74-567: The Five Year Forward View was produced by NHS England in October 2014 under the leadership of Simon Stevens as a planning document. It received praise for brevity, being only 39 pages, and lacking the illustrations which had graced its predecessors. Like the NHS Plan 2000 with which Stevens was also associated it was supported by the great and good of the NHS, but in this case it was regulators - Monitor ,
148-860: A Federated Data Platform (FDP). An FDP would enable every hospital trust and integrated care system (ICS) to have their own platform through which they could connect and share information between them where helpful. The FDP would build on the work done with the Covid Data Store .The contract to provide the FDP would be worth up to £480 million. Palantir are widely thought to be the frontrunners to win. This has prompted further criticism from civil liberties groups. Specialised services are those provided in relatively few hospitals and accessed by comparatively small numbers of patients, but with catchment populations of usually more than one million. These services tend to be located in specialised hospital trusts that can recruit
222-735: A HST may have a Provincial Sales Tax (PST), which are collected in British Columbia (7%), Manitoba (7%) and Saskatchewan (6%). Alberta and all three territories do not collect either a HST or PST. VAT was introduced in Chile in 1974 under Decreto Ley 825. From 1998 there was implemented a 18% tax. Since October 2003, the standard VAT rate has been 19%, applying to the majority of goods and some services. However certain items have been subjected to additional tax, for instance, alcoholic beverages (between 20.5= – 31.5% for fermented to distilled products), jewellery (15%), pyrotechnic items (50% or more for
296-497: A VAT Trustee if they: register and collect a Business Identification Number (BIN) from the NBR; submit VAT returns on time; offer VAT receipts; store all cash-memos; and use the VAT rebate system responsibly. VAT Mentors work in the VAT or Customs department and deal with trustees. The VAT rate is a flat 15%. VAT was introduced on 1 January 1997 and replaced 11 other taxes. The original rate of 15%
370-501: A business below the margin of profitability. The effect can be seen when VAT is cut or abolished. Sweden reduced VAT on restaurant meals from 25% to 12.5%, creating 11,000 additional jobs. VAT offers distinctive opportunities for evasion and fraud, especially through abuse of the credit and refund mechanism. VAT overclaim fraud reached as high as 34% in Romania. Exports are generally zero-rated , creating opportunity for fraud. In Europe,
444-456: A decade, it was imposed only on certain categories of goods and at differing rates. In 1994, VAT became universally imposed on production, wholesale, retain, and importation of all goods. In 2016, business tax was replaced with VAT nationwide. VAT's significance to China's tax revenues increased drastically after this. In 1993, a standard rate of 23% and a reduced rate of 5% for non-alcoholic beverages, sewerage, heat, and public transport
518-410: A lower rate to products that are more likely to be consumed by the poor. Some countries compensate by implementing transfer payments targeted to the poor. The incidence of VAT may not fall entirely on consumers as traders tend to absorb VAT so as to maintain sales volumes. Conversely, not all cuts in VAT are passed on in lower prices. VAT consequently leads to a deadweight loss if cutting prices pushes
592-414: A reduced rate of 12%. Goods and services were redistributed among different tax rates. There was only one services that shifted from the standard rate to the reduced rate and that were non-regular land passenger bus services. These are not taxi services, which apply a VAT rate of 21%. Books and printed materials, including electronic books, were zero rated. Several services were moved from reduced rates to
666-559: A requirement to reduce running costs, which would reduce staffing by around 500. The 27 teams outside London were reduced to 12 in 2015. Amanda Pritchard , the Chief Operating Officer of NHS England, was promoted to Chief Executive on 1 August 2021. NHS England produced a planning document – the Five Year Forward View – in October 2014 which envisaged development of new models to suit local needs. In conjunction with
740-452: A team of staff with the appropriate expertise. NHS England is responsible for commissioning £19.3 billion of specialised services in 2021-2 and for dealing with Individual Funding Requests in respect of the specialist services it commissions. There are proposals to move some of this commissioning to integrated care systems . The Shelford Group expressed concerns in May 2022 about services "where
814-581: Is a VAT introduced in Australia in 2000. Revenue is redistributed to the states and territories via the Commonwealth Grants Commission process. This works as a program of horizontal fiscal equalisation . The rate is set at 10%, although many domestically consumed items are effectively zero-rated (GST-free) such as fresh food, education, health services, certain medical products, as well as government charges and fees that are effectively taxes. VAT
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#1732851164258888-440: Is a consumption tax that is levied on the value added at each stage of a product's production and distribution. VAT is similar to, and is often compared with, a sales tax . VAT is an indirect tax , because the consumer who ultimately bears the burden of the tax is not the entity that pays it. Specific goods and services are typically exempted in various jurisdictions. Products exported to other countries are typically exempted from
962-509: Is a national sales tax introduced in 1991 at a rate of 7%, later reduced to 5%. A Harmonized Sales Tax (HST) that combines the GST and provincial sales tax, is collected in New Brunswick (15%), Newfoundland (15%), Nova Scotia (15%), Ontario (13%) and Prince Edward Island (15%), while British Columbia had a 12% HST until 2013. Quebec has a de facto 14.975% HST: it follows the same rules as
1036-403: Is input-output based. Producers are allowed to subtract VAT on their inputs from the VAT they charge on their outputs and report the difference. VAT is purchased quarterly. An exception occurs for taxpayers who state monthly payments. VAT is disbursed to the state's budget on the 20th day of the month after the tax period. The law took effect on January 1, 2022. The goods and services tax (GST)
1110-545: Is that VAT is collected at the national level, while in countries such as India and the US, sales tax is collected at the point of sale by the local jurisdiction, leading them to prefer the latter method. The main disadvantage of VAT is the extra accounting required by those in the supply chain. However, payment of VAT is made simpler when the VAT system has few, if any, exemptions (such as with GST in New Zealand). 10% sales tax: So,
1184-482: Is the greatest contributing factor to the US current account deficit , and estimated this disadvantage to US producers and service providers to be $ 518 billion in 2008 alone. US politicians such as congressman Bill Pascrell , advocate either changing WTO rules relating to VAT or rebating VAT charged on US exporters. A business tax rebate for exports was proposed in the 2016 GOP tax reform policy paper. The assertion that this "border adjustment" would be compatible with
1258-428: Is their best or only option, have no hope of access to funding. Most have been waiting many months. Approximately half of these patients are at imminent risk of a catastrophic event (renal bleed or kidney failure) with a high risk of preventable death." It authorises and pays for treatment of narcolepsy with sodium oxybate by means of individual funding requests on the basis of exceptional circumstances. In May 2016
1332-548: The Care Quality Commission and the like, rather than the Royal Colleges and Trades Unions of the earlier plan. This new national leadership of the NHS issues an unprecedented warning to politicians, none of whom are included in the endorsements, that it cannot continue at current funding levels, and additional resources worth more than 1.5 per cent a year in real terms will be required. No more top-down reorganisation
1406-513: The NHS app was unveiled, with public backing from Matt Hancock , who presented it as the key to a radical overhaul of NHS technology. The NHS Long Term Plan set a target for all secondary care providers to move to digital records by 2024, which "will cover clinical and operational processes across all settings, locations and departments and be based on robust, modern IT infrastructure services for hosting, storage, networks and cyber security." In 2020
1480-714: The National Health Service in England as set out in the Health and Social Care Act 2012 . It directly commissions NHS general practitioners , dentists, optometrists and some specialist services. The Secretary of State publishes annually a document known as the NHS mandate which specifies the objectives which the Board should seek to achieve. National Health Service (Mandate Requirements) Regulations are published each year to give legal force to
1554-609: The United States . German industrialist Wilhelm von Siemens proposed the concept of a value-added tax in 1918 to replace the German turnover tax . However, the turnover tax was not replaced until 1968. The modern variation of VAT was first implemented by Maurice Lauré , joint director of the French tax authority, who implemented VAT on 10 April 1954 in France's Ivory Coast colony. Assessing
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#17328511642581628-511: The 15 million people with long term conditions. Two new models of care – multispecialty community providers, and primary and acute care systems – involve integrating primary care and hospital care in a single provider organisation. The fact that the word “competition” does not appear once in the document was hailed as a victory by Labour. Stevens said that the health service would have to break out of its “narrow confines” and promote healthy lifestyles. Employers are key to promoting better health in
1702-518: The Board deems appropriate. The direction will be in place until the end of 2020. Applications by GPs to reduce their catchment area are dealt with by NHS England. In November 2014, Mr Justice Popplewell declared that NHS England "has acted unlawfully by reason of its failure to make arrangements for the involvement of patients in primary care commissioning decisions as required by the National Health Service Act 2006". The case involved
1776-505: The EEC, following which, other member states (initially Belgium, Italy, Luxembourg, the Netherlands and West Germany) introduced VAT. As of 2020, more than 160 countries collect VAT. VAT can be accounts-based or invoice-based. All VAT-collecting countries except Japan use the invoice method. Using invoices, each seller pays VAT on their sales and passes the buyer an invoice that indicates
1850-632: The FutureNHS collaboration platform, built on the Kahootz collaboration software. An evaluation study of the platform estimated that it has saved the NHS £3.5 million within its first year in 2017. Integrated primary and acute care systems will bring together GPs, hospital, community and mental health services. Money will be directed from a joint budget to wherever patients are judged to need it most: Multispecialty community providers are supposed to bring specialist services, like chemotherapy and dialysis, out of
1924-455: The GST, and both are collected by Revenu Québec . Advertised and posted prices generally exclude taxes, which are calculated at the time of payment; common exceptions are motor fuels, the posted prices for which include sales and excise taxes, and items in vending machines as well as alcohol in monopoly stores. Basic groceries, prescription drugs, inward/outbound transportation and medical devices are zero-rated. Other provinces that do not have
1998-504: The High Court ordered NHS England to provide funding to treat a teenager with severe narcolepsy. The judge criticised their "thoroughly bad decision" and "absurd" policy discriminating against the girl when hundreds of other NHS patients already receive the drug. The Department of Health is also paying for the treatment of people whose narcolepsy was caused by the swine flu vaccine Pandemrix in 2009–10 by means of private prescriptions outside
2072-466: The NHS Commissioning Board to buy services from the private sector, thereby bypassing CCGs. The Exercise of Commissioning Functions by the NHS Commissioning Board (Coronavirus) Directions 2020 came into force on 20 March 2020, and were revised to widen the definition of independent providers on 27 March. The directive also allows NHS England to exercise functions normally carried out by CCGs, as
2146-772: The NHS and councils to work together to provide more healthcare in care homes, and to provide better preventive services there: Development of the NHS 111 is a central issue for most of these projects. It's intended that it should meet all urgent clinical needs rather than just be a signposting service so that appointments could be made directly with GPs or rapid access mental health services. A further wave of 8 new sites were announced in July 2015: In February 2016 NHS organisations in England, both Clinical Commissioning Groups and NHS trusts , were grouped into 44 footprints which were each required to produce joint plans with their local authorities for health and health service transformation for
2220-458: The NHS awarded an emergency contract to Palantir Technologies for the creation of a Covid Data Store system for a statutory fee of £1. Palantir then won a £23.5 million contract with the NHS to continue with its work in December 2020. Palantir's involvement with the NHS was subject to criticism from civil liberties groups, including Open Democracy . In 2023 the NHS began a procurement process for
2294-637: The NHS could deliver £22bn of annual savings in 5 years’ time, is the latest of a long line of reports to assert that there is scope for the NHS to make major savings, but the report does make it clear that more resources, an extra £8bn in Government funding by 2020 would be needed. It claimed that there would be a "radical upgrade in prevention and public health", but as Dr Sarah Wollaston pointed out in October 2016 there were reductions in other areas of health spending outside NHS England’s budget, in particular public health. Without improvements in social care she said
Five Year Forward View - Misplaced Pages Continue
2368-491: The NHS could not be expected to deliver the Five Year Forward View. NHS efficiency savings of 2% to 3% a year from 2015 to 2021 were supposed to save £22 billion a year. Between 2004 and 2014 NHS output increased considerably. Hospital admissions increased by 32%, outpatient attendances by 17%, primary care consultations by 25% and community care activity by 14%. Hospital death rates reduced, especially in stroke. At
2442-602: The National Health Service. In May 2022 it produced guidance that said 65 of the 154 services they commissioned were ready and suitable to be devolved to the integrated care systems . It is expected that most will be jointly commissioned with their neighbours, rather than on their own. The organisation's responsibilities include arbitration in disputes between clinical commissioning groups and NHS trusts . VAT A value-added tax ( VAT or goods and services tax ( GST ), general consumption tax ( GCT ))
2516-509: The UK in June 2015. The organisation was reported to be developing a strategy to support the use of personal health records in June 2015. This, it is hoped, could achieve up to £3.4 billion in annual efficiency savings by 2020. In April 2016 it published an index of digital maturity, where each of the 239 NHS trusts assessed its own "readiness", "capabilities" and "enabling infrastructure". In 2018
2590-507: The amount of tax paid excluding deductions (input tax). Buyers who themselves add value and resell the product pay VAT on their own sales (output tax). The difference between output tax and input tax is the amount paid to the government (or refunded, in the case of a negative amount). Using accounts, the tax is calculated as a percentage of the difference between sales and purchases from taxed accounts. VAT provides an incentive for businesses to register and keep invoices, and it does this in
2664-412: The apparent revenue is churned – i.e. taxpayers are given the money to pay the tax, reducing net revenue. Refund delays by the tax administration can damage businesses. Compliance costs are seen as a burden on business. In the UK, compliance costs for VAT have been estimated to be about 4% of the yield, with greater impacts on smaller businesses. Under a sales tax system, only businesses selling to
2738-480: The chairmanship of Professor Fritz Neumark made its priority objective the elimination of distortions to competition caused by disparities in national indirect tax systems. The Neumark Report published in 1962 concluded that France's VAT model would be the simplest and most effective indirect tax system. This led to the EEC issuing two VAT directives, adopted in April 1967, providing a blueprint for introducing VAT across
2812-493: The consumer pays 10% ($ 0.15) extra, compared to the no taxation scheme, and the government collects this amount. The retailers pay no tax directly, but the retailer has to do the tax-related paperwork. Suppliers and manufacturers have the administrative burden of supplying correct state exemption certifications that the retailer must verify and maintain. The manufacturer is responsible for ensuring that their customers (retailers) are only intermediates and not end consumers (otherwise
2886-516: The decision to scrap the minimum practice income guarantee. Richard Stein, a partner at Leigh Day , said the declaration could mean that patients would have to be involved in discussions on changes to the GP contract. NHS England awarded a four-year contract to Capita to become sole provider of administrative services including payment administration, management of medical records, and eligibility lists for practitioners for GPs, opticians and dentists across
2960-481: The document. It already conducts 75 per cent of consultations remotely using phone or Skype . Patients have an electronic care plan they can manage themselves, and digital access to consultant advice. According to Nick Timmins it is the first NHS document he could recall that said NHS structures did not have to be the same everywhere. This document, published in March 2017, outlined progress since 2015 and priorities for
3034-573: The end-user are required to collect tax and bear the accounting cost of collecting the tax. Under VAT, manufacturers and wholesale companies also incur accounting expenses to handle the additional paperwork required for collecting VAT, increasing overhead costs and prices. The American Manufacturing Trade Action Coalition in the United States consider VAT charges on US products and rebates for products from other countries to be an unfair trade practice . AMTAC claims that so-called "border tax disadvantage"
Five Year Forward View - Misplaced Pages Continue
3108-479: The expanded application is zero VAT for many operations and transactions. That zero VAT is the source of controversies between its trading partners, mainly Russia, which is against the zero VAT and promotes wider use of tax credits. VAT is replaced with fixed payments, which are utilized for many taxpayers, operations, and transactions. Legislation is based largely on the EU VAT Directive's principles. The system
3182-601: The experiment as successful, France introduced it domestically in 1958. Initially directed at large businesses, it was extended over time to include all business sectors. In France it is the largest source of state finance, accounting for nearly 50% of state revenues. Following creation of the European Economic Community in 1957, the Fiscal and Financial Committee set up by the European Commission in 1960 under
3256-466: The first sale or import) or soft drinks with high sugar (18%). AS of 2023, the VAT tax includes majority of services excluding Education, Health and Transport, as well as taxpayers issuing fee receipts. This tax makes the 41.2% of the total revenue of the country. VAT produces the largest share of China's tax revenue. In 1984 the State Council announced that China would begin collecting VAT. For
3330-426: The forerunner to becoming a non-departmental body on 1 April 2013. It was renamed NHS England on 26 March 2013, although its legal name remains the NHS Commissioning Board. Sir David Nicholson , who became Chief Executive at the establishment of the Board, retired at the end of March 2014 and was replaced by Simon Stevens . One of Stevens' first acts was to announce a restructure of the 27 area teams, in response to
3404-428: The form of zero-rated goods and VAT exemption on goods not resold. Through registration, a business documents its purchases, making them eligible for a VAT credit. The main benefits of VAT are that in relation to many other forms of taxation, it does not distort firms' production decisions, it is difficult to evade, and it generates a substantial amount of revenue. VAT has no effect on how businesses organize, because
3478-520: The historical allocation was slow, and CCGs which were above their allocation did not suffer a reduction. From April 2016, however, CCGs with more than 10 per cent above their fair share were to receive "flat cash" – an effective reduction. This would also ensure than no CCG was more than 5 per cent below its target allocation in 2016/2017. In October 2016 it introduced the Operational Pressures Escalation Levels (OPEL) system for
3552-457: The hospital and closer to people’s homes. They were described as a "political vanity project" in April 2017 by Dr Tom Coffey , who is NHS England London clinical director of emergency care. NHS England announced three potential routes for MCP contracts in July 2016: By August 2017 some of these providers appeared to be merging into the proposed accountable care systems . Approved proposals: Models of enhanced health in care homes will enable
3626-410: The largest budget deficits. It is intended to reduce their spending by around £500 million, and health leaders were told to "think the unthinkable". In 2022 there were seven regional teams and 10,640 full time equivalent staff. NHS England allocates funding (£69.5 billion in 2016/2017) to CCGs in accordance with a funding formula. Until 2016, progress towards the amount indicated by the formula from
3700-591: The main source of problems is carousel fraud . This fraud originated in the 1970s in the Benelux countries. VAT fraud then became a major problem in the UK . Similar fraud possibilities exist inside a country. To avoid this, countries such as Sweden hold the major owner of a limited company personally responsible. Because VAT is included in the price index to which state benefits such as pensions and welfare payments are linked in some countries, as well as public sector pay, some of
3774-556: The management of operational difficulties in English hospitals, replacing the system of red and black alerts which was locally defined. OPELs range from 1 (normal) to 4 (a major crisis requiring external intervention either regionally or nationally). This is intended, among other things, to enable comparisons of trends over time and between areas. In view of the coronavirus pandemic , the Secretary of State for Health and Social Care directed
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#17328511642583848-503: The mandate. In 2018 it was announced that the organisation, while maintaining its statutory independence, would be merged with NHS Improvement , and seven "single integrated regional teams" would be jointly established. NHS England is the operating name of the NHS Commissioning Board and, before that, the NHS Commissioning Board Authority. It was set up as a special health authority of the NHS in October 2011 as
3922-428: The manufacturer charges the tax). In addition, the retailer tracks what is taxable and what is not, along with the various tax rates in each city where it operates. 10% VAT: In the VAT example above, the consumer has paid, and the government received, the same dollar amount as with a sales tax. At each stage of production, the seller collects a tax and the buyer pays that tax. The buyer can then be reimbursed for paying
3996-482: The nation. He pledged to get junk food out of hospital canteens. The plan also pays far more attention to the potential for technological innovation using the internet and mobile phone and apps than any previous NHS document. Technology, it envisages, will enable self-management, integration and patient centred care. This has already been done by the Modality Partnership which is given a favourable mention in
4070-463: The next two years. Containing the growth in A&;E admissions and bed days is to be a priority. GP practices are to be organised into area hubs covering populations of up to 50,000. At least 150 new inpatient beds for children and young people with mental health problems are to be provided. There will be reforms to increase the number of nurses and reforms to enable more flexible working. Its claims that
4144-481: The numbers and evidence base supports the planning and provision of care being done at a population size larger than a typical ICS footprint." In 2015 there was criticism of delays in deciding on a policy for the prescription of Everolimus in the treatment of tuberous sclerosis . Twenty doctors addressed a letter to the board in support of the charity Tuberous Sclerosis Association saying "around 32 patients with critical need, whose doctors believe everolimus treatment
4218-616: The other central regulators, the organisation established what is called a "success regime" in south and mid Essex, North Cumbria and north east and western Devon in June 2015. It was intended to tackle "deep rooted and systemic issues that previous interventions have not tackled across [a] whole health and care economy". In 2016 it organised the geographical division of England into 44 sustainability and transformation plan areas, with populations between 300,000 and 3 million. These areas were locally agreed between NHS Trusts , local authorities and clinical commissioning groups (CCGs). A leader
4292-539: The period up to 2020. Each had a leader, some from the NHS and some from local authorities. See Sustainability and transformation plan . NHS England NHS England , formerly the NHS Commissioning Board for England , is an executive non-departmental public body of the Department of Health and Social Care . It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of
4366-470: The population and there should be incentives to encourage participation in Weight Watchers-type schemes. The plan includes a focus on the health of NHS staff, saying that three quarters of hospitals fail to make available nutritious food for nurses and other workers on night shifts. Stevens said NHS staff should set an example by leading healthier lifestyles as part of a drive to improve the health of
4440-531: The price at which it is sold increases. VAT has been criticized by opponents as a regressive tax , meaning that the poor pay more, as a percentage of their income, relative to the wealthier individuals, given the higher marginal propensity to consume among the poor. Defenders reply that relating taxation levels to income is an arbitrary standard and that the VAT is in fact a proportional tax . An OECD study found that VAT could even be slightly progressive. VAT's effective regressivity can be reduced by applying
4514-457: The proposal to erode the distinction between hospital consultants and General practitioners, encouraging hospitals to employ GPs - a distinction which has lasted in the UK for more than a century - and permit the development of "Accountable Care Organisations" similar to those in Spain and parts of the United States. There is much stress on the fact that 70% of the NHS budget is spent on the management of
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#17328511642584588-432: The rest of England 1.3%. Both MCPs and PACS saw substantially slower growth in the rate of emergency admissions per 1,000 population than the rest of England. Growth for MCPs was 2.6% and for PACS the figure was 1.2%. In the rest of England it was 4.9%. In order to ensure the knowledge from the new models of care was captured and shared throughout the health and care system, the national new care models programme established
4662-454: The rules of the WTO is controversial; it was alleged that the proposed tax would favour domestically produced goods as they would be taxed less than imports, to a degree varying across sectors. For example, the wage component of the cost of domestically produced goods would not be taxed. A 2021 study reported that value-added taxes were unlikely to distort trade flows. The VAT rate is 20%. However,
4736-406: The same amount of tax is collected regardless of how many times goods change hands before arriving at the ultimate consumer. By contrast, sales taxes are collected on each transaction, encouraging businesses to vertically integrate to reduce the number of transactions and thereby reduce the amount of tax. For this reason, VAT has been gaining favor over traditional sales taxes. Another difference
4810-496: The same time there was an increase in wages of 24% and an increase of 10% in the number of staff and increases in the use of equipment and supplies. As a whole NHS output increased by 47% and inputs by 31%, an increase in productivity of 12.86% during the period, or 1.37% per year, considerably less than envisaged in the Five Year Forward View. 29 areas were selected (from 269 applicants) to pilot new models for localised healthcare in March 2015. When insufficient transformation funding
4884-644: The tax, but only by successfully selling the value-added product to the buyer at the next stage. In the previous examples, if the retailer fails to sell some of its inventory, it suffers a greater financial loss in the VAT scheme, in comparison to the sales tax regulatory system, by having paid a higher wholesale price on the product it wants to sell. Each business is responsible for handling the necessary tax paperwork. However, businesses have no obligation to request certifications from purchasers who are not end users, or of providing such certifications to their suppliers, but they incur increased accounting costs for collecting
4958-483: The tax, typically via a rebate to the exporter. VAT is usually implemented as a destination-based tax, where the tax rate is based on the location of the producer. VAT raises about a fifth of total tax revenues worldwide and among the members of the Organisation for Economic Co-operation and Development (OECD). As of June 2023, 175 of the 193 countries with UN membership employ a VAT, including all OECD members except
5032-422: The tax. The simplified examples assume incorrectly that taxes are non-distortionary: the same number of widgets were made and sold both before and after the introduction of the tax. However, the supply and demand economic model suggests that any tax raises the cost of the product for someone. In raising the cost, the supply curve shifts leftward. Consequently, the quantity of a good purchased decreases, and/or
5106-534: Was allocated in September 2016 the plans were scaled down. Proposals for companies to run primary and acute care systems or multispecialty community providers appear to have been prevented because they would be liable for VAT . In the 12 months to September 2017, compared to the 2014–15 financial year, there was a reduction in the rate of hospital bed days per 1,000 population - for Primary and acute care systems 0.5%, for Multispecialty community providers 1.5%, and for
5180-424: Was appointed for each area, who is to be responsible for the implementation of the plans which are to be agreed by the component organisations. They will be "working across organisational boundaries to help build a consensus for transformation and the practical steps to deliver it". In April 2017 it introduced a capped expenditure process, applied to NHS commissioners and providers in the 13 areas across England with
5254-528: Was increased to 17.5% in 2011. The rate on restaurant and hotel accommodations is between 10% and 15% while certain foods and goods are zero-rated. The revenue is collected by the Barbados Revenue Authority . VAT was 20% as of 2023. A reduced rate of 9% applies to baby foods and hygiene products, as well as on books. A permanent rate of 9% applies to physical or electronic periodicals, such as newspapers and magazines. Goods and Services Tax (GST)
5328-738: Was introduced in 1991, replacing sales tax and most excise duties. The Value Added Tax Act, 1991 triggered VAT starting on 10 July 1991, which is observed as National VAT Day. VAT became the largest source of government revenue, totaling about 56%. The standard rate is 15%. Export is zero rated. Several reduced rates, locally called Truncated Rates, apply to service sectors and range from 1.5% to 10%. The Value Added Tax and Supplementary Duty Act of 2012 automated administration. The National Board of Revenue (NBR) administers VAT. Other rules and acts include Development Surcharge and Levy (Imposition and Collection) Act, 2015; and Value Added Tax and Supplementary Duty Rules, 2016. Anyone who collects VAT becomes
5402-400: Was introduced. In 2015, rates were revised to 21% for the standard rate, and 15% and 10% reduced rates. The lowest reduced rate primarily targeted baby food, medicines, vaccines, books, and music shops, while maintaining a similar redistribution of goods and services for the other rates. In 2024, a law aimed at reducing the national debt featured return to two rates: a standard rate of 21% and
5476-400: Was proposed, but instead the development of new models to suit local needs, something quite radical for the NHS, which is accustomed to the imposition of uniformity regardless of local conditions. It seeks to break away from Enoch Powell ’s 1962 Hospital Plan for England and Wales which established the district general hospital as the central pillar of British healthcare. Even more radical is
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