Taxing retired households to pay for care

Guest blog

This is the third and final guest blog that we are publishing in the run-up to the launch of the final report from the Commission on the Future of Health and Social Care in England.

Each blog focuses on one of the possible options for funding future health and social care considered in the commission’s interim report. Here, Andrew Harrop of the Fabian Society argues that retired households should contribute more towards the costs of health and care. 

The commission will make its final recommendations on 4 September.

Here’s an £8 billion answer to the health and care funding crisis: ask retired people to pay their fair share. For this sum is the difference between the amount of tax that retired households pay in a year and the amount they would pay if they were not retired. According to ONS figures, in 2012/13 non-retired households with middle incomes paid 35 per cent of their gross income in tax. This compares to the 29 per cent paid by retired households with roughly the same income (after making an adjustment for household size). 

It is hard to think of plausible reasons to justify this inequality. It’s not about pensioners being poorer overall: the tax gap is a calculation based on the difference we pay in tax as a share of our income (and anyway the gap isn’t observed between young and old households with very low incomes). Nor can it be justified by differences in wealth: retired households have higher assets than non-retired households on average. If wealth was taken into account and we thought broadly about ‘ability to pay’, the inter-generational tax gap would be even larger.

Instead, the gap is explained in two words: National Insurance. So, with the funding of health and care in crisis and retired households richer than ever, is it time for older people to pay National Insurance on their income? Or, to put it another way, is it time to merge National Insurance and income tax?

But to win the public’s support, the money must be earmarked for retired people’s health and social care. This cannot be just a tax rise, but a solution to a financial crisis facing us all in old age: ‘from older people, to older people’.

Indeed it is only because of history that retired households – those who use the NHS the most – don’t pay National Insurance. In the Beveridge Report of 1942, health care was listed as one of the insured benefits to which National Insurance created entitlement. But from day one, retired people were enrolled into the NHS without being asked to contribute. Back then, there was no way that most pensioners could have afforded to pay - they were too few in number for it to make much difference anyway. Today, the £8 billion gap shows this is now a discrepancy worth worrying about.

The Fabian Society, using the latest ONS data on income, tax and benefits, calculated that you could raise more than £8 billion if you levied National Insurance on older people’s total taxable incomes (including earnings, pensions and investment income). This would treat retired households on roughly the same basis as working households whose income mainly consist of earnings. 

To protect those with low incomes it would make sense to introduce a high starting threshold for National Insurance, imitating the coalition’s reforms to income tax. The table below illustrates the impact of a 12 per cent contribution on income over £10,000 in today’s prices. The policy would leave the average retired household paying £23 per week extra: not a terrible membership fee for a world-class health and care system. Better still, the reform would be progressive. Many people in the poorest fifth of retired households would pay nothing, while those in the richest fifth would pay over £70 each week, on average.

The impact of applying National Insurance at 12 per cent to pensioners’ incomes, with a lower threshold of £10,000 per year

Income quintile of retired householdsPoorest234RichestAverage
Income range of quintile (assuming 2 person family)under £14,400£14,400 to £17,600£17,600 to £21,600£21,600 to £28,800over £28,800-
Average National Insurance payable per week£0£6£12£28£71£23

Source: The effects of taxes and benefits on household income 2012/13, ONS, 2014; author’s calculations

This could all be phased in over time. For example, in each Budget in the next parliament, the chancellor could cut National Insurance employee and self-employed contributions by two pence in the pound and increase the basic rate of income tax by the same amount. National Insurance would wither on the vine and income tax would rise to take its place.

The main objection to the whole idea is political: would anyone dare to take on the grey vote? It would take a skilful politician to sell this as a ‘something for something’ deal, not a tax raid on the nation’s grannies. But every penny would go to pay for health and care in our long retirements. 

What are the alternatives? Ever deeper cuts to other hard pressed public services? A lottery where some older people pay huge sums themselves? A hike on National Insurance for workers, whose incomes have stalled for a decade, unlike those of older people? A death tax, which the truly rich can always evade?

No tax rise is an easy sell, but this has one great advantage: it is fair.

Andrew Harrop is General Secretary of the Fabian Society, Britain’s oldest political think-tank.

This is a guest blog post. The views expressed are the author’s own and do not necessarily represent the views of The King’s Fund.

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#42438 Wills

This is a ridiculous theory. Pointing the finger at the elderly, the sick, the poor, the young, all abandons the sensible 1945 principles of public provision of health and social care: to each according to need, from each according to ability and it will all work out over a lifetime. Those who do pay in more than they get out are the lucky ones because they were naturally fitter and more able.
Specifically on this hair-brained scheme:
1) Those who are retired now have already spent their working lives paying contributions for the care of the then-elderly in an implicit contract that the same would be done for them.
2) A good proportion of the income of the retired goes on ensuring that they do not require the health and social care system. (Proper heating, food, adapting homes.)
3) Any significant savings held excludes the retired from free social care anyway so they will not be taking money from the state.
You might as well argue that 16-year-olds should not be treated on the NHS until they've built up a sufficient balance in the system. It misunderstands the cost-efficient system based on mutualism.

#42439 bryan

The wealthy retired have generally been the beneficiaries of enormous tax cuts toward the end of their working lives, at peak earning levels.

#42440 Roger Avon
Previously Government, local government, NHS & others

I think this idea is a non-starter and is only looking for an income source when what is required is a fundamental restructuring with much larger 'Business' sized trusts (would cut non-core admin by 50%+) but no reduction in operational staff coupled with targeted payment areas e.g. meal charges for all except those on benefits and under 18's, tighter residency rules for non emergency treatment, all lifestyle treatment to be charged, etc

#42442 A Crail

This is a preposterous suggestion. Tax people more in their years of need. Not quite a pensioner, I am finding things are starting to require attention and so far have had to turn to the private sector every time for prompt and decent healthcare. For the previous 5 decades I have scarcely needed or had anything from the NHS. Why not tax younger people who drink, play sports and in other ways cause the NHS to spend money on them? And stop encouragng, even forcing, people to seek a longer life if expenses on the elderly are unpalatable. How old is the author of this blog anyway? He may change his tune in time.

#42443 Geoffrey rivett

The wild proposals from today's bright young thinkers are in the teeth of everything that Bevan stood for and the thin end of a thick and nasty wedge that could as easily tax smokers and sportsmen and the chronic sick more. There are many people who do not pay their fair share and we should not go down these roads with copayments and the rest. I begin to feel that the fund is ceasing to be fit for purpose.

#42444 Roger

Here we go again. Just why is it that people don't think ahead? Government knows that we all get old, yet refuses to make sure that the care system is funded properly through taxation when the cost is spread across the whole of the population whether working or retired. What happens if a person has spent their pension pot before getting "old"?
All governments seem to want to do is to cut taxation and cut services and funding of essential health and social care.
Strange that we can always find billions for the services to fight overseas, yet nothing for our own citizens when vulnerable and in need.

#42445 Vince Molloy
The Molloy Preservation Society

I fought in a long forgotten Gulf War, was an unpaid family carer for most of my life and voluntarily contributed to many aspects of my community for years. I have medals, the gratitude of successive Governments and letters of appreciation.

Now some young blogger says that it would be totally fair for me to pay some additional Tax.

Idiot! We should all pay more Tax.

#42446 Loyola Weeks
Non executive Director
O Donovan Weeks Ltd

The inequality of the ' new pension' system makes me so angry I have worked since I was 16 , as a nurse could retire at 55 did so for a pittance pension and then was informed my state pension would be moved to 67!
When I asked my MP to explain the inequality of male / female system was sent a patronising letter from Steve Webb MP quote ' many women in your constituency, such as Ms Weeks s will be primary beneficiaries of the new scheme,,,,,, does he really believe this ? And how rude is he , ?

#42447 Dr Mike Warren
Retired GP Hospice Trustee
St Johns Hospice Lancaster South Lakes

Odd to remove NI - it was to fund NHS amongst other things! I am of a generation whose parents instilled "save up for your old age" and have done so (based admittedly on a good job). Health and social care has to be paid for - directly from my pocket - kids miss the inheritance but, in general terms pay less tax, or they pay more and get my money and house. Taxing me extra as an older person is effectively the same as expecting me to self fund. Money does not grow on trees! Political dynamite without realism which is unpopular.

#42448 Robin Webb

I agree with Andrew and would advocate slightly higher contributions. I am retired and in the poorer part of his table of suggested NI contributions but not the poorest. What isn't fair is the fact that it is needed. Surely those in power must have been asleep. The elderly haven't just popped out of nowhere - we have always been here and population numbers have always been known. Shame on those who were too inept to realise, or perhaps was it because of wooing the public with lower NI contribution promises in past years, to get votes? What a shocking system of selfishness on the governments part. If we the population of U.K. need services, then we should expect to pay for them. Let's have some honesty in politics - you know it makes sense and will pay for itself in the long run.

#42450 John Crawford

Totally agree with your comment, mutulalisation and sharing of risk across generations is the right way. It is manifestly unfair for change the rules when one generation reaches retirement age, having contributed to society through their working life.

#42451 John Kennedy
Medical Practitioner

I think the idea has merit,providing there were sufficient safeguards for those for whom this would prove too burdensome. The younger tax payers (and I can't include myself in this group) are now paying through taxation for the pensions of the retired public sector workers from age 60 whilst they,themselves will not retire before age 68,if then and are likely to have much reduced pensions. Hence, further consideration of what might be fairer for working and retired people does not seem so unreasonable given the context.

#42453 Jim
Health & Wellbeing

Somewhat ironic that in a discussion about age, many of these comments seem to dismiss the rhetric of the blogger due to his youthful looks...irrelevant in my opinion.

This argument is practical in the sense that it brings attention to the widening gap between health and care costs and the drindling monetary provisions supplied by government to meet people's needs.

I'm not in favour of this proposal's a seperatist approach and is not in keeping with the principles of the NHS as it was founded.

The funding gap needs to be addressed by: greater investment and statutory support for preventative models of health and care, greater efficiency, greater choice (personalised budgets) and increased taxation accross all generations. The burden must be shared by all!

#42454 Christopher Heg...
Values Based Commissioning Ltd

I agree with Wills' comment (42438) for the same reasons. Most retired people have paid Tax and NI for 40 or more years, many at higher levels; and many have paid into private pension funds but often receive relatively small pensions. For example, the average individual private pension fund is only c.£20,000 and buys a very small annuity. What has happened to the collective covenant where we pay when we can and receive beneffits when we need them. I am sorry that the Fabian Society appears to have become a branch of the Tory Party - its not what I signed up for. Perhaps it would be better if the Fabians developed improved collective proposals that would hold the NHS and social care together in a covenant that values everyone and does not seek to pauperise those without income-earning potential who mostly live on small often fixed incomes.

#42455 Rush

Ridculous elderly have been paying like the young do today all their working lives towards the NHS. We need to look at the NHS and consolidate the waste.

#42456 Stuart Tilsley
Healthcare Consultant
ST Healthcare Associates

Interesting to note that Mr Harrop is young. When many hard-working folk have paid into the system for 50 years & more, some prat feels we should pay more at a time when we are entitled to some payback. Typical of left-leaning organisations - always good at spending other peoples money!

#42457 Gary
IT Sales Team Manager

A non starter for me, looking to impact people who have paid into the system all their lives at the point that they will need this service more than ever! What about looking at people who mis-use the NHS system, why dont we charge for people who get drunk- this is their choice- They get so drunk that they have to have an ambulance sent out and then admitted to hospital,as its their choice and not an illness or natural emergency they should be charged for using the NHS. What about taking a payment off NHS Tourists- People who come into our country knowing that they will recieve treatment and then return to their country of origin without paying for the treatment they recieved, I know we are supposed to hand over a charge but look at the owed money to the NHS- Take the money up front! What about Hoax calls- review the calls made to 999 /111 and the impact that has on the time of the advisor and possible resource that made be sent out to triage just in case they are hurt - as the NHS has to be risk adverse they have to attend in most cases- charge again for mis-use. There are other ways to review the financial impacts to the NHS, taxing the retired is not one of them in my view.

#42458 Piers
Managing Director
Healthcare Investment Company

It is unfortunate result of an ageing population that the funding gap alluded to in the blog has become such a huge issue. When the NHS was first created average life expectancy was 72 (or retirement plus 7 years). Now it's closer to 82 meaning that the average Briton lives for 17 years in retirement.

The cost of looking after an ageing population naturally puts pressure on those of working age to pay more tax into the system. That's why the current government is pushing the retirement age back to 68 in an effort to expand the workforce and shrink the number of retirees.

It makes no sense, however, to increase taxes for those who are already in retirement. The state is already withdrawing from the provision of social care which implicitly forces working people to make provisions to pay for their own care. Along with the phenomenal increase in property prices, the other reason why so much wealth is stored in the older population is fear. Fear that the government won't look after them when they're vulnerable. Fear that their children will be unable to afford care costs that can easily reach £1000 per week. Fear that the National Insurance they've paid for 40 years has already been frittered away by successive governments.

At any given moment in our lifetimes it is ridiculous to expect that tax paid in should exactly equal the cost of services used. We start in deficit, pay our way to a surplus and then reduce back towards par. We might as well expect our children to start paying for their own childcare costs if we expect older people to meet the full cost of their care.

The system is undeniably broken but this isn't the answer.

#42459 Paul Thackray
Retired / Unpaid Volunteer

The problem is that current generations want it all now and in the future ,and borrow beyond their means to achieve this. Earlier generations paid a much greater proportion of their incomes in taxes and were prepared to forego current satiation for future benefits.
The proposal will only make matters worse by encouraging yet more profligate behaviour.

#42460 Joe Farrington-...

A shame most commenters haven't bothered to look further than the headline and the photo.

It is not true that today's pensioners have paid into a pot that they can now draw on. They have paid for contemporary need which, while they were working, was smaller.

It would be difficult, and unfair to one generation, to introduce this proposal overnight without a significant increase in entitlement to free care - this might then be acceptable as a something-for-something deal.

Rather than eliminating NI, shouldn't we go the other way and ensure that a greater proportion of health and care spending is collectively pre-funded by today's generation, for their own old age? That would be the way for long term sustainability.

#42461 Christine Usher
Clinical Scientist

This is illogical and pointless. Firstly it assumes that NI is a hypothecated tax for the NHS, when in fact its just another form of income tax. Second, all the retired people have already contributed through their working life, in the indurance model its perfectly reasonable - they have paid up and now they are claiming the benefits. I assume the argument is that older people use the NHS more so they should pay more, but they already have through taxation which most will have paid for 40 years. The ones who haven't contributed there fair share are all those kids getting born, getting vaccinations, etc without contributing a penny. If you think the proposal that children should be charged for health care is daft, it is equally daft to charge older people more letting people who live unhealthy lifestyles and die prematurely off by contributing less.

#42462 judith irene brown
management member Bristol Older Peoples Forum

Thanks Andrew, for nearly giving me a stroke! I have paid since the age of 16 towards the NHS, worked until 69 and I am now 75. You can save 8 billion by cutting the amount of money wasted in so called overseas development which goes in corruption,the pockets of local bigwigs, and bribes, money which seems unaccounted for, and which fails to help the poorest. We give this money to places like India, who can afford their own nuclear weapons. I would cut the budget in two, give half to oxfam and put the other half into the NHS. You are too young to have heard the old adage 'Charity begins at Home' so let me remind you. Could it possibly be time to think of our own people first? Angry Nan, Bristol

#42463 Marie

I was ready to fire from the hip as a lot of the commentators have as a result of the head line of this blog. Then I actually read it! I have worked in the public sector for the last 33 years, and I am part of the demographic of women that has seen the state pension age shift to 67 years in the so called name of equality. So I have my own issues with what has happened to pension provision. However it is right that there should be parity of contribution to the costs of the NHS paid by each adult citizen taking into account the actual level of income of each citizen. This means that whether you are a pensioner or not if your income reaches a certain threshold you should pay an equivalent contribution to the non-pensioner citizen on the same level of income. Whether you call it tax or National Insurance it almost doesn't matter. What does matter is that we have a NHS that returns to functioning on the basis of its founding principles- free at the point of access and that provides a high standard of care for all as needed. Lets stop taking a punitive approach to risk taking behaviour and life style choices and lets also stop dividing people into the deserving and undeserving. Instead we need to set taxation fairly to cover the costs of services that we know it is more beneficial to provide through communal means , on a not for profit basis (i.e a social democratic model). This way we will gradually improve individual and communal well being for all.

#42465 David Jones
E/M National Pensioners Convention

Here we go again! Intergenerational divisions, but am not surprised it comes from the Fabian Society. Some of us are old enough to remember what it was like before the NHS was created and people forget that the main reason was to improve the health of the nation and its workforce.
That still applies and I am pleased to see that most contributions support an increase in some form of taxation to help fund one of the best health services in the world. Andrew forgets one important point. Who are picking up the pieces of our welfare state that is being destroyed by this government. It is older people out in the community covering for services that have gone because of drastic cuts to local authorities.

#42467 Ian Williams
Williams & Associates

Two problems which bedevil public provision are;
- the failure of successive governments to invest Income tax/National Insurance (same thing) in an interest generating fund. (see Norway in respect of oil revenues)
Had they done so I can prove for e.g that all persons having paid in sufficient NI to qualify for a full state pension would more than have covered the full entitlement.
- A similar argument applies to the funding of the NHS.
Consequently whinging about the demands of the elderly is totally misplaced and dangerously divisive.
I suggest that Mr Harrup pays more attention to eliminating massive government waste and the idealogical pursuit of unlimited immigration which has placed far higher burdens on State provision than any elderly indigenous British citizens.
Mr Harrup welcome such advances in medicine which are improving the quality of life for elderly citizens and take pride in funding this provision rather than the illogical largesse of unklimited immigration and profligate government waste and incompetence.

#42472 Rob Greig
CHief Executive
National Development Team for Inclusion

Clearly the Fabian Society is no longer the bastion of progressive and socially just thinking that it once was. By this logic, disabled people should pay a higher tax rate, as should poor people (given the clear links between poverty and ill health and thus demands upon the healthcare system. It is just a ridiculous and frankly offensive suggestion that, as I type this, I am wondering why I am giving the author attention by deigning to writ ethos response.

#42475 Helen
Health research

I support the founding principles of the NHS, agreeing with many of the views already expressed and would not support such proposals. However, I believe that the money for the NHS should be raise through an hypothecated tax, which I would be supported by the majority of the population, whereas general increases are never popular. Much of one’s personal health is accounted for by either genetics or luck, and much less by ‘behaviour’ than the government would want to admit. We were unlucky in that a family member needed expensive tertiary care throughout her life, but lucky to be healthy ourselves throughout the same period.

#42476 Helen
Health research

I support the founding principles of the NHS, agreeing with many of the views already expressed and would not support such proposals. However, I believe that the money for the NHS should be raise through an hypothecated tax, which I would be supported by the majority of the population, whereas general increases are never popular. Much of one’s personal health is accounted for by either genetics or luck, and much less by ‘behaviour’ than the government would want to admit. We were unlucky in that a family member needed expensive tertiary care throughout her life, but lucky to be healthy ourselves throughout the same period.

#42477 Helen
Health research

I support the founding principles of the NHS, agreeing with many of the views already expressed and would not support such proposals. However, I believe that the money for the NHS should be raise through an hypothecated tax, which I would be supported by the majority of the population, whereas general increases are never popular. Much of one’s personal health is accounted for by either genetics or luck, and much less by ‘behaviour’ than the government would want to admit. We were unlucky in that a family member needed expensive tertiary care throughout her life, but lucky to be healthy ourselves throughout the same period.

#42478 Paul Devenish

I am astonished at the vitriol that the author faces - though the fact that many of the people commenting are clearly the potential 'victims' of his proposed higher taxes may explain it, suggesting some self-interest...

Read the piece and you may get the following:

- Working people have paid the price as a result of the economic downturn - they are worse off, whilst pensioners are better off. The idea that you ask the former to pay all the extra costs through higher taxation is frankly selfish and unfair.

- Working people pay higher taxes than retired people as a proportion of their income - all the author proposes is to equalise tax rates, so that everyone pays the same proportion of income.

- The retired are the chief cause of increased NHS costs - there are a lot more older people, and there are a lot more treatments for them. Yes, we could do something about access to the NHS for people coming from abroad, etc., e.g. 5 years paying in before qualifying for treatment - something I would advocate - but this would not meet the funding gap, as those people tend to cost a lot less than the costs of treating the elderly.

- Above all, there is an inter-generational question: young people entering work today will find it difficult to get on the housing ladder; pay for their own university costs (and without a degree will not be able to progress up the career ladder as was possible for the Boomer generation); need two workers per family, not one to afford housing, which means they then need to pay for childcare. And you have, on average, the wealthiest pensioner generation ever, with assets built partly on unearned growth in house prices as well as a tax break through MIRAS that no longer exists - and you're all suggesting that young people should pay for your care, a system which you voted for but they didn't.

And you say that the author is advocating selfishness and / or is offensive! Take a look in the mirror...

#42488 Jan

Having worked in the NHS as a nurse for about 40 years I am now a patient receiving home haemo dialysis. I'm so very grateful to have this expensive care and support. I've been on the kidney transplant list for 4 years, cheaper to have a transplant than to dialyse. I would be happy to pay another 1% tax towards healthcare if everyone eligible to did. There would have to be a real promise that that money was not used for anything but health care.
What does concern me is with the increasing privatisation of health care how much tax will end up in share holders pockets. That offends me greatly.

#42494 John Taylor
Stockport MBC

At the end of his blog, Andrew slips us an alternative which he dismisses out of hand: "A death tax which the truly rich can always evade." I take this as a challenge. Nowadays those who inherit from the truly rich are likely to have feathered their own nest to a reasonable extent. They should expect to declare the value of their inheritance and pay tax on it at their marginal income tax rate.
Minimum pain-sheds of money.

#42495 Andrew Harrop
General Secretary
Fabian Society

Thank you to everyone for taking the time to comment on the article - including those who didn't like what I had to say.

Several people mention that retired people have paid in all their lives in the expectation of health and care in retirement. This argument applies to the funding of existing care but not for new entitlements like universal free social care. It does seem reasonable that the pool of beneficiaries should pay for this, rather than younger cohorts.

But there's a broader point on lifetime contributions. Although there is a clear psychological contract linking previous contributions to receipt of public services in retirement, in practice retired people today may have paid in too little. A think tank, NIESR, published this paper in 2011 which presents data to suggest that on average, over their lives, today's older people will pay in less than they receive and that the opposite is true for people aged under 40 (table on page 15). The paper is very techie and the findings are based on a lot of assumptions (including that taxes on older people won't rise in the way I propose). However the general point is clear.

#42515 Nick

Utter tosh. This argument starts from a premise that 1) we should just continue to fund the NHS as is, and 2) that it's ok to keep hiking taxation. Both wrong. It is perfectly possible to reform the NHS to drive out cost while retaining the founding principles. For too long clinicians unions have known they only need to seed fear long enough to get spineless politicians throw more money at the problem instead of fixing it.
And hats off to the commentators who have pointed out that there is no such thing as a ring-fenced tax. Profligate governments have one after another plundered the coffers to spend where votes can be won.
There is a perceived contract around NI that allowed Gordon Brown to raise additional funding for the NHS. Break this at your peril.

#42533 Happy65
Retired professional

Please tell me why you have put the retired at the top of paying their 'fair' share, when EU nationals can claim full benefits including maternity, after only being in this country 3 months:-

For example - one of the most stretched NHS services and Welfare payments is maternity:-

'Maternity Allowance is a weekly payment that can be claimed through Jobcentre Plus. It can be paid for up to 39 weeks. The amount depends on your earnings.
You may be eligible for Maternity Allowance if:
you’re employed but not eligible for SMP
you’ve been employed or self-employed for at least 26 weeks in the 66 weeks before you’re due to give birth
you’re registered as self-employed and paying Class 2 National Insurance contributions or have a Small Earnings Exception certificate
you earned at least £30 a week on average over any 13-week period during the 66 weeks
you’ve recently stopped working
GOV.UK has more information about Maternity Allowance'

#42537 Judith Wheelton
Retired Professional
Library Services

While welcoming a concerted attempt to simplify heath and care services I would like to make 2 comments:-
1. When are we going to start charging Healthcare `tourists' from other countries (possibly even from Scotland and Wales?) up front? Wouldn't this help to reduce the financial burden of the people who have paid and are still paying National Insurance?
2. Not all pensioners are `wealthy'. What is wealthy? Who will define it? We are pensioners in our 60's and 70's with a teenage daughter who may be at home for years to come. Who will assess people such as ourselves? We are certainly not wealthy and having spent 43 and 56 years respectively working without a break cannot see the justification in taxing people a second time round on pensions that are already being taxed.

#45083 Mike
I a

Agree with Largely with Wills commercial taxing privatising rationing the nhs ?
Who pays some of the ideas! Very worrying

#45695 Millie
Functional Nutritional Therapist

Bad health is the result of bad lifestyle and diet choices and very little genetics. Rather than pay for those who don't look after themselves those who look after ourselves should be allowed to opt out of the NHS.

Bad lifestyle and diet choices are known to be linked to poverty and bad education. The logical projection of current policies that target 'better off' older people is for all to become dependent on government at the level where we receive means tested benefits. Singling out SOME older people as a scapegoat group for glaring failings in government and health care is demoralising and may result in even higher costs. National cares should be paid by nationally devised policies that do not victimise the old.

Finally why should anyone pay for the NHS - a service which does not recognise prevention as their role and is not looking for innovation but to do more of the same as now - allowing the growth of chronic diseases so that they can then be treated by expensive consultants who doe not communicated between specialties. Chronic diseases are diseases of the whole body that build up over years and are preventable. The only money worth investing are in education and professional nutrition therapy practicing personalised functional medicine. See news from US innovators here

#49602 Colin Godber
Retired NHS consultant in mental health of older people
Currently Age Concern trustee

Rather late in seeing this. I agree totally that those in retirement ahould pick up the excess cost of their ill health in old age. Our contributions were never enough to cover our full life time health and social care costs. Had they anticipated the rise in life expectancy and scale of medical advance and interventions Bevan and Beveridge would have created a realistic National Health and Social Insurance Fund into which we would all have been paying sufficient to fund the rising cost of care in older age. For decades now politicians have lacked the honesty and courage to put the issue to the electorate and have taken the easy option of steadily squeezing the care of chronic illness and disability out of the NHS, boosting the scale of means testing to a level that would have had Beveridge turning in his grave. While agreeing with Andrew Harrop that this cost should be shared in a progressive way across the retired generation I feel that it is better to source the contribution from wealth than income. For nearly everyone income falls fairly abruptly on retirement; in a general sense pensioners are "capital rich but income poor". For years I have advocated the win-win solution of assessing everyone's personal wealth at 65 and earmarking 15% to be collected after death in return for free health and social care in older age. I would remind some of the critics above that at least half of the capital tied up in our homes is an unearned windfall from house price inflation and that the wealthier end of our generation has also had the perks of free higher education and higher rate tax relief on pensions. As a generation we have huge inequality of wealth and trimming a bit off what we pass on to our children (many of whom have already got a few rungs up the ladder via the "bank of Mum & Dad") is a small price to pay for some solidarity with less fortunate contemporaries who will have contributed a lot to our infrastructure and comfort over the years. If we can help to get health and social care back on track by catching up on our payments in this way it might be a bit easier for the politicians to get their act together and set up a proper prosective National Insurance Fund hypothecated for health and social care that would be affordable for the generations to follow. The catch up pensioner wealth tax could then gradually taper out as lifetime contribution to this prospective fund worked through. The other important point is that this approach neutralises "demographic time bombs" and the current "baby boomer" bulge by ensuring that each generation covering its own health and social care cost.

#54282 Pearl Baker
Carer/Independent Mental Health Advocated and Advisor
Independent mental Health Advocate and Advisor

As a Carer, in receipt of a state pension are you aware that we are saving the Country millions! Are you aware that if you receive a state pension you cannot claim a carers allowance, so I would say the retired are already doing our 'bit' and then are many of us. If we ask for help in our caring role, we have to undergo an assessment of our Income, and guess what many have to pay for this as well.

Before you start considering asking the retired to contribute more than others, just remember we have already paid our National Insurance.

Unlike the previous contributor to this debate I do not receive a great pension that this NHS Consultant receives, including inflation linked, which we the general public are paying.

I like many others was unfortunate to have saved for my retirement through Equitable Life, the first Pension Company to nearly obliterate my Pension 'pot' my pension reduces each year, not like the NHS Consultant who had the privilege of working for the NHS and all the benefits that go with on retirement.

By the way 40 percent of my estate will be collected after the nil rate tax band is reached on death. My income was taxed, my savings are taxed, and then 40 percent is going back to the Government on death. Perhaps Scotland is a better place after all.

#54929 David Grimes
retired consultant physician

If we are to continue to increase funding for the NHS (and everyone seems to think that we should do) then the suggestion is sensible that the retired (if they have a good income) should continue to pay national insurance - we already pay income tax. My age of 70 is not "old" these days and I have a life expectancy of 20 years. Many retired people have good pensions and have paid off mortgage. They should no longer have financial responsibility for their children. That we have already paid for our old age is not realistic these days. The model was that we worked for about 40-45 years, retired at 65 and die at 70-75 years of age. 40 years of work and NI, followed by 10 years benefit. Today the benefit is spread over 20 years, but contributions during working life remain the same. The sums do not add up and the retired are taking more benefit than they paid for during their working lives. The voices are simple:
1. Benefits are reduced or frozen, including pensions and NHS spending.
2. The present working population pays more tax and NI, not just to fund their expected long years of retirement but also to fund the unexpected benefits of the present retired.
3. The present retired make a greater contribution to their unexpected long years of retirement and the associated costs.
Perhaps the solution is a combination of all three, but the third option of NI contributions for the retired is realistic. It would not be popular, but it would be more equitable than increasing taxation of the present working population.

#433727 John McFadyen

Jim's final paragraph is significant. The problem with this proposal now enshrined in The Barker report, is that it has 'face' value. It appears to make sense. However in my own case I served the NHS for forty years and paid income tax and national insurance for all that time, during which I was a low user of services, in the expectation that in retirement, with a vastly reduced income I would be relieved of some of my 'tax' burden.
Going back to Jim's comments, there is far too much inefficiency and waste in the system. The idea of merging health and social care is said to be more costly which in logical terms makes little sense if administrative costs are considered. In addition I still find it reprehensible that we have created multiple commissioning bodies with all thier administrative costs to replace the old health authorities. It always looked like madness and still is. It was a political ploy to manoeuvre GPs and NHS consultants around the chesss board.

#543581 Pearl Baker
Carer/Independent Mental Health Advocate and Advisor

I am 74, Carer of two sons with LTC, grandmother of child with Autism, provide free of charge Advocacy and Advisory for those with Mental Illness. I receive no money for my Caring role, because I am too old, and receive a State Pension. I save the State thousands because I provide my care for free. So if your idea that the old should pay more taxes or NI is 'blown' out of the window' because we already penalised through age, and denied the Carers Allowance. It is the other way around, the elderly should receive some additional financial help. The elderly are discriminated against don't you agree.

#544431 Julie Bailey
Retired. Widow. Disabled.

Agree with much. Would be happy to pay NI according to income but why top band only £28,800 pa? Thats not much these days, especially if you're still supporting a younger generation - harder for them now to set up home & family whilst repaying ridiculous uni fees. I assume this extra NI would cover Care on same basis as Health - mad to separate the inseparable! But many retired people's income is well above this given maximum, so a higher band or two would help add to the fund, perhaps enabling the lowest band to be removed.

Incidentally, none of my suggestions would apply to my position, so its only self-interested in that I want the NHS+Social Care to thrive as well as its funding taken out of Government or Private plundering.

If social care is not included, hands off pensioners' money! i may soon need some care which would have to be paid for from my income, ( which just covers food & basics - no exotic holidays or luxuries) £7,000 - 10,000 pa for just one hour a day: the savings I carefully made for this eventuality would vanish alarmingly fast.

#544464 Valerie John-Charles
Clinical Service Lead

Go back to to basics and revamp a system that is over managed, consists of wasteful so called managers, directors, deputies and so on and so forth. By the time we have paid for these and the never ending traunch of project workers/ management consultants, there is little left for patient care. Previous comments mention - do the math! We have invested and wasted money on useless IT systems; PFI buildings that are now being seen as white elephants; sold off NHS land at next to nothing; continuously reformed the NHS and it is still in a mess yet we continue doing more of the same!! We have devalued the input of clinicians to favour a market approach to health. Integrated care is not a new concept - I am a nurse with many years of experience, as a District Nurse if I assessed patients needing social care input I made a call to my colleagues in social services and support systems were put in place for that patient and their family. Now I would have to go through hoops - referring, patient put on waiting list; another assessment; onward referral - another assessment and the list goes on. Everything has become so complicated. I would also like to point out that it is a fact that those who are articulate enough to ask questions and challenge decisions get results. There are many older persons out there caring for their own - who do not rely on the state or the NHS! To tax this group of people is obscene, especially when they have paid taxes and NI benefits all of their working life. Many of us will be supporting our children way into our seventies - work is hard for them to find and with us working into our late sixties and seventies they are unlikely to get jobs! The rich will just use tax havens and nothing will affect them in the way it does those that receive average pensions. If we introduce a tax - remember it will go up and up, especially if we continue with this ridiculous wasting of public funds. I really value to the concept of a NHS but in reality I think it is now defunct - it saddens me but this is reality. Do not get me wrong I do think health needs to be managed but we have gone way beyond this and the results are plain to see.

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