55 comments on “But no amount will ever be enough, will it?

  1. If more leeches are applied to the patient then the bad humours in the blood will be drawn out. If this doesn’t work, then it’s a matter of insufficient leeches having been applied.

  2. http://www.leadershipacademy.nhs.uk/blog/diversity-advisors/

    “following an FOI request they found that there were 165 diversity advisors in the NHS being paid a total of £6.8 million. Just so you know, that averages out at an entirely reasonable £41,212 per person, not exactly a king’s ransom”

    http://www.firstdaytoncyberknife.com/dr_hughes_blog/5-facts-you-need-to-know-about-cyberknife-and-prostate-cancer/

    “If CyberKnife is so good, why don’t all hospitals have it? I believe that economics may play a big role in equipment selection by hospital administrators. Firstly, CyberKnife is much more costly than ordinary linear accelerator devices. In fact, it’s a $5 million investment.”

    I’m sure people could do this all day.

  3. Cynic: “…an entirely reasonable £41,212 per person…”

    FFS! Whoever wrote that has been into the drugs cabinet!

  4. Hard to believe how otherwise normal people find it impossible to see themselves paying for healthcare like they pay for dental work, glasses, etc.

    Of course all politicians want it to continue because it is such an insane amount of money. The Tory vision is to make it increasingly bad so that people opt to spend on extra healthcare on top of the massive taxes already levied, eventually making the NHS a less important thing that it is currently. The Labour vision is to fearfully worship the money eating beast as it devours the country.

    No political party ever will suggest defunding it, privatising the useful bits, and reducing taxation by a corresponding amount. And stupid ideas like a national care service get a serious hearing from almost everyone. So depressing.

  5. Is it still true that spending on the NHS has increased (above inflation) in every year since its foundation, bar the Labour years of the late seventies?

  6. Lesson for all nations contemplating installing a NHS system: it will consume ever more money, dominate virtually all political discourse and still leave everyone unsatisfied. It can never be changed, and it will never be tamed in any way.

  7. Strange how those parties who say they are outward looking and pro-Europe, simultaneously seem to think that all those European countries with larger market systems providing universal health care are doing it wrong.

  8. “an entirely reasonable £41,212 per person”

    There’s the problem right there. People who can unashamedly write that sentence. That’s a fucking good salary for someone running a few workshops, even necessary ones, let alone unnecessary ones.

    I’ve yet to work in any private sector business with a diversity officer. If someone acts inappropriately, management deals with it. Few people do though, because this isn’t the 1980s. People are either not sexist, racist and homophobic, or smart enough to know that you don’t say things publicly.

  9. This post reminds me of two things I’ve read about the NHS and I’ve no idea if they’re accurate.
    A) The number of non-medical staff approaches 50%. I suspect diversity advisers are part of that segment and are dispensable except to someone’s local empire. Anybody know what the medical vs nonmedical breakdown is? Is it reasonable?
    B) That the likely current value of legal claims against the NHS is in the order of £55bn, i.e. approaching 50% of the annual budget. It’s largely due to “call me Dave” agreeing to the current “no win no fee” rules for lawyers a few years back. Can this be true?

    If so, I suspect Watcher is correct; it is a gravy train for too many. We might just have to hope that some of us get the right treatment at the right time. I gave up a lifetime principle recently and went private for a simple op which Lothian NHS were estimating (unofficially) at 35 weeks.

  10. The problem is the solution is so simple, but the politicians won’t even acknowledge it. They say it is too toxic, but the real reason is that they are a bunch of self serving tossers. Don’t vote. It only encourages them.

  11. As someone who thinks that the spend on diversity coordinators should be zero, I think commentators should again about the total cost for each. These aren’t salaries, they are total costs, and include both employers’ NI and employers’ pension contributions. The average salary is probably rather close to the national average wage.That doesn’t stop the money being pissed up the wall, it just isn’t as high as some people think!

  12. an entirely reasonable £41,212 per person

    As they are completely worthless they are in fact overpaid by £42,212 p.a.

    The original statement was made by answering another question: “would I like to earn that salary for doing fuck all?”

  13. Tomsmith: “The Tory vision is to make it increasingly bad so that people opt to spend on extra healthcare on top of the massive taxes already levied, eventually making the NHS a less important thing that it is currently.”

    Evidence please!

  14. “It’s largely due to “call me Dave” agreeing to the current “no win no fee” rules for lawyers a few years back”.

    Were it that simple. A no win no fee lawyer will take your case if you have a very reasonable chance of winning, so its not a case of shooting enough arrows hoping some will stick.

    When you’re dealing with bureaucracies, they have 1 expensive advantage, and that is time. As an individual, there is nothing you can do if they obstruct you. It has happened to me against Tfl, and it took them 2 years to admit liability, then another 2 years to settle. No “no win no fee”, and there is no way in the world I could have afforded to sue them.

  15. > there were 165 diversity advisors in the NHS

    The NHS has to be the most ethnically diverse public-sector organisation in the country. We can safely say that their work is done, and they can all go home.

  16. @Rob

    I’d go further: race-baiting is distinctly unhelpful. Much like the bloody HR dept, getting rid of these ghastly people would also take away a disruptive burden on the folks trying to do actual work.

    I threw in Cyberknife as a comparison as I was once in a club that was raising money to help buy one. Stuck in my mind, that, charities having to fund NHS equipment.

    @Excavator Man: I suspect this is the av. pay that the employee sees, so I’d expect the direct cost to the NHS would be higher. A good chunk of that immediately circling around back into HMRC due to maintaining the fiction that the public sector pays tax, which gives perverse stuff like this:

    https://www.unison.org.uk/news/press-release/2015/11/unison-says-national-insurance-increase-will-rob-public-sector-workers/

    “The rise in National Insurance (NI) payments will hit pay packets in April 2016. This is when the current 1.4 per cent rebate for employees and 3.4 per cent for employers will be abolished. It means earnings could drop by around £22 a month for those on a £25,000 annual wage. The wage bill for the NHS could soar by £1bn and by £800m for local government, says UNISON.”

  17. there were 165 diversity advisors in the NHS

    Very specific. I wonder how many people are doing similar non jobs with different names?

  18. Rob – “The original statement was made by answering another question: “would I like to earn that salary for doing fuck all?””

    My experience of the public sector is that these people do not do f**k all. If only. We could live with people on a cushy sinecure who didn’t even bother to turn up. No. They are self-important and on a mission. They need to go out and prove they are doing important work. They look for trouble. They stir up trouble. They cause trouble.

    We would be better off putting a bullet into the head of each and every one.

  19. dearieme: see https://www.nuffieldtrust.org.uk/chart/a-history-of-nhs-spending-in-the-uk for data on NHS total spend, 1949-2011.

    Up from £12.6 B (real terms, 3.5% of national income, to £137.4 B, 8.9 % of income.

    Quote: “The average annual real growth rate over the NHS’ history has been 4.0 per cent … The tightest four-year period of NHS funding was during the period 1950/51 to 1954/55 (an average annual real cut of 2.4 per cent). The tightest period of funding in the last 50 years was during the period from 1975/76 to 1979/80 (average annual real growth of 1.3 per cent).”

    Remind me which governments were in office, 1975/6 to 1979/80.

  20. ScottR; you need to be a bit careful with the 55bn number, since that’s a stock (or an estimate of the total future flows). The annual amount paid in compensation appears to be on the order of 6-7bn, or ~5-6% of the annual 120bn budget.

    That annual compensation number does appear to have risen ten fold from 6-700m over the last ten years, no idea what’s driving it, but the number of claims doubled over the same period. The current reserves seem to be ~25bn.

    Staffing breakdown; rough (personal) rule of thumb – productive work to admin/support is between 1-2 and 1-3. Total FTE workforce is 1.2m, qualified clinical staff ~0.6m of which 0.15m are doctors, 0.31 nurses​ and the remaining 0.14 are otherwise clinically qualified. So doctors to nurses is 1-2, doctors to nurses and others is 1-3.

    The other support staff are 0.31 clinical support, and 0.18 infrastructure, call it 0.5m. That’s near as dammit 1-1, so it looks like the NHS runs with about half the support staff it needs, but assuming that the otherwise​ clinically qualified don’t do much of the patient interaction stuff, then doctors and nurses together (0.46m) have 0.64m support staff available, which is about 1-1.5, still a bit low.

    I doubt if adding on GPs and their nurses and support staff will change the ratios that much, so if anything I reckon the thing is short of around 0.25m support staff. Good luck flogging that to the public.

    All of which is probably completely irrelevant, unless someone knows what the total return on NHS spending actually is.

  21. Very specific. I wonder how many people are doing similar non jobs with different names?

    Don’t forget all the layers of management for those 165 diversity advisors. That probably adds at least another 500 on multiples of the salary.

  22. Wasn’t “no win no fee” a Blair thing rather than a Cameron thing? Not that the two are readily distinguishable, I’ll grant you.

  23. All the talk of money is starting from the wrong end. When was the last time someone had a long hard look at everything the NHS does and considered whether or not it should be doing it all?

  24. The quick response to anyone saying there should be more spent on the NHS is ” how much more exactly?”

    They are likey to quote Labour’s latest sweetshop offer so a slightly longer response to try is ” so what.percentage GDP should be spent on health then?”

    Either way, always follow up with ” how much would be too much and why?”. At the very least the conversation changes.

  25. Ducky,

    My proportions (in an actually relatively productive company) is more like 2:1… which I hardly consider best practice by the way

    Even assuming that the proportions are right your conclusion is not supported as you assume that the productive staff is right-sized. The problem tends to be that the admin/support staff don’t support the productive staff but instead create more admin work for the productive staff which means that they can spend less of their time doing productive work. In other words, you could probably cut 50% of the productive staff by making sure that the admin staff supported them instead of say advising on diversity. Then your proportions would be reached.

    Ps. “Productive” and NHS in the same sentence is a bit strange use of words

  26. Cynic, yeah. 165 odd diversity advisors shouldn’t really be a problem, I think it works out at just over 1 per trust or 0.3 per hospital or something, but how much do they, plus the rest of them, suck otherwise productive time out of everyone else?

    It’s like Cloughie on the offside rule in reverse; if you’re not interfering with play, what are you doing on the pitch​?

  27. No win, no fee was Maggie.

    Sack everyone with coordinator in their job title. My experience is that they don’t have responsibility for delivering anything and therefore no incentive to add value.

    As to that £41k that’s not the cost to the NHS. They need office space, computers, IT support, HR support, managing, expenses etc as a rule of thumb double their salary to get the cost to the organisation And you won’t be far off.

  28. how much do they, plus the rest of them, suck otherwise productive time out of everyone else?

    Well I now have to do a diversity questionnaire with every patient. Among other 15 or so questions it asks if my patients are still the same sex they were born as. Try explaining that to a deaf 90 year old.

  29. @cynic @ 10.16

    The most hated man of the left here, Amancio Ortega one of the 3 richest men in the world (depending on the stockmarket), owner of 60% of Inditex (Zara), has a foundation which, spoke to all the regional health authorities (which make up the Spanish NHS), saw a real problem regarding cancer outcomes and donated 320 million euros worth of new cancer treatment equipment across the country. A total of 290 new state-of-the-art machines.

    Made me smile. Next time I am with all my leftie friends I shall be bringing it up. Direct to the health service, without passing through the Exchequer. Not a penny lost in the process.

    But, but…

    When people use him as a poster boy for the rich (who should be dispossessed) I always ask ‘Just exactly who is worse off due to him becoming rich?’ The answer being, of course, no one.

  30. Emil, it’s just rough and ready really, based on the service companies I’ve seen. Though they seem to get to 2.5:1 or higher by adding cover, or redundancy, over 2:1. Other solutions may be available.

    Yes, agreed. There doesn’t seem to be a way of discovering that though given the structure of the damn thing and the political climate around it.

    On the admin point; the amount of paper generated is ridiculous, mainly through duplication. Each hospital/centre creates another set of records, and duplicates tests. Ok, so that project spunked, what, a third of the Trident budget?, straight up the wall and they ended up with nothing out of it at all?

    ps. It is a bit isn’t it? But again, we spend about 20% of the total tax take on healthcare, in order to, what exactly? Does it improve GDP? Reduce volatility in GDP per capita? Broaden labour market participation? By what amounts? Compared to what? If it’s purely moral, then the budget is clearly potentially infinite, and everyone’s willy-waving over how much they’ve spent.

  31. @Ironman

    Very good.

    It’s another in the vein of “so what is the correct temperature for planet Earth?”, which a (real) scientist friend of mine asked my wannabe scientist friend in debate.

  32. I remember there being some insistence that the NHS budget needed to keep increasing by 4% pa to keep up with demand (found a source saying similar here*).

    Let’s say the economy grows by 2% every year.

    Silly quick exercise with Excel, taking 2011 Dept for Health spending and UK GDP, both in US$.

    $437bn vs $2,431bn.

    Extrapolate 4% pa for the former, 2% for the latter.

    2064 health spending = 50% of GDP.
    2100 = 101%.

    At some point, UK gov health spending just has to stay in line with economic growth (and occasional decline).

    *https://www.kingsfund.org.uk/projects/verdict/how-much-money-does-nhs-need

    Why is this happening? Since 2010, the NHS has had an unprecedented funding squeeze. Over the period between 2010/11 and 2015/16, the NHS budget will have increased by £6 billion in real terms – an average of 0.9 per cent a year. This is significantly lower than the long-term average increase in NHS spending which is 4 per cent.

  33. “The quick response to anyone saying there should be more spent on the NHS is ” how much more exactly?””

    Not only that, but a promise that if we do agree to spend that amount and the NHS is STILL needing MORE money in say 5 years time, then we (those against spending more money now) get to reform the entire NHS in whatever manner we see fit, and those wanting MOAR MONEY get to STFU.

  34. daniel

    Well I now have to do a diversity questionnaire with every patient. Among other 15 or so questions it asks if my patients are still the same sex they were born as. Try explaining that to a deaf 90 year old.

    If any medic tried that on me, I’d be inclined to tell them to take a dump, help get it out of their system. FFS.

  35. Over bere in America I watched an episode of the Penelope Keith show No Job For a Lady wherein she was a newly elected MP ( Labour , of course). Anyway, there was a throwaway bit where a little old lady was requesting ( pleading) a senior MP to arrange for her husband to jump the queue for a kidney transplant. The impression was that this was an unremarkable event. This was outrageous to my Yank sensibilities. The idea that politicians could wield this kind of power is nauseating.

  36. PF, and I’d agree with you that that is the correct response. I usually deal with the ‘equality and diversity’ questionnaire by asking ‘Do you want to answer some pointless and intrusive questions? For some reason I have the lowest response rate in my department. No doubt at some point I will have to explain myself to an diversity advisor.

  37. dearieme

    For NHS spending across the years, try
    https://www.nuffieldtrust.org.uk/chart/a-history-of-nhs-spending-in-the-uk

    1949/50 at 2012/13 prices, £12.6 B. As % of national income, 3.5.

    2010/11, £137.4 B. As %, 8.9.

    Quote: “The average annual real growth rate over the NHS’ history has been 4.0 per cent … The tightest period of funding in the last 50 years was during the period from 1975/76 to 1979/80 (average annual real growth of 1.3 per cent).

    Remind me which governments were in power, or at least in office, during that time.

  38. Tim

    I am trying to post statistics about NHS spending to your blog. `they don’t get through. Why not?

  39. Alas, for that was a potential comment agreeing with Tim, with only one link.

    Moral from this uncertain.

  40. How much more? I suggest we should spend about the OECD average, excluding the USA. Why not?

  41. Sorry, mistyped there. The OECD includes a lot of much less wealthy countries. Make that the G7 average, excluding the USA.

  42. Among other 15 or so questions it asks if my patients are still the same sex they were born as.

    I have an official form I’m half way through filling out that asks me what sex my mother is.

    I haven’t got to the bit where I fully expect it to ask me what sex my father is.

  43. No political party ever will suggest defunding it, privatising the useful bits, and reducing taxation by a corresponding amount.

    Fortunately, technology is about to make it obsolete. Until the NHS is finally put out of its misery, the future of healthcare will probably involve flying to China or Eastern Europe for gene-hackers to cure problems at their source.

    We’re getting pretty close to a question I used to ask NHS supporters when I lived in the UK: if someone invented a pill that cured all disease and made everyone twenty again, would the NHS support it, or oppose it?

  44. But why? The argument for the NHS is that by getting rid of all that wasteful competition we’re more efficient. Thus we should spend less.

  45. “We’re getting pretty close to a question I used to ask NHS supporters when I lived in the UK: if someone invented a pill that cured all disease and made everyone twenty again, would the NHS support it, or oppose it?”

    We all know the answer to that, the NHS being primarily run for the benefit of its employees. Any advance in technology that threatens to put vast swathes of the NHS to the sword as no longer needed will be opposed bitterly, as ‘dangerous’, ‘untested’, ‘too expensive’ ‘impersonal’ etc etc.

  46. But why? The argument for the NHS is that by getting rid of all that wasteful competition we’re more efficient. Thus we should spend less

    Perhaps, but not so much less. The sensible thing to do would be to spend the same amount, and see whether we get better healthcare.

  47. ” The sensible thing to do would be to spend the same amount, and see whether we get better healthcare.”

    What happens when we don’t? Can we raze the NHS to the ground and start again?

  48. Perhaps, but not so much less. The sensible thing to do would be to spend the same amount, and see whether we get better healthcare.

    What’s so sensible about some G7 “average” spend?

    If fixated on G7 averages, one obvious response – based on it being our money rather than someone else’s – might be to spend the least we can in order to get the same G7 average outcome (I presume it’s their “outcomes” we hold in high regard)?

    However, I would suggest that “sensible” is: a) Consider what you (as a country) want in terms of outcomes; b) consider what you are prepared to spend; c) etc, other factors, including such as what the relationship is between a) and b) (privately spent or publicly) – and then perhaps negotiate those positions focusing on what the priorities are.

    (apologies if repeating comments above, I’ve not read it all)

  49. It’s the sensible thing to do if you want to find out which system is more effective.

    If we were able to establish that, say, the French system works better than the UK system, given the same level of funding, then of course we should move towards a French-style system. But we’ll never find out if we continue to spend much less.

    My personal observation is that in the areas I know about my local hospital is understaffed, but that the non-mercenary doctors (which is most of them) make up for it by doing extra unpaid work. Meanwhile, the outsourced service I’ve been treated by is the most inefficient operation I’ve ever encountered.

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