e.g. it's safer to do certain things in centres of excellence than mediocre local hospitals where the surgeons don't get enough practice). However most of us know how expensive it is to move house...

It has to do with where the money comes from to fund the NHS.
The government's idea is to cut corporation tax to 17%. At 20% it is already quite low. It does not need to go any lower when the government needs to fund social care to help the NHS get out of the mess it's in.
It's ideological.

Ah I see!

The government is not like a household economy. Undershooting a borrowing target when interest rates are so low could be seen as a missed opportunity. Austerity works for a household if it's spending more than it's earning, but it doesn't work like that at a national level, because saving in one area has a knock-on effect in others. An example of that is the NHS.

The government needs to increase taxation. Some spending would pay for itself in time, including building and infrastructure projects, which increase income tax by providing quality jobs. It would also drive the cost of renting down, so decrease the housing benefit bill.
nother way the government could increase its income is by abolishing higher rate tax relief on pension contributions, which would raise approximately £8 billion. This is one of the most common ways high earners avoid taxation.

We might be able to raise a bit more money via tax, but not much. As I've mentioned elsewhere, higher tax rates, whether income tax or whatever, just don't seem to make much difference to to the total tax take. Its always close to 35% of GDP, and we're close to that now. Also, increasing tax can act to lower GDP for various reasons. It's a dilemma. If it's at all ideological, it's based on a belief that lower taxes can be better for the country - including the poor - as a whole.

Does GDP matter if the profits from growth are not shared fairly? Seriously!

The UK has very low productivity compared with other advanced states. We also have low wage growth for the majority - averages are deceptive. Some people haven't seen any growth in wages since before the 2008 crash. Others have seen an actual reduction in wages.

Austerity has been a con anyway, because the wealthier haven't suffered. True austerity would spread the effects across the whole population, but that isn't what's happened. Low state investment is costing the country and not just financially.

I disagree with you that the country couldn't raise much in taxes. I've already given an example of how £8 billion a year could be raised and I could make more suggestions.

PS. It's ideological for wealthy people, because they don't want to give up their wealth, but it's getting to the stage where pragmatism is more important, unless people want to live in gated communities and close their eyes completely to the society in which they live.

GDP does matter because a bigger cake means more money to tax. If lower tax leads to more GDP, that lower tax rate might bring in more money than a higher cut ofasmaller cake. UK might have low productivity but we have high growth on a pretty respectable GDP. The £8bn theoretical tax take almost certainly wouldn't appear. Various govts. Have tried any number of ways of collecting more tax (e.g. Labour income tax rates of up to 102%!!) but the race take remains, always, at or around 35% of GDP. I think we are are a little under that at the moment but, as always, very close. We are actually spending more like 45% of GDP. Again, pretty much all we can afford. If we want to spend more we will have to earn more - so we get around 45% of a bigger number.

Sorry if this is behind a paywall (I have a subscription, so I'm not sure), but it's worth reading to understand why GDP isn't a good measure of an economy's health and doesn't mean what you say. www.economist.com/news/briefing/21697845-gross-domestic-product-gdp-increasingly-poor-measure-prosperity-it-not-even

If you can't read it, I'll copy and paste it, but it's quite long.

Sorry, but growth in itself is a smokescreen. The main reason we have growth is because we have an increasing population. No, we don't have to earn more. We have to collect more tax and use the wealth we have more efficiently.

Thanks daphne but I won't be able to look at this until tomorrow at the earliest. Sounds interesting though.

Just some examples of state spending as a percentage of GDP:

Norway 48.5%
Germany 42%
Latvia 37.5%
Brazil 26%

China, India, Russia, Brazil and Indonesia all have a higher GDP than the UK.

Where would you rather live?

Daphne, I've read the article now. I can see that there is a lot of uncertainty in measuring GDP, but I don't think the article seriously challenges the basic proposition that the percentage of the officially declared UK GDP collected as tax historically remains around 35%, despite any number of different taxes and rates of tax. It makes no sense to simply say we can collect significantly more - that may be possible, but the evidence suggests otherwise (though as I've mentioned before I do think it would be worth trying out a bespoke NHS levy, which people might buy into more readily than the usual "soak the rich" proposal). I do agree that the level of GDP is not the end of the matter. But in terms of spending, of the countries you mention only Norway spends more than the UK as a percentage of its GDP. The govt. is trying to reduce the debt, but we are still taxing and spending a lot of money. In any event, I agree more money will need to be found for the NHS, but exactly how much will depend on how the current plans work out, and I was pelased to see that the King's Fund have given them tentative approval.