Nhs Faces More Cuts To Avoid £10Bn Shortfall, Report Warns

[interestrateripoff]

http://www.guardian.co.uk/politics/2010/dec/26/nhs-cuts-shortfall-report

A "complacent" Department of Health will face an annual £10bn shortfall unless it speeds up efficiency savings across the NHS and considers cuts to social care and cancer research charities, according to a secret Whitehall report leaked to the Guardian.

The damning report warns that ministers will face an "unpalatable trade-off" between longer waiting times or a massive increase in the NHS budget unless dramatic savings are found.

It also warns that the central reform proposed by health secretary Andrew Lansley – to devolve 80% of the NHS budget to GPs – could have "patchy" results.

The findings are outlined in a blunt letter to Danny Alexander, the Treasury chief secretary, from the Independent Challenge Group, which was set up at the time of the budget in June to question Whitehall thinking.

The letter, leaked as David Cameron expresses private concerns at Lansley's failure to drive reforms, quotes a senior Department of Health official outlining the scale of the challenge. The proposed changes are "greater and more rapid than those achieved in any national health service in any country in the past," the official said. But the group showed impatience with the department when it warned:

• Proposed savings under the Quality, Innovation, Productivity and Prevention (QIPP) programme "may not be achievable". This is due to account for the bulk of the £16bn annual efficiency savings the department needs to make by 2014-15.

• The benefits from the transference of spending powers to GPs will be variable. The letter says: "We fear that the results will be patchy with some commissioning consortia performing very well, but others performing poorly, again reducing the pace of overall cost benefit realisation."

• Ministers will have to consider "even greater" cuts to the social care budget than a so far unannounced £3.4bn in service cuts because £2.2bn of efficiency savings "must be in doubt".

• The NHS cannot afford to spend up to £200m a year supporting research by big charities such as Cancer Research UK.

• The government should scrap the "very bad policy" of employing all doctors when they graduate.

Perhaps we should employ some more managers to make the NHS work. Clearly it's not working as it should, I blame not having enough managers or targets. I think this is the way forward, more managers to manage effectively.

Due to poor decisions in the past the NHS is slowly imploding, too many VI's trying to protect their own interests. Little empires do wonders for creating an efficient system.

[MrFlibble]

Perhaps we should employ some more managers to make the NHS work. Clearly it's not working as it should, I blame not having enough managers or targets. I think this is the way forward, more managers to manage effectively.

Totally agree. We need to fire all the front line staff too and ensure so much red tape is introduced that people end up dying before they even get a sniff of any treatment

Flame all you want but the only thing that needs privatised in this country is this albatross of inefficiency.

If you want decent healthcare in the UK then you are left paying twice, once for the broken NHS and then again for Private.

Edited December 27, 2010 by MrFlibble

[bogbrush]

It's a supper-duper-tanker, turning this baby may take a generation.

I'm afraid relying on organisation to do it is a non-starter. Someone needs to take some nasty decisions about what will be funded and what won't, and to what extent. Currently it's a blank cheque for diverse interests from pressure groups through to big pharma.

[corevalue]

It's a supper-duper-tanker, turning this baby may take a generation.

I'm afraid relying on organisation to do it is a non-starter. Someone needs to take some nasty decisions about what will be funded and what won't, and to what extent. Currently it's a blank cheque for diverse interests from pressure groups through to big pharma.

Right, let's start with scrapping our imperial adventures overseas, and using the money saved here back at home.

[bogbrush]

Right, let's start with scrapping our imperial adventures overseas, and using the money saved here back at home.

Whilst I agree with that particular point, it's not relevant nor really material to the issue with health.

The real issue is deciding what we are going to treat and to what point. Eternal life really isn't much of a practical mission.

[Prescience]

Core problem is like education, the NHS has been a political football since Thatcher's time.

Dividing my time now between France and UK the contrasts are immense.

Not only does the French system present with a far higher ratio of qualified staff to patients, nurses in France (Infirmiers) are very well qualified, there are a less well qualified group too, however they are still properly qualified, registered and licensed; and it's mandatory to read, write and speak fluent French.

HCAs (Hospital Care Assistants) are unqualified minimum-wager, mostly from agencies such as BNA.

Most startling of all, the French health service is cheaper at the point of delivery than the NHS: and delivers a far superior product, in most cases.

Perhaps the very worst reality of the NHS is the mythical concept that "It's free": it isn't; we pay for it!

Doesn't prevent NHS staff in far too many case patronising patients as if they were charity cases.

Perhaps the very worst aspect of the NHS is how doctors and consultants on staff then moonlight, for such as BUPA, thus prejudicing their moral and contractual obligation to NHS patients.

The whole thing is now a shambolic, disgraceful and utter mess.

If you wind back the clock and consider which political names pop up as past Secs. of State for health, Since Nye Bevan nationalised the thing and created the NHS, then it's hardly surprising, is it?

SeeHere:

[Executive Sadman]

If NHS expenditure had grown in line with earnings since 1997, its budget would be around £50 billion. Less than half its current level.

Bear that in mind, its an out of control monster.

[Bloo Loo]

It's a supper-duper-tanker, turning this baby may take a generation.

I'm afraid relying on organisation to do it is a non-starter. Someone needs to take some nasty decisions about what will be funded and what won't, and to what extent. Currently it's a blank cheque for diverse interests from pressure groups through to big pharma.

they could fix this tommorrow with some real wages Austerity.

50% off all salaries above the national average wage of 25K.

those £100K docs could get by nicely on 62.5K, head nurses on 60K could struggle on 42.5 and the hospital managers on 150K could scrape the barrel on 87.5K with tax savings to boot.

And no company cars for admin.

and how about actually negotiating with suppliers?

[council dweller]

Yes indeed, cut the 200 million to Cancer Research...and I say that as someone who has lost all family members to cancer!

My wife is an HCA at a major hospital and according to her the major problem is that people are too fat! Overcome this and the cost of the NHS will fall 50%.....even while they're in hospital they're being fed fattening junk!

[bogbrush]

they could fix this tommorrow with some real wages Austerity.

50% off all salaries above the national average wage of 25K.

those £100K docs could get by nicely on 62.5K, head nurses on 60K could struggle on 42.5 and the hospital managers on 150K could scrape the barrel on 87.5K with tax savings to boot.

And no company cars for admin.

and how about actually negotiating with suppliers?

I don't know about wages (as in "I don't know", not "I disagree") but I certainly think buying is hopeless in tjhe public sector generally - which is inevitable when you're not spending money you have to earn through sales. Green seemd to think so, and whatever anyone thinks about him he's a canny buyer.

[Bloo Loo]

I don't know about wages (as in "I don't know", not "I disagree") but I certainly think buying is hopeless in tjhe public sector generally - which is inevitable when you're not spending money you have to earn through sales. Green seemd to think so, and whatever anyone thinks about him he's a canny buyer.

I dont know what the wages are either, they are probably all over the place....but the public sector earns more on average than the private sector I see reported now and again, and the NHS is ripe for the top paying jobs, doctors, lawyers and architects, planners and teams of "inspectors".

differentials have got way out of hand in this and all games....IMPO.

[Phil S]

If NHS expenditure had grown in line with earnings since 1997, its budget would be around £50 billion. Less than half its current level.

Bear that in mind, its an out of control monster.

This takes absolutely no account of the following facts:

1. The NHS was starved of funding by the tories pre 1997

2. The NHS faces hugely increased demands due to an ageing population and the cost of new drugs and treatment

3. The quality of care is vastly improved compared to 1997

[SarahBell]

2. The NHS faces hugely increased demands due to an ageing population and the cost of new drugs and treatment

Increased demands from people who want to live forever?

Something has to give!

[Prescience]

This takes absolutely no account of the following facts:

1. The NHS was starved of funding by the tories pre 1997

2. The NHS faces hugely increased demands due to an ageing population and the cost of new drugs and treatment

3. The quality of care is vastly improved compared to 1997

Then it should stop wasting taxpayer's cash on things like fertility treatment, cosmetic surgery ("I'm depressed Doc: my boobs are too small-too large; my nose is nasty: I've tried all the diets going, Doc (I can't stop eating 25 Big Macs a day), I must have my stomach banded!"). Etc.

1. The NHS was starved of funding by the tories pre 1997

Wholly apocryphal and typical NuLab LieBor political nonsense!

See here:

The core problem with any out-of-control and wholly unaccountable institution which is funded by tax handouts rather than profit-driven, is it will spend all its allocation and more: and always find excuses to need more in order it can "Deliver a better service "etc......

Same with education: same with Local Authorities and County Councils.

The NHS faces hugely increased demands due to an ageing population and the cost of new drugs and treatment

Nice if true!

Operating a system of Triage, means that NHS hospitals, PCTs and NICE have been in reality operating a most effective policy of let's call it, "Fiscal Euthanasia" now for many years.

[ChumpusRex]

Perhaps the very worst aspect of the NHS is how doctors and consultants on staff then moonlight, for such as BUPA, thus prejudicing their moral and contractual obligation to NHS patients.

Perhaps you can explain why it is prejudicial to care to 'moonlight' in the independent sector.

The work would be performed outside of work time for the NHS (e.g. occasional weekends). The patients treated would not have come from the NHS, but would have been referred in from BUPA or have self-referred themselves because they don't want to use the NHS. By and large, the treatments offered privately are the same as those offered on the NHS, it's just that the people using the private service want to pay twice for it.

Don't forget that the NHS itself actively promotes private healthcare: many trusts actively encourage their consultants to undertake private work, using their facilities - because that brings in additional income, to subsidise the main NHS work. E.g. an operating theatre may not normally run on a Sunday, but many hospital managers will offer the use of that operating theatre to their consultants on a private basis, in order to get the income - otherwise one of the private provides, like BUPA, will take the work.

Doctors don't normally go round telling people, 'Oh. I'm too busy to see you on the NHS, but I'll happily see you tomorrow privately'. That sort of behaviour is regarded as unprofessional and unethical. While it may happen, the GMC do take a dim view of that.

The thing is that NHS salaries, while pretty decent, don't actually as far as they used to, due to the rampant inflation in cost of living. For example, I know of one London hospital that stipulates in the contract of employment for consultants that 'your main residence must be within 15 minutes travelling distance from the hospital [at St. Paul's]', in case of emergency. Would anyone like to venture what sort of home you can obtain on a consultant's salary of £70k? 20 years ago, this would not have been a problem. Today it is.

The other thing is that overtime for doctors within the NHS is essentially banned (due to the European working time directive). It was quite common for doctors to do extra shifts because of recruitment gaps or because of sickness. This is no longer legal - this gives 2 problems. There is no scope to boost income with overtime, and the NHS is forced to turn to employment agencies for emergency staff shortages (often giving lower quality staff who do not know how the hospital works, at a much higher price).

[shipbuilder]

What first shafted the NHS, in my opinion, was the proliferation of targets followed by the mantra of 'choice'. When asked, I imagine most people don't want a choice, they just want decent health services a reasonable distance from home.

The NHS is there to provide a basic service for all and those who want the frills should pay extra.

[needsleep]

It's a supper-duper-tanker, turning this baby may take a generation.

I'm afraid relying on organisation to do it is a non-starter. Someone needs to take some nasty decisions about what will be funded and what won't, and to what extent. Currently it's a blank cheque for diverse interests from pressure groups through to big pharma.

Totally agree. It requires complete restructuring and even the proposed reforms to primary care, in the great scheme of things, are little more than heavy-handed tinkering at the edges.

But here we see again the naivety of the Tories being played out. They (just about) entered government feeling omnipotent. They could do anything. Change everything. But they can't because they will be (like every government before them) royally ******ed over by every VI going. They also lack strategy with their policies not joined-up in any way. They're not equipped to push any meaningful changes forward. They're going to end up looking even worse than the last government and when they start screwing the NHS up hundreds of thousands will pay with their jobs.

[needsleep]

Then it should stop wasting taxpayer's cash on things like .... cosmetic surgery

My 10 year old son just had successful cosmetic surgery on the NHS for a disfiguring condition present from birth. It has changed his life.

So you were saying?

[ken_ichikawa]

My 10 year old son just had successful cosmetic surgery on the NHS for a disfiguring condition present from birth. It has changed his life.

So you were saying?

Erm such things build character. My teens I had a completely flat nose from the beatings I sustained. There were quite a few pizza face people and a few people who were dis-figured. They got used to it and grew stronger. Correcting anything and everything is bad.

http://www.guardian.co.uk/world/2009/nov/01/lou-jing-chinese-talent-show

For some background info. I suffered that in reverse!

[needsleep]

Erm such things build character. My teens I had a completely flat nose from the beatings I sustained. There were quite a few pizza face people and a few people who were dis-figured. They got used to it and grew stronger. Correcting anything and everything is bad.

http://www.guardian.co.uk/world/2009/nov/01/lou-jing-chinese-talent-show

For some background info. I suffered that in reverse!

Oh dear. Such fcukwittery.

[123Jim]

Back to the main topic

The battlefield for this Gov could well end up being the NHS

It is the one-eyed monster devouring all before it

It is the symbol of our move to a state-sponsored bureaucratic system

Either this gov will go-on ring-fencing and pandering/cowering/U turning before every cosmetic demand and be screwed by the markets into or they will show some real grit and chop off the monster's head. My guess is they will wait and blame the monster's eventual fate on "outside forces".

[Laughing Gnome]

Credit to Government where it's due, they are masters of distraction.

Here they have spawned a fantastic squable, and no-one mentions the rising cost of PFI.

Edited December 27, 2010 by Laughing Gnome

[needsleep]

Credit to Government where it's due, they are masters of distraction.

Here they have spawned a fantastic squable, and no-one mentions the rising cost of PFI.

PFI is just a political sideshow. A minor aspect of our overall debt. No party can claim the moral high ground with it. Cons introduced it to the UK. Labour ran with it and Cons had plans to do the same.

[Laughing Gnome]

PFI is just a political sideshow. A minor aspect of our overall debt. No party can claim the moral high ground with it. Cons introduced it to the UK. Labour ran with it and Cons had plans to do the same.

Both parties are up to their necks in it, no argument there. But I disagree that it's a sideshow, I suspect it's the main issue.

No figures to hand unfortunately, but hey, shoot me down!

[needsleep]

Both parties are up to their necks in it, no argument there. But I disagree that it's a sideshow, I suspect it's the main issue.

No figures to hand unfortunately, but hey, shoot me down!

In true 21st century economic crisis-stylee I will band about huge numbers as if they mean nothing. In the recently hyped-up UK true national debt figure of £4.9tn PFI accounted for £200bn, or about 4%.

That said in the context of the NHS it could be hugely significant given the endemic use of PFI in NHS infrastructure projects. So I sort of agree with your point where the NHS is concerned.