Why are we paying £12 BN extra NI a year?

I don't blame nurses, doctors and dentists leaving in droves. Who'd want a highly stressful job - and one you can't even do properly or take a pride in?

We were already in dire straights before the pandemic, with an NHS starved of funds, equipment and staff since 2010. Any 'extra funding' (including the supposedly 'new' hospitals) can't begin to make up for that.

We are not taxed for our health care. We pay for it ourselves. With the exception, of course, of Medicare. We have fine care where I am and if you have the proper insurance you are not seriously out of pocket in America. Nothing is free. You pay for it through your taxes or directly. Our healthcare system is not that easily quantified or explained and it's quite unfair to project it as a worse yet situation. I have read many, many complaints about the NHS om Grandsnet. I have had socialized medicine care in Canada. It was a long time ago. I believe it was free. I had a doctor tell me I wasn't pregnant while I insisted I was. I have a daughter to prove that I was right and he was wrong. I live in America so I think I can say fair what's going on.

Because the very rich pay nothing. Here are a few examples:
www.theguardian.com/uk/2012/dec/14/prince-charles-estate-tax-avoidance

Well, I'm very happy to report that my NHS doctor agreed I was pregnant twice. "Socialized" medical care in the UK isn't all bad.

People are very definitely being pushed into private health care at least for their first consultation. Living in London I was offered an appointment in a major London hospital 44 weeks away, and another in another London hospital 22 weeks away. This is standard for an initial diagnosis and treatment is much further down the line. There are lots of people who will pay the £200 or so to see a private consultant immediately who will then add patients onto their NHS lists so essentially they buy six months or much longer of the waiting time. That's happened for ever as far as I can remember but it's now happening much more often - don't know the statistics but many hospital consultants are now booked up solidly in their private practices. The patients are coming from somewhere - from those who are tearing their hair out with the NHS.

Growstuff one change I would make is to match specialised training needs more closely to what is required to fulfil future needs and to guarantee that once accepted onto a training path, a doctor, provided he/she passes the exams and has acceptable clinical practice, can continue on that path without the constant need to compete for training posts. This would at the very least, give young doctors more stability and the opportunity to put down roots. I would require consultants to work more sessions actually in hospital as they are key to training and supporting young doctors as they progress through their training. One of the most stressful situations for medics is knowing when to contact/call out a consultant when they feel they are getting out of their depth with a very sick patient and they find they are the most senior doctor on the premises!

Gwyneth

What a ridiculous comment paddyann. Staffing is the major issue plus lack of beds. I don’t think even Boris would dare spend NHS money on his wife!!

Are you for real?! He " dares" to donwhatever he bloody well likes! Don't be so naïve and stop acting like you even have a clue as to what he's like! We all know he's a liar, we all know he's a chancer, we all know he cares only for himself. And that's ALL we know, and I for one don't want to know any more , get rid of his corruption and let's all move on with the business of paying our way and to stop constantly trying to avoid paying for the stuff we all need! Successive governments mostly Tory make a career of tax dodging, other countries are astounded at our lack of social conscience and our inability to see that if we want a fair society we must pay for it! With the rich paying their way as much as anyone else!

And we all know you don’t like him Mummer but your likes and dislikes are irrelevant. Gwyneth is right, the problem is too few doctors. This is historic and not down to BJ. There are also too few beds. Many medics have left the NHS during the pandemic, thus making the situation worse.

foxie48

Growstuff one change I would make is to match specialised training needs more closely to what is required to fulfil future needs and to guarantee that once accepted onto a training path, a doctor, provided he/she passes the exams and has acceptable clinical practice, can continue on that path without the constant need to compete for training posts. This would at the very least, give young doctors more stability and the opportunity to put down roots. I would require consultants to work more sessions actually in hospital as they are key to training and supporting young doctors as they progress through their training. One of the most stressful situations for medics is knowing when to contact/call out a consultant when they feel they are getting out of their depth with a very sick patient and they find they are the most senior doctor on the premises!

Thanks for the answer foxie. It was a genuine question and I'm interested in the suggestions.

Growstuff I find it depressing that anyone thinks that making doctors pay back the cost of their training, which was circa £220K in 2019, because they move abroad to work or leave medical practice in the UK will solve the problem of medics becoming demoralised. Most newly qualified doctors already have 5/6 years of university debt round their necks and unlike their peers have been unable to earn any money. The starting salary is not great and most graduates with good degrees in professional type jobs will be earning far more than doctors do at this stage in their career.
All it would do is discourage bright students from poorer households from going to med school, discourage doctors from improving their skills by learning from the best in the world and lock unhappy doctors into continuing in the NHS when they would clearly would rather not. Should we also be asking teachers (c£25K) or nurses (c£51K) etc etc to return the costs of their training if they don't stay working for the state? tbh I don't think anyone would suggest this.

As that was clearly directed at me, I will respond.

As you say, for each doctor who qualifies the cost to the taxpayer is £220k+. I see it as a contract. We pay the fees to qualify in a well-paid job, and in return you work for the NHS. I would build in assurances that this wouldn't allow for exploitation in the shape of low wages and so on - it would have to be a fair deal.

Students who are sponsored by the forces have to pay back their fees if they don't serve for the years specified in their 'deal', and I don't think that this is any different. I think that teachers at least have to complete their probationary year, too - they certainly have to pay back fees if they don't complete the course.

WRT nurses and other healthcare professionals - yes, I do think that they should have the same opportunities - a free training course in return for agreeing to work in the NHS. Far from deterring people from poorer backgrounds from going to university and paying fees after graduation, I think it would be an incentive.

Doodledog The hippocratic oath taken by doctors includes "to teach the secrets of medicine to the next generation". I'm not sure if most people are aware of this but as soon as doctors qualify they take on a "teaching" role so although the training of doctors is costly, it is the doctors themselves that are doing most of the training. Even as a foundation level doctor my daughter was organising and helping to deliver training and conferences for medical students, presenting research papers at National conferences and taking part in research programmes. This is done in the main in their own time, is unpaid and whilst helping to build their medical and teaching skills, also contributes to the training and development of medical students and more junior doctors. Doctors stop practising or move abroad for a variety of reasons. The cost of training is not just five (or six years for those who intercalate) it is also the further 7-10 years (or more) of training that is required to become a consultant during which time these doctors are the backbone of the NHS. I honestly don't think it's fair to punish doctors who decide for what ever reason that continuing to work in the NHS is not for them but I, of course, accept your right to disagree.

Because Boris Johnson , Nick Hancock and this incompetent government have just written off 9 billion on their covid PPE mistakes

Medics who teach in universities are paid more than doctors from other disciplines - as much as £26k a year more (usually pro rata, as they can also be working in the NHS and privately). Many GPs and hospital consultants work part-time and supplement their earnings by giving lectures. A professorial rate at a Russel Group university is up to £200k a year, so adding £26k to that is a very decent salary - far more than the average lecturer will earn, even though they will also have spent years studying. Junior doctors may pass on their knowledge free, but it is certainly well remunerated at a higher level.

I don't see how expecting medics to stay in the system that trains them is punitive, particularly if, as I would prefer to see, their entire training were free.

When hospital doctors are working and training 'on the job' to become consultants, they are being paid to work, and I don't think there is anything to be paid back there. Their time at university, however, I see as a different matter. It seems to me wrong that someone can train (largely) at the taxpayer's expense and then take their expertise out of the system that paid for them.

Of course not all will do this cynically, and I repeat that I fully understand your loyalty to your daughter, but I feel that just as students who get fees paid by the armed forces understand that this is a two-way street, medics (who cost far more to train than most) should do the same.

Do me a favour, next time you are seen by a hospital doctor, tell them they ought to pay for their training if they want to work abroad and see what their response will be. Doctors don’t leave to work abroad because of the pay, it’s the working conditions in the NHS that really get them down.

Absolutely foxie. People who make the ludicrous claims that doctors (but no other graduates) should pay for heir own training show a complete lack of understanding or empathy for the very people they were clapping for in 2020. They also show massive ignorance of the situation that doctors are in, especially during and after the pandemic. They also appear to have no knowledge of how many years doctors train for, and it is not just the 5/6 years in university. My daughter is a GP. She trained at UCL, that is University College London for those who are unaware, and it is one of the top universities in the country, in particular it’s medical degree course. She spent six years in London training (she did the intercalated course, which means she got two degrees) she then spent two years as an F1 and F2 in a county hospital. After that she worked for a year in psychiatric hospital. She then applied for GP training which took another three years. So my daughter trained for twelve years, and for eight of them she was working on the wards and in GP Practices. Which bit should she pay for? The parts where she was working, two years clinical practice in UCH and other hospitals when she was still a student, or the work in hospitals and GP Practices?
But what drove her abroad a year ago was the appalling way that GPs were written and talked about by Gransnetters and the public at large and in the media, during the worst of the pandemic. As a GP she worked much longer hours, saw patients face to face without the necessary PPE at first, had to push her youngest child into a day nursery suddenly and without preparation because grandparents were told not to care for grandchildren, and put her twins into key worker care and try to home school them on the two days she didn’t work. Her husband was the same, but he also worked in the Covid Hub till midnight several nights a week after his GP shift. Inevitably they contracted Covid and one of their twins also got it.
They had enough of the British public’s attitude towards GPs, the criticism, the rudeness, the entitlement of some people, the demands! They gave up and went abroad.

Doodledog it is attitudes such as yours that actually drive doctors abroad.
Thousands of people get degrees in Britain and go to work abroad. Should they all pay the full cost of their education back too?
Incidentally my daughter also helped with training other doctors. She wasn’t paid. She continues to train others and sit exams in her new role in New Zealand.
When she was in the UK she took on a management role alongside her clinical role. She was instrumental to the roll out of the vaccination programme in the south eastern corridor, alongside her role in ensuring the distribution of services in the same area.

Doodledog med students are taught by a variety of different lecturers whilst in lecture rooms, some are doctors teaching part time, some are not doctors, however, clinical practice is taught in placements with students learning alongside practising doctors doing their every day jobs. You seem very focused on the money aspect but from the research that I have read it is burnout rather than salary that leads most doctors to leave the NHS. I was so proud when my daughter became a doctor but sometimes I wish she'd taken a different direction as she has the skills, drive and intelligence to succeed in so many careers where she would have a better work/life balance. She certainly didn't enter medicine for the money!

I very much doubt that my attitude, or my posts on Gransnet are responsible for people emigrating . Of course I wouldn't berate a doctor for anything. As I've said, I use the NHS, so other than personal friends, doctors I see are in that system, and by definition are not working abroad. Also, I am neither rude nor confrontational in company, so even if I met a private doctor home for a holiday the situation just wouldn't arise.

I understand people being defensive about their children. As I have said, I am a mother too, and would react to someone making comments that I thought were about my children. My comments are not personal, however. They were in response to a thread asking why we are paying an extra *£12billion a year in National Insurance, and I simply responded to that with a suggestion.

Whenever anyone dares to criticise waiting lists, their inability to get to see a GP or anything to do with the NHS people jump on them indignantly with tales of their children's exemplary academic ability and how they have given their all to the system. Again, I understand pride in one's children, but I do wonder whether parents of medics are so used to being lauded for their superior offspring that any criticism of any part of the system is taken as a personal slight.

I repeat. I am showing no disrespect to doctors at all, never mind the offspring of posters on here. I fully understand the way their training works, and know that they work long and unsociable hours.

I also know that many other people work long and unsociable hours, take a long time to qualify, and are paid a lot less. Pay isn't the issue for me though - it is the fact that medical students cost the NHS a lot of money, and don't always stay in the system when they have qualified.

I've mentioned the armed forces as an example of people having their education subsidised in return for a promise to serve a minimum term on graduation or pay back the fees. It's a simple return on investment. In the private sector it is not unusual for employers to pay for training courses on the same basis - they are investing in the future of their company by ensuring that their staff are well qualified, but not acting out of charity - if the staff then take their expertise to a rival within a predetermined period they have to pay back the money.

What I am suggesting is that doctors and other NHS professionals should get their training free, which would encourage able students from all backgrounds to join, and would swell the numbers of staff in the NHS, which is something that everyone seems to agree needs to happen as a matter of urgency. By 'free' I mean just that - not just the majority of the fees that sit above their £9k pa contribution. I believe that student midwives get a bursary, for instance? If so, that's the sort of thing I mean. The payback would be that graduates have to pay back the fees, bringing them in line with students from other disciplines, unless they work for the NHS for a pre-defined period, which would be made clear to them before they apply.

Thinking about it, as long as we have fees, and as long as university places are competitive, a lot of people are unable to access higher education. As we are always being told that few people pay back their loans why not scrap fees, but make it a condition that graduates pay NI for a minimum period before qualifying for benefits or free pension contributions? I know several people who graduated when education was free, only to 'retire' from the workplace on marriage or pregnancy, having taken a place that could have gone to someone who would have contributed in their turn. That also seems to me unfair.

Whilst I don't see education as being to 'fit people to jobs', I do think that it is a privilege, and if discouraging those who never pay back their loans because they never work from taking places from those from all backgrounds who fully intend to work and pay into the system that supports us all, that would surely be a good thing?

In all cases, there would, of course, need to be safeguards to protect people who enter the system in good faith but are overtaken by events beyond their control.

I have no doubt that my son who gained a first class degree in Jurisprudence from Oxford cost the country a great deal of money. Oxbridge students are taught individually, or in groups of two or three. There is no obligation on them to attend lectures as Oxbridge students learn through tutorials rather than lectures. This is a particularly expensive way to educate undergraduates. Should my son be repaying the costs of his education? He could well afford to, unlike his sister, because as a barrister at a top set of chambers in London, he earns far more than she does. However no one has suggested that he should repay his education costs, as no doubt his skills as a barrister are apparently valued. What about my other son, who graduated from The University of Wales, and went on to train as an accountant. He now works in financial management and earns rather more than my daughter. Perhaps he should repay the costs of his university education?
Why should doctors alone repay pay back the cost of their university education? Why? What is different about them?

Incidentally, both of my sons pay a great deal of tax. That is how they pay back into the system.

"Whenever anyone dares to criticise waiting lists, their inability to get to see a GP or anything to do with the NHS people jump on them indignantly with tales of their children's exemplary academic ability and how they have given their all to the system. Again, I understand pride in one's children, but I do wonder whether parents of medics are so used to being lauded for their superior offspring that any criticism of any part of the system is taken as a personal slight."

Ouch! That's a bit below the belt! "Doodledog" as I have already said, you are entitled to your opinion and all I have attempted to do is put a different view point based on the experience of currently having a daughter who is a junior doctor. I do not believe that making doctors repay the cost of their training if they cease working in the NHS would do anything more than demoralise them further. One way forward though would be to do exit interviews to find out why doctors are leaving, currently less than 4% are offered one. Having worked in several companies that invested heavily in training it's work force, I'm shocked that the NHS does not currently do this with their highly trained and expensive staff (or perhaps they'd rather not know.)

Waiting lists or the inability to see a GP are absolutely nothing to do with whether or not medics (alone) should pay back the costs of their education (although I’m unable to see how this would in any way prevent them from leaving the system.) Waiting lists and an inability to see a GP are caused by 1) too few doctors and 2) Covid. Making doctors pay back the costs of their education will not improve this. It will not make one jot of difference. Preventing doctors from going to work abroad won’t work either as we live in a free society, and it would be entirely unethical to pass a law which would prevent a qualified doctor from going to live and work abroad.

Somehow we have to pay to give housing, fuel, food and medical care to those who have come, uninvited to our shores!

Incidentally the army or firms that pay for a student’s university fees and often also pay a bursary/living expenses is in absolutely no way comparable to a trainee doctor, who pays his/her own tuition fees (or the parents do) and takes out loans to provide for his/her living expenses. Of course the first example owes the army or company a few years of service. Medics pay the same tuition fees as all other students and take out loans like other students. They are not given any more than any other student. Therefore after their two years of clinical work whilst still a student, and then completing their two Foundation years, they have already worked for the NHS for four years. They owe the NHS nothing. The NHS has benefited from them for at least four years and usually longer. My daughter worked in the NHS until she was 37 years old. How long do you think she should have worked Doodledog before she was allowed to work abroad?

LilyoftheValley are you suggesting that doctors should pay for asylum seekers by paying back the cost of their training?