Our National Debt

wotsthat

steampowered wrote: »

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.

If someone is morbidly obese and has a few other diseases of wealth to go with it then it's probably in the bests interests of the taxpayer if they did one. It's difficult to dress this up as a win for the taxpayer. Rather it has just bought an end to the losing streak.

The win for the taxpayer comes if our friend doesn't suffer from diseases of wealth in the first place or is efficiently treated if he does. Pension costs are a bit of a red herring in my view - we already know that if more people get to pension age and live longer the government will adjust the qualifying criteria anyway.

The NHS is a victim of its own success. Not so many years ago our friend would've been dead already. The NHS are preventing deaths in people who otherwise wouldn't have survived. It's reasonable to assume that this is (a) very expensive and (b) people who have been rescued from death by the NHS are probably more expensive to keep alive than people who didn't need rescuing in the first place.

A_Medium_Size_Jock

steampowered wrote: »

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

You are not "taking stock" though are you, instead you are seizing upon a very few examples that I suggest and ignoring the majority of possibilities in order to make your suggested savings appear negligible.
As you ignored the £5 billion potential saving suggested by Lord Carter in your figures in your last post; why is that?
Is it because you just do not want to accept that substantial savings are indeed possible?
Because combined they are not potentially insignificant savings; they are substantial.

Yes, the "unpalatable choices" do indeed amount to much more than the small portion you persist upon referring to.
As I keep saying, using phraseology like "for example".
Which you keep ignoring, clinging rigidly to for example Paracetamol yet ignoring so many other prescription items which also need not be free, like Ibuprofen or Aspirin.
*Just in case you miss it again, these too are examples only. Not intended as a complete, comprehensive list.*
You want a list?
Use your imagination; there's a large list to choose from which cost more in total to prescribe than to buy "over-the-counter".
That without considering those which could be considered just plain unnecessary or inappropriate.
Without the above, would you like another figure towards savings?
From current prescriptions it is estimated that £300 million of prescribed medications are wasted annually.
https://www.england.nhs.uk/wp-content/uploads/2015/06/pharmaceutical-waste-reduction.pdf

You insist upon using terminology like "cut the NHS budget".
No, not so.
I would like to see reallocation and rationalisation of the budget.
Funds from cuts such as those suggested *and more, remember* should be used for increasing capacity in the most-needed areas.
No, IMHO fertility treatment is not a necessity; not having a child will not put your life at risk..
If you can afford the costs involved in having children but cannot conceive, fund fertility treatment yourself.
If you cannot fund treatment your ability to provide for your proposed child must be questioned.
*Another example.*

As for "we fund less than the ...." argument, so what?
I do keep saying that more funding would be good.
But first please can we ensure that funding goes where it is needed rather than where some want it to go?

Again I am not suggesting hospital closures.
Just better use of the available resources - which in fact would preferably even lead to expansion.

In summary then you are not being realistic about such plans as I suggest.
To make a comprehensive list would require time, patience - and much more space than this thread affords.
If on behalf of an appropriate source you wish to fund me in order to receive a qualified, complete appraisal together with full budgetary costings packaged in a plan for a review of the NHS I would be most pleased to so do.
For a modest fee.
Perhaps now we can cease going around in circles?

steampowered

A_Medium_Size_Jock wrote: »

You are not "taking stock" though are you, instead you are seizing upon a very few examples that I suggest and ignoring the majority of possibilities in order to make your suggested savings appear negligible.
As you ignored the £5 billion potential saving suggested by Lord Carter in your figures in your last post; why is that?
Is it because you just do not want to accept that substantial savings are indeed possible?
Because combined they are not potentially insignificant savings; they are substantial.

I addressed that in the last part of my post. As I pointed out, if a private sector organisation with turnover of organisation with £116.4 billion could only save £5bn by becoming more efficient; that would be considered an extremely efficient organisation by any standard.

I'm very sceptical the £5bn could be achieved - is it really feasible for an organisation facing ever changing demands like the NHS to run at 100% efficiency?

Even if you did achieve 100% of those savings - which would truly be remarkable - you've only reduced the NHS budget from £116.4 billion to £111.4 billion.

Yes, the "unpalatable choices" do indeed amount to much more than the small portion you persist upon referring to.
As I keep saying, using phraseology like "for example".
Which you keep ignoring, clinging rigidly to for example Paracetamol yet ignoring so many other prescription items which also need not be free, like Ibuprofen or Aspirin.
*Just in case you miss it again, these too are examples only. Not intended as a complete, comprehensive list.*
You want a list?

We've been through pages and pages of this stuff, and you've only been able to come up with three examples of possible savings. Which curiously all seem to have been Daily Mail headlines.

You identified two examples (gender reassignment and paracetamol) which together add up to 0.089% of the NHS budget.

If you want to convince me that there are so many examples of savings, I would quite like your examples to add up to a bit more than that.

The other suggestion - ending fertility treatment - I find quite frankly unpalatable. Infertility is a serious medical condition and I think people should receive care if they suffer from it. Even if you did eliminate it you've still only eliminated a tiny chunk of the budget.

Perhaps now we can cease going around in circles?

If you'd like to stop going round in circles, the best way would be to tell us what your "fundamental reform" looks like.

You've talked about "fundamental reform" and "better use of resources" several times now, but given us no indication at all of how this might actually be achieved. I am all ears.

If you can't tell us what the "fundamental reform" looks like, I think its time to admit that you don't have a magic wand, and don't have anymore of a clue how to save significant sums of money than the NHS does.

steampowered

wotsthat wrote: »

The win for the taxpayer comes if our friend doesn't suffer from diseases of wealth in the first place or is efficiently treated if he does. Pension costs are a bit of a red herring in my view - we already know that if more people get to pension age and live longer the government will adjust the qualifying criteria anyway.

The point I'm making is not about the size of pension expenditure as a whole. The point I'm trying to make is that healthy people who live a long time take a much greater share of the pension pot.

People who live a long time are also going to require much greater care costs. For example is it really more expensive to treat an obese person with diabetes who dies early as a result, than a person of healthy weight who has dementia?

For that reason it is not obvious to me that obesity is a long-term cost to the taxpayer. Certainly there is a cost to the individual, and short-term healthcare costs, but long-term healthcare costs are reduced.

kabayiri

steampowered wrote: »

...
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.

There's a local IT company in the NW which sells eProcurement solutions and services. I was talking to one of the senior managers.

He claims to have saved the NHS in the region some serious amounts of money, and also believes this is a relatively untapped market.

A_Medium_Size_Jock

steampowered wrote: »

I addressed that in the last part of my post. As I pointed out, if a private sector organisation with turnover of organisation with £116.4 billion could only save £5bn by becoming more efficient; that would be considered an extremely efficient organisation by any standard.

I'm very sceptical the £5bn could be achieved - is it really feasible for an organisation facing ever changing demands like the NHS to run at 100% efficiency?

Even if you did achieve 100% of those savings - which would truly be remarkable - you've only reduced the NHS budget from £116.4 billion to £111.4 billion.


We've been through pages and pages of this stuff, and you've only been able to come up with three examples of possible savings. Which curiously all seem to have been Daily Mail headlines.

You identified two examples (gender reassignment and paracetamol) which together add up to 0.089% of the NHS budget.

If you want to convince me that there are so many examples of savings, I would quite like your examples to add up to a bit more than that.

The other suggestion - ending fertility treatment - I find quite frankly unpalatable. Infertility is a serious medical condition and I think people should receive care if they suffer from it. Even if you did eliminate it you've still only eliminated a tiny chunk of the budget.


If you'd like to stop going round in circles, the best way would be to tell us what your "fundamental reform" looks like.

You've talked about "fundamental reform" and "better use of resources" several times now, but given us no indication at all of how this might actually be achieved. I am all ears.

If you can't tell us what the "fundamental reform" looks like, I think its time to admit that you don't have a magic wand, and don't have anymore of a clue how to save significant sums of money than the NHS does.

It really does look like all you are doing is trying to prevaricate and provoke argument.
In fact you have addressed nothing at all.

You ignore what I post regarding examples and attempt to provoke by suggesting (to what end other than argument?) use of only one publication whilst contributing nothing yourself.

As I say earlier;

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?

That much is patently obvious from your posts on this subject so far in this thread.
Hence I refuse to be further drawn by one so clearly intent on provocation.

A_Medium_Size_Jock

An interesting report (and chart) regarding European Debt:

Although many are concerned about levels of debt in Greece, there are several other countries in the EU that have debts to rival the struggling nation, according to figures released by Eurostat.

http://www.telegraph.co.uk/news/0/european-debt-crisis-not-just-greece-drowning-debt/

steampowered

A_Medium_Size_Jock wrote: »

As I say earlier;
That much is patently obvious from your posts on this subject so far in this thread.
Hence I refuse to be further drawn by one so clearly intent on provocation.

To be fair, I make a lot more from private sector clients than public sector clients. I do undertake some public sector work on major projects like major new IT systems, outsourcing, asset divestments, infrastructure projects and the like (though I've never acted for the NHS) but it tends to be at lower rates. The reason why businesses engage consultants like me to help deliver major projects is because I actually look at the evidence and give advice based on the facts, and on what can actually be delivered, rather than making sweeping assertions based on nothing. And frankly major projects just involve a lot of work so sometimes outside help is required.

What you seem to be asking for is a "fundamental restructuring" of the NHS. Yet nowhere have you actually said what that "fundamental restructuring" involves or how it would save money.

You make it sound like yet another pointless shuffling of assets between different parts of the NHS, which would be quids in for consultants like me, yet would deliver no benefit to the taxpayer.

The only examples you've given were not "restructuring", they were simply service cuts. Services which together add up to less than a tenth of a percent of the NHS budget.

I am not trying to provoke an argument. But I am going to fact check you when you make sweeping, inaccurate statements. In my view there is no reason why the NHS shouldn't be properly funded - in line with the average for other developed countries.

steampowered

kabayiri wrote: »

There's a local IT company in the NW which sells eProcurement solutions and services. I was talking to one of the senior managers.

He claims to have saved the NHS in the region some serious amounts of money, and also believes this is a relatively untapped market.

Yes, I think that's fair. Public procurement can certainly be improved; just as private sector procurement can be improved.

How much of an impact such improvements would actually have on the budget though I'm very sceptical. The links posted earlier suggested that this sort of saving might shave £5bn off the NHS' £116.4 billion budget which would be great, but not resolve the deficit. And of course you'd have to employ more procurement managers to get those savings.

antrobus

steampowered wrote: »

The point I'm making is not about the size of pension expenditure as a whole. The point I'm trying to make is that healthy people who live a long time take a much greater share of the pension pot....

It would be better to assume that there is no pension pot.

The national debt might well be £1500 bn. But there is another £1500 bn outstanding in terms of off-balance sheet public sector liabilities.

You need to look at the WGA to see a fuller picture.
https://www.gov.uk/government/publications/whole-of-government-accounts-2014-to-2015