How To Cut The Cost Of The Nhs In Half

[tomandlu]

Afaict, offering nothing but palliative care to anyone over 65 would save around 50% of the cost of the NHS.

Now, I am not a heartless ******* (I hope), and not too far off 65 myself (only another 15 years to go), but we're not designed to live that long and a bunch of oldies sucking up resources seems just silly. I'm not suggesting suicide pills and I'd love to see a more positive focus on palliative care, but nature has provided us with a perfectly good mechanism for avoiding an insolvable demographic trap - why don't we just accept it?

[Nuggets Mahoney]

Afaict, offering nothing but palliative care to anyone over 65 would save around 50% of the cost of the NHS.

Now, I am not a heartless ******* (I hope), and not too far off 65 myself (only another 15 years to go), but we're not designed to live that long and a bunch of oldies sucking up resources seems just silly. I'm not suggesting suicide pills and I'd love to see a more positive focus on palliative care, but nature has provided us with a perfectly good mechanism for avoiding an insolvable demographic trap - why don't we just accept it?

That would cut the cost of the NHS dramatically? Do you think?

I don't. I reckon we'd end up with half the care, with just as much money spent.

And in next week's episode...

Why slashing the services provided by local authorities in half very possibly won't result in any reduction of your council tax bill

[rxe]

OPs suggestion is probably a little harsh for the mainstream.

My suggestion would be to merge the budgets for care between hospitals, social services and all of the other blood suckers that sit on the government payroll.

Say you had a treatment that would increase the survival rate of stroke victims and lessen the impact of the stroke. There is no business case for a hospital to do this - it would not result in more money for them. To wider society, there is a huge business case (i.e. having a person at work, paying tax, vs having their backside wiped for them) - but the people who make the decision do not see this.

Ditto keeping people in expensive hospital beds - social services don't care, it is one less person that they have to look after.

If these were one single budget, with one accountable body, it would change a lot faster.

[tomandlu]

That would cut the cost of the NHS dramatically? Do you think?

I don't. I reckon we'd end up with half the care, with just as much money spent.

Well, that's a different argument... bottom line, around 50% of the NHS budget is spent on the over-65s, and most of that on the over-85s...

[@contradevian]

Afaict, offering nothing but palliative care to anyone over 65 would save around 50% of the cost of the NHS.

Now, I am not a heartless ******* (I hope), and not too far off 65 myself (only another 15 years to go), but we're not designed to live that long and a bunch of oldies sucking up resources seems just silly. I'm not suggesting suicide pills and I'd love to see a more positive focus on palliative care, but nature has provided us with a perfectly good mechanism for avoiding an insolvable demographic trap - why don't we just accept it?

I think the NHS is doing a perfectly good job of killing people off, if recent reports are to be believed. Shame it is not saving any money.

[Bruce Banner]

Disband the NHS and distribute half of the money spent on it to the population as tax cuts, benefits, pension payments etc and let them spend it as they wish.

[Nuggets Mahoney]

Well, that's a different argument... bottom line, around 50% of the NHS budget is spent on the over-65s, and most of that on the over-85s...

My argument is that any large bureaucracy like the state/ NHS sucks as much money off the punters as it can, divvies up the spoils afterwards and never, in its opinion, receives enough.

If the money wasn't spanked on delivering care it'd just be spanked on something else.

[Dorkins]

I work with a lot of medics and hear some stories about waste in the NHS. One colleague of mine worked in a surgery unit where they were hacking out big lumps of tumourous liver from people in their late 70s/80s even though they knew perfectly well that the cancer had already metastasised and the patient was terminal. This is not a kind thing to do: it's a big operation which will take many months to recover from, especially if you are a frail old person dying from cancer. As far as my colleague could tell, the main reason for doing these operations was to meet the unit's monthly targets.

Another problem is that too many patients and their families will agree to these major interventions because they are uncomfortable facing the fact that death is inevitable. Meanwhile, doctors make different choices when their own time comes:

How Doctors Die

[Bruce Banner]

I work with a lot of medics and hear some stories about waste in the NHS. One colleague of mine worked in a surgery unit where they were hacking out big lumps of tumourous liver from people in their late 70s/80s even though they knew perfectly well that the cancer had already metastasised and the patient was terminal. This is not a kind thing to do: it's a big operation which will take many months to recover from, especially if you are a frail old person dying from cancer. As far as my colleague could tell, the main reason for doing these operations was to meet the unit's monthly targets.

Another problem is that too many patients and their families will agree to these major interventions because they are uncomfortable facing the fact that death is inevitable. Meanwhile, doctors make different choices when their own time comes:

How Doctors Die

A GP friend told me that the most important medical decision you can make is a living will.

[Nuggets Mahoney]

Another problem is that too many patients and their families will agree to these major interventions because they are uncomfortable facing the fact that death is inevitable. Meanwhile, doctors make different choices when their own time comes:

That's going down a different path to offering only palliative care to the over 65s, as floated in the OP

I've seen enough close, terminally-ill family members be put through futile treatments to see the sense in telling people 'that's it, your number's up' rather than effectively torturing them in their final days. That's irrespective of age btw and not the same thing as saying to someone 'no, replacement hip for you, you're too old, f*** off'.

[Bloo Loo]

Well, that's a different argument... bottom line, around 50% of the NHS budget is spent on the over-65s, and most of that on the over-85s...

I see you are canvassing ideas for a Sci Fi Death Panels book horror story.

[Dorkins]

That's going down a different path to offering only palliative care to the over 65s, as floated in the OP

I've seen enough close, terminally-ill family members be put through futile treatments to see the sense in telling people 'that's it, your number's up' rather than effectively torturing them in their final days. That's irrespective of age btw and not the same thing as saying to someone 'no, replacement hip for you, you're too old, f*** off'.

Yes, I think telling people to f*** off is not the right approach. It would be better for them to understand that sometimes it's in their best interests to f*** off.

[Nuggets Mahoney]

Yes, I think telling people to f*** off is not the right approach. It would be better for them to understand that sometimes it's in their best interests to f*** off.

Like I say though, that's going to apply to some under 65s and not apply to some over 65s.

[Dorkins]

Like I say though, that's going to apply to some under 65s and not apply to some over 65s.

True. Cancer death rates start to shoot up in the late 40s.

[Nuggets Mahoney]

btw, I've lost track

What's the future state retirement age up to now? 67? 68?

It'd be a bit of a cheek taxing people for 2-3 years whilst not even pretending to be offering anything but a syringe stuffed full of morphine in exchange.

[Boomer Baby]

Afaict, offering nothing but palliative care to anyone over 65 would save around 50% of the cost of the NHS.

Good thinking although you could go further.

Obviously, private health insurance would get around the simple elegance of let the over 65’s die so why not embrace that by offering lifetime loans for medical services to elderly NHS patients with a charge against their estate?

No estate, no possibility of a charge and of course they’ll have to settle for palliative care even if they’ve just been run over and have a compound fracture that will lead to death unless treated.

Hold on though, if no estate and no possibility of recouping the private health insurance charge then we could spawn a whole new no win, no fee industry whereby over 65’s involved in accidents could sue for the complete cost of their treatment.

What’s not to like with newly created jobs (private sector, of course) PLUS innumerable public sector appointments of Post-65 Recovery of Incidental Care Key Workers (must be a snappy acronym for that) who would liaise between the elderly, their relatives, NHS, lawyers, private hospitals and insurance companies?

Obviously, your suggestion is not meant to be divisive, inhumane or downright daft so let’s take the opportunity to look at other drains on the NHS that have been talked about before but shelved as impractical.

It goes without saying that drug abusers, smokers, those consuming more than the recommended units of alcohol, the obese and people engaging in extreme sports should only be offered palliative care (or private health insurance loans) but what about anorexics, depressives, schizophrenics?

As for paraplegics, quadriplegics, those born with disabilities ….. well, do we REALLY need to wait until they’re 65?

Ummmh….smell the ovens.

[tomandlu]

I see you are canvassing ideas for a Sci Fi Death Panels book horror story.

I know/hope you're joking, but just to make it clear that's not what I'm suggesting at all - just letting nature take its course...

Various anecdotes - my father, on finding he had lung cancer and rapidly encroaching dementia, refused all treatment and had a 'good' death at the age of 80. Another close relative has about 3 months to live (cancer), and rather pointlessly had six months of treatment which made them miserable and sick as a dog. My wife, meanwhile, works in renal dialysis, and there are vast numbers of very elderly patients undergoing dialysis 3 times a week for 4 hours at a time - once again, for what purpose no one is quite sure.

[tomandlu]

That's irrespective of age btw and not the same thing as saying to someone 'no, replacement hip for you, you're too old, f*** off'.

Yeah - an exception for hip-replacements and similar procedures, as well as being humane, has a practical purpose...

[tomandlu]

What's the future state retirement age up to now? 67? 68?

It'd be a bit of a cheek taxing people for 2-3 years whilst not even pretending to be offering anything but a syringe stuffed full of morphine in exchange.

And one of the reasons for the need to raise the retirement age is... That aside, I'm ambivalent - after all, they're being taxed to pay for schools and they don't use them either...

[Nuggets Mahoney]

I know/hope you're joking, but just to make it clear that's not what I'm suggesting at all - just letting nature take its course...

Various anecdotes - my father, on finding he had lung cancer and rapidly encroaching dementia, refused all treatment and had a 'good' death at the age of 80. Another close relative has about 3 months to live (cancer), and rather pointlessly had six months of treatment which made them miserable and sick as a dog. My wife, meanwhile, works in renal dialysis, and there are vast numbers of very elderly patients undergoing dialysis 3 times a week for 4 hours at a time - once again, for what purpose no one is quite sure.

But why is your proposal based on an arbitrary age?

Why would it make sense trying to treat a terminally ill person in their 20s and not offer a treatment to someone in their late 60s that would improve the quality of their life for 5, 10, 15 years?

[thecrashingisles]

That would cut the cost of the NHS dramatically? Do you think?

I don't. I reckon we'd end up with half the care, with just as much money spent.

Yes, that was Tony Blair's great achievement - the same level of care at twice the price.

[tomandlu]

of course they’ll have to settle for palliative care even if they’ve just been run over and have a compound fracture that will lead to death unless treated.

Well, there'd be a little more nuance than I posted. I'm talking/thinking about chronic, eventually fatal diseases that are the result of the body breaking down and doing what comes naturally, rather than shifting through the wreckage of a car crash and shoving the oldies into the nearest skip...

Obviously, your suggestion is not meant to be divisive, inhumane or downright daft so let’s take the opportunity to look at other drains on the NHS that have been talked about before but shelved as impractical.

It goes without saying that drug abusers, smokers, those consuming more than the recommended units of alcohol, the obese and people engaging in extreme sports should only be offered palliative care (or private health insurance loans) but what about anorexics, depressives, schizophrenics?

As for paraplegics, quadriplegics, those born with disabilities ….. well, do we REALLY need to wait until they’re 65?

Ummmh….smell the ovens.

Indeed - and that is by far the best argument against any change to the status quo (although I'd argue that a clear-cut demarcation based solely on age should prevent any 'project creep'). Nevertheless, where do we stop? Anyone read Gulliver's Travels?

Struldbrug

[tomandlu]

But why is your proposal based on an arbitrary age?

Because an arbitrary age is better than an arbitrary decision...

Why would it make sense trying to treat a terminally ill person in their 20s and not offer a treatment to someone in their late 60s that would improve the quality of their life for 5, 10, 15 years?

It doesn't make any sense to treat a terminally ill person in their 20s for a start - you offer palliative care, or you should (although definitions of 'terminal' vary). That aside, I'm talking about a general statistic, rather than exceptions. Obviously, if we just stopped the NHS treating anyone who was ill, we could really save a packet... My general point is that, at 65, you really should be getting used to the idea that you're nearing the end of your natural life.

[fluffy666]

Say you had a treatment that would increase the survival rate of stroke victims and lessen the impact of the stroke. There is no business case for a hospital to do this - it would not result in more money for them. To wider society, there is a huge business case (i.e. having a person at work, paying tax, vs having their backside wiped for them) - but the people who make the decision do not see this.

So what you are basically saying is that doctors don't give a monkey's about their patents survival?

It's an interesting manifestation of the 'war on professions' which goes with the 'war on science', in which it is assumed that absolutely everyone is completely corrupt and acts solely to maximise their financial advantage.

In reality, there is a professional requirement on Doctors to be up to date with the best treatments and press for their inclusion in standard-of-care.

[tomandlu]

So what you are basically saying is that doctors don't give a monkey's about their patents survival?

I missed this one, but rxe is talking complete tosh.