Should "Care" be part of the NHS? If do how would you pay for it?

There would have to be a step-change, I think Doodledog. However, I would leave that to others to work out! I can't see anything wrong with your thinking personally.

Having looked at the research being done, or rather not being done, it looks as if it would end up as NI paid by those continuing to work and a surtax, equivalent to NI on everyone else over SPA. This happened in the 70s so it's not unknown.

If insurance does come in, it should allow for the fact that many people over 60 (or younger) will have existing conditions that have not been covered earlier in the policy. To make it affordable (and fair, considering the fact that most older people have contributed NI for decades, and are often no longer in a position to pay more), there should be a sliding scale of age-dependent reductions on premiums and exclusions from penalties for existing conditions. This should continue until any change from the current scheme is replaced by an insurance-based version, and anyone born with a condition, or who develops it in childhood (before payments have to be made) should not be penalised either.

IMO, any government bringing in such a scheme would need to make it clear that those paying are not automatically subsidising those who don't pay. Any insurance scheme works on the principle that there will be people who never need it, and that is fair enough, IMO, as is the fact that some will be unable to contribute because of disability etc. Also, those with more money should pay more in premiums.

But there has to be fairness and an expectation that everyone covered by the scheme has contributed according to ability, and that saving or making other provision will not exclude people from making claims. If that doesn't happen, people will object. It is already the case that the same social care goes to those who haven't paid as to those who have (regardless of whether they could have done), and this causes resentment. WFA goes to those with no pension provision, but not to those who have worked and paid into an occupational scheme, even when the amount of pension is very small. Those on certain benefits get reductions and exemptions that people in work do not, even if they have worked long shifts in unrewarding jobs all their lives. Pension Credit can make those who claim it better off than those who don't. If this carries on into health care I think people will revolt. Society is fractured as it is, and IMO it is vital that something like this doesn't make things worse. It will be very difficult to make something like this fair, particularly in the transition period.

"It's not just funding the baby boomer generation, is it? It is also a whole range of disabilies, physical and mental."

I think most people know this. Basically:

Health Care (NHS Care)
Paid for by: The government, through taxation.
Who provides it: The NHS (National Health Service)
Cost to the individual: Generally free at the point of use for UK residents (exceptions: Prescriptions (in England only — free in Scotland, Wales, and Northern Ireland.) Dental treatment. Eye tests and glasses.

Includes: GP visits, Hospital treatment, A&E care, Community nursing, most mental health services

Exceptions: Prescriptions (in England only — free in Scotland, Wales, and Northern Ireland), Dental treatment, Eye tests and glasses. These may require patient contributions or full payment unless you qualify for exemptions (e.g. low income, children, older adults, certain medical conditions).

Social Care (Adult Care and Support)
Paid for by: A combination of individual contributions and local authority funding.

Who provides it: Local councils, private care providers, or charities.

Means-tested: What you pay depends on your income and savings.

In England:
If you have savings or assets over £23,250, you usually pay the full cost yourself (“self-funder”). If your assets are below £14,250, the local authority covers most costs, and you contribute from income. Between £14,250 and £23,250, you pay part of the cost. The council assesses both your care needs and your financial situation.

In Scotland:
Personal and nursing care for older people is free, but accommodation costs in care homes are means-tested. Wales and Northern Ireland have their own systems, with different thresholds and caps.

Types of Care Covered by Social Care:
Home care (help with washing, dressing, meals, etc.)
Residential care (living in a care home)
Nursing care (care homes with nursing staff)
Support for carers or people with disabilities

This should make clear the division between what I meant as this "Care" that could/should(?) be covered by those over State Pension age paying NI. Any government would have to convince those of pension age that this insurance is worth it.

You are right to highlight “care” for people with special needs (also referred to as additional needs or learning disabilities) Once again this falls under both health care and social care, depending on the person’s needs and age. I don't think (or know) whether this would be enough. It seems the only analysis that has been done is on what putting NI on those still working after SPA. It is a large amount but nowhere near what would pay for this area of "care".

It seems governments and researchers have done very little to assess what could be raised by charging passive income of pensioners the same taxes as working income. As I think I suggested somewhere, that what we might shorthand as Special Needs" might be paid for by putting an NI tax equivalent on the passive income of those under SPA.

Casdon

I’m not sure the question fully defines what you mean DaisyAnneReturns? Are you talking about all the provision which is arranged by Social Services departments, for people of all ages, including children and disabled younger people, as well as elderly care services? Are you including those elements of care for older people which are purely social? Where is the link with residential, supported and extra care housing that you envisage? Sorry to be persnickety, but it’s a very big issue, and it needs parameters to understand what you’re suggesting.

Nail on the head, here. Lots of care unrelated to the NHS.

OK - in an ideal world, parts of care should be under the NHS, but with its current systemic communication problems and the huge size,

For now, no, but to improve communications especially when the decisions lie between two authorities, two areas, in that vital handing over between post hospital care and LA care.

Care funding should be equal through the country, I don't know how they could get there: yes to central actual funding.

But since many people with complex care needs draw on assistance not just from SSD, (my DGD is one, and this will be the case all her life) but also a mish mash of other providers, care decisions need to be local and locally managed.

Money: yes, we will have to pay more. Sadly we are stuck in a country where pole demand better care but don't want to shell out.

It's not just funding the baby boomer generation, is it? It is also a whole range of disabilies, physical and mental.

agree better lifestyle choices would sort out my health issues !!!!

No Casdon, someone else introduced it. They obviously thought it was important so I have replied.

agreed!

Do you see prescriptions as ‘care’? It might just be me, but I don’t understand the vision you have.

Free at the point of need as I said Casdon not, under currently agree economics, free.

Prescriptions are free for all in Scotland and Wales, and over 90% are free due to exemptions in England DaisyAnneReturns.

Siptree and David, I think it's essential to remember that health care is not free, prescriptions are not free and care would not be free. They are/would be "free at the point of need".

This may mean that care has to be brought in in a graduated manner. It may mean things we haven't yet imagined. But hang on to truths. It's always worth it.

Social needs are part council tax part centrally funded and they are means tested, changing that would mean a very large tax increase .

Care and prescriptions etc should be free to those that have no means to pay. If you have savings or a house then you should pay. The idea of getting free care so you can leave your money to your children is outdated. Care is too expensive now to be free.if you get free care and leave money to your children, someone else's children are paying for your care.

I lived in Germany for a while and the tax was higher than uk but it was proportionate, the more you earn the more you pay particularly into the health service. You can actually identify what percentage of your taxes go to senior care etc. There is still a payment for prescriptions. If you are a visitor you pay full price. They pay more but they earn more and have a higher standard of living. Our money has never been managed properly that is why UK is such a mess. I have 43 years contributions, one of the lowest pensions in Europe and sadly a barely functioning NHS through lack of funding and proper management, no tinkering will work, a complete overhaul is needed.

FranP

DaisyAnneReturns

There are only two possibilities I can see but you may see more. I do think it would have to come from the older generation to be acceptable to all.

1. Continuing to pay NI after State Pension age.
2. Increase in taxation

I was appalled that my NI contributions stopped at 60, even though I was still working. Thy raised it to state pension age a bit later, and I was happy about that.

I was appalled that my NI contributions stopped at 60, even though I was still working. Thy raised it to state pension age a bit later, and I was happy about that. [FranP]

I just keep thinking that there is nowhere in the world where you could buy health insurance and when you reach a certain age - and are likely to be at your most expensive health wise - they would offer free cover. It makes no sense. As long as payment is progressive it seems only fair. But it could also be an opportunity to add this to passive income (it's been done before) and include at least a wider view of NHS care.

That would make very little difference undines, I just did a quick search on AI.n
‘Management costs are a small proportion of the NHS budget, with estimates for administrative and management costs around 4-6% of total spending. When including broader non-clinical costs like IT and estates, the figure can rise to 6-10%. A 2023 estimate suggested NHS England's core administration and program costs accounted for approximately £3.2 billion of its £152.6 billion budget.’

When you put back in the essential clinical support administration, ‘upper tier management’ probably accounts for less than 1% of total expenditure. It might be still too much, but losing it will make very little difference financially to the NHS.

Sack at least half the upper management in the NHS - their empire building and massive salaries are at least half the problem

DaisyAnneReturns

There are only two possibilities I can see but you may see more. I do think it would have to come from the older generation to be acceptable to all.

1. Continuing to pay NI after State Pension age.
2. Increase in taxation

I was appalled that my NI contributions stopped at 60, even though I was still working. Thy raised it to state pension age a bit later, and I was happy about that.

I'd be happy to pay extra tax of some kind to get state provided care when I get old and incapacitated - IF - it was sufficient and good quality.

I don't really know what to say to that.

I'd be happy to pay extra tax of some kind to get state provided care when I get old and incapacitated - IF - it was sufficient and good quality. I remember the days when it was medicalized in the old psychiatric asylums, before community care. Huge, effectively locked, wards full of elderly dementia patients cared for in the most basic way. I'd like to think the care is better than that now but I would be concerned that basic state funded care would be of a similarly poor standard. However, like Angela Raynor, I have the future of a disabled young person to think about and I fear for their future if I can't pass on a decent inheritance to ensure they can keep their home, so the thought of having it all spent on my care is worrying. I guess it's off to Switzerland while I've still got my marbles 😕

Lathyrus3

aonk

I completely understand your point of view Lathyrus 3. I’d just like to say that I’ve struggled for a long time with blood pressure and cholesterol issues. Despite my best efforts I haven’t been able to achieve the right levels without the help of medication. I’m not at all overweight, don’t smoke, have 1 alcoholic drink a week, get exercise and eat sensibly. My GP says this isn’t uncommon and that the medication is essential for me.

Yes, I take some stuff myself now so I do know sometimes your body won’t do as it’s told!😬

I don’t have an easy solution to prescription charges but except a feeling that those who can pay, at least something towards the cost, should. I can afford to pay a charge more easily than that one of my neighbours who is in her forties. But because I’m old I don’t 🤔

A friend of ours, who left well over £1m cash and two houses paid for, used to stockpile various free prescriptions, even for things like paracetamol*, that you can buy anywhere for pennies.

I once counted over 60 items in his bathroom.
More than once, most of them were thrown away by an ex nurse friend.

The thing was, he was incredibly tight (except for anything he personally wanted) so I’m sure he’d never have taken so many items he didn’t need, if he’d had to pay even £3 each.

*I once read that every prescription, regardless of the cost of the item, costs the NHS £7 in admin/payment to the pharmacist. I dare say it’s more than that now.

valdavi I wasn't thinking of it as part of the NHS or separate. What I was suggesting was that our insurance should cover all health needs.

I generally feel businesses work best if kept as small as possible, hiving off areas that become a business in their own right. They can still be under one overall Chairman (Minister). I don't see why that shouldn't be applied to health. However, I very strongly feel we must stop outsourcing. Without ownership of the assets you cannot control the budget as well as you can with them.

The changes made by governments are incredibly slow. Devolution should have already started to equalise what the mayoral areas receive. I may be wrong but I see no sign of that. Keeping people at home has to be the aim but to do that you need more day care, etc. This is probably too much detail away from how we pay!

Ah, I see. Can we tax wealth too, while we are about it?

I am not qualified to say which fund should support what, but wonder whether there should be a 'social care' fund to cover those who need it. Care homes for the elderly, provision for young disabled people and so on. Would it help if it were separate from the NHS and LA?

As I see it, social care is exactly the sort of thing that everyone should contribute towards, as those who need it are often not in a position to pay for it, for obvious reasons.

I'm not sure that NI is the way forward, as that seems to be a tax on work, which is not fair.

I was aiming to suggest that NI is charged on all income. The very thing I feel we must avoid is increasing NI on earned income. I hope that clarifies that area Doodledog.

Yes, I know many people have been moved out of expensive London boroughs to cheaper rental areas, with the London LA paying their rent for the first period, and then expecting the LA they have moved to to pick up the tab Lathyrus3, a lot have ended up in South Wales that way. The way I read DaisyAnnReturns post was that she was talking about a new model of care though, so that compensating for the current inequality could be built in I think.