Magic Bullet

As well as greedy corporations and businesses not paying their share to the taxman,there are many rich British people (including celebrities) with several homes in a number of countries, whose accountants help them to avoid paying tax in Britain. One dodge is to spend only a limited amount of time over here - while still qualifying for residential advantages - including the NHS emergency and other services.

We had a neighbour at one time who was a consultant obstetrician. He earned a lot and had inherited a lot.Anything he didn't immediately need for his fast cars (he told us) was invested in offshore companies to avoid paying tax....Time to close these loopholes! And ringfence the money saved (crucial).

But let me tell you a funny story. My son is a paramedic.A key issue for him and his colleagues is that people call for an ambulance when it is not an emergency.Of course this wastes money and prevents really ill people from being treated quickly.

A few years ago, he and his colleagues were getting thoroughly cheesed off with late Saturday night 999 calls from one drunk in particular who regularly claimed to be dying of alcohol poisoning and to be having difficulty breathing. They soon realised that the drunk was using the service as a taxi because he lived next door to the hospital! One Saturday night they picked him up - but went out of their way to drop him off at another A&E fifteen miles away. He was furious that it was not his local hospital and that he had to make his own way home.Yes, the team had spent an extra half an hour taking him there. But he never did it again......

People from all walks of life call ambulances for many reasons which are not emergencies - and often when it would be quite possible to get to A&E under their own steam or with the help of a friend or relative with a car...that would save the NHS a few pounds.

Just been chatting with someone who is a secretary in a local general hospital. She herself is 'bank' staff but has been working at the hospital full-time for 3 years. She said the hospital is regularly employing extra managers whereas they expect the bank staff to take on any extra work. I know the medical staff do an amazing job but I do wonder how much money is being wasted on admin and 'management'.

As suggested by some that overweight people should not be treated as this is usually, although not always, their fault. How about those who have problems through drinking, drug taking. Also if you indulge in a sport and have an accident, you drive a car etc which is entirely your choice. The list is endless. Where does it stop?

A few years back Sir Gerry Robinson made some tv programmes entitled " Can Gerry Robinson fix....." One of the problems Sir Gerry looked at was the NHS. He came up with reasoned, sensible solutions using his expert, experienced business eye.

These programmes are now used by the Open University but, as far as I know, none of his sensible suggestions were put into practise.

Just a note re the Baby Boomers. I am a Baby Boomer and wonder why the powers that be didn't plan ahead properly for us. They knew that post-war there would likely be a rise in the birth rate, but precious little seems to have been done to prepare for it.

Doing the best I can to stay healthy here !

Foreign Aid accounts for 0.7% of our taxation, while undoubtedly, some of this is misspent, even if you abolished Foreign Aid completely the amount of money released would be insignificant compared with the NHS need and next time there is a catastrophic earthquake in a country like Nepal or Haiti, we would do nothing to help, neither send specialist rescue groups nor provide basic tents, temporary housing or food for those suffering and dying. We would just not get involved. Would you be happy with this. I wouldn't

The main problem lies in this countries resolution under parties of all persuasion to make us a low taxation economy that is attractive to international companies, banks etc etc. The idea is that this benefits us all, but I can see scant evidence of that. All it has done is make the rich richer.

If we were to have tax regimes like those in France and Germany, not only would our total tax take be much higher, but if we spent 10% of our tax take on health, the amount of extra investment in the NHS would be far greater than just stopping Foreign Aid.

We are the fifth largest economy in the world. It's a disgrace that we cannot look after our elderly and ill. We are going to build a new railway line that gets us to Birmingham 10 minutes quicker though! So what if the NHS is overfunded ??...who wouldn't want to be properly looked after in a comfortable place with well payed caring people to look after us when we are desperately ill... priorities priorities!!!... my friend of 98 who was a teacher in the east end during the war and looked after children fleeing from the Nazis, was sent home with a terribly broken arm to spend the night alone because caters worked days only. She fell, she was readmitted , she was sent home again... she died not long after. I despair... money fixes most things in life.. our health comes first.

Many of the current problems of the NHS arise from poor and short-sighted thinking. The closure of so many local and district hospitals and the concentration of A&E and all other facilities in large high care hospitals is not just the problem of bed blocking but also patients with simple problems requiring hospital care occupying high tech high cost beds, when they could just as well have been treated in less well equipped cheaper local hospitals.

Of course we need the centres of excellence, but not every patient needs to be there. One way to save money would be to expand community hospitals or develop halfway hospitals close to Regional hospitals which patients could be moved to as soon as they ceased to need high tech care or daily supervision by a specialist. Something like convalescent homes.

It seems to me that currently the NHS is run for the convenience of the administrators and civil servants rather than the patients and staff

DD has a friend who is an anaesthetist. Some years ago he was complaining that most hospitals had more managers than beds and I doubt if anything has changed since.

Not everyone needs to go to a large A&E miles from home with a cut finger requiring a couple of stitches, an eye which needs irrigation or even an X-ray to ascertain if the injury is a sprain or a break.

Unfortunately, many Minor Injury Units have closed and patients now have to travel miles to 'centres of excellence' where they have to wait hours because they are not a high priority.

There have been two major studies of NHS management over the last five years: one by the King's Fund and the other by the Nuffield Trust. Both concluded that the NHS is, if anything, under-managed in terms of numbers doing management roles. The number of managers compares unfavourably with big private companies.

However, one of the conclusions is that management spend too much time doing administrative jobs, which could be done by lower paid and less skilled staff.

One of the reasons for this is that managers have too many centrally imposed targets and are not allowed to use their management skills to run hospitals, etc effectively.

The big con of the Health and Social Care Act was that it was supposed to put the NHS in local hands, but it did nothing of the sort. More than ever targets are set by central government and local providers have to go through the hoops, tick the right boxes and save money at the same time. Managers have no control over the targets - they just have to try and make them work. (Schools are in a similar situation.)

A truly patient led, local service would look at all the issues in a given area and, as others have mentioned, almost certainly decide that local 'cottage hospitals' are needed.

When I was in an emergency situation NHS 111 advised me to get myself to the nearest A&E and I had a choice of two not too far away. An eye specialist was called from his bed in the night and he saved the sight in my left eye. Amazing service from the moment I stepped through the door.

All staff were extremely professional and caring whilst they dealt with the very sick, a young man who had been in a fight and was still in drunken fighting mood; a young man who was hiding a can of beer behind his seat and was complaining loudly about having to wait to get a gashed hand stitched; a young man behind a screen where the nurses were shouting to keep him concious and trying to ascertain whether he'd had alcohol, drugs or both. Apparently this is a common occurrence most Friday and Saturday nights. I formed the opinion then that some patients should be paying for treatment for injury caused by drunken/ reckless behaviour. It must cost a fortune in every town and city.

The medics in A&E Depts are amazing people and we (and Mr Hunt), can be very, very grateful that they continue to do their job, sometimes in the most dire circumstances and poorly paid, as without them we really would be f.....

We must campaign for the NHS to be maintained and in some areas, restored.

I agree with everything you say vq. The Tories say they are the party who will reduce the national debt but in spite of all their austerity measures they've increased the debt. Of course this hasn't had an impact on the government. I understand the vast majority of the cabinet are millionaires, can't see many of them down at the local hospital. They want to run the NHS down to such an extent that they think people would have no option but pay for treatment if they can. It's OK paying but if something goes wrong the NHS have to pick up the pieces. I worked in the NHS before retirement and I've seen it first hand. Many hospitals have been forced to close down wards contributing to a lack of beds.
Plus government said OK we'll put social care under local government control, starve them of funds then say "it's nothing to do with us, not our responsibility." Stop closing down local authority care homes. Private homes do it for profit. Medical tourists are another smoke screen the Tories and right wing media like to blame. This amount is insignificant in the scheme of things. My daughter is a doctor and if someone comes to her from abroad they pay up front. I go to Spain a lot and have had no problem getting excellent medical care. Just produce my EHIC. Stop selling our NHS to people like Richard Branson. Make big companies like Google pay the right amount of tax. My son in law has his own small business.HMRC are ruthless in collecting his taxes.

Cottage hospitals are very useful. But that doesn't mean they are cost effective in comparison with alternatives that may be inconvenient, but which perhaps redirects some money towards more critical cases. I don't have any stats on the subject, but spending money on small hospitals to treat minor injuries doesn't feel to me the right way to go. There may be other ways to do something similar but at less expense, perhaps through expanding the remit of some, larger, GP practices.
Ginny - I like your idea of charging the drunken wasters!

One thing re tax I've often thought of is, how many landlords don't declare rental income? Especially the slumlord type - most likely to demand cash in hand, and there are plenty of slumlords about.

There is no national register of landlords, and on a self assessment tax return you are only asked how many properties you have, and what the rent is, they don't ask for addresses.
I wouldn't mind betting there are masses - and not just slumlords - who don't declare it at all, or who declare only part of it. If you don't declare it, who is to know? -that is unless your tenants suspect and shop you to the taxman.

This must be an obvious thing to crack down on. I do realise that it would mean more admin, but IMO given such a large private rental market in the U.K., it's high time it was better regulated.

We have been paying to have our green waste collected for years, it is £60 !
We compost as much as possible but only have a small garden so the rest has to be collected, don't begrudge it as otherwise what would we do with it?

The 'huge increase in the elderly' has obviously been entirely foreseeable for decades and should have been better planned for. The Conservative government, deep down, cares not a jot for the welfare state which they have always opposed. Their joint paymasters, the banks, were allowed to bankrupt the country at no great loss to themselves. We live in a nation where the rich pay little or no tax, where average earnings are not only pityfull but result in little tax revenue for the state. Rather than increase the tax revenue by actually taxing the better-off and closing all the (largely government-designed) tax loopholes, as well as forcing banks to repay the money they were lent, the Tories prefer to wind down all aspects of the welfare state regardless of the pain it causes. As for the NHS, they could save millions by refusing to treat the A&E patients whose conditions are entirely voluntary: the drunks and the drug addicts.

SheilaClare
As for the NHS, they could save millions by refusing to treat the A&E patients whose conditions are entirely voluntary: the drunks and drug addicts

I wonder what allows some people to become drunks and drug addicts and others not. The same as those who chug their way through mounds of unhealthy food without getting fat whilst others become obese. These conditions are far too complex to generalise.
Additionally, in most cases pregnancy is a life choice, should we charge for obstetric care?
The point of the NHS at the outset was that it was available for all who needed it, free at the point of service and paid for through taxation.
I think society should take some responsibility for the overuse of the service by creating an entitlement mindset and this may take some effort to reverse this if it can be, but I dont think targeting specific groups is the answer when there their condition cannot truly be attributable to choice. I would imagine nearly 100% would not wish to be as they are. Those blessed with strong wills and good metabolism may find this difficult to comprehend.

Good post Joel

Good post supersonic . I agree with you re; the new high speed rail link, that typically will only benefit the South of the Country anyway. Why not spend that money on "saving" the NHS, then the UK will benefit as a whole.

I also agree with most of your post SheilaClare Especially We live in a nation where the rich pay little or no tax, where average earnings are not only pityfull but result in little tax revenue for the state. Rather than increase the tax revenue by actually taxing the better-off and closing all the (largely government-designed) tax loopholes

I don't however agree with your last paragraph As for the NHS, they could save millions by refusing to treat the A&E patients whose conditions are entirely voluntary: the drunks and the drug addicts

IMHO people who drink too much and/or take drugs are often victims themselves. Victims of poverty, abuse, or just life itself. I try not to judge how people got themselves into these sad circumstances and again IMHO, I feel we should concentrate on understanding how we can prevent such things from happening not refusing treatment.

And what would happen to those who were deemed to have 'brought it on themselves'? Would they be turned away from A&E and dumped on the street - some possibly dying?

That cannot be the way forward.

I do agree that everyone has a responsibility to care for themselves and to try and have a healthy lifestyle, but am I the only one who is beginning to dislike the way the overweight are being vilified?

Yes, bad diets and lack of exercise isn't good but please remember many overweight people are stuck in a cycle of illness, medication and enforced sedentary lifestyle.

As a woman who was active all her life I was felled in my early fifties by ill health. Resulting operations and an incredible amount of prescription meds, including painkillers saw me gain weight very quickly. A fat person in pain can't do an awful lot to help themselves, except make good dietary choices.

One thing that rankled too was the way this professional business woman was treated by doctors and the general public when she became fat and slow. I was tempted to hang a placard around my neck stating " five years ago I was playing tennis and abseiling."

Trying to justify becoming overweight and out of shape still seems like an excuse. It is interesting to note how some GNetters view the overweight.

I am lucky in that I have become slightly more mobile, due to my own efforts. I still have to take fifteen tablets every single day, and the side effects of many are lethargy and weight gain. Getting my fitness back is a real struggle, but I value my mobility and want my life to be active. There are no NHS rehab programs for the likes of me alas.

I see the stares and hate what I see in the mirror. Gaining weight can lead to misery and self- loathing, both feelings which can trap the overweight in a miserable cycle of despair.

Not all weighty people are lazy, gluttonous couch potatoes.

I have to add, and I dare say I'll be criticized for mentioning a truth, but I'll go ahead anyway.

Anyone had to visit their local hospital outpatient's department recently? I have to go for check-ups quite frequently and there is no denying that the hall in which patients sit as they wait to be called is absolutely packed to the rafters of late.

It was never like this a few years ago. That's an honest observation. We are trying to fit a quart into a pint pot. Are new hospitals being built? No.

I'll also be slammed for observing a huge cultural shift as well. It has to be said that the hall was full of people of Asian and Eastern European backgrounds. I watched advocates helping them and translators at work.

If this is the face of modern Britain so be it, but those who say the service isn't suffering from a greater number of people using it need to check out their local outpatients departments.

Sick people, wherever they come from need care. It would seem blindingly obvious to me that the NHS is struggling to cater for the numbers using it, and anyone who waves aside that notion has to be blinkered.

Observations:

The NHS needs to manage its money more effectively. There is too much waste ie pills having to be thrown away once they have been dispensed to someone. Imo they should be re-cycled as sometimes packets have not even been opened.

Health tourism should be banned. If tourists need medical help it should be provided upon receipt of health insurance. This is what we have to do when we go abroad after all. This is costing the NHS £Millions!

Consultants should not be allowed to work both in the NHS and in Private hospitals.

Nurses should not be allowed to take leave from the NHS so that they can work as an agency nurse. Also nurses should be trained on the job and not in Universities.

The ambulance system is crazy. Ambulances are sent out of their own county to another county because of finding a specialist hospital to treat the patient in. This means they leave the county short of ambulances. They sometimes are away for hours on end and petrol is not cheap.

Jnr doctors are made to work too many hours. How can anyone make life and death decisions when they are half asleep?

There is too much wastage in hospital catering. Food is left out of reach of some patients and it is then thrown away. Too many hospitals are providing food that is expensive to produce. Basic menus should be introduced. It is not necessary to have so much choice as long as the food is nourishing. What is left at the end of the day is thrown away.

Too many people do not turn up for appointments. This costs the NHS money which could be spent elsewhere.

Too many old people are left in hospital when they do not need to be. This causes bed blockage (no fault of their own) so more should be done to provide care in the community.

The Government should stop giving with one hand and secretly taking away with the other.

Just a few examples of where money could be saved imo.

I firmly believe that this Government is deliberately running down the NHS so that they can introduce an American Health System. Some old people living in UK are being let down. They have paid in to the NHS all their lives via National Insurance contributions and now that they need help they are being denied the care they have paid for.

Totally WRONG imo.

But surely Day 6 what you are saying about the people in outpatients is irrelevant. People have moved to the UK from other countries because we do not have enough people in this country to do all the work available. When here nearly all of them work, many in professional high paid jobs, like those you no doubt saw working as doctors and nurses when you were in outpatients.

All these extra workers are earning money and doing jobs that contribute to the growth of the economy and paying tax and national insurance, which helps to swell the tax revenue the government has at its disposal to spend on health care. That the government chooses not to spend any of this extra income on health care is entirely the government's responsibility.

Similarly these new workers have not arrived all of a sudden in the last year they have been coming in, mostly legally, over several decades. The government have been doing planning on the provision of health services based on current and future population estimates. They have chosen to continue to close hospitals and not build new ones, knowing what the population count is. Do not blame the patients, regardless of nationality, for the Government#s failure in planning