Successive comments in a another thread for me thinking. One talked of “brutal cuts to the NHS” another talked of a friend who emigrated to work elsewhere as he was tired of the cuts. in real terms the NHS budget has gone up over the Tory rule. So what’s happening here: A) there are no cuts, but population is increasing so it’s a per capita cut. B) there are no cuts, but population is aging so the usage has gone up and budget doesn’t increase enough. C) Full fact figures are wrong D) Money is going away from frontline into management E) Money is going away from frontline and siphoned off by privatisation. F) Money is being swallowed by final salary pensions Genuine question from someone who doesn’t work in NHS. Would be good to get some insider insight rather than political slogans on this one. The NHS seems to be struggling, but if we increased budget by 5% would they struggle any less due to where the money is being directed?
Money does have to be directed well. Sure there are some problems in the NHS, but it is also pretty efficient in many respects when you look at the health outcomes for the UK against comparators like Germany and France that spend significantly more. However to make a step change in its resilience to winter pressures/other spikes and to drive towards a first class response to cancer and other serious diseases it needs another big injection of money and the ability to constantly innovate. The other problem for the NHS is that as a whole the UK is a dysfunctional society with maybe 20% of the population missing out on wealth and health, living in bad conditions, working too long, poor pensions, rubbish sick pay, unable to afford to eat well, suffering unnecessary levels of MH issues. This is very apparent when you visit towns outside of the South of England, but plenty of problems there too. This means that primary care, GPs etc are overrun by the consequences of other failures in education or social care. The solution, to raise standards at the bottom for wages, education and housing isn’t just a moral requirement, it’s also efficient.
I think there are other things to consider: Procurement of materials and equipment, I heard that some trust simply don't shop around for better value for money. Better care and understanding and medical advancement, for example 25 years ago a baby born at 24 weeks had about a 10% chance of survival, now it's north of 50%. Add on to the fact that babies born at that age a fair percentage of those will have life-long conditions. NHS being held to ransom by some pharmaceutical companies. Litigation, this must cost the NHS more than it used to.
PFI too. Loads of reasons that cut across governments of all persuasions. I always think the management point is a bit of a red-herring, likewise arguments from people who go on about health tourism. My gut feeling is the costs from both of those are tiny in the scheme of a multi-billion pound endeavour.
I imagine it’s way to complex a topic to expect to fit it in an A to F answer. We do need to be able to explore potential alternate financing models without all the emotion that gets in the way.
There is an odd tendency to think that all NHS management is waste, as if other large organisations in every sector don’t have people who look after other people, or buildings, procure and commission things, do lawyering, bean counting etc. X% of NHS money is spent on managers!! As if it would be a good use of a heart specialist’s time if he or she did the payroll. And I’m not one for the avoidance of doubt.
I don’t think anyone thinks all NHS management is waste. That would be ridiculous. But questioning if the balance is right and if there is too much bureaucracy is a valid question (as it is for all organisations).
It was an attempt to stimulate discussion. Funding is up, yet people feel (rightly I imagine given beds are down), that frontline services are being cut. So what is the reality? On a wider question we cut police and military numbers yet Government spending continues to rack up debt. Schools say they are underfunded. So where on earth is all the spending going? All swallowed by paying pensions?
I had a similar observation a year or two ago. There must be a degree of mismanagement, procurement, etc. GP's now find that it makes little sense for them to work as they lose out on their pension, despite the fact that their salaries are higher than ever. That makes no sense at all.
Funding will never be enough to provide a first class service to every patient immediately on demand, because that implies capability for any scenario. That would be incredibly expensive and incredibly wasteful - we don’t get pandemics every year. And we have to operate within our means. So funding has to be provided against the most likely scenarios. A budget is simply that - a prediction of what scenarios the NHS is likely to face and what capability would be needed. The NHS (and the gov) doesn’t help itself really, it could communicate the scenarios it predicts and therefore how the budget has been set each year, but it doesn’t (eg x number of patients, y number of operations etc). Instead it leaves a vacuum for everyone to have an unqualified opinion. None of us really have any clue if the budget is enough because we don’t know what the predictions are.
It is, but you know full well that the NHS is widely considered as inefficient and having too many managers by people who simply want a political football and have little other than a feeling to back it up.
I actually struggle with this a little bit. A pandemic like this is (hopefully) a once in a century occurrence. There would be some significant inefficiencies and overspending going on if the NHS were well placed to tackle this at any given point, just in case. That’s not to say it isn’t underfunded and that all the points raised aren’t valid, but to expect a national health service that is essentially free to be able to take this in its stride is not even close to realistic if you ask me. Not a great example but it’s a bit like when we get heavy snow and everything grinds to a halt. It’s that infrequent that the investment in everything we’d need to be able to avoid that happening just isn’t worth it.
G. bloated CCGs full to the rafters with useless non-jobs (deputy director for transformation on 120K) on hideosuly high salaries holding meetings and creating jobs for themselves is what swallows up the great majority of any new money. They certainly arent getting more Drs and nurses in the numbers they need.
What we need is resilience in all sectors so when something like this occurs it doesn’t fall over on pre-existing fault lines. So for example, social care is weak and underfunded with a skills shortage. It has direct consequences for the NHS unable to discharge patients into the community.
His particular point doesn’t mean that it is widely justified by right wing commentators with no such knowledge. No one needs £120k to run tranformations and I’m not for self-justifying senior salaries as you know, but it’s hardly a small job, for example managing projects to open new buildings, clinical centres etc. Whether it is generally done well is another matter and I don’t blame anyone front line for being frustrated by the many management failures. Managers and Directors are in general a pain in the backside. The whole World thinks so and the NHS is not immune. But unnecessary?
People live longer so instance per person go up exponentially When Bevan set up the NHS didn’t he think it wouldn’t be needed in the future as he thought it would help to eradicate most diseases
