Our National Debt

A_Medium_Size_Jock

steampowered wrote: »

Is that actually true though?

I've been working with large private and public sector organisations on major projects for a number of years now, both on the procurement and provision side. The waste in large private sector organisations is unbelievable. Public sector organisations have it as well but not nearly as much (and the public sector certainly negotiates our fees harder than the private sector).

Of course that is purely anecdotal. In terms of hard evidence, the Commonwealth Fund found that the NHS was the most efficient health serviced out of the countries studied - which like most countries have a much greater proportion of their healthcare run by private providers than we do.

Similarly, you will get a much higher number of people on £100k+ salaries and highly paid managers in the private sector than you will in the public.

I do worry that we may, once again, be in a fantasy land of believing there are significant easy savings to be made by simply eliminating waste (which by the way most of the public sector has been trying extremely hard to do since the 2007 spending review - which at the time was perceived as being quite a tough settlement).

I'd be delighted if someone is able to correct me, but right now I see no evidence that there there are potential savings out there capable of making a meaningful dent in the deficit without a significant reduction in jobs and services.

Ah, I think we can now see just why you simply want more money for the NHS and think that any costcutting and/or reform is not actually going to save money.
Your first sentence explains clearly; you are someone that earns (or at least has earned) money from the NHS with your so-called "major projects".
You really just do not want these potential earnings to dry up, do you?

Because there is absolutely no way that any sensible person disagrees that there are ways savings can be made - I for one have noted your focussing only upon examples given, rather than a wider picture.
Now I know why.
"How much money are you really going to save by stopping prescriptions for paracetamol and gender reassignment surgery? Not enough to make a significant difference.

Let me run some figures for you. The NHS spent £87m on paracetamol prescriptions last year. The NHS budget last year was £116.4 billion. In other words, 0.07% of the budget." you say earlier.

Yet you disregard the potentially very numerous other potential savings which - even you must admit - would combine to save a far greater percentage of the overall NHS budget.
I did after all say "radical reform" is needed.
As stated earlier, restricting NHS procedures to those which are potentially life threatening being just one example.
Things like ending gender reassignment surgery or medications; ending fertility treatment; there could be quite a long list and to deny that the funding for these would make no difference is frankly ridiculous.
These saved funds could be used to increase bed space for the essential aspects of the NHS.

You quoted efficiency in a link from the Commonwealth fund.
Well, here's one back at you from Lord Carter just last year which suggests that the NHS wastes £5 billion annually.
http://www.that-figures.com/inefficiency-costs-nhs-5bn-year/
https://www.gov.uk/government/news/review-shows-how-nhs-hospitals-can-save-money-and-improve-care
Are all these potential savings starting to add up yet?

I am not suggesting such radical reform will be easy or indeed welcomed by the UK public.
But sold correctly by informing the public that the choice is reform, cuts or privatisation for example it is possible.
Indeed for our NHS to continue it must be made possible.

A_Medium_Size_Jock

Filo25 wrote: »

I tend to agree, there are undoubtedly savings to be found, there always are, but I suspect looking for massive savings is likely to lead to disappointment all round, its a predictable mantra of those on the right politically that efficiency savings will be the answer to any awkward questions on public spending/services. In much the same way as the Left love to plug holes in public finances with questionable numbers for closing tax loopholes and tackling evasion and avoidance.

The underlying issue remains that with an aging population, the demands on the health service will continue to rise significantly, leading to significant further funding being required each year.

As you said, previously, we do not actually spend massive amounts on healthcare as a proportion of GDP compared to many other comparable economies.

A funding increase would indeed be good.
What funding there is, increased or not needs to be better-targetted at those who most need it though.
Not at the myriad unnecessary things or non life-threatening procedures currently undertaken by the NHS.

lisyloo

Not at the myriad unnecessary things or non life-threatening procedures currently undertaken by the NHS.

Be interested to know what you think we should cut.
IVF? Knee operations? or what?

Thrugelmir

lisyloo wrote: »

Be interested to know what you think we should cut.
IVF? Knee operations? or what?

At the very least the onus should be on people to look after themselves. Eating habits, weight etc. In order to receive expensive treatment or surgery.

Someone I work with is complaining about the NHS. As her husband is suffering from severe diabetes. Turns out that he hasn't lost any weight since he was diagnosed 11 years ago. As a consequence they've now blocked certain channels of assistance. Much to her disgust. They've put the onus firmly back on him to do something first.

Filo25

Thrugelmir wrote: »

At the very least the onus should be on people to look after themselves. Eating habits, weight etc. In order to receive expensive treatment or surgery.

Someone I work with is complaining about the NHS. As her husband is suffering from severe diabetes. Turns out that he hasn't lost any weight since he was diagnosed 11 years ago. As a consequence they've now blocked certain channels of assistance. Much to her disgust. They've put the onus firmly back on him to do something first.

I'd agree with that, within reason as well.

People have to at least try to manage conditions they have as effectively as possible.

In general in life maybe we need more of a balance between rights and obligations, most people are reasonable and fair but not everyone is.

A_Medium_Size_Jock

lisyloo wrote: »

Be interested to know what you think we should cut.
IVF? Knee operations? or what?

I gave a few examples earlier.
It boils down to the simple fact that the NHS is not a bottomless pit ........ unless you and a majority of the British public decides that they are willing to contribute more to make it so, that is.

It is either that, or:
Would you rather fund a few rounds of IVF for a couple who cannot conceive naturally or fund an elderly dementia sufferer to live in safety for a while?

As we are seeing and indeed have seen over the last decade or so, something has to change with the NHS.
Unpalatable choices must be made.
We are nearing the time (if we are not already there) when these choices must be made.

steampowered

A_Medium_Size_Jock wrote: »

radical reform

You've mentioned the word "radical reform" in your post several times.

Yet despite reading all your posts I have absolutely no idea of what your "radical reform" actually means or how it will save money.

What does your proposed "radical reform" look like and how exactly would it save money? Are you simply talking about cutting services or is there something more to it?

Things like ending gender reassignment surgery or medications; ending fertility treatment; there could be quite a long list and to deny that the funding for these would make no difference is frankly ridiculous.

Last year the NHS spent £17.13 million on gender assignment surgery. That represents 0.014% of the NHS budget. You'd have to cut gender reassignment surgery 72 times over to save 1% of the budget.

I think you are giving us examples of miniscule savings which do not even amount to tinkering around the edges. You are tinkering with the edge of the edge of the edges.

My personal view is that the NHS should be paying for people who need it to get fertility treatment. Being unable to have children sounds like a medical condition to me. There is a very obvious social interest in helping people conceive. I have no idea why you would want to cut this. But I suppose that's a separate debate.

But sold correctly by informing the public that the choice is reform, cuts or privatisation for example it is possible.

The choice is not as binary as you suggest. I refer you to the graph I posted demonstrating that the UK spends less on healthcare than nearly all other developed countries.

Well, here's one back at you from Lord Carter just last year which suggests that the NHS wastes £5 billion annually.

By private sector standards, an organisation which spends £117.4 billion a year but could save £5 billion a year by being more efficient, would be seen as an extremely efficient organisation. Perhaps some of that could be realised by making further changes to how the NHS is run but frankly I'm doubtful.

steampowered

A_Medium_Size_Jock wrote: »

Unpalatable choices must be made.
We are nearing the time (if we are not already there) when these choices must be made.

I just want to take stock of the cuts you've proposed.

Annual NHS Budget: £116.4 billion.
NHS budget after all your cuts = £115.9 billion

Made up of the following:
Annual cost of gender assignment surgery: £17.13 million.
Annual cost of paracetamol: £87 million.
Annual cost of fertility treatment: £400 million

(I couldn't find a more exact figure for the cost of fertility treatment so have linked to the Daily Mail's estimate which does not appear to have a proper source. If anyone has the correct exact figure I'd be much obliged).

I'm not feeling convinced that you actually have a realistic proposal for materially cutting the NHS budget.

If you genuinely want to cut the NHS budget, perhaps the "unpalatable choices" are much more serious than you have let on with your references to paracetamol and gender reassignment. Perhaps what you are really talking about is hospital closures.

wotsthat

Thrugelmir wrote: »

Someone I work with is complaining about the NHS. As her husband is suffering from severe diabetes. Turns out that he hasn't lost any weight since he was diagnosed 11 years ago. As a consequence they've now blocked certain channels of assistance. Much to her disgust. They've put the onus firmly back on him to do something first.

If it's T2 diabetes there's a good chance he can reduce/ eradicate the disease if he loses weight, he'll be better able to exercise and enjoy life. I'll have to pay less towards his ongoing care and, who knows, he might be in a better position to make more of a contribution himself. Maybe a channel of assistance that involves diet and mental health support is required?

Here's what I think will really happen. He won't lose weight, his condition will worsen, he'll continue to cost the taxpayer a fortune, be miserable and, after quite a few trips to A&E, will die. Nobody wins.

The NHS won't really be able to save money by refusing chronic care unless they also refuse acute care too. Unless our friend loses weight he'll still cost us - we'll just be spending the money later in acute care.

Not sure what the solution is to this conundrum.

steampowered

wotsthat wrote: »

Here's what I think will really happen. He won't lose weight, his condition will worsen, he'll continue to cost the taxpayer a fortune, be miserable and, after quite a few trips to A&E, will die. Nobody wins.

I imagine the taxpayer wins. Maybe I am being very morbid, but if someone dies early as a result of being obese, they are no longer drawing a state pension and do not require so much care in old age.

If everybody stopped being obese you'd have a temporary reduction in costs on things like diabetes treatment, but greater long term pension and care costs. I'm not sure which cost is greater but I suspect it is the latter.