UKC

It's often said the Tories always screw up the NHS and Labour the economy.

I think there is quite a bit of truth in these claims. Has Lansley, with his bungled "reforms", effectively lost Cameron the election? It seems to me if the government had got the NHS less wrong, they would be in a much stronger position.

In reply to MG:

I'm not sure - at least the Tories are trying to improve the NHS by looking at ways to change the way it works, whereas Labour seem to think that more money = more improvement - and that the NHS should have an infinite budget. Unless we want to either pay astronomically high taxes, or have a government that gradually stops funding schools, the military, police, et al, there needs to be a limit on spending. Lansley's reforms had some merit - unfortunately the usual claptrap about 'privatising' the NHS took all coherency out of any debate.

In reply to whenry:

Per capita spending in the uk is actually quite modest:

http://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditur...

A bit more cash would definitely help the situation.

Speaking to many friends in the medical profession, I'm yet to find a supporter of Lansley or his policies.

I doubt that anyone who has had recent experience of recent changes would.

In reply to Oldsign:

Indeed. Another commentator explaining why he thinks the Kings Fund got it wrong:

http://campaign.r20.constantcontact.com/render?ca=42307b19-d6b5-4c98-ae45-1...

In reply to whenry:


Really? When did Labour say that the NHS should have an infinite budget? I must have missed that one.


Isn't it possible to have slightly higher levels of tax without them being astronomically high? Particularly if we actually want to have public services worthy of one of the world's leading economies.


What merit might that be?

In reply to tony:
I'd go one futher, if we collected the taxes due with current taxation levels we could afford to spend a lot more on the NHS. Still, gotta fund a political party somehow.

In reply to mhawk:


Who is that comment aimed at? Do you trouble yourself to declare all your income? The second hand jacket you sold on UKC? The proceeds from a car boot sale. The interest on your deposit account (if you pay tax at 40%)? Do you pay employer's NI on your baby-sitter's (or even cleaner's for that matter) wages? Ever paid a builder in cash? That's Income, NI and VAT fraud in three easy stages. And I bet everyone on here is guilty of at least one.

In reply to BnB:

On the day that HSBC is reported to have helped tens of thousands of people avid large amounts of tax, illegally. HMRC estimated in the 2010 to 2011 financial year there was a tax gap between what's collected and what's due of about £32 billion – 6.7% of the total tax that HMRC estimates was due – and tax evasion and avoidance together accounted for £9 billion of this.

That's quite a lot of money, and would make a significant contribution to public services.

In reply to tony:

I don't disagree. I'm just pointing out that everyone, yes even Labour voters, is at it.

So how is the remaining (and considerably larger) £23bn that isn't attributable to tax avoidance comprised?

In reply to BnB:
Lots of people are guilty of many of those, because most of them aren't illegal in any way. Selling a jacket second hand for less than you bought it for does not incur tax. Same with car boots.
Unless you have your own personal cleaner , who works for you only, you don't have to pay NI.

In reply to stevieb:
Good point re second hand sales although a lot of people recycle second hand gear at a profit. Many boast as much on here. Or sell on behalf of their ebay-averse relatives for a commission.

The tax arrangements for domestic labour are complicated https://www.gov.uk/au-pairs-employment-law but for sure tax is due one way or another. You're extremely likely to be colluding in your self-employed workers' own fiddles (cash economy) or failing to meet your NI (inter alia) obligations as an employer.

In reply to tony:


I think you might be waiting a while.

In reply to tony:
"David Cameron said no government had done more to tackle tax evasion and "regressive" tax avoidance than his"

This statement just makes you wonder -just how little- it is possible for any party to do?

From what I have gathered , there are claims that there is Conservative Government practice of quietly giving big handouts/ cuts to the rich/ hedge fund managers and suchlike, with an unwritten agreement they disclose/ hand back a modest amount of that windfall, so that :-

1- Government can get some of it back in donations direct to their party from those who have benefited.

2- the government can also get a modest amount back on behalf of the taxpayer, and appear/ claim to be seen to be tough on evasion by getting some back (5 billion I think they claimed) that was apparently more than had previously been 'recovered'

Everybody's happy ( except from the ripped -off taxpayer)

Of course this could not possibly have a grain of truth in it.

Edit Ripped for tipped,, typo.

In reply to Jim C:

And Ed today promised to slip new fathers a couple of ton if they'd vote for him.

Ignoring the complete lack of evidence for your smear what exactly is unusual about parties favouring their electorate?

The question I want answered is the one I posed above. If avoidance accounts for 25% of HMRC's missing billions. What makes up the majority?

In reply to MG:

Here in Oz we have compulsory private health insurance if your income is over a certain level. I have to pay $90 a month to BUPA or face paying more tax. When I do my return I have to submit the statement from the provide showing what's been paid. I only ever use the fund to claim the odd physio visit. I can still go to the doctor for free but there is a plan to introduce a co-charge. I didn't notice anything similar in the UK for higher income earners but it would seem to be one way to bring a lot more money into the system. It would however require the health department to talk to the tax department so maybe it's a non-starter!

In reply to Morgan Woods:

There aren't a great number of these high earners though. Picking on them achieves not much more than the politics of envy. What we do have is a very large number of basic rate taxpayers and the way to balance the books, as any economist will tell you, is to stick 1% on the basic rate of income tax (which rich people also pay and probably wouldn't quibble if the same was added to their higher rate tax too).

Hardly a vote winner though is it?

In reply to BnB:



As you say, the solution (really the only viable solution) is so easy and obvious, even if a little bit uncomfortable. Mind you, in some countries in Europe the electorate - less brainwashed by an anti-tax philosophy - might be more likely to vote for it.

In reply to BnB:

You need to sell on a regular basis to owe tax. Selling some unwanted items is not classed as being a trader.

Just for info....

In reply to Gordon Stainforth:


It's not that simple though. Play to the end. You get the same outcomes for vastly different spends

http://www.google.co.uk/publicdata/explore?ds=d5bncppjof8f9_&ctype=b&am...

In reply to MG:
The two factors involved here are lifestyle and efficiency of the system. The NHS appears to be recognised as being pretty efficient in comparison to other systems, but as a country we do have more lifestyle issues compared to say, southern European countries.

It is also worth considering the GDP of countries like Norway, they spend far more than us and have similar outcomes, but actually as a proportion of GDP, the amount is similar, just 0.1% in it.

In reply to The New NickB:

My link was PPP but yes, I agree.

In reply to flopsicle:

Thank you for the info. But that wasn't really my point was it?

In reply to BnB:

I can assure you I pay my fair share of tax at every opportunity. I happen to rent my old home (at a very low rate, like to be socially conscious and all) and would have plenty of opportunities to 'claim' against the tax, but don't', because it is wrong and unfair. I would certainly never pay someone to aggressively hide my money and deprive society of its dues, the same society that educated me, looked after me when I was ill and protected me from harm. Please don't try and judge me without knowledge and evidence, it is both ignorant and rude.

In reply to mhawk:

I was neither judging you nor addressing my comments at you in particular. Though I'm sorry if you took offence. My observations were meant to capture the widespread piecemeal tax evasion that occurs on every level of society and on every street. I take pride in paying my taxes as you do but I couldn't claim never to have been drawn into someone else's tax evasion, be that payment in cash or taking another form.

If tax avoidance and evasion on the part of the rich accounts for 25% of the hole in HMRC's accounts, could the other 75% comprise of the accumulated small transgressions of the multitude? If raising the basic rate of income tax is politically impractical, could everyone being a little more honest and willing make all the difference, instead of always blaming another segment of society?

In reply to BnB:



The cleaner who cleans for my Dad is employed by somebody else...

In reply to BnB:

"Ignoring the complete lack of evidence for your smear what exactly is unusual about parties favouring their electorate?"
The Government was passed written evidence of named tax dodgers, 6 years ago, and what have they done about it?

If it was drugs, they would look for the 'Mr big' who orchestrates the various criminal acts, and jail them.
We instead, apparently bring them into Government, then promote them to the House of Lords.
(That includes sex crimes as well as financial.)

No need for you or me to smear anyone they willingly writhe around in their own filth with no help from us.

In reply to BnB:

Fair enough, and yes 'we' should all do our bit and pay our fair share. In my opinion tax avoidance is wrong (at all levels). However, I think it is sad and very wrong that there is a whole industry set up to support aggressive attempts to avoid tax and hide money.

In reply to BnB:


Apologies, I thought this was to infer doing a car boot or selling a jacket is taxable:

"Do you trouble yourself to declare all your income? The second hand jacket you sold on UKC? The proceeds from a car boot sale."

Bit lost as to what the point was?

Unpaid tax is a big issue and has been for years, as has the aggressiveness with which benefits fraud is dealt with in comparison to tax evasion, by both media and law.

I picked up on what appeared to be your point as it deflects away from the uber rich towards people that, for whatever reason, find it worthwhile to haggle over the pennies of their belongings - and, in fact, owe no tax unless they do so regularly enough to be classed as a trader. For some reason we forgive the rich and target those with less - as a whole society, not aimed just at any one person.

In reply to Jim C:




Not really: the second biggest element of the tax gap is "criminal attacks" i.e.criminal gangs, much like drug criminals, involved in smuggling,VAT fraud etc. But the size of this suggests the authorities find it hard to get them as well.
The biggest element is the "hidden economy" which is basically often your window cleaner, plumber etc

But since you "gather it" your analysis cannot possibly wrong.

In reply to whenry:

Sadly, the reality of that is the insistence on bringing in wave after wave of 'management consultants', and the reality of that is feckless, 22-year- old 'consultants' who know f*ck all about ANYTHING, to get in the way of people trying to do their jobs. At best, they'll sit on their spotty arises for three months, and not get in the way, whilst leeching the NHS at about £1000 a day. Only for the next batch of parasites to be sent in...

Want to know how to improve the NHS? Management: listen to, and trust your staff; they know what's really going on. Government? Don't let your old Etonian mate from Touche, Tw*t & Anderson Consulting con you into thinking they have a Clue.

Oh, and 'changing the way it works' generally means outsourcing to US-owned health giants, not exactly known for their efficiency. But generous in many other ways, I'm sure...

In reply to captain paranoia:

I think UKC needs a 'Rant of the week' award...

In reply to flopsicle:
My point was that instead of maturely debating whether the Tory's NHS changes have been positive, this thread rapidly deteriorated into blaming tax avoidance for the ills in the NHS, as if the tax-shy rich had been cherry picking funds allocated to health. Yes, it is perverse that an industry should exist whose purpose it is to help major corporations or any individual subvert their moral obligation to contribute, particularly when the practitioners work for the same firms on whom HMRC relies for accurate auditing of corporate profits, but it is right to question how few individuals of every status can genuinely claim to have volunteered every penny of tax throughout their lives.

As for the NHS, I'm with captain paranoia. But as someone whose business, inter alia, performs software development for the NHS in competition with those management consultants I have some good insight into the process of selection of external experts. And it's got bugger all to do with Eton. Ingrained in the procurement process is the concept of blame. Who can we blame if this projects goes to the dogs? How can I avoid blame if this goes wrong? And the blame culture motivates supplier choice. The management consultants are very good at portraying themselves not as infallible, but as a good choice to have made if projects don't meet their objectives. To the NHS procurement professional it is far riskier to their own career to select, say, a small supplier brimming with industry specialists, than to hire a consultancy behemoth ready to foist new graduates on the NHS at outrageous cost. So much money could be saved, and better projects delivered, if procurement were emboldened to make good choices instead of cowed into making poor but "safe" decisions.

In reply to MG:


The link higher up the thread gives % of GDP.

In reply to BnB:


Have you read "The Blunders of our Government"? A lot of procurement decisions seem to be poor and very far from safe, resulting in massive overspends.

In reply to tony:

As a supplier to our government I bet I could contribute to it. The issues I've identified seem to boil down to procurement being motivated by a climate of fear and blame to base their decision-making primarily on factors that secure their personal indemnity from blame without placing enough emphasis on the outputs, cost, the needs of consumer of services or the taxpayer

In reply to MG:

For anyone's information, there are two new books out this month and the next:

"The End of the NHS" by Allyson Pollock, and "NHS for Sale" by Jacky Davis et al.

A. Pollock is usually very thorough and insightful but can be a bit 'academic'; the latter book should be cogent and revealing, if their previous one, "NHS SOS" is anything to go by.

Jon

In reply to MG:
Leaving aside the NHS for a moment.
(Which alone should cost the tories the election.)

This alone should also cost Cameron the election:

http://www.theguardian.com/politics/2015/jan/17/andrew-lansley-united-natio...
http://www.bbc.co.uk/news/uk-politics-30220178
http://www.globaldashboard.org/2014/11/28/lansley-ocha/
http://blogs.channel4.com/lindsey-hilsum-on-international-affairs/role-came...

There's a kind of 'rotation' with the UN's top jobs, so it's fallen to the UK's prime minister to nominate his choice of candidates for this job. What is supposed to happen is that the PM nominates three highly qualified candidates for the UN to consider, rather than one wholly unqualified old mate to whom he feels he owes a favour.

In reply to captain paranoia:


That was actually part of the reforms purpose - give more control to those with the most patient contact (i.e. GPs), and reduce micro-management by the DoH.

In reply to tony:

>What merit might that be?

Demand driven supply instead of central planning, greater patient involvement in their treatment plans, a focus on patient care, not simply churning people through A&E to meet time-based targets... all of that sounds pretty reasonable.

In reply to The New NickB:
>I think you might be waiting a while.

Not too long

In reply to whenry:


It does sound reasonable, nothing has actually changed of course but the buzz words do sound good.

I can only speak for the Manchester area but those who worked at the PCTs now work at whatever the PCTs are now called and do their job in exactly yhte same way. Doctors/nurses/health proffesionals continue to do their best for the patients in their care regardless of these changes. Thank god the reforms don't cost much......

In reply to whenry:


Turn medical professionals in to part time accountants and managers is not terribly efficient use of resources.

Local control through PCTs was OK at doing this, it is arguably most efficient when delivered by staff GPs rather than contractor GPs, but that is a product of the history of the NHS. Something I would like to see reformed.

Shame that this Government promised no top down re-organisations then set about Lansley's catastrophic top down re-organisation.




So what in Lansley's plans achieved or even realistically attempted to achieve that, we all love motherhood and apple pie, but I'm not seeing anything in the oven.

In reply to The New NickB:


I got the impression that their might have been apple pie in the oven had not their been such an uproar about touching our beloved NHS that the reforms were completely watered down .

In reply to whenry:


So how come we are continually hearing about failures of A&E departments to meet time-based targets?

In reply to tony:

I work in Procurement.
It can be 'services' (usually Engineering based granted)

But we don't specify the actual requirement, and further to that we are not the ones to decide if the offers we obtain is complien.
(that is done by the expert specifier, usually - Engineering in my case - Not sure who that is in the NHS)

Further to Engineering bid Reviews are done by individual disciplines , like Metallurgy, Quality/Safety,Treasury, Planning,and uncle Tom Cobbly all have their say.

It may well be stated as 'Procurement' to blame, but we usually ensure that the blame is spread as widly as possible amongst others.

So , when you next read of a 'Procurement fiasco' in any Government Department you can be sure that the failure has been endorsed by many other incompetents, and not just the 'Buyer'.

In reply to whenry:

I think if there had been a coherent, understandable, achievable set of proposals that would have been OK. As it was there was a complete mess no one understood that has cost a fortune in cash, goodwill and political capital.

Health costs are rising faster than GDP so something has to change but we now have a situation where Labour having nothing to say except carry on as normal, while the Tories has seen as (rightly) incompetent and (probably wrongly) trying to introduce a US style system.

In reply to tony:

Because the government hasn't managed to get the reforms they needed in place yet (government being like an oil-tanker trying to go into reverse), and so we're still stuck with purely time-based targets.

In reply to BnB:
To the NHS procurement professional it is far riskier to their own career to select, say, a small supplier brimming with industry specialists, than to hire a consultancy behemoth ready to foist new graduates on the NHS at outrageous cost.....

It does not work like that where I work(or at least I hope it does not work like that in the NHS) Procurement Professionals are rarely 'expert' in anything, but the Procurement Process itself.

As I said earlier, Procurement are never the sole 'selector' of anything.
There is a Team of people, and the eventual proposed Supplier is endorsed by that team, each with their area of expertise.
(We also have approved Suppliers, from which the initial bidders list can only be compiled, the Public Sector may be a bit different in that regard, not sure.)

All risks are highlighted and weighted, as are risks.
(or 'risks' of size may be seen as an opportunity, depending if it is something that needs to be flexible or not)

It would however, be impossible for Procurement under an robust process to individually recommend any Supplier that was not agreed as firstly fit to bid, or that the 'experts' in their field had not then subsequently endorsed as the best of those suitable Bidders.

The teams recommendation is tabulated, an Excecutive Summary is added, and then every department involved in that process, can see that their input is accurately presented, and then they all sign that document to say as much.

When that recommendation goes to the top of the tree for a signature, which is usually beyond the top Procurement person, the excecutive authoriser can see exactly how the recommendation was arrived at, and it is an open process.

The real 'experts' are the ones who initially define and requisition that service, Procurement mearly ensure that the correct process is followed, and that the final choice of the Team of expert reviewers, is reached in the correct way, on a level playing field, like-for-like, and all those usual phrases.
That then becomes the recommended bidder.

In reply to Jim C:

That sounds horrendous!

In reply to Jim C:


I don't doubt it. Indeed the book I mentioned does highlight the comprehensive buy-in by all parties which contributes to the dismal run of failures, including the external contractors who are supposed to manage the contracts.

In reply to whenry:


So it's not yet possible to say whether the reforms have delivered what they were supposed to, and claiming their success would be premature.

In reply to tony:

I haven't claimed that they've been successful, merely that I think they're a good idea. Others, however, have been very vocal about their failure.

In reply to Jim C:

Frightening really .

I can see why when the private sector looks at these processes we shake our head in disbelief at such a waste of time and money for most buying procedures.

Do you ever use gaming theory to get the lowest price ?

In reply to neilh:


He is describing the private sector isn't he, big, complex procurement is big and complex, public or private.

Having gone back and read Jim's post again, he is definitely describing the private sector.

In reply to BnB:


Yes, that's fair; that was a true ranty bit...

Ad I'd agree that employing management consultants to make decisions that you already know the answer to is a way of avoiding blame. The problem is (and this is perhaps where the Eton bit does come in...) is that the Government have encouraged (mandated?) the use of management consultants.

And, even if the decsions are seen to be 'wrong', the management consultants are still brought in...

In reply to whenry:


That was always a flawed policy; GPs don't have the big picture of what is required by a PCT, or regional health board, to do proper planning and resource management. Replacing DOH micromanagement with local micromanagement.

Sure, GPs need to be involved in planning, since they are 'customers' of the hospital side of the NHS, but I think PCTs and regional health boards are better placed to plan resource loading, since they can see the need across a larger scope. Then there are issues of national best practice, economies of scale in buying, etc.

In reply to The New NickB:

Yes Private sector Nick, but we have staff who have come from all areas, and the processes will have a core that is the same as they all will have likely studied for CIPS qualifications.

Companies also strive to show their internal Procedures are aligned with CIPS, so for large purchases, that we are talking about, thay should all follow similar procedures. ( I do remember having to get 18 signatures for one purchase. )
http://www.cips.org/en-GB/

In my early days ( 70's) I worked in 'Buying' , I now do much the same thing, and they call it ' Procurement'
(which is just buying stuff with lots of buzz words, a lot more paperwork)

(I'm old school, they will put me down soon, as 'Going Forward' I will be too cynical)

In reply to The New NickB:

I thought he worked in the public sector, my mistake.A few years ago I was involved in multi million £ bids for both private and public sector. There was always a big difference in terms of negotiating the best price/deal. Shall we say there was more " haggling" in one than the other.Granted you do not have to consider EC procurement rules in the private sector.

In reply to neilh:


As I confirmed, I Am in the private Sector, granted on a large scale,.
We will share work/ resources across other offices:- Atlanta; Shanghai: London; Chennai, (Tipton and Glasgow so uniform procedures are used across business.


Just as the salesmen are taught to negotiate ( by some highly paid consultant, ) the same highly paid consultant teaches Procurement staff negotiating skills that counteract those of the salesman . Game theory is part of the course.

(You might be happy to know that the lowest price is not always what clients are after - particularly in the nuclear sector)