Public 'prepared' to pay for healthcare

[thesultanofsheight]

Well I’m the public and they can fuck off. I already pay tax and NI and make charitable donations to some of the third sector agencies too. Might as well hand my whole salary over to them at the end of the month and they can piss that up the wall on their salaries and pensions too! 

[cheesypeas]

in fairness, the UK NHS is in strife too according to the news. 

Can we have a five star service, when we only submit 3 star contributions.

Correct me if I'm wrong, but Norway pay something like 40% tax, and their health service is fabulous seemingly.

[monasqueen]

Norway's taxes and duty are pretty steep, and one has to assume that their wages/salaries are large enough for them to cope.

Norway also has huge amounts of income from their oil and gas fields.

The UK has large oil and gas fields too, but they piss the money away.

[benl]

I think in many Nordic countries you pay before you see a clinician. It's about £10 for a GP appointment and £30 for an A&E or out of hours service. In Sweden, there is an annual cap on the cost but this depends on the administrative region, so in Stockholm after you've paid £100 in a year all services become free. Personally, I wonder if this is more of a barrier in dissuading those who are reluctant to visit rather than frequent fliers. 

There seems to be a mantra of saying the service is underfunded but is it really, I think that depends on what our expectations are. I wonder if the Isle of Man should focus more on cost-effective medicine,  accepting that some of the novel cancer drugs don't provide a great return for the investment, particularly for quality of life. I think there needs to be an honest discussion about what people want or are willing to pay for. I don't think, in my opinion, that a semi privatisation is equitable and risks driving social inequalities which I suspect are already quite prominent. 

I don't think the Island will ever win the pay battle for locum doctors, a shortage in the UK, isolated location and no training posts beyond basic training all limit recruitment. That or propose at least secondary care is run by an NHS trust in the UK so staff can rotate through and services can be shared (I suspect this would never be palatable as people hate travelling Douglas-Ramsey as it is). 

I suspect another review really doesn't seem like the best idea, how many of the west mids suggestions have been acted upon? 

[Uhtred]

1 hour ago, war baby said:

My suggestion requires little or no admin cost.  I would contribute a fiver a visit.  Who else would?

Relatively few I fear. 

[Uhtred]

34 minutes ago, benl said:

I think in many Nordic countries you pay before you see a clinician. It's about £10 for a GP appointment and £30 for an A&E or out of hours service. In Sweden, there is an annual cap on the cost but this depends on the administrative region, so in Stockholm after you've paid £100 in a year all services become free. Personally, I wonder if this is more of a barrier in dissuading those who are reluctant to visit rather than frequent fliers. 

There seems to be a mantra of saying the service is underfunded but is it really, I think that depends on what our expectations are. I wonder if the Isle of Man should focus more on cost-effective medicine,  accepting that some of the novel cancer drugs don't provide a great return for the investment, particularly for quality of life. I think there needs to be an honest discussion about what people want or are willing to pay for. I don't think, in my opinion, that a semi privatisation is equitable and risks driving social inequalities which I suspect are already quite prominent. 

I don't think the Island will ever win the pay battle for locum doctors, a shortage in the UK, isolated location and no training posts beyond basic training all limit recruitment. That or propose at least secondary care is run by an NHS trust in the UK so staff can rotate through and services can be shared (I suspect this would never be palatable as people hate travelling Douglas-Ramsey as it is). 

I suspect another review really doesn't seem like the best idea, how many of the west mids suggestions have been acted upon? 

A first class contribution to this thread.

[Mr Shoe]

Three things:

1. If the DHSC continues to go over budget by the same ball park figure, then maybe the budget figure is wrong?  I can budget all I want for £8 a month to cover my Sky and Netflix, but it ain't gonna happen. Accountants and Exec teams are too fond of stating budgets with no basis in reality.

Funny how when departments come in under budget, they NEED to spend the money (think Sloc). But when things come in over budget....?   

2. Why does a £9m a year overspend bring on a no-holds-barred review of the Health Service where a £50m shortfall in the Public Pension Scam.....la la la I'm not not listening.

3. If all cloth throughout government had been cut (ridiculous pensions, early retirement, paid workers sitting round without work, retirees returning on big contracts, jobs for pals, grants for pals, government contracts for pals. MASSIVE conflicts of interest throughout, jollies, expensive re-branding exercises, etc, etc, etc) then I might consider paying more towards my health care.

But I'm not paying more just so you can fucking waste it.

 

[quilp]

Is all of the overspend down to the medical side? How much of that budget includes the more mundane stuff like maintaining the structure, services and facilities? Can't find any definitive breakdown figures... 

[asitis]

My wife thought she had paid 45yrs of NI for a bit of healthcare and some pension provision .......  how wrong can you be, pension delayed by 6 years and the healthcare is crap unless you are prepared to pay for everything on top !

Young people should be pushing to do away with the NI and pay directly into private healthcare and pensions, giving money to governments is nonsensical !

[Craig King]

20 minutes ago, asitis said:

My wife thought she had paid 45yrs of NI for a bit of healthcare and some pension provision .......  how wrong can you be, pension delayed by 6 years and the healthcare is crap unless you are prepared to pay for everything on top !

Young people should be pushing to do away with the NI and pay directly into private healthcare and pensions, giving money to governments is nonsensical !

I paid money into a very reputable private pension (NPI National Provident Life now Phoenix Life.)

It was a hefty enough 5 figure sum and I thought I could leave it safe until such time I needed it. It transpired that one of their associates had been lifting money from my account. By way of fees and 'legitimate' extraction he was charging around 3,000GBP per letter which went to an old address and so I didn't pick up. He was eventually picked up by the police and my money returned. The point being, who do you trust. I transferred the scheme but the new place seemed to be losing the fund in shares. There's a lot to be said for keeping your money in a biscuit tin under the bed. 

[Galen]

'Is all of the overspend down to the medical side? How much of that budget includes the more mundane stuff like maintaining the structure, services and facilities? Can't find any definitive breakdown figures...  '

 

In acute health care (ie hospitals) the 'rule of thumb' was always that 70-75% of the allocated budget was salaries and wages the remaining 25-30% being on everything else from drugs and dressings, food for patients to maintenance of the buildings and engineering. A few years ago Nobles maintenance was centralised and brought under the control of DOI who took over the staff and the budgets. The result is that there is no professionally qualified estates personnel looking after the DHSC estate, and those staff that have any health experience are deployed on all sorts of health and non-health maintenance, with few dedicated maintenance personnel on the site who fully understand the systems or how they work. Contract maintenance staff are used as they are 'cheaper' than employed staff with little appreciation of the longer term consequences.

While to the uninitiated, repairing certain appliances may not seem location dependent, in health premises maintaining control infection is paramount meaning that what is involved in carrying out a repair to a sink in say an operating scrub area is very different to the same type of repair in a school toilet. (Other examples are available!)

Equally, there are some very specialised engineering services in hospitals that are not obviously in industry or commerce for example, medical gases, sterilisers, operating theatres. However, our great and good do not appreciate such nuances, and consequently when this situation combined with an IT system that cannot track who did what repair, when and where, but can tell you how much it cost, Nobles engineering services are a potential disaster waiting to happen. Further, health maintenance is well down the pecking order when it comes to funding, even when centralised under DOI whose senior managers only understanding of health care is visiting a sick relative or being there when their kids are being born.

Many of the former building and engineering problems of the old Westmoreland Rd  Nobles disappeared when the new Nobles was built. However, what the accountants failed to appreciate was that the new engineering and building assets in the new Nobles had to be properly maintained from day one. Failure to do so has meant that a backlog of maintenance issues has built up and is expensive to sort out properly. As a result the cheapest possible fixes are used as there is no money to do the job properly. Consequently, it is highly unlikely that it is the 'mundane stuff' that is the cause of the overspend.

 

 

[Uhtred]

40 minutes ago, Galen said:

'Is all of the overspend down to the medical side? How much of that budget includes the more mundane stuff like maintaining the structure, services and facilities? Can't find any definitive breakdown figures...  '

 

In acute health care (ie hospitals) the 'rule of thumb' was always that 70-75% of the allocated budget was salaries and wages the remaining 25-30% being on everything else from drugs and dressings, food for patients to maintenance of the buildings and engineering. A few years ago Nobles maintenance was centralised and brought under the control of DOI who took over the staff and the budgets. The result is that there is no professionally qualified estates personnel looking after the DHSC estate, and those staff that have any health experience are deployed on all sorts of health and non-health maintenance, with few dedicated maintenance personnel on the site who fully understand the systems or how they work. Contract maintenance staff are used as they are 'cheaper' than employed staff with little appreciation of the longer term consequences.

While to the initiated, repairing certain appliances may not seem location dependent, in health premises maintaining control infection is paramount meaning that what is involved in carrying out a repair to a sink in say an operating scrub area is very different to the same type of repair in a school toilet. (Other examples are available!)

Equally, there are some very specialised engineering services in hospitals that are not obviously in industry or commerce for example, medical gases, sterilisers, operating theatres. However, our great and good do not appreciate such nuances, and consequently when this situation combined with an IT system that cannot track who did what repair, when and where, but can tell you how much it cost, Nobles engineering services are a potential disaster waiting to happen. Further, health maintenance is well down the pecking order when it comes to funding, even when centralised under DOI whose senior managers only understanding of health care is visiting a sick relative or being there when their kids are being born.

Many of the former building and engineering problems of the old Westmoreland Rd  Nobles disappeared when the new Nobles was built. However, what the accountants failed to appreciate was that the new engineering and building assets in the new Nobles had to be properly maintained from day one. Failure to do so has meant that a backlog of maintenance issues has built up and is expensive to sort out properly. As a result the cheapest possible fixes are used as there is no money to do the job properly. Consequently, it is highly unlikely that it is the 'mundane stuff' that is the cause of the overspend.

 

 

This (convincing and clearly well-informed) analysis is deeply troubling.

[woody2]

3 hours ago, cheesypeas said:

in fairness, the UK NHS is in strife too according to the news. 

Can we have a five star service, when we only submit 3 star contributions.

Correct me if I'm wrong, but Norway pay something like 40% tax, and their health service is fabulous seemingly.

bad management.....

 

[Uhtred]

Julie Edge is quoted (and there’s a soundbite) on the Manx Radio website this morning spouting off in high dudgeon about the “open chequebook” cost of the forthcoming health review and the fate of previous reviews. So did she therefore express these concerns in last week’s Tynwald debate and vote against the motion? No, she didn’t, because a quick check of Hansard reveals that on the afternoon in question she’d been granted leave of absence. Ok Julie, if you harbour such reservations about the use of our money, perhaps you could do us a favour and actually turn up to do your job. The job for which more of our money is used to pay your generous salary. Charlatan.

http://www.manxradio.com/news/isle-of-man-news/open-chequebook-fears-over-health-review/

 

[yootalkin2me]

On 24/01/2018 at 12:20 PM, 2112 said:

I think the charge that HQ and AC and the Civil Service wish to introduce is a charge for visiting a GP. HQ has made enough noise about this, in particular about people failing to attend appointments (was suggested £5). Inconvenient as it is personally I would pay despite the messing around and cost. What I don’t like is charges being levied and then wasted by Government.

Agreed, but it should be £10 per visit and a £20 charge if you miss an appointment, same with the dentist.

That's not a saving but a tax and should be done simultaneously with real savings, cutting of waste and doing away with at least one layer of management.