HMRC IR35

[quikshop]

Multi-million pound IT contracts getting stalled or cancelled as a huge exodus of knowledge and talent leaves the NHS. Full time vacancies go unfilled because of the derisory pay banding 20%+ less than the private sector equivalent.

One report put the self employed or PSC workers contribution to GDP at 3 times that of the UKs entire manufacturing contribution. By driving out self-employed highly skilled workers from the public sector, with plans to do the same in the private sector the Government in one fell swoop has cut a limb off the UK economy.

A curious act of self-harm from a political party that is pro-capitalism and market forces, or a sensible move to curtail the greedy money-grabbing ego-inflated work-shy self employed!?

 

[STDFR33]

The ideal world for the government would be to have every worker in the country on PAYE. They seem intent on trying to achieve it.

 

[garyk]

Another short sighted move.

I don't know who comes up with these plans but obviously the intent is to raise more tax but they never seem to consider that people will still avoid it if possible.

Its already happened in the buy to let market with stamp duty, the government were hoping to raise alot more money by introducing stamp duty. What happens? Private landlords not buying property! Buy to let market in free fall.

Same with this IR35 now, I find the small mindedness of the civil service staggering.

 

[midgetman]

Its not just the IT contracts in the NHS, the consultants are also demanding huge increases in their hourly rate, my wife (who is a manager) has told me that they are demanding rates of £120 per hour! or they will walk out and go elsewhere that are willing to pay.

One consultant has told her to her face that they will bring the NHS to its knees if need be.

 

[The Byre]

I am no expert on healthcare economics, but looking in from the outside, I would say that great chunks of the NHS are on their knees already.

The government is desperately short of tax revenues. The public spending deficit is hopelessly out of control and the downturn in the economy cause partially by Brexit and partially by a gradual, yet inevitable rise in interest rates, combined with the fall in the value of the pound, which in turn, is also fuelling inflation, is also fuelling public and private debt.

The hope for IR35 was that it would increase tax revenues, but like all these things, the reality of unwanted consequences is kicking in!

 

[STDFR33]

It's not just the NHS that uses contractors. There are lots of government organisations that rely heavily on contractors.

Despite what the government think, contracting is a business. And those business owners are highly skilled and expect to receive £X after tax. If the government squeezes them through tax, then their rates will inevitably go up.

In the wise words of nobody (I've just made it up):
If you sh1t on their doorstep, don't be surprised when they put it back through your letterbox.

 

[Deleted member 59730]

A major problem with the NHS is that they just do not know how to manage. Some of their ideas are total madness. And as for morale, they haven't a clue how to treat their staff.

 

[midgetman]

"A major problem with the NHS is that they just do not know how to manage. Some of their ideas are total madness. And as for morale, they haven't a clue how to treat their staff."

Thats a very sweeping generalisation on NHS Managers, and in truth totally unfair, unless you have first hand experience you cannot make that kind of comment.

Yes my wife is an operational manager, yes she is in control of 3 very big areas of her hospital and once a month is on call manger, that means she is in total charge of the entire hospital. Every day she has juggle diminishing budgets, told to cut costs, told she cannot recruit due to cuts, doctors and consultants demanding more money from an already empty purse, it makes me mad as hell when she comes home from a 11hr day which is far more than her staff work, and far more than her contracted 40 hr week.
When, as now she is faced with a lack of doctors and consultants that puts patients at risk, that means they have to go to red alert and start cancelling operations, restricting the number of admissions as there are not enough doctors to look after them (rewind to the doctors strike that meant her hospital had in effect to close to all new admissions).

Its proven that no matter how much money is pumped in it will never be enough and yet now because of this silly change the pure greed of consultants ( already on at least £100 per hour and also coining it from private work) now want more.

And then I see that all NHS Managers are crap? really?

 

[Deleted member 59730]

Yes my wife is an operational manager, yes she is in control of 3 very big areas of her hospital and once a month is on call manger, that means she is in total charge of the entire hospital. Every day she has juggle diminishing budgets, told to cut costs, told she cannot recruit due to cuts, doctors and consultants demanding more money from an already empty purse, it makes me mad as hell when she comes home from a 11hr day which is far more than her staff work, and far more than her contracted 40 hr week.
When, as now she is faced with a lack of doctors and consultants that puts patients at risk, that means they have to go to red alert and start cancelling operations, restricting the number of admissions as there are not enough doctors to look after them (rewind to the doctors strike that meant her hospital had in effect to close to all new admissions).

Read My post again. What you describe proves my point.

 

[Alan]

Head of NHS Simon "Stevens was paid a salary of between £190,000 and £194,999 by NHS England, making him one of the 328 most highly paid people in the British public sector at that time." (source wikipedia )

"£117.229 billion in 2015/16. Planned expenditure for 2016/17 is £120.611bn."

NHS Staff = 1.3 million ish people

So they are paying peanuts for an executive responsible for a simply massive organisation. Pay peanuts for management - what do you get.

Compare say - Shell - employs 100,000 ish so less than a tenth the size. Difficult to compare, but cash flow from operations £20billion - so lets say 6th the size of the NHS.

What is a CEO worth of an organisation a sixth of size of the NHS.?

Something like £20million.

Its not surprising when you pay the people that are meant to drive a massive organisation just £80k per years than one of his thousands of consultants ( average £117,00 p.a ).

Certainly you are not going to attract the best commercial minds are you?

 

[paulears]

The NHS is a collection of medical professionals who's expertise is in their chosen field - but where they get promoted, they suddenly become 'management'. In many departments, the management is carried out by the person on the highest pay grade in the department, and most have no idea at all about management or business skills. It's a complete joke. People get pressed into gaining new qualifications, yet there is nobody to actually do training, so they use Google, answer the on-line multi-choice exams, and get the band hike - AND - suddenly extra responsibility in an area totally new. Every department is like a different country, no culture of everyone working to the same goal. Each department is only concerned with themselves, because that is how the beat is designed. People, frequently the new keen ones, have ideas that are perfect sense - yet get ignored by the managers because it comes out of their budget, or will take time, or is simply more work, when nobody even knows what they do. Departments who finish at 5.30, but know that the last patients are still in a queue elsewhere in the hospital. So they close up, and call in a locum five minutes later when the patients arrive!

 

[Mr D]

I've worked with several charities who have had dealings with the NHS. One of the more annoying parts of what I had to do was attend meetings - I had to get the brief and changes firsthand and clarify or block points as needed - and any time the NHS was involved there was meeting after meeting. For them to utilise a building as a base for targeting the users of the building - 11 meetings, none of them involving management on their side, none of them with the same staff twice so had to explain the premise each time, none of them involving decisions made by NHS. They wanted the service, they wasted over 70 man hours on our side and at least that much on their side. Another group wanted to do more involved work with the clients, same building, the meeting was just one meeting and took just over 2 man hours.


Every single occasion a group I was with needed NHS involvement, even when paid for elsewhere, the meetings were far and away the biggest issue to slow the project down and waste everyone else's time. The culture.... the staff often found it hard to grasp that someone had already made a decision. Or that work could go ahead and be done before the next meeting.

Have seen multiple projects that were good ideas, with known quantifiable demand and pressing need, simply abandoned because NHS could not stop having meetings about the project without making decisions. Not financial, had that covered before any meeting, simply agreement for a project to go ahead.

More than once recommended bypassing the NHS entirely.

 

[Newchodge]

Its not surprising when you pay the people that are meant to drive a massive organisation just £80k per years than one of his thousands of consultants ( average £117,00 p.a ).

The NHS exists to provide health services. The primary requirement for the provision of health services is health professionals. The NHS has developed an horrendous management culture in which more is spent on administration, sourcing 'providers' , developing internal markets than is spent on its primary purpose - the provision of health care.

It is high time the NHS stopped being a business and returned to being a direct provider of health care.

 

[Newchodge]

What is a CEO worth of an organisation a sixth of size of the NHS.?

Something like £20million.

That is not what the CEO is worth. That is what he (invariably he) is paid. Very very big difference.

 

[Alan]

That is not what the CEO is worth. That is what he (invariably he) is paid. Very very big difference.

The general principals of a free market is an item is worth what someone will pay for it.

The NHS has developed an horrendous management culture in which more is spent on administration, sourcing 'providers' , developing internal markets than is spent on its primary purpose - the provision of health care.

What are the facts behind this? How does the management culture compare between the NHS and similar organsation of similar size? What is the ratio of 'management' to 'producers'? Are the 'internal markets' less efficient or more efficient than whatever exists before them? ( I don't know the answer to these question )

 

[midgetman]

I do wonder how many of you work in the Nhs I have often told my wife that if it was a private company it would have been declared bankrupt years ago, by the way she has not had a pay rise for 5 years now except the 1% imposed, so how many you would accept that?

 

[Mr D]

Midgetman, when companies I worked for offered low pay I moved to a different company. If pay rises are a reason to be unhappy in a job, a place with bigger pay rises would suit?

My father in law was in hospital for almost 3 months last year, he went in for a week. Except a small fall while in hospital, he bed blocked for 11 weeks. Because they would not let him leave without this, then without that, then requiring a care plan with 4 care visits a day - which my wife and I argued against - which eventually was dropped to physio twice a week. Then they sent him home without a walker when they had insisted he needed one.

Every few days he was moved between wards, every few days had a new help assessment, every few days someone else came up with something else he needed.
No sympathy now for NHS financial problems, I have seen firsthand how much of it is due to the NHS.

 

[Newchodge]

How does the management culture compare between the NHS and similar organsation of similar size?

There is no similar organisation. Whether of similar size or of different size. The NHS is not a business and cannot be run as such. It is a service provider, and what matters is whether it provides the service, not whether it makes a profit.

 

[Newchodge]

Midgetman, when companies I worked for offered low pay I moved to a different company. If pay rises are a reason to be unhappy in a job, a place with bigger pay rises would suit?

Doctors and nurses in this country, generally, work for the NHS. There is no realistic alternative employer. Some have set themselves up as limited companies to provide their services to the NHS. They should be caught under IR5. there is very little private sector employment for doctors. A bit more for nurses.

 

[Mr D]

Doctors and nurses in this country, generally, work for the NHS. There is no realistic alternative employer. Some have set themselves up as limited companies to provide their services to the NHS. They should be caught under IR5. there is very little private sector employment for doctors. A bit more for nurses.

You means besides the many GP surgeries? Haven't heard of a GP employed by the NHS in many years, the staff of the surgery will be employed by the surgery - which is often a company set up by the partners of the surgery.
The private healthcare providers? The nurses can work for nursing homes.

The NHS is the biggest employer of the medical staff. Its far from the only employer.

Now if you were unhappy at the small pay rises you were getting what would you do?

 

[Newchodge]

GP practices are private companies. Wholly funded by the NHS. They are unable to undertake private work outside a very narrow band. they cannot, for example, offer private medical care to their NHS patients.

If I were unhappy at the small pay rises I would look for an alternative employer. There are some for nursing staff, there are very few for doctors.

What this disgraceful government is trying to do is to dismantle the NHS and introduce a US style system which will have huge benefits for medical companies, few benefits for NHS staff and huge problems for NHS patients.

 

[Mr D]

Yes they are funded by the NHS but they are not NHS staff and the wages and pay rises can be different. They can also get bonus funding for hitting particular targets or providing particular services. The partners / board of directors are also capable of making their own business decisions

You will also find hospices employing doctors and nurses - oh look they are also funded by the NHS, though only in part usually. And they can also set their own wages and pay rises...

The NHS is a healthcare provider and purchases healthcare from private companies. It tries to do two things.
Why do we have hospices? Because the NHS is great at end of life care? Or because there is sufficient demand in an area for a non-NHS approach to end of life care?

 

[Deleted member 59730]

The NHS is a collection of medical professionals who's expertise is in their chosen field - but where they get promoted, they suddenly become 'management'. In many departments, the management is carried out by the person on the highest pay grade in the department, and most have no idea at all about management or business skills. It's a complete joke.

This exactly fits my neighbour. Totally unsuited temperementally to manage. Half the time she is dealing with the frustration of others like herself who never had any aptitude for management.

 

[Deleted member 59730]

GP practices are private companies. Wholly funded by the NHS.

And in desirable areas doctors have to buy their way in to a practice at a very high price which is split between the retiring doctor and his partners.

 

[Mr D]

And in desirable areas doctors have to buy their way in to a practice at a very high price which is split between the retiring doctor and his partners.

Not all doctors buy in. They can simply be employees of the practice under a contract same as any other staff. Can be good money as a partner in the business like in any profession - if the business is run well.
Not all businesses are run well.

 

[UKSBD]

From my (admittedly very limited) observations.

A big problem is the years of training provided by the NHS compared to the years worked for the NHS

There seem to be a lot of people who spend years being paid by the NHS to train, they spend 10 years working for the NHS, take early retirement from the NHS, set up privately and then if they can't get their own private work they subcontract back to the NHS

I would like to see the statistics showing how many people over 55 are actually employed by the NHS

 

[STDFR33]

http://www.rotherhamccg.nhs.uk/Age in the NHS.pdf

 

[quikshop]

Its not just the IT contracts in the NHS, the consultants are also demanding huge increases in their hourly rate, my wife (who is a manager) has told me that they are demanding rates of £120 per hour! or they will walk out and go elsewhere that are willing to pay.

A very good friend has contracted in Councils at a senior level for a number of years. The rates on offer for her role have dropped from £600 a day to £250, on top of the increased tax burden.

The irony is she saves Councils millions, proper millions, by renegotiating poor procurement contracts and redesigning services, but all some of her former and potential clients see is the daily rate.

The actual consequence is that rather than pay the market rate for the best talent from across the UK who could afford to relocate to do the job, they now only select from a far narrower local talent pool of less experienced personnel.

One consultant has told her to her face that they will bring the NHS to its knees if need be.

My last contract post, the NHS organisation had been trying to recruit a full time employee to for 18 months without success. They turned to the contract market in order to fill the position and see some projects completed that will improve patient safety and care. The contracting market is vital, but in one fell swoop the Government has removed 70, 80, 90% of highly experienced capable people from the public sector.

To cap it off, articles in the Tory papers whine about locums and other contractors "holding the NHS to ransom".

 

[Newchodge]

A very good friend has contracted in Councils at a senior level for a number of years. The rates on offer for her role have dropped from £600 a day to £250, on top of the increased tax burden.

The irony is she saves Councils millions, proper millions, by renegotiating poor procurement contracts and redesigning services, but all some of her former and potential clients see is the daily rate.

The actual consequence is that rather than pay the market rate for the best talent from across the UK who could afford to relocate to do the job, they now only select from a far narrower local talent pool of less experienced personnel.



My last contract post, the NHS organisation had been trying to recruit a full time employee to for 18 months without success. They turned to the contract market in order to fill the position and see some projects completed that will improve patient safety and care. The contracting market is vital, but in one fell swoop the Government has removed 70, 80, 90% of highly experienced capable people from the public sector.

To cap it off, articles in the Tory papers whine about locums and other contractors "holding the NHS to ransom".

If the public service contracts are no longer available, and there used to be hundreds and hundreds of them, are there enough private sector contracts to keep these people occupied?

 

[Mr D]

Presumably these contractors will go elsewhere to get the jobs paying what they want? While the various public bodies try and recruit paid staff, then get rid of paid staff....

 

[quikshop]

Presumably these contractors will go elsewhere to get the jobs paying what they want? While the various public bodies try and recruit paid staff, then get rid of paid staff....

But that's the problem, the public bodies cannot recruit full time staff because their pay bands are 20-30% below the equivalent job in the private sector. Why would I work full time at the NHS organisation on a band 8a for circa £45k when the same type of role in the private sector pays £65k-£75k?

I can only think that this is another purposeful attack on driving the public sector into the ground from an ideological Tory perspective.

 

[Newchodge]

But that's the problem, the public bodies cannot recruit full time staff because their pay bands are 20-30% below the equivalent job in the private sector. Why would I work full time at the NHS organisation on a band 8a for circa £45k when the same type of role in the private sector pays £65k-£75k?

I can only think that this is another purposeful attack on driving the public sector into the ground from an ideological Tory perspective.

If there are enough jobs in the private sector for everyone who wants a job to get one, then you have a point. If there are more people than jobs then it is an employer's market, and they set the pay levels.

 

[quikshop]

If there are enough jobs in the private sector for everyone who wants a job to get one, then you have a point. If there are more people than jobs then it is an employer's market, and they set the pay levels.

It has operated as a free market, so contracting rates over the last 17 years have fluctuated with changes in investment, technology, public sector ambition and regulatory environment, and the contracting rates have reflected the realities of supply and demand.

I would argue that day rates have remained largely the same over that period of time so in reality have fallen taking inflation into account. The issue is not one of day rates, the issue is in gross under-investment in the public sector.

The Government make a lot of noise about new investment in NHS IT systems and paperless by 2020 aspirations, but you look at most organisations and they cannot afford the BAU IT operational costs, or up-grading from out of support software, networks that cannot cope with the increase in traffic from wireless and interop projects, hardware that would embarrass a primary school games room, security still something stuck in the last decade.

Sorry, I could rant about this for a looong time, better go and enjoy the sun

 

[Mr D]

As I said, the various public bodies try and recruit....
Back when I was in the civil service I knew a few of the IT staff on the site working for various departments. The general pattern seemed to be spend a couple of years with the civil service then go for private sector jobs - having experience and qualifications they didn't have when they joined the civil service.
A number of them applied for and were accepted at contractors who worked with the civil service - on at the time (early and mid 90s) double the money or so.

Government in recent years has been told that its paying the contractors too much and they are avoiding tax. So they took steps to deal with both issues.
The result - that is what we are seeing.

Oh and back in 1990 we were told we would be a paperless office by the year 2000. Guess what? In the year 2000 we had more paperwork and more manually generated statistics.

 

[Alan]

There is no similar organisation. Whether of similar size or of different size. The NHS is not a business and cannot be run as such. It is a service provider, and what matters is whether it provides the service, not whether it makes a profit.

Really? None any where in the world? Are there no other massive non businesses orgainisation that provide a service? What about the police? What about the army? What about health services in other countries?

 

[Mr D]

If the NHS was run as a business then maybe it would improve.
At the moment governments chuck money at it, the administrators do what they do and it creaks along. I have no idea of the efficiency of the organisation as a whole but I do know of multiple instances where it has been quite inefficient.
Perhaps if it was run as a business with head office doing back room functions the patients do not need to see while the hospitals become the local branches.... ?

 

[thetiger2015]

The more the NHS is made to look inefficient, the more chance there is that ordinary folk would accept it being privatised.

The government have no reason to invest properly, if they did that, the NHS would be more efficient and provide even better levels of services...that would mean they couldn't push ahead with privatising and selling off any assets that still remain.

A true government of the people would look to enrich and improve our lives. They would spend tax money wisely and encourage high quality services, staffing support, new buildings and logistics. But I don't know of any government in the last few decades that doesn't think of the pound signs first and worry about the consequences later.

The same is happening in education. Sell off the land, privatise the classroom, make lots of money now but sign ridiculous contracts that mean the tax payer has to bail out those that fall apart due to their own mismanagement. Then the tax payer also has to foot the bill for sorting out the mess, which will be sorted out by a private company, thus boosting it's shareholder profits.....madness.

 

[Mr D]

We already accept privatisation with GP surgeries and hospices.
Have we had a true government of the people? Ever? Are we likely to ever get one with democracy?

 

[The Byre]

The more the NHS is made to look inefficient, the more chance there is that ordinary folk would accept it being privatised.

The only problem with that sentiment is that the NHS is grossly inefficient and a cursory look at the numbers shows why - too few specialised medical staff and too few beds.

Germany spends $5,424 p.a. per person and has 3.9 doctors per 1,000 population and 8.2 hospital beds.

France spends $4,945 p.a. per person and has 3.2 doctors and 6.4 beds.

The UK spends $4,277 and has 2.8 doctors and just 2.9 hospital beds per 1,000 population.

Because both payroll taxes and other payroll deductions are far, far higher in France and Germany and also pay for medical staff is higher in France and Germany, spending per person is actually comparable.

Ireland has more or less the same system with GPs and a national health care system paid out of taxes and the situation as as bad, if not somewhat worse (waiting lists, waiting times at A&E, etc.) France and Germany have a system of social insurance schemes.

You also have to bear in mind that to call yourself a medical doctor in France and Germany, you have to have qualified as a specialist and have written a doctoral thesis in that speciality. There is no such thing (any more - there used to be) in those countries as a General Practitioner. In most of the rest of Europe, what we often refer to here as doctors, are actually better qualified nurses.

 

[MikeJ]

Ireland has more or less the same system with GPs and a national health care system paid out of taxes and the situation as as bad, if not somewhat worse (waiting lists, waiting times at A&E, etc.) France and Germany have a system of social insurance schemes.

My wife is Irish. The first time she visited a doctor over here, she was trying to work out when they were going to ask for money. The Irish system is very far from ours.