Carwyn could do better setting aside ...

... the baggage of "only public service allowed", it just doesn't fit with life in the 21^st century, a life that should be a reflection of the following letter in today's Times :

Sir, As head of radiology at a Glasgow teaching hospital for 23 years, I was very much in the front line of financial problems. Of course the NHS has been a success, much loved by the British public. But it is a huge monster devouring every penny it gets. The service could be fitter and slimmer.

On retirement, when working in Sydney, I was most impressed with the emphasis on service. All staff realised that they were in competition with other groups; the practice income and their pay depended on the quality of their service. Patients were examined that day or the next and left with a typed report — no delays for CT scans. Indeed, seeing the need for a scanner this group arranged its own funding; no need for endless time-consuming committees and layers of bureaucracy.

Patients were covered mainly by State insurance, some privately. If the practice did well, the income increased and staff were better paid. No obscure “Clinical Excellence” Awards there. Not only that, the practice handled a workload similar to that of UK hospitals but with fewer staff and a better service.

We must get away from political dogma — enterprise, ability and good service at all grades must be rewarded. Whatever else, the founding principles of the NHS must be preserved, free healthcare for all based on clinical need. Dr J.K.Davidson Glasgow Sir, Ian Rogers (letter, Feb 14) suggests that Clinical Excellence Awards for senior doctors should be scrapped because “hospital doctors undertaking the same responsibilities and workload should receive the same payment”. ............ letter in full £

Dr Andrew Bamji, Rye, E Sussex 

How might the experiences of Dr Bamji be applied to the NHS in Wales ?

Over the last 6 months or more I have had a very personal and direct association with our NHS doctors surgery (practice) and our local Health Board (Aneurin Bevan), what have I learned ?

The story...

Initially the practice diagnosed a probable meniscus tear to the left knee although I was told it could be arthritic, I had an x-ray within two weeks, followed by an MRI scan two weeks later, and an appointment with the consultant surgeon two weeks following.

At the appointment with the surgeon he was surprised that both x-ray and MRI scan results were in his hands, he explained that it was usual for the diagnostics to be requested by him, our practice had cut 6 to 8 weeks from the period of diagnosis.

Things got a little complicated, after a week off work the company I work for convinced me to return to work (light duties), this was probably a mistake, the pain at times when I was in the warehouse was pretty bad, some of the staff can be a problem which puts me on my feet and walking.  I was losing condition, muscle, I put it down to the knee pain.  During a visit to family during October, my sister in law commented that I "looked frail", not an expression I had heard before, it played on my mind.  Worried I visited the practice, not many questions asked, none to do with the knee, answers "Yes" to each question, the doctor smiled at me and said "join the club, its a royal club, you have diabetes".  There followed a week of tests and the first diagnosis that I had Type II diabetes.  During the following month medication and diet was modified until it seemed my Blood Glucose had stabilised.

The diagnosis was important to me, but unknowingly it would set back treatment for the knee.  Mid November a letter arrived to attend a Pre-Admission Clinic for knee surgery, happy days, not so happy, the newly diagnosed diabetes would put back surgery until such time that both my diabetic medication and Blood Glucose had stabilised.

During November and December we worked on the diet so as not to need further modifications to the medication, by early January I felt everything was looking good, so booked an appointment to see the diabetic nurse who arranged for a series of tests to confirm my feelings, I was right but it was better than my feelings, cholesterol both good and bad had dropped to normal readings, my 3 month average Blood Glucose was better than my readings (better test).  An angel, she was straight on the phone and followed everything up to the surgeons team by letter, a week later a letter of appointment arrived for 26^th Jan, it was just a test for nasties the surgical team preferred not to come into their theatres.  A couple of days later a letter for surgery 3^rd February.

How does my little tale help Carwyn, well, it could be any business dealing with departments, but it is also a description of a business dealing with another business['s], in my case 3 [4 including post operative therapy] enterprises...

• General Practice
• Diagnostic services
• Surgery
• Therapeutic services ()

 At present the departments are evaluated through politically set targets, what do politicians or their familiars know of the realities of medical process.

Dr Bamji might offer Carwyn the benefits of his experiences in Australia as it might be applied to Wales, Carwyn might also consider the need to devolve tax raising powers for health to give greater control, he might convince the voters to contribute more, Carwyn might consider the need to devolve wages to NHS businesses, not to cut salaries, but to enable salaries to rise in the wake of greater customer satisfaction, and a by-product of that satisfaction, greater productivity.

Just thoughts ........

Tim Worstall writing at the Adam Smith Institute blog might be ...

... considered a little shallow in his conclusion, that we should accept state subsidies by the China government as a bonus, a bonus for whom I wonder, not the British public nor the China public, the blog may be read here.

So, are we the recipient of subsidies by the China government, or might it be "smoke and mirrors" of a dishonest kind, consider for yourself ...

... any subsidy must be paid from the general population of the subsidising country, the factory workers of China.

... the cost of unemployment in the recipient market is paid by the population as a whole, including borrowings, not the industry in the market that imports from China, or any other subsidising country or group of countries (the EU and farming is an example closer to home).

... the price at the till will not relate to the subsidy, but be exactly what the market will bear, not its intrinsic value, therefore any benefits of subsidy will not reach the consumer except during poor trading periods.

So, what should be our response to any subsidies .......

I don't pay enough taxes he said ...

... in today's "Times".

The world’s third-richest man is unhappy about the amount of tax he has to pay: he says it is not nearly enough.

That’s not all. Warren Buffett says that his wealthy friends do not pay enough either. Indeed, he says that his tax rate is barely half that of his secretary. Mr Buffett calculates that his effective rate last year was 17.4 per cent compared with 33 to 41 per cent for colleagues in his office. 

Well that will make us very happy Mr Buffett, unfortunately yours is a lone voice, and when he says ...

... that his own tax rate comes about because most of his income comes in the form “earned interest” — probably from capital gains and share dividends — which is taxed at a rate of 15 per cent, instead of the top marginal rate of federal income tax of 35 per cent that applies to Americans who earn $373,650 or more.

... he skips past the problem, the complexity of taxation, the complexity brought about by the powerful influences who have negotiated unfair advantages, lower tax rates and allowable expenses.  Unfortunately the retired local authority worker of Anglesey has not been able to negotiate such advantages whilst supporting the more affluent members of society in his or her daily toil..

There should only be a single rate of tax coupled with a single tax allowance, and a business should be compelled, at inception, to be created as a Limited Company or later morph into a Public Limited Company, that way our businesses become "people", the company will pay tax on its income at the rate that each member of the taxpaying public will.

It's true that income from business to the individual will have been paid twice, once by the company and then recipients of dividends, but that's not a problem as I consider a single tax rate of 20% across the board would work, and when you consider a tax rate of 40% has been the norm for the wealthier members of society there is little to shout about.

What about company investments, that's an expense if the investment is made in our country, whatever country you reside in, if it is an investment elsewhere, raise the money elsewhere and let the local population enjoy the benefits.

What about tax-havens, pointless as income is taxed at source, if you want a foreign bank account, then move on to that country.

What about those that cheat the system, we have prisons.

What about the businesses and financiers who play hard-ball with government, you know the tack ...

... if you don't do it our way, if you don't give us an advantage we will leave.

... there is always someone else to take up the strain, that's "Capitalism".

Why am I so convinced that taxation is so unfair, it is because an industry has grown up to gain advantages for the few, and to minimise a persons contribution to the tax pot, the proof of the pudding is in the eating.  It's very difficult to cheat when the game is simple ...