Tax increase to pay for Social Care...

[whelk]

I don't know, speaking to my mates and family in Surrey most seem to be up for the idea, as am I (also a Surrey resident).

 

Good on you. As I said earlier annoying the deflection of the issue onto councils who also picking up burden from failing NHS

[Whitey Grandad]

I am aware how funded. Sorry can't be arsed with the link to a daily mail article as sure to be one of the ones they have on tap just to get the likes of you frothing and suitably angry as to why a special needs kid can't get the services they needs in one of the richest economies in one of the most prosperous parts of the UK. In no way this is tax or cut based, just wasting it all on expensive plants or paying someone managing a billion pound budget £200k (and more than the PM don't you know).

All the usual Tory spin goes out the window when a Tory led council is raising the issue. Akin to Oxfordshire situation when the naive David Cameron replied with some blithe b0llocks to the Tory leader when his mum was campaigning against cuts.

 

Anyway views are entrenched and all the selfish bastards who like to take what they can from society and hate the thought of giving any back to the less well off or vulnerable will not be swayed.

Wish they would just acknowledge that rather than cry waste

 

You know nothing about 'the likes of me'. I amd merely putting some perspective on the situation.

 

Besides, I hate the Daily Mail with a vengeance. I wouldn't even hang it on the wall in my toilet, not even the one reserved for visitors.

[whelk]

You know nothing about 'the likes of me'. I amd merely putting some perspective on the situation.

 

Besides, I hate the Daily Mail with a vengeance. I wouldn't even hang it on the wall in my toilet, not even the one reserved for visitors.

 

Ok fair point Whitey and I retract. Too easy to generalise.

 

And quoting you didn't mean inferring you are like Duck and Trousers (sounds like a good pub name)

[Whitey Grandad]

I don't know, speaking to my mates and family in Surrey most seem to be up for the idea, as am I (also a Surrey resident).

 

You do realise that Surrey will be inundated with elderly people seeking care in their later stages? Or are you considering introducing a postcode or residency qualification?

[Whitey Grandad]

Ok fair point Whitey and I retract. Too easy to generalise.

 

Thanks, very noble of you and much appreciated

[OldNick]

Got any evidence for that? Cut services and yeah it's the poor old bin man pension that is the cause.

Worrying how many dumb easily spun people there are out there.

Its not the low paid public employees who have the meaty pensions

[Whitey Grandad]

Its not the low paid public employees who have the meaty pensions

 

Indeed they don't.

[trousers]

You need to do some research.

 

Quite possibly. My 'evidence' for the existence of inept NHS procurement outcomes emanates from my sister-in-law (NHS senior nurse) and wife (NHS Temporary Staffing Coordinator). Not to mention how often they bang on about the wasting of money that exists for internal practices too. But, yes, I accept any 'evidence' I have is largely 2nd hand and anecdotal.

 

p.s. the temporary staffing issues (e.g. extortionate agency rates) at the hospitals that my wife covers has pretty much been sorted now, resulting in significant savings.

[Unbelievable Jeff]

You do realise that Surrey will be inundated with elderly people seeking care in their later stages? Or are you considering introducing a postcode or residency qualification?

 

To be fair Whitey, considering the cost of property in Surrey I don't think that will be an issue. Those that can afford to move here can afford their own social care.

[badgerx16]

The problem is that historic pensions take so much much of the council tax we pay. So many of the council pensions were far too generous.

But, having been contracted out of the additional state pension scheme, former council staff will take a smaller slice of the over £100 billion annual pension spend, which comes from your general taxation liability.

[buctootim]

Surely that's only true if the NHS procurement department(s) aren't very good at their job?

 

There's a middle ground to all of this though, it just has to be well-managed, which we don't seem to do very well.

 

There is a middle ground. The trouble is social care is nothing like making widgets in a factory, developing an IT project or buying in supplies. In those examples you have scope to design better, get quicker machines, import cheaper from low wage countries, use an existing software package developed elsewhere etc. There is no scope for that in homecare.

 

In a council directly managed service your costs are basically a manager, workers who are already on minimum wage or near to it and some transport. If you contract out to a private company you start running up additional costs. The council needs to pay for a competitive tendering process and they need to employ contract managers to oversee that process and the subsequent contracts. The bidders have costs in preparing the tender process, in tendering for the contract, employing their own contract managers (in addition to service managers) and they cant employ people at less than minimum wage - and after paying those additional costs they still need to need to run the service cheaper in order to make a profit. Where are the savings going to come from? The savings come from reducing the service, cutting corners, not doing things properly so you can do them quicker.

 

If you want to buy TVs for a hospital, contract out. If you want to build a hospital contract out and pay for it, don't PFI it. If you want to run core services, keep it in-house and create an Audit Commission type body to oversee.

Edited 20 January, 2017 by buctootim

[whelk]

Quite possibly. My 'evidence' for the existence of inept NHS procurement outcomes emanates from my sister-in-law (NHS senior nurse) and wife (NHS Temporary Staffing Coordinator). Not to mention how often they bang on about the wasting of money that exists for internal practices too. But, yes, I accept any 'evidence' I have is largely 2nd hand and anecdotal.

 

p.s. the temporary staffing issues (e.g. extortionate agency rates) at the hospitals that my wife covers has pretty much been sorted now, resulting in significant savings.

 

I am far from saying there are not huge examples of waste in NHS and is painful to see. I fully applaud your example of resolving the temp staffing exorbitant rates - i think we are saying same thing.

[buctootim]

I am far from saying there are not huge examples of waste in NHS and is painful to see. I fully applaud your example of resolving the temp staffing exorbitant rates - i think we are saying same thing.

 

The temp crisis is a classic product of poor central government policy. Why are hospitals paying through the nose for agency staff? because they have to, they cant get permanent staff. Why no permanent staff? because the Government thought it was a whacko wheeze to save £10 by cutting nursing training and ended up landing the trusts with a bill for millions a few years down the line.

[buctootim]

Quite possibly. My 'evidence' for the existence of inept NHS procurement outcomes emanates from my sister-in-law (NHS senior nurse) and wife (NHS Temporary Staffing Coordinator). Not to mention how often they bang on about the wasting of money that exists for internal practices too. But, yes, I accept any 'evidence' I have is largely 2nd hand and anecdotal.

 

p.s. the temporary staffing issues (e.g. extortionate agency rates) at the hospitals that my wife covers has pretty much been sorted now, resulting in significant savings.

 

Why does Britain pay some of the lowest prices for drugs in the developed world? Because NHS procurement is crap and dont know what they're doing? It would be so much better if we broke up the huge purchasing power of the NHS into small blocs and contracted out so people had a fair and reasonable opportunity to make profits on cancer drugs. Then we could be like the US - paying a fortune for the same products.

 

http://usu ****.com/news/us-drug-prices-in-the-us-are-literally-insane-when-compared-to-other-nations/ remove the space between usu and **** on address, it should say us un cut

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00449-0/abstract

Edited 20 January, 2017 by buctootim

[trousers]

Why are hospitals paying through the nose for agency staff? because they have to, they cant get permanent staff. they cant get permanent staff. Why no permanent staff? because the Government thought it was a whacko wheeze to save £10 by cutting nursing training and ended up landing the trusts with a bill for millions a few years down the line.

 

That doesn't match my understanding (based on chats with the missus and her sister).

 

One of the main reasons they had a constant drain on permanent staff, at the hospital trust my wife looks after, was because the agencies paid way over the market rate. Simple as that. Meanwhile, the agencies kept bumping up their charge-out rates to the hospitals (because there was nothing contractually stopping them doing so... i.e. weak procurement...?) which in turn attracted more permanent staff over to the dark side. i.e. it was a vicious circle. Last year, a cap on agency fees was introduced (can't remember by whom.... central government or the trust themselves?) and now the temporary/permanent balance is starting to re-adjust.

[trousers]

Why does Britain pay some of the lowest prices for drugs in the developed world? Because NHS procurement is crap and dont know what they're doing? It would be so much better if we broke up the huge purchasing power of the NHS into small blocs and contracted out so people had a fair and reasonable opportunity to make profits on cancer drugs. Then we could be like the US - paying a fortune for the same products.

 

http://usu ****.com/news/us-drug-prices-in-the-us-are-literally-insane-when-compared-to-other-nations/ remove the space between usu and **** on address, it should say us un cut

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00449-0/abstract

 

I wasn't talking about drug procurement, per se. I know even less about that side of it than I know about the other stuff

 

The areas I know most about is staffing, services and non-clinical stock.

 

I'm no expert (does it show?! )... just sharing what I've heard anecdotally.

[benjii]

Why does Britain pay some of the lowest prices for drugs in the developed world? Because NHS procurement is crap and dont know what they're doing? It would be so much better if we broke up the huge purchasing power of the NHS into small blocs and contracted out so people had a fair and reasonable opportunity to make profits on cancer drugs. Then we could be like the US - paying a fortune for the same products.

 

http://usu ****.com/news/us-drug-prices-in-the-us-are-literally-insane-when-compared-to-other-nations/ remove the space between usu and **** on address, it should say us un cut

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00449-0/abstract

 

You've answered your question - it's because of commercial leverage and economies of scale due to size. That's a structural aspect of having a great big monolithic health service and, in this case, a virtue. It's not, in itself, evidence of procurement norms (positive or negative).

[buctootim]

You've answered your question - it's because of commercial leverage and economies of scale due to size. That's a structural aspect of having a great big monolithic health service and, in this case, a virtue. It's not, in itself, evidence of procurement norms (positive or negative).

 

Agreed. Im not saying there is never room for improvement, a few drugs appear expensive compared with peers. However overall the NHS has a very good record in procurement - especially given that in many cases there is only one supplier of newer non generic drugs so no opportunity for playing one off against another.

[buctootim]

I wasn't talking about drug procurement, per se. I know even less about that side of it than I know about the other stuff

 

The areas I know most about is staffing, services and non-clinical stock.

 

I'm no expert (does it show?! )... just sharing what I've heard anecdotally.

 

If they have a good record in areas where you can objectively measure their performance against other countries, is it not reasonable to having a starting position that they are competent in areas where comparisons are more difficult? My experience of the NHS is that almost everytime you look into things which appear odd, it turns out there is either a good reason for things being that way, or there is some Government imposed regulatory requirement that they should be.

Edited 20 January, 2017 by buctootim

[buctootim]

That doesn't match my understanding (based on chats with the missus and her sister).

 

One of the main reasons they had a constant drain on permanent staff, at the hospital trust my wife looks after, was because the agencies paid way over the market rate. Simple as that. Meanwhile, the agencies kept bumping up their charge-out rates to the hospitals (because there was nothing contractually stopping them doing so... i.e. weak procurement...?) which in turn attracted more permanent staff over to the dark side. i.e. it was a vicious circle. Last year, a cap on agency fees was introduced (can't remember by whom.... central government or the trust themselves?) and now the temporary/permanent balance is starting to re-adjust.

 

Yes but how did the Catch 22 come about? The supply of qualified nursing staff no longer matched the demand so hospitals started going to agencies to fill the gaps - and because staff were scarce prices were high. Existing staff learned they could get far more working for an agency than their current employer and so left to work on a an agency basis, thereby exacerbating the problem. Sky high expensive agency staff is not the only problem cutting nursing training places created, it also drove the massive influx of overseas nurses as hospitals tried to fill gaps.

[angelman]

Couple of questions...

 

1) If the 15% rise comes in, is this going to be ring-fenced and when is the next 15% increase going to be?

 

2) As typically about 20-25% of council tax raised from people (as opposed to central government grants) goes for pensions (or used to), is there not already not enough money being raised? That's rhetorical as obviously there isn't, but more that councils often spend money elsewhere. I do wonder how many people have ever read the council financial statements. Surrey's is interesting. Various things like £125m PFI liability. £2.8bn pension liabilities. They've got long term liabilities of £1.8bn (compared to Hants CC long term liabilities of £584m, and pension liability of just over £1bn)

[trousers]

If they have a good record in areas where you can objectively measure their performance against other countries, is it not reasonable to having a starting position that they are competent in areas where comparisons are more difficult? My experience of the NHS is that almost everytime you look into things which appear odd, it turns out there is either a good reason for things being that way, or there is some Government imposed regulatory requirement that they should be.

I'll introduce you to the missus and her sister one day. Then you can hear their gripes about everything that is wrong with local management first hand

Edited 20 January, 2017 by trousers

[trousers]

Yes but how did the Catch 22 come about? The supply of qualified nursing staff no longer matched the demand so hospitals started going to agencies to fill the gaps - and because staff were scarce prices were high. Existing staff learned they could get far more working for an agency than their current employer and so left to work on a an agency basis, thereby exacerbating the problem. Sky high expensive agency staff is not the only problem cutting nursing training places created, it also drove the massive influx of overseas nurses as hospitals tried to fill gaps.

I'll run that point of view by my 'insiders' and let you know if they concur

[buctootim]

I'll run that point of view by my 'insiders' and let you know if they concur

 

You can have a legitimate opinion on quality of local management but what happened to training places from 2010 onwards is a matter of fact. There are dozens of stories about it from 2010 warning of the consequences right up till now exposing the problems. This one from the Telegraph covers most bases.

http://www.telegraph.co.uk/news/nhs/11689202/NHS-spends-huge-sums-on-foreign-nurses-yet-two-thirds-of-local-applicants-are-rejected.html

https://www.theguardian.com/society/2015/apr/04/nhs-recruits-one-in-four-nurses-from-abroad

[badgerx16]

Couple of questions...

 

1) If the 15% rise comes in, is this going to be ring-fenced and when is the next 15% increase going to be?

 

2) As typically about 20-25% of council tax raised from people (as opposed to central government grants) goes for pensions (or used to), is there not already not enough money being raised? That's rhetorical as obviously there isn't, but more that councils often spend money elsewhere. I do wonder how many people have ever read the council financial statements. Surrey's is interesting. Various things like £125m PFI liability. £2.8bn pension liabilities. They've got long term liabilities of £1.8bn (compared to Hants CC long term liabilities of £584m, and pension liability of just over £1bn)

 

The underlying issue relates to how councils are funded, and the balance between central and local funding. Historically there have been 3 main sources of funding; Council Tax, Business Rates, and Government grant funding. Since the coalition government took office, grant funding has been heavily cut, and this is planned to continue until at least the end of this Parliament. ( Net, over the 10 years of the 2 Parliamants, some councils will have had grant cuts of over 50%, allowing for inflation ). This puts pressure on councils of all sizes and political hues, and is exacerbated by restrictions on their ability to increase Council Tax to compensate, and the transfer of additional statutory service responsibilties, such as Public Health. For several years Council Tax increases were 'strongly' discouraged by Westminster, with punitive measures imposed for ignoring Central Government's ruling. Now, as with Surrey CC, they can in theory increase local taxation beyond Westminster's recommendation, subject to a local referendum to assess voter support for it.

The third aspect of funding, Business Rates, is also being overhauled, such that many councils will lose money. This is because the original process involved all BR collected going into a national pot, which was then redistributed by Westminster, which meant that some councils got back less than they paid in, and others got more. The new proposals mean that all monies raised stay within the specific local authority, which should reverse this imbalance.

 

So in answer to your points, (1), that is down to Surrey CC's budgetary management. The referendum will be on whether the 15% raise is acceptable, the ring-fencing may well turn out to be a "politician's promise". Any further rise depends on an awful lot of ifs, buts, and maybes.

 

(2), many of the councils that have to provide statutory Social Care; Counties, Mets, and Unitary Councils, claim to be in the position that once they have accounted for their statutory obligations, mainly Social Care but including pensions, there is literally nothing left in the pot.

Edited 20 January, 2017 by badgerx16