Why we need to spend less on the NHS

[horizon]

Despite my political affiliations, I believe we ought to spend less on the NHS, not more. My impression is that the only sort of new health intervention that gets used and promoted is one that makes money. Drugs, devices, surgery, operations, vaccines. Anything that doesn't make money - exercise, diet, counselling, chiropractic for example - doesn't get much support.

The reason for this is simple: for something new to be developed, it needs an incentive. If research is in the hands of private companies, they will research drugs and products that may eventually make a profit. Nothing wrong with that, but you still need plenty of people working towards ideas that make people healthy but may not make a profit. What we actually see in fact is more life-long drugs, more vaccines, more high-tech procedures. And we see doctors pressured by salesmen and the health service mesmerised by drugs and technology.

By the way, I'm not complaining about privatisation per se. That is bad enough, depending on your stance on it. But what might be privatised (for example cleaning or sample analysis) may still have to be done anyway. What I am referring to is the medical procedures themselves, whoever carries them out, private or not. If these are motivated only by profit, then health will become a very expensive commodity. Fresh air is cheap, new medicines aren't.

Lots of people rely on the health service: whether that's to fix a broken leg or deal with cancer. But if the resources of the NHS are slowly but inexorably turned over to money-making, the cost of the NHS will rise and rise until it becomes unsustainable. The waits in A&E become longer while cash is poured into the latest (somewhat dubious) universal vaccine.

Cutting the overall target spending figure for the NHS may just focus minds on how health can be delivered cost effectively. Maybe cycle lanes would then get a look in.

[beardy]

I suspect that NHS spending can only go up because of the ageing population and the aim of extending life as long as possible regardless.

Most of us for most of our lives visit the NHS and walk away cured for a relatively small amount.
There are however people who dont get cured and are going to be kept alive with an ever increasing number of complications, many of which are side effects of the treatment.

This is already making itself felt because the old idea of having wards for different types of illness is collapsing as the majority of patients present are suffering from multiple failures as they are being kept alive against an increasing cocktail of complaints. The extent to which that can be done is governed by how much money is available (or occasionally somebody saying "enough is enough" but that is reserved for those above a certain age).

I do agree that you can put off people reaching that stage as long as possible through some healthy living but all of our bodies (or minds) will start to fail sometime.

[maxcherry]

But if you cut the money (I'm all for that) the only ones who will suffer are the patients and staff.
The NHS does spend a lot on agency staff Nurses,cooks,portes,cleaners who get paid more than the in-house staff
There was a time when all NHS staff were employed by the NHS (They also gave Guinness to pregnant women) but
I guess things have gone all modern.

I can see it Imploding in 10 years and privatisation coming in. The population is far to big, and
lives for far to long.

[Psamathe]

You seem confidant that if they cut budgets them this will result in the less crucial aspects of the health service being cut back whilst the critical life saving aspects are maintained to a sensible standard. Recent history (and personal experience) seems to suggest this is not necessarily the case. So cutting budgets will undoubtedly result in people not getting the life saving procedures they need whilst others with less critical issues get high priority care.

I do think that a lot of the problems facing the NHS have been created by politicians and these will get worse as more and more of the straightforward profitable aspects are passed for profit making companies whilst the public sector gets left handling the less profitable more complex aspects, but now without the economy of scale.

Ian

[horizon]

But if you cut the money (I'm all for that) the only ones who will suffer are the patients and staff.

No. What I'm saying is that it is the medicine itself that is wrong. You can cut the NHS if you change the way you make people healthy. So the typical example would be cycling to school and work not lifetime diabetes drugs. Don't forget that I have posted this on a cycling forum, not a party political one. Fewer people going less often to the doctors means an easier life for the staff. I think the NHS have got health wrong - we on here have got it right. As regards all the astounding things they do to stitch people up after an accident - that would remain.

[[XAP]Bob]

They are currently not a health service, but a sickness service.

That's the fundamental problem, that and the obsession with hospital based everything (childbirth being the classic example), and the strange concept of choice...

There are also a number of procedures which are not essential - and a complete lack of focus on mental health (just try their services, it's not good).

GPs are generally fabulous, but they are forced into some strange decisions by, I presume, budget constraints...

[RogerThat]

They are currently not a health service, but a sickness service.


GPs are generally fabulous, but they are forced into some strange decisions by, I presume, budget constraints...

GPs are generally not forced into anything, they're running a business, for profit. Disappointingly I spent the afternoon with a group of young medical grads, some of them seemed very enthusiastic about GP practice as opposed to hospital based, I asked this young chap the reason for his enthusiasm (unusual as its never really a 'first choice' option) :

"Well, I'd like to have million pound practice".

Therein lies the fundamental problem with the modern NHS. We have GPs which we often have cover night shifts when we're short staffed, especially in A+E. They're paid roughly £1000 for a single 10 hour shift. More services are shipped out to private providers every single day. The problem imo is not spending on essential services, but greed and connivance at source. Aided and abetted of course by a compliant administration in government, who hopefully in ten days time will no longer be with us.

[Stradageek]

The view from inside the NHS is terrifying.

I have heard numerous first hand accounts of over-bloated management staff levels and inflated salaries compounded by people taking the system for a ride (6 months off for a twisted ankle on full pay) and no-one challenging this because it's all too cushy.

I've also heard from people supplying the NHS charging £60 to clean a stainless steel tray, £300 to replace a sink with one without an overflow (for cleanliness reasons) when a steel bung for 50p would solve the problem. My friend persuaded this doctors surgery to adopt the 50p solution.

There is also the pervasive fear of making mistakes that cripples change and sensible management - one local trust decided it didn't have the expertise to decide which subcontractors to use so it gave the decision making to a subcontractor whom they pay a percentage of the value of the contracts awarded!!!!!! Think about it!

And if you want to see what government intervention has done to try and improve this, watch this Kings Fund video - and weep

http://www.kingsfund.org.uk/projects/nh ... hs-england

[pete75]

Part of the problem might be the level of pensions the NHS has to fund. I was speaking to a lawyer the other day and she said she is doing a divorce for a retired consultant who has an NHS pension of £80,000 a year. At current annuity rates it would require a fund of £2.5 million to buy the same level of indexed linked pension. The pensions aren't even funded though, they're paid directly out of money the NHS receives from the tax payer. A reform of the pension system might lead to the NHS costing a lot less.
There's nothing wrong with people receiving a decent pension but, as with benefits, there should be a cap on the maximum amount of a public sector pension. £25,000 a year wouldn't be unreasonable - it gives over £30,000 per annum in conjunction with the state pension. Those on a salary which currently provides a pension greater than 25k have a big enough income to make private provision if they want more than the capped amount.

[blackbike]

The NHS doesn't need more money.

It can afford to give all staff excellent terms and conditions such as index linked final salary pensions, above average holiday entitlement and short standard working weeks.

If these perks were reduced to the level of the average generosity available in the private sector work force NHS employee costs would be significantly reduced.

There's also the matter of the NHS's very high levels of 'sick' leave , perhaps linked to the fact that 700,000 NHS staff are obese, something that also costs us millions.

http://www.telegraph.co.uk/men/active/m ... obese.html

I see no reason why the NHS should not take steps to reduce employee costs.

After all, most of the people who fund the NHS work in private companies which have to control staff costs or go bust. Those companies can't just put up prices so that their employees can keep all their perks.

The NHS should learn similar frugality instead of just expecting everyone else to keep paying more and more money so its staff can be kept in the style to which they have become accustomed.

[Psamathe]

I agree about the pension issue. But it applies to all of the public sector. Get public sector employee pensions "under control" and there will be loads more money "in the pot" to spend of other stuff. I don't know about the NHS jobs, but across the entire public/private sector, last data I recall (from the Office of National statistics) was that public sector was about 3% above private sector (pay), then add those fabulous pensions on top of that ...). And although public sector pay is largely frozen at the moment, private sector pay for most is also going nowhere (unless you are in the top elite few or a banker).

I have one public sector pension from early in my career (about 5 or 6 years at a pretty junior grade) and despite having subsequently paid towards a private pension for the rest of my career (including generous lump sum contributions from 13 years when I part owned the company), the 5-6 years junior public sector pension is probably my most valuable one !!

Interestingly though, I would have expected NHS GPs (and their employees) to not be getting these fabulous public sector pensions as they are not employed by the NHS/government (as I understand it anyway).

Ian

[Vorpal]

I don't know... Are the pensions really all that expensive? IMO, the reason for high sick leave rates is that many cuts have been made without allowing people to work more efficiently, and in some cases, it has gotten worse. Everyone I know who works in the NHS works long hours, and IMO, the job isn't so easy when they have to deal with screaming toddlers and people who are irritable for being sick.

Also, I think their pay level is not as good as in the private sector, so the pension goes some way toward making up for that.

But all that beside the point, I agree that we should spend less on the NHS, and the way to do it is to get people healthier. More doctors should prescribe an active lifestyle, more companies should put in place programs to help their employees, and more should be done to encourage active travel.

IMO, GPs have a tendancy to tell people that they need to *exercise* more, and people don't really want to do that. IMO, GPs should instead precribe walking to the shops twice per week, and a family bike ride on Sundays or something.

That said, for people who do want to exercise, it should be easier. The government should offer incentives for companies that have on-site gyms, sports clubs, sponsored activities, etc. Community facilities should be more readily available and cost less, or even nothing at all to use.

Obviously these things will cost money, but it's likely to be less that the cost of maintaining people's ill health and bad habits.

[Mick F]

I have a service pension having spent 27years in the RN.
For the record, I receive £12,700 after tax per annum, and index linked.
I've never been coy about money and wages and I'm happy for anyone to know.
I was a lowly Chief Petty Officer, but I know very senior ex-officers round here and one ex-captain, and I reckon he's on quadruple of what I'm on.

The way it was funded (last time I was told when I was serving) was that 10% of the defence budget paid for pay and pensions. These days on the news, they're talking about maintaining 2% of UK's GDP going to defence. Do the arithmetic if you want to see what we pay our armed forces .......... and ex-armed forces.

No doubt the same figures can be used for the NHS?
How much of our GDP goes to the NHS? I reckon more than 2%.

I don't think they've ever stated a percentage.

[al_yrpal]

http://www.oecd-ilibrary.org/docserver/ ... 1F95144EB0

This says we don't. We are spending more or less the same as other countries but are not near the top which is where we should be. I believe that in the French and German systems which are reportedly better than the NHS you are to have insurance as well and pay more for some treatments from your own pocket. Perhaps we have to do that too.

As the spouse of someone who worked in the NHS all he working life I know how dedicated the staff generally are. A lot of problems seem to emanate from the NHSs 'political football status where large tranches of cash get totally wasted. We should concentrate on solving that and perhaps it would improve because the NHS is pretty good but it stutters...

Al

[Psamathe]

Everyone I know who works in the NHS works long hours, and IMO, the job isn't so easy when they have to deal with screaming toddlers and people who are irritable for being sick.

All through my career I have worked "long hours" (normally 90+ hrs per week, virtually no holidays, no bank holidays, etc., no overtime). And although I did not have to deal with screaming toddlers, etc, it was never like the job was easy (there are different forms of "difficult"). NHS is not the only employment to involve hard work.

But all that beside the point, I agree that we should spend less on the NHS, and the way to do it is to get people healthier. More doctors should prescribe an active lifestyle, more companies should put in place programs to help their employees, and more should be done to encourage active travel.

IMO, GPs have a tendancy to tell people that they need to *exercise* more, and people don't really want to do that. IMO, GPs should instead precribe walking to the shops twice per week, and a family bike ride on Sundays or something.

I would have my doubt about how much more effective it would be for a GP to recommend more exercise to a GP prescribing more exercise. As I understand it, GPs have a mechanism for a health professional to "refer" somebody to a Council Health Centre (there is such a scheme round me). GP, nurse or healthcare worker can refer somebody for a variety of reasons and they then get a check at the health centre, trained in their chosen activity and then 12 sessions. The forms are available at GP surgeries, but I have no idea how often a GP/nurse will proactively recommend it for somebody; and no idea how many then take-up the referral and complete the scheme. Private gym's are expensive. Even my local Council Leisure Centre (Gym, etc.) is £5 per session or over £300 per year.

That said, for people who do want to exercise, it should be easier. The government should offer incentives for companies that have on-site gyms, sports clubs, sponsored activities, etc.

I think companies could do a lot more and it would have many additional benefits for them as well. e.g. ward "points" for cycling into work and those "points" could be spent e.g. in the staff canteen. cost minimal but company gets somebody arriving at work fit and alert. Most companies I have worked for don't have enough parking so it's always a game of musical cars and when somebody wants to go somewhere, half the company has to leave their desks to move their cars to let that person out - so cycling reduced that waste of time.

The government scheme for treating parking at work as a taxable benefit (or however they were going to charge people for parking at work) was an excellent idea (although a bit more carrot than stick) - but little seems to have happened (a few have reported local council equivalents).

One company I worked for/part owned gave everybody company based membership of the local sports centre (good one, swimming pool, squash courts, gym, etc.), but we had to declare it as a benefit and everybody had to pay income tax on that benefit.

It would be so easy for companies and governments to make massive changes at minimal cost but they just don't seem to want to bother. Maybe that is something CTC should be doing - coming up with a list of advantages for having people cycle into work and ideas for companies to encourage it. Often when we were talking to customers about potential IT systems, we would have quite a lot of "input" into their cost/benefit analysis they needed to get their board approval for the expenditure. Same with CTC; come up with some realistic figures to help companies justify encouragement.

Ian