How To Cut The Cost Of The Nhs In Half

[olliegog]

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

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.

my bold

this is ageist and bigotted - go to mumsnet where you belong.

[AThirdWay]

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.

That's the point, isn't it? Your generalising. I regularly meet people in their 70's while hillwalking, and if walking during the week, I'd go so far as to say that the majority I meet are retired. I regularly meet people my age (50's) in the pub who, literally, get a taxi into town 'cos they can't be ar$ed to walk to the bus stop. We had a marathon runner in their late 80's in Dundee, I believe she recently died in her 90's.

Age is only arbitrarily linked to the end of your natural life

[fluffy666]

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.

Basically we should be realistic about what treatments we give to people who are already old and frail..

Hard though, especially if you have younger relatives in denial about what's going on and demanding that 'everything is done'.

[tomandlu]

my bold

this is ageist and bigotted - go to mumsnet where you belong.

Shan't. And, fwiw, I posted this after considering my own approaching old-age and the burden it could potentially place on others. Besides, I've worked in or for the NHS for most of my working life, and I've seen enough needless prolonging of life in miserable circumstances to view a blanket keep-em-alive-at-all-cost approach as both cruel and lazy.

[tomandlu]

Age is only arbitrarily linked to the end of your natural life

Sex, voting, driving, and criminal responsibility would disagree with you... just to re-emphasise, I'm not suggesting for a moment we start bumping them off - just take a more considered approach to what treatments should be valid, and by and large, emergency injury treatment would be totally exempt.

[Nuggets Mahoney]

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

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.

In my experience, when someone close to you is near the end of a protracted, terminal illness there can come a point, particularly when pain or discomfort is involved, when you ask yourself 'are we keeping this person going for their sake or ours?'.

My own answer is that wanting to preserve life is part of being human and that doesn't evaporate simply because someone is near death.

We're all worm food at the end of the day, even the youngest and fittest of us

Personally, I rather be part of a group of people that expended its resources on caring for it members, however ultimately futile, rather than saving those resources for what? In the ****ed-up economic system we're currently subject to it's not as if the money saved would be invested in productive endeavours, is it?

[swissy_fit]

No need for any of this nasty kill off the old people stuff.

If you want to save money in the NHS, do this.

One free doctor's appointment per year allowed for UK citizens and/or those with proof of recent payments into NI. Maximum 3 appointments can be accumulated(kind of like a no-claims bonus)

All other appointments cost 30 quid, no exceptions. No proof of nationality/NI payments and this becomes 100 quid.

Job done.

[tomandlu]

Personally, I rather be part of a group of people that expended its resources on caring for it members, however ultimately futile, rather than saving those resources for what? In the ****ed-up economic system we're currently subject to it's not as if the money saved would be invested in productive endeavours, is it?

I'd love to agree, but, IMHO, it doesn't matter how you slice the cake. You can't have a growing population of old, infirm people without at some point hitting a brick wall. Savings are meaningless in that scenario.

[Executive Sadman]

Automate everything that can be automated. Seems odd that a car factory can produce as many cars as in 1960 but with 1/20th of the labour. And yet the NHS is supposedly the worlds biggest employer after the chinese red army. Sure healthcare requires more human input than car production, but the sheer growth of numbers despite decades of technological improvement reeks of 'military industrial complex' sydrome to me. People employed and money spent purely for the sake of employing people and spending money.

[scrappycocco]

You can't make cuts in a socialist care system, any savings will be eaten up by employee benefits and salary increases.

[Dorkins]

Personally, I rather be part of a group of people that expended its resources on caring for it members, however ultimately futile, rather than saving those resources for what? In the ****ed-up economic system we're currently subject to it's not as if the money saved would be invested in productive endeavours, is it?

If the point of healthcare is to give us healthy lifespan in which to do the things we want to do, it seems silly to overconsume it. There's little point in a situation in which everybody ends up spending an extra 5 years of their lives slogging away at work so that the state can buy them another 18 months of healthy lifespan in their 80s.

[Dorkins]

You can't make cuts in a socialist care system, any savings will be eaten up by employee benefits and salary increases.

Of course you can, you just do it from the top down. Osborne could say to Hunt "Your budget this year is £xx bn. How you spend this money is up to you and your management team."

[faloos]

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?

You have never mentioned the big fat lumps that you see while out shopping , Women and Men of all shapes and sizes who are not even 40 years old whose BMI must be off the scale. surely they cost us a fortuneas they will develop all sorts of ailments at an early age .These overwieght people cannot work , they do not contribute to our economy they are parasites toall of us with the benefits they recieve. Not to mention immigrants and people ( on so called holiday)that come from other countries land here and expect us to cure their ailments or treat for Aids at a cost of 20000 pounds each. (Clinic near Gatwick Full of Africans and all sorts just off a plane straight to that clinic that you are paying for.

The over 65s have in a lot of cases served thier country worked for a great part of it. Everyone should have a credit of point for every year worked to recieve a higher service and if you dont have these credits then insurance is the only way, or ofcourse as harriet harman says , we can always work in Bulgaria or Romania , we have the choice, see if you get the same NHS treatment there. Immigrants should be screened for Aids and if you have then refused entry to UK . You must be free from Aids to work in the Middle East , you must have medical proof before leaving your own country and upon arrival you are tested again , great system why dont we learn from the Arabs?

One other point Who are going to be the childminders if you want to kill off the over 65s ? look around when you are out, old people doing the childminding so that the couple can work to pay for their little box.

[Nuggets Mahoney]

I'd love to agree, but, IMHO, it doesn't matter how you slice the cake. You can't have a growing population of old, infirm people without at some point hitting a brick wall. Savings are meaningless in that scenario.

I'm not talking about blank cheques. There will always be limits to what we can do

I'm not a very trusting soul though. So, if things have got a point where the NHS has to start letting oldsters shuffle off en masse for reasons of cost, there are one or two other things I would see tried out before it came to that. Just to see if that brick wall really had been hit.

I'd be for closing a whole load of s**t down, dispensing with all sorts of people and ripping up a whole bunch of bent contracts, inside and outside of the NHS, before I started letting people die.

[winkie]

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

I have seen the NHS change drastically over the years.....not all in improved ways, sometimes it seems the people that run it are in it protecting their own more ways than the people, their customers/patients who are in effect paying their wages and who should be prioritised before their own self interests.....compassion and individual care is a secondary consideration in some parts of it.....a postcode lottery in many ways......do your own homework.

[tomandlu]

Sure healthcare requires more human input than car production

Unfortunately, if there is over-employment in the NHS, it isn't in the areas that require it - but that's another matter.

[winkie]

Unfortunately, if there is over-employment in the NHS, it isn't in the areas that require it - but that's another matter.

...too much expensive, expanding fat in the middle.

[Executive Sadman]

Yes, there is that too. Japan has relatively low health spending (despite an aged population) but is healthy. Its probably shameful to be fat. Their companies even have enforced fitness sessions, such is the collectivist culture over there. So costs are low and results high.

At the other end, even without their broken healthcare model, america would still probably spend more than most countries on health and get lesser results because people are obese. I guess thats due to a heavily individualist, instant gratification, no shame or stigma to being fat kind of society.

Personally id rather maintain freedom. Nothing more nauseating than some opinionated lycra clad cyclist telling me how I should get about. Public health policy should be confined to controlling virus's and the outbreak of diseases and the like. Not micromanaging every aspect of everyones life so they can eek out a few more miserable years just so some commie MP can gloat about our life expectancy being a few months longer than swedens. If they want to put taxes on beer and tobacco and fatty foods to internalize the costs or whatever, fine. But stop with all this orwellian propaganda. We all know whats bad for us, we choose to live that way anyway.

[tomandlu]

I'd be for closing a whole load of s**t down, dispensing with all sorts of people and ripping up a whole bunch of bent contracts, inside and outside of the NHS, before I started letting people die.

Agree 100%.

That aside, we are in the middle of a great experiment. Bear in mind that people expecting to live much beyond 65 (even if they made it that far), is something that's basically happened in the last 60 years or so. Geriatric care, if it's going to be provided at a level that isn't inhumane, is very labour-intensive. Complex treatments are expensive. However you look at it, we're heading for a demographic cluster-fvck. Ship in immigrants to take over geriatric nursing? Trying that - but it's a ponzi essentially.

To put it another way, in the past, people essentially worked until they dropped, with a couple of years of retirement, with a statistically small number of exceptions. Now we have a situation where the majority can expect to make it into their 80s, but still expect to retire in their sixties. I don't see how that can work. Savings? Pensions? Pfft. A twenty year old cannot look after 50 patients with dementia however much you pay them... cruelty, to my mind, would be impoverishing the young to give a shitty end of life experience to an army of pensioners...

[tomandlu]

You have never mentioned the big fat lumps that you see while out shopping

That's a different matter. FWIW I don't favour any kind of life-style based rationing.

One other point Who are going to be the childminders if you want to kill off the over 65s ? look around when you are out, old people doing the childminding so that the couple can work to pay for their little box.

I'm not sure how much child-minding the over-65s do, but I doubt the ones who do would fall prey to my evil master-plan. Healthy OAPs, even with a few hip-ops, aren't the problem.

What do they think has happened, the old fools,

To make them like this? Do they somehow suppose

It's more grown-up when your mouth hangs open and drools,

And you keep on pissing yourself, and can't remember

Who called this morning? Or that, if they only chose,

They could alter things back to when they danced all night,

Or went to their wedding, or sloped arms some September?

Or do they fancy there's really been no change,

And they've always behaved as if they were crippled or tight,

Or sat through days of thin continuous dreaming

Watching light move? If they don't (and they can't), it's strange:

Why aren't they screaming?

[Bloo Loo]

I'd love to agree, but, IMHO, it doesn't matter how you slice the cake. You can't have a growing population of old, infirm people without at some point hitting a brick wall. Savings are meaningless in that scenario.

You can...cut all NHS salaries over 25K by 50% and pensions over 5K by 75%.

Stop paying £150 for a table that sells for £30.

Sack 75% of the admin staff.

[Dorkins]

Yes, there is that too. Japan has relatively low health spending (despite an aged population) but is healthy. Its probably shameful to be fat.

Japan is getting fatter:

http://www.japantimes.co.jp/news/2012/03/11/national/obesity-on-the-rise-as-japanese-eat-more-western-style-food/#.Ue_dPY3qlBM

The current Japanese oldies are thin and healthy but the future is chubby.

[Dorkins]

But the management will just get rid of the front line staff and blame the government for the rise in dead people.

So you fire the managers who try to pull that trick and replace them with somebody (younger, poorer, keener) who will do the job properly. This is what ministers are supposed to be doing with their days.

[tomandlu]

Nice to have if we have lots of cash, but we do not have the spare cash, so perhaps we should get on with the job of treating sick people.

Oh, the (horror) stories I could tell... essentially, the whole system, from the lowest grade nurses to upper management, has become entirely focussed on ****-covering and box-ticking, with minimal awareness of what their job actually is (assuming the job isn't ****-covering and box-ticking).

[winkie]

People being able to retire early is not a bad thing, they retire because they have planned and seen to it that they have sufficient to support themselves...relinquish their higher paid jobs and prepared to take lower paid part-time jobs thus giving them more of a life and the younger generation a chance of promotion to better themselves, anyway new fresh blood with new ideas is good for business (some people think they are worth more than they are when they are not, all they do is block the better jobs), sometimes better than the old set in their ways reluctant to change old types......anyway, why should everyone have to pay for old age long-term care from the public purse when many of these people have assets like a house they can sell to help pay for it.....it is NOT the public's responsibility to pay for high cost long-term care when people with money and assets can afford to pay for themselves....only those with nothing should be helped, and there should be NO caps......born with nothing die with nothing, independent, self reliant people pay their own way in life, they always have and always will.