[york]

york

January 12, 2018 at 3:52 pm #445

@mary Perhaps my point was buried in my overly long post.

When I wrote “old age care” I meant specifically the kind that requires some kind of medical supervision and equipment, a care home, or whatever the term is at the moment.

When I wrote “not everybody requires care in old age” I also meant that some people are able to live in their own homes with a lesser degree of support, or live with other members of their family.

I don’t believe that it is fair that somebody easily able to pay for his own old age care in a home should be lodged at the someone else’s expense. But I am certain that this is what will happen in a system where a person’s house will be seized and sold off to finance such care: the property will be transferred to another person or to an entity from which is cannot be seized and the State will left to foot the bill.

And this is why I think that such care, where it is necessary, should be funded through a fund into which the person who finally benefits from the care will have contributed, either through NI contributions or through some sort of tax.

When I pay contributions to the health service, I don’t get a refund for not using the service. But it’s there if I need it. Two of my cousins and several of my friends have no children; their taxes are not reduced to take into account that they don’t have children making demands on the education system. My opinion is that old age care should be the same: we all pay in, and benefit from it if we need it.

[york]

york

January 12, 2018 at 3:49 pm #443

I was born and grew up in the UK, have lived in several countries and seen how the health services work there as a user of those services. I also have a brother who is an anaesthetic technician in hostpital operating theatres in the UK, friends who are nurses and specialist nurses, are GPs or are specialist doctors in France and in the US, so I get to hear stories from the professional side, too. For five years in the US I worked on molecular biology analysis machines for hospital and research labs. And I read a lot. The Economist is a good source of information about healthcare economics.

As I see it, the demand for service has changed, and the provision has changed but has not matched the change in demand.

The demand, as others have pointed out, is that the population is in general older and less fit than before. Even among those under fifty (and even those under thirty) there are far more cases of obesity, diabetes, asthma and allergies than there were during the three decades after the founding of the NHS. I would call this the purely medical increase in demand. This has, to some degree, been mitigated by reduction in pollution, improved safety (everything from improved food safety through testing and hygiene to better road safety).

To this we need to add what I’ll call, for want of a better term, the psychological increase in demand. This goes from a desire to get the best health care possible for ourselves, our children and our parents through to (excuse me if this sounds elitist and aloof) stupidity and an overblown sense of entitlement. People turning up at the Accident and Emergency department for coughs, colds (“but it’s flu”), a sprained ankle or a minor cut that can be treated at home. The thinking that “I’ve paid for this through my National Insurance contributions, so I’m entitled to [insert desired treatment]”.

These demands clog up GPs surgeries with malingerers, pushing other malingerers into A&E. The whole system gets clogged up.

An on top of all that, the cost of new diagnostic kit and of new treatments is expensive.

So the system needs reforming in the way it provides care.

But society needs to reform, too.

People need to change their behaviours to reduce unnecessary demand. Parents should learn how to take a child’s temperature, rather than just put a cold hand to a forehead and rush off to A&E claiming “my baby has a fever!” (of course, they do this because the GP works only by appointment, and the next available appointment is in eight days). Basic first aid training in school. Bring back “home economics” classes, too, so kids learn how to cook properly.

Lots of mismanagement within the NHS (although by no means universally). But the main problem is the galloping increase in life expectancy, accompanying tremendous increases in cost-per-head while we prop people up into their eighties and nineties and beyond, and a complete unwillingness to fund it. That’s not just politicians, by the way; only a tiny proportion of people would be prepared to pay more tax to fund the services we demand. The sums do not add up.

We need different types of care and more of them, better management, and more money. But I think we also need to accept as individuals that our requirements are completely unrealistic – the state can’t fund endless care home places at a grand a week, because the taxpayer can’t / doesn’t / won’t contribute the amount necessary. Nor are people prepared to save properly for pensions, or use their savings or equity to help fund their own care. It’s bonkers.

Even with better financial management in the NHS – even if it was perfect! – there still wouldn’t be enough money in the system. Either we reduce the services we expect, or we all pay more, or both.

It will be more bonkers as things go on as you have a generation of people coming up who have been unable to buy their own homes so don’t have that sort of equity either, and have had a much poorer deal on any pensions they have (no final salary set ups etc).

What was the level of home ownership in the 1950s, 1960s, 1970s? What were pensions like back then, for ordinary people, even in the days of final salary pensions? When a factory worker’s final wage packet was crap and he lived in a rented house, where was his “equity”? Well, his old age care didn’t need funding, because five years after retirement he was dead of heart disease caused by disrupted circadian rhythms and hormone levels, from working night shifts, or he was dead from a disease caused by his work environment.

Relying on each individual’s “equity” to finance his or her old age care is not going to work. Those who, as you say, can’t get on the famous housing ladder will not have a house to sell to fund that care. And those who reach old age with a house worth seven or more times the median annual income will have put that house into a family trust or similar vehicle to keep it from being seized to fund old age care.

I am convinced that the only way to finance care is through a national scheme, through NI contributions or through taxes of some kind, so that everyone pays as they earn. Just like acute, chronic and accident care. I don’t expect to be presented with a bill for radiology and another for surgery, when I turn to hospital up with a broken arm because I slipped on the ice.

You might argue that there is a difference between my example of an accidental broken arm and the person requiring old age care; after all, ageing happens to everybody. But not everybody requires care in old age, and some people (for one reason or another) simply never reach old age. And this is why it can be rolled into National Insurance: it is not funding a place in a retirement home for every single person on reaching some threshold age, it is funding a place for those unfortunate enough to need that kind of care.

[york]

york

November 23, 2017 at 1:37 pm #290

Having witnessed the mess that PFI caused the NHS, which was then followed by the closure of so many psychiatric beds that bed occupancy frequently runs at over 100%, which then means that people have to be admitted to private psychiatric hospitals (often hundreds of miles from home) at a cost to the NHS of thousands of pounds per week, not to speak of the cost in human terms, I can only presume that the dismantling of the NHS has been a political intention for nearly twenty years.