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As a UK tax payer, and as a UK tax payer that winces every time they see how much they lose to taxation in their P60 each year (six figures in tax), what are pe

As a UK tax payer, and as a UK tax payer that winces every time they see how much they lose to taxation in their P60 each year (six figures in tax), what are people's solutions to this? It seems like the NHS budget keeps on going up and up and up [1], as does the number of doctors and nurses (while "managers" has either declined or stayed relatively static) [2]. So NHS is getting more funding, and there are more doctors and nurses. Yet there is still outcry about how we need MOAR MOAR MOAR! We're spending ~10% of GDP on the NHS at the moment [3] - how much more do people want? 10% appears to be roughly comparable to other developed nations (except USA...) and the data says that nurses and doctors are increasing in numbers while "managers" are not, so the usual cries about the money being spent on "management consultants" appears to be ill-founded, as does the complaints that it is the Tory party reducing funding. Throwing money at the problem appears not to be working because the budget keeps going up, the numbers of doctors and nurses keeps going up, yet people are still complaining about it being awful? What gives? What is the solution when just spending more money isn't working? 1 - https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/funding/nhs-funding-data-analysis https://www.bma.org.uk/advice-and-support/nhs-delivery-and-w... 2 - https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#how-many https://www.kingsfund.org.uk/audio-video/key-facts-figures-n... 3- https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#how-much-does-it-cost https://www.kingsfund.org.uk/audio-video/key-facts-figures-n...

rdl 4y ago
The best thing about NHS (from my perspective as a US person, although I lived in the UK for a while) is the use of QALYS to allocate budget, rather than spending huge sums on a small number of interventions at extreme cost and limited benefit. Has that focus shifted? (My personal belief is there should be a level of universal medical care funded by some public entity, probably the nation state currently, but it should be capped at a relatively low level, probably closer to 1% of GDP and allocated on a QALYS and emergency or communicable biased, with private care in a relatively unregulated market outside of that. Probably would end up in the 5% range overall, but with universal access to basic and cost-optimized care and probably a wider variety of private, charity, experimental care.) We should not spend excessively on medical care vs. other interventions -- it's absurd that in the US we can have homeless people on the street with extremely limited assistance on housing or lifestyle interventions, but as soon as they develop some medical condition, they get essentially unlimited much higher cost intervention to remediate those things, but still nothing to address the underlying cause. There are a bunch of cases where we could shift $1k out of medical spend for $10 in other spend and achieve a better outcome for the person and for broader society.)
- simonh 4y ago
  We still use QALYS. The problem is you don’t get to choose how much a given level of health care costs, and I think 1% of GDP is woefully inadequate. You spend about 4% of GDP just on Medicare alone. As a US tax payer you pay about as much for Medicare, Medicaid and CHIP as tax payers in most developed countries do on health care in total. But then to actually get health care yourself you have to pay about the same again fir private health insurance. I get private health care here in the UK through my employer. I pay for the NHS through taxes, and that’s actually how I and my family get most of our health care in practice. The private cover is basically a top up. If I use it I can get treatment more quickly, but at no cost to the NHS. I think this is the best of both worlds. As a nation we get health care comparable to the US at half the cost, it’s truly universal so millions of people don’t fall out of the system. So I fully support the NHS, as a beneficiary of private health care I still think I and my family have got excellent value for money from it throughout my life. Private health care expands health care capacity, and reduces demand in NHS services, so everyone benefits. It may not see, ideal, but in practice I think it works very well, and frankly it’s how well it works that actually matters. Currently the NHS is in rough shape, but this is mostly down to the flat economy since the financial crisis and the pandemic. Spending levels at the peak of the boom in 2008 were unsustainable whoever was in power.
  - s1artibartfast 4y ago
    >and I think 1% of GDP is woefully inadequate. You spend about 4% of GDP just on Medicare alone. That all depends on the spending ROI. If the first 1% of GDP gets you 90% of the benefit and is universal, it may be just fine.
    - simonh 4y ago
      The problem is I don’t think it would. That logic just doesn’t scale. If one tenth of spending gave 90 of the benefit, then one hundredth of the spending should give you 90% of that, or about 80% of the benefit. That’s not how skilled labour intensive service costs work though. It’s probably more like one tenth of the spending would get you about 20% of the benefits. That’s certainly more efficient, but it’s just not going to be acceptable.
pharmakom 4y ago
Funding may go up but demand increases more because UK population is old and overweight… and getting more so. This is the reality of an aging population plus socialised health care.
- ParksNet 4y ago
  Add at least 60,000 illegal immigrants each year: https://www.bbc.com/news/explainers-53734793 https://www.bbc.com/news/explainers-53734793 Who are likely to be entering the country already with health problems.
mhh__ 4y ago
Note that your bma source contains a graph titled "Regular healthcare expenditure if it had kept pace with the historical average over the last decade"
vehementi 4y ago
> Yet there is still outcry about how we need MOAR MOAR MOAR! Was the budget increased enough in the first place to what the experts recommended? "I generously give my employees a raise every, single, year, of 0.5%, and yet all I hear is that they want MOAR MOAR MOAR"
Scoundreller 4y ago
> how much more do people want? I believe they voted for 350 million pounds a week to fund the NHS https://leftfootforward.org/2022/02/where-is-the-350-million-a-week-for-the-nhs-the-brexit-bus-promised/ https://leftfootforward.org/2022/02/where-is-the-350-million...
londons_explore 4y ago
Is it possible the NHS took on lots of 'bad deals' in the 2000's, and is now having to repay them? Things like a "Get this cheap building, but now you're locked into paying inflated rent and service charges on it every year for the next 50 years"
- makomk 4y ago
  Oh yes. There's a comment elsewhere talking about how the Blair-Brown years had heavy NHS investment and how they used PFIs to fudge the numbers, and that's exactly how it worked - instead of paying the upfront cost of, say, a new hospital they got a private sector firm to build it and committed future governments to paying a bunch of expensive fees to that firm for decades. So they got lots of nice fancy NHS investments and improvements to point at whilst eating into the capacity of every future government to fund... well, everything really. It wasn't sustainable at all.
oliwarner 4y ago
It's because they're acting as an emergency care home. My local 450-bed DGH has over 150 medically fit patients waiting to be discharged into community care that isn't available. And this happened secondary to central government funding being withdrawn from social care. So hospitals like this one are actually running at 120% in summer. They do need "MOAR MOAR MOAR" but that more is a place to look after the patients that don't need to be in hospitals.
twic 4y ago
Other countries spend more (10 - 20 % more) and get better outcomes, so it seems like the solution is indeed to spend more. The fact that it has been climbing slowly and we haven't seen radical improvement doesn't contradict that. Sorry.
b1n 4y ago
The solution is for young people (tax payers) to form a "Youth Union" and start demanding that older people pay more towards their health care. When this doesn't work, the solution is for the members of this union to leave.
willyt 4y ago
From your first source; The combination of a mismanaged economy plus an aging population has meant that the NHS spend is 50BN less than projected but is a now a larger share of GDP compared to other EU economies because the UK economy has performed so badly compared to the rest of the EU. Productivity has flatlined while people bought more and more expensive houses of each other on credit. My theory is that the conservatives have fucked the economy by being too tight fisted with public sector pay causing a drop in disposable income for about 1/4 of UK workers leading to lower spend in small businesses like pubs and hairdressers etc which has caused 10 years of general stagnation.
mellosouls 4y ago
There are potential answers to your questions in other comments in this discussion that have been there for hours, it might be more useful to move understanding forward to address them rather than just opening a new thread as though they aren't there...
cameronh90 4y ago
The issue is undoubtedly multifactorial. I agree with you that we cannot persist with above-inflation spending increases. This is economic fact. Moreover, we're currently enjoying an artificially cheap healthcare system by underpaying nurses and doctors. My partner and many friends and family work for the NHS, and these are my general observations, in order of significance. 1. The biggest problem is underfunded social care. If we took money out of the NHS and moved it into social care, we'd have a better NHS. At the moment, the NHS is full of inappropriate patients with nowhere to go. We also need to consider how we handle the elderly in this country. The idea of having elderly people stay at their suburban homes while the state pays for nurses and doctors to visit is hugely expensive. I suspect caring for your elderly relatives at home is going to need to become more common. 2. The NHS is inefficient BECAUSE there are to too few admin staff. In NHS terms, this includes IT and other similar roles. Currently, my partner spends over an hour a day just waiting to log in on one of her department's three computers. She then spends ages sending emails, following up transfers and doing a whole load of other jobs that should be done by an administrative person. Technology is massively underexploited because investing in technology costs money that we don't want to spend. It's like that death spiral that I'm sure many of us have seen in our careers, where you get nothing done because you spend all day firefighting, and everything eventually grinds to a halt. 3. We need to focus more on preventative care. Right now we largely leave problems until they are much more difficult to treat. This is in large part cultural, and partly due to the firefighting I mentioned before. We have a very unhealthy population (myself included) and more needs to be done to fix that. Other countries have deployed very successful strategies that we've so far failed to apply ourselves. 4. We need to look more at how we handle the end of life process. Sadly, death is an unavoidable reality currently, and we spend a ridiculous amount of resources trying to slightly delay the inevitable. Many of my partner's patients are in their 80s or older, and it seems borderline immoral to be performing such invasive surgeries on extremely unwell elderly people. Interventions continue to get more incredible, but also vastly more labour and resource intensive. Many of these patients may live an extra few months due to these interventions, but we really need to be honest with ourselves and ask whether it's worth it. Currently an intervention is deemed value for money depending on the average QALY added across all patients, but obviously in reality, the same intervention would be usually much more value for money on a healthy 40 year old, and much less on a frail 90 year old. This is an extremely controversial and morally difficult area with extremely challenging issues around every corner, however. This isn't a problem of funding, either. This is a problem of basic population dynamics. We could throw hundreds of billions more at the problem, but where are we going to get all these new carers, nurses and doctors? Who's going to be left to build their houses and grow their food? If we import all these people from overseas, which is politically unpopular, how are we going to integrate them? We could look into whether we continue with the Beveridge Model. Certainly some things about it don't work brilliantly. But honestly I don't think the model matters so much as the fundamentals, other than better aligning incentives will make it marginally easier to fix.
deleted 4y ago
[deleted]

rdl 4y ago

The best thing about NHS (from my perspective as a US person, although I lived in the UK for a while) is the use of QALYS to allocate budget, rather than spending huge sums on a small number of interventions at extreme cost and limited benefit. Has that focus shifted? (My personal belief is there should be a level of universal medical care funded by some public entity, probably the nation state currently, but it should be capped at a relatively low level, probably closer to 1% of GDP and allocated on a QALYS and emergency or communicable biased, with private care in a relatively unregulated market outside of that. Probably would end up in the 5% range overall, but with universal access to basic and cost-optimized care and probably a wider variety of private, charity, experimental care.) We should not spend excessively on medical care vs. other interventions -- it's absurd that in the US we can have homeless people on the street with extremely limited assistance on housing or lifestyle interventions, but as soon as they develop some medical condition, they get essentially unlimited much higher cost intervention to remediate those things, but still nothing to address the underlying cause. There are a bunch of cases where we could shift $1k out of medical spend for $10 in other spend and achieve a better outcome for the person and for broader society.)

simonh 4y ago
We still use QALYS. The problem is you don’t get to choose how much a given level of health care costs, and I think 1% of GDP is woefully inadequate. You spend about 4% of GDP just on Medicare alone. As a US tax payer you pay about as much for Medicare, Medicaid and CHIP as tax payers in most developed countries do on health care in total. But then to actually get health care yourself you have to pay about the same again fir private health insurance. I get private health care here in the UK through my employer. I pay for the NHS through taxes, and that’s actually how I and my family get most of our health care in practice. The private cover is basically a top up. If I use it I can get treatment more quickly, but at no cost to the NHS. I think this is the best of both worlds. As a nation we get health care comparable to the US at half the cost, it’s truly universal so millions of people don’t fall out of the system. So I fully support the NHS, as a beneficiary of private health care I still think I and my family have got excellent value for money from it throughout my life. Private health care expands health care capacity, and reduces demand in NHS services, so everyone benefits. It may not see, ideal, but in practice I think it works very well, and frankly it’s how well it works that actually matters. Currently the NHS is in rough shape, but this is mostly down to the flat economy since the financial crisis and the pandemic. Spending levels at the peak of the boom in 2008 were unsustainable whoever was in power.
- s1artibartfast 4y ago
  >and I think 1% of GDP is woefully inadequate. You spend about 4% of GDP just on Medicare alone. That all depends on the spending ROI. If the first 1% of GDP gets you 90% of the benefit and is universal, it may be just fine.
  - simonh 4y ago
    The problem is I don’t think it would. That logic just doesn’t scale. If one tenth of spending gave 90 of the benefit, then one hundredth of the spending should give you 90% of that, or about 80% of the benefit. That’s not how skilled labour intensive service costs work though. It’s probably more like one tenth of the spending would get you about 20% of the benefits. That’s certainly more efficient, but it’s just not going to be acceptable.

pharmakom 4y ago

Funding may go up but demand increases more because UK population is old and overweight… and getting more so. This is the reality of an aging population plus socialised health care.

ParksNet 4y ago
Add at least 60,000 illegal immigrants each year: https://www.bbc.com/news/explainers-53734793 https://www.bbc.com/news/explainers-53734793 Who are likely to be entering the country already with health problems.

mhh__ 4y ago

Note that your bma source contains a graph titled "Regular healthcare expenditure if it had kept pace with the historical average over the last decade"

vehementi 4y ago

> Yet there is still outcry about how we need MOAR MOAR MOAR! Was the budget increased enough in the first place to what the experts recommended? "I generously give my employees a raise every, single, year, of 0.5%, and yet all I hear is that they want MOAR MOAR MOAR"

Scoundreller 4y ago

> how much more do people want? I believe they voted for 350 million pounds a week to fund the NHS https://leftfootforward.org/2022/02/where-is-the-350-million-a-week-for-the-nhs-the-brexit-bus-promised/ https://leftfootforward.org/2022/02/where-is-the-350-million...

londons_explore 4y ago

Is it possible the NHS took on lots of 'bad deals' in the 2000's, and is now having to repay them? Things like a "Get this cheap building, but now you're locked into paying inflated rent and service charges on it every year for the next 50 years"

makomk 4y ago
Oh yes. There's a comment elsewhere talking about how the Blair-Brown years had heavy NHS investment and how they used PFIs to fudge the numbers, and that's exactly how it worked - instead of paying the upfront cost of, say, a new hospital they got a private sector firm to build it and committed future governments to paying a bunch of expensive fees to that firm for decades. So they got lots of nice fancy NHS investments and improvements to point at whilst eating into the capacity of every future government to fund... well, everything really. It wasn't sustainable at all.

oliwarner 4y ago

It's because they're acting as an emergency care home. My local 450-bed DGH has over 150 medically fit patients waiting to be discharged into community care that isn't available. And this happened secondary to central government funding being withdrawn from social care. So hospitals like this one are actually running at 120% in summer. They do need "MOAR MOAR MOAR" but that more is a place to look after the patients that don't need to be in hospitals.

twic 4y ago

Other countries spend more (10 - 20 % more) and get better outcomes, so it seems like the solution is indeed to spend more. The fact that it has been climbing slowly and we haven't seen radical improvement doesn't contradict that. Sorry.

b1n 4y ago

The solution is for young people (tax payers) to form a "Youth Union" and start demanding that older people pay more towards their health care. When this doesn't work, the solution is for the members of this union to leave.

willyt 4y ago

From your first source; The combination of a mismanaged economy plus an aging population has meant that the NHS spend is 50BN less than projected but is a now a larger share of GDP compared to other EU economies because the UK economy has performed so badly compared to the rest of the EU. Productivity has flatlined while people bought more and more expensive houses of each other on credit. My theory is that the conservatives have fucked the economy by being too tight fisted with public sector pay causing a drop in disposable income for about 1/4 of UK workers leading to lower spend in small businesses like pubs and hairdressers etc which has caused 10 years of general stagnation.

mellosouls 4y ago

There are potential answers to your questions in other comments in this discussion that have been there for hours, it might be more useful to move understanding forward to address them rather than just opening a new thread as though they aren't there...

cameronh90 4y ago

The issue is undoubtedly multifactorial. I agree with you that we cannot persist with above-inflation spending increases. This is economic fact. Moreover, we're currently enjoying an artificially cheap healthcare system by underpaying nurses and doctors. My partner and many friends and family work for the NHS, and these are my general observations, in order of significance. 1. The biggest problem is underfunded social care. If we took money out of the NHS and moved it into social care, we'd have a better NHS. At the moment, the NHS is full of inappropriate patients with nowhere to go. We also need to consider how we handle the elderly in this country. The idea of having elderly people stay at their suburban homes while the state pays for nurses and doctors to visit is hugely expensive. I suspect caring for your elderly relatives at home is going to need to become more common. 2. The NHS is inefficient BECAUSE there are to too few admin staff. In NHS terms, this includes IT and other similar roles. Currently, my partner spends over an hour a day just waiting to log in on one of her department's three computers. She then spends ages sending emails, following up transfers and doing a whole load of other jobs that should be done by an administrative person. Technology is massively underexploited because investing in technology costs money that we don't want to spend. It's like that death spiral that I'm sure many of us have seen in our careers, where you get nothing done because you spend all day firefighting, and everything eventually grinds to a halt. 3. We need to focus more on preventative care. Right now we largely leave problems until they are much more difficult to treat. This is in large part cultural, and partly due to the firefighting I mentioned before. We have a very unhealthy population (myself included) and more needs to be done to fix that. Other countries have deployed very successful strategies that we've so far failed to apply ourselves. 4. We need to look more at how we handle the end of life process. Sadly, death is an unavoidable reality currently, and we spend a ridiculous amount of resources trying to slightly delay the inevitable. Many of my partner's patients are in their 80s or older, and it seems borderline immoral to be performing such invasive surgeries on extremely unwell elderly people. Interventions continue to get more incredible, but also vastly more labour and resource intensive. Many of these patients may live an extra few months due to these interventions, but we really need to be honest with ourselves and ask whether it's worth it. Currently an intervention is deemed value for money depending on the average QALY added across all patients, but obviously in reality, the same intervention would be usually much more value for money on a healthy 40 year old, and much less on a frail 90 year old. This is an extremely controversial and morally difficult area with extremely challenging issues around every corner, however. This isn't a problem of funding, either. This is a problem of basic population dynamics. We could throw hundreds of billions more at the problem, but where are we going to get all these new carers, nurses and doctors? Who's going to be left to build their houses and grow their food? If we import all these people from overseas, which is politically unpopular, how are we going to integrate them? We could look into whether we continue with the Beveridge Model. Certainly some things about it don't work brilliantly. But honestly I don't think the model matters so much as the fundamentals, other than better aligning incentives will make it marginally easier to fix.

deleted 4y ago

[deleted]