Social care funding

[JP1]

My experience of the NHS spending is similar to that described by @Danllan. Incredible wastage.
On one of Mum's regular hospital jaunts, she was incarcerated (bed blocking) for three days. Not because there was nowhere for her to go. But because the system couldn't get its ducks lined up to organise discharge paperwork, drugs and ambulance transport at the same time. The ward sister said she had three patients (out of 12) in the same boat. So not always the fault of the receiving end.
I contacted the hospital CEO and got mother out - but without her drugs. They followed by taxi five hours later. An 80 mile round trip.

When we moved her, repeat prescription drugs filled one kitchen cupboard. Collected but not taken. Protein drinks were stacked in the pantry - not drunk. And after she died, pads, dressings, lotions and potions, left in her room by the District nurses filled a black bin bag.
Nothing could be returned to be reused, even if in date.

Another thing that irritates, is staff using the hospital post franking system for their own private use. Every year I'd get several holiday cottage enquiries in pre stamped envelopes from both NHS and Nuffield staff, asking about their own accommodation. And Christmas cards sent similarly. Using the franking machine belonging to the hospital (charity or company) in my book, is stealing.

So many parallels.

What finally got me to kick off on behalf of my Aunt was the totally dysfunctional discharge procedure at her (then) local hospital.

Doctors swanning around too late in the morning to approve discharge already discussed days before, hospital social services interference (they really are useless) and then ambulance transport booked too late. I recognised for years that about 2.30pm was the very latest to arrange this. Circuitous walking patients drop off route and when Aunty's final night carer slot of 8pm could not be met and with safeguarding issues, being re-admitted through A&E and a night on a trolley with all the drunks in a corridor.

My Aunt's new GP "owns" her welfare including assessing her epilepsy medication etc and it keeps her almost completely away from hospitals. The care home staff constantly monitor her vital signs and even when she is confused they can assess her needs as opposed to a remote contact centre via an intercom for part of her day.

 

[Danllan]

Well... my mother was admitted on Monday afternoon to Glangwili (Carmarthen) Hospital; she was taken by non-emergency ambulance because our GP didn't want her out of medical oversight. She is, as I write this, still in a side room in A & E despite her condition having been stabilised, all her 'readings' being satisfactory, and there having been a definite diagnosis of the problem made.

She certainly does need to remain in hospital until a specific procedure has been carried out, she certainly doesn't need to be in A & E. Remarkably, there is a bed waiting for my mother on an appropriate ward but, you guessed it, there is a 'delay' in organising her transfer - also, a nurse told me, the bed was available yesterday afternoon but A & E were only informed early this morning... The staff in A & E have been superb from top to bottom, treatment has been great too and she is very comfortable. But they, the staff, are banging their heads against the wall in frustration at not being able to move her on.

When I left her yesterday evening, there were two people on stretchers waiting to come into A & E proper, there may be none now, or more, but the fact that she - and maybe others - are stuck in A & E unnecessarily is crazy both for them and for the hospital.

 

[capfits]

What about the money for education aswell?
The trouble is we want services that are as good as say in the Nordic nations yet we have a tax system that has so many leakages it is unbelievable, so people do not feel compelled to pay more tax.
The question should be do you want to pay more taxes if everyone else is.

On a personal level I blame the UKs obscene fascination with houses. They certainly are not taxed enough when you consider that the capital growth, ie unearned income, can be higher than wages in some cases and in many many cases outstripping wage growth.
Time for a Land Value tax, because all we are doing at the moment is taxing work, just look at NI debacle.

 

[Danllan]

What about the money for education aswell?
The trouble is we want services that are as good as say in the Nordic nations yet we have a tax system that has so many leakages it is unbelievable, so people do not feel compelled to pay more tax.
The question should be do you want to pay more taxes if everyone else is.

On a personal level I blame the UKs obscene fascination with houses. They certainly are not taxed enough when you consider that the capital growth, ie unearned income, can be higher than wages in some cases and in many many cases outstripping wage growth.
Time for a Land Value tax, because all we are doing at the moment is taxing work, just look at NI debacle.

I disagree, for the reasons given earlier, but also because I'm not a revolutionary socialist. A 'land value tax', really? Well, that will very probably kick the feet out from under British agriculture and also see a massive increase in business for any practising in Chancery (trusts) law.

You want more money brought in? Make it rational, make it reasonable to most and then enforce it ruthlessly. If you want a quick fix, look at raising consumption tax - VAT - if you like, charge more for a Rolls Royce than a Kia etc. etc., that will get you cash in the short term but will not help in the long term.

From your post I assume you have no personal property - it would be a bit hypocritical if such were not the case - and may well, therefore, be writing from personal envy of those that do.

Joking apart, if the people in the know - in the NHS - think that there is massive waste, then that is manifestly the place to start making changes.

 

[capfits]

@Danllan Is housing not a consumption the way the market is behaving?
For example my 4000 square foot hovel will be worth significantly less than 4000 square foot palace in central london., Yet the tax system does not reflect that infact it arguably goes against my home in the form of crude local land value taxation.
The fact is that a once wet bog was worth the same as my once wet bog the thing is the London wet bog with a house on it has had its value supported by state apparatus, roads, electricity gas etc whereas my wet bog with house on it has been supported to lesser extent. It is the value of the land that has lifted.

Yet Land Value taxes work in other places indeed wealth taxes work in other developed European contexts. If not Land Value then Capital gain tax should be applied to homes.

It has to part of a mix for sure

By the way your assumption on property ownership could not be more wrong.

 

[Danllan]

@Danllan ...By the way your assumption on property ownership could not be more wrong.

Then the other, implicit, assumption is not...

Lots of things work elsewhere and some things that work well here do not work in them; national character, taste and preference are all factors. Nonetheless, you make an important point - that some people have more than others. So what? That's life outside of a communist 'utopia'.

The logical conclusion of what you suggest is that certain areas will be exclusively for the rich, far more so than is now the case, since if one thing will be guaranteed to remove the asset rich-only people from an area, it is taxing them at the same rate as their wealthy just-moved-in neighbours. Would you make an allowance for their lack of income? If so, your notional land value tax will cease to have consistency.

Out of interest are you farming and, if so, what would your liability be if your proposed tax system were to be introduced and how would that affect your overall income?

 

[capfits]

@Danllan assumptions can be dangerous thing.
Better to do a bit of reconnaissance to see what is what, is it not?

Yes I am land owning farmer aswell as a tenant farmers, a shareholder, a pension holder, I am also a parent, son and a grandson, and just so you do not have to make an assumption a living breathing HUMAN being.

Do you wish a furthur disclosure of my personal situation, I will let you go first......

Situation not enough beans to pay for proper provision of services, be it education, healthcare.
Solutions, pay staff less, raise more funds to pay for services, reduce services in other areas say Polaris for example.

As for a land value tax it could be any rate, I believe in Texas it is about 1.9%, and I do not see free enterprise grinding to halt out there. Closer to home in Denmark another capitalist nation it is 2.4%. In France wealth taxes cannot exceed 75% of income. Put very simply land values have grown quicker than wages in this country and I would suggest, that this could lead to intergenerational issues and a burden being put on the poorest ie non asset holders in our population.

Perhaps I have missed something along the way but what solutions to profer to deliver the babies, aid the care of our elderly, educate our young people, dispose of our litter ?

 

[Danllan]

@capfits when I was in the army the general saying was 'Assumption is the mother of all f*ck-ups!' and this can often be so, but not always; and reasonable assumptions are a necessary thing. (On the military subject, I assume you mean Trident, not Polaris...).

But I digress... the examples you give are fine for where they are given and, I dare say, could be adapted for application here in the UK. But it must be borne in mind that in Denmark and France there is a more 'socialist' culture per se. and a public acceptance that high tax is a 'good thing'; in Texas the overall tax burden is significantly less than here, so the land value tax is not as oppressive as it could - and almost certainly would - be here, perhaps excessively so if raised at a local level.

Another important point to recognise is why land / property values have risen or, more importantly, why they have risen so significantly compared to income. Immigration and foreign purchases are very significant factors in this matter, affecting wage levels and purchase price respectively; my guess is that this will change somewhat in the next decade or so, allowing for wages to catch up some of the way.

A further factor you allude to is age. We, as have many other Western countries, have an artificial situation here; populations rise and fall, this is natural, and neither good nor bad, it is just a fact. As our population ages and dies off, property values - away from the sillier 'West End' prices - will decrease in real if not absolute terms, I have seen this first hand in Japan which is a few years ahead of us on the age-curve.

In re' your last bit, I am not quite sure what you are asking. If you seek my opinion on how to pay for public services as a whole, it is very straightforward: facilitate and encourage the creation of wealth and then tax it reasonably.