Monday 4 November 2019

The real election numbers not being discussed

Here is the formal UK data chart for the share of government spending 5 years ago  - total spending  £743 Billion

And here is the same chart for 2019 - total spending £821 billion ( a 10%  gross increase)

As we can see, as he numbers are so large little really changes. The big and obvious change is that Healthcare spend has gone for 17% of Government spend to 20%. Pensions have edged up a little and this offsets welfare that is down a little. Education spend remains the same over the 5 years.

The long term trend is for healthcare, pensions and welfare to increase, since 2010 they have eaten up another 5% of annual government spend. Meanwhile Education has dropped from 13% to 11% and been held there.

For an election campaign, I would have zero sympathy with the usual Labour NHS stories. The real question is how as a Country will we ever stop the ongoing march of government spending on Healthcare (hint; we need more additional private provision). I have more sympathy with the teachers as school spending has been held down and also welfare spend has had a tiny squeeze - but remains a big spend item considering the economy has generated near full employment.

It is always interesting that no parties ever frame their offer in practical terms about what they would do, how they would grow or shrink this pie and also how they would make changes to the allocations.


andrew said...

Has welfare dropped partly becauuse there are fewer unemployed?

Also uplifting the min wage / living wage should reduce the welfare bill.

If this is the case as unemployment is at a cyclical low, I would expect it to rise over the next 5 years.

Anonymous said...

A cure (or cures) for dementia would save a great deal of money. Money invested in medical research is very worthwhile.

Think how much we have not had to spend on TB sanatoria.

Don Cox

DJK said...

To some extent, pensions and healthcare can be added together as "old people", since the major consumers of healthcare are the old. In an ageing society --- and societies are ageing worldwide --- this is perhaps inevitable.

In other news, I note that the idea of the Magic Money Tree has now become mainstream. Central bankers seem to have decided amongst themselves that they can just print money to invest in green tech and so solve climate change.

YDG said...


I have to respectfully disagree with your ...

"The real question is how as a Country will we ever stop the ongoing march of government spending on Healthcare (hint; we need more additional private provision)"

Back in the days when I still read paper newspapers and Brown was Chancellor I remember reading an analysis in The Times of Brown's spending bonanza in the NHS. The standout observations were, roughly, ...

Number of doctors, nurses, cleaners etc up around 5%, give or take.
Bureaucrats up 35%

Based on my own experience of dealing with them, NHS bureaucrats are mostly incompetent or occasionally just plain vicious - an impression that is confirmed by a procession of NHS scandals (Gosport, contaminated blood, Mid-Staffs, ... ) in which cover-up, bullying, suppression of evidence and promoting the guilty is just normal. The existing NHS bureaucracy will waste any amount of money and then pay themselves bonuses for their "achievements".

Unless, of course, when you said "private provision" you meant a top down clear out of the dross that has been running the NHS for decades.

Oli said...

YDG. Your numbers may be right but you can't just look at Brown's increases, you have to consider the starting positions. No-one wants more NHS bureaucrats - but when they make up around 6% of the NHS budget overall, I would suggest that cutting NHS bureaucrats isn't going to make much difference overall, and woudl just be so much tinkering at the edges.

CityUnslicker said...

YDG - interesting view. I just don;t think there is much mileage in trying to reduce bureaucracy in the NHS - on all international studies it comes out quite well in these terms.

Where is does poorly is on health outcomes because we won't buy the best treatments because they are expensive. More private provision would allow for this an improve some of the overall outcomes.

Sobers said...

From my experience of the NHS (via my aged father with multiple ailments) its not lack of money thats the problem, its total lack of competency. The amount of money just wasted is vast. Mass swathes of people being paid to do 'work' that never achieves anything, indeed often manages negative achievements, ie makes things worse. The lack of co-ordination, and the inability to make people just do their f*cking jobs properly is mind boggling. I know multiple people with various long term ailments - they all have a litany of failed attempts to solve their problem, not failed because medical knowledge is not sufficient, failed because the case management process collapses repeatedly - follow up appointments disappear into the ether and the whole process has to be started again, that sort of thing.

All of which is to be expected in a system that never punishes failure and often rewards it with more 'resources' poured in to try and improve things. It took 70 years for socialism to bring the USSR to its knees, give the NHS was founded just over 70 years ago, my guess it that the NHS is approaching its Berlin Wall moment some time soon as well.

As increasing numbers of the voting public are exposed to the NHS's tender mercies via either their own health issues or those of their friends and relatives, a ground swell of completely hidden public opinion is growing. Rather in the way Brexit was a huge shock to the political class, their reaction to finding out that a significant proportion of the public would vote (and maybe just have done) for the NHS to be abolished and replaced with something else will be mind blowing.

If you think the NHS is a 'battleground' now, when every single party is pro-NHS, imagine the bloodshed there will be when someone actually stands up and says what many of the public are thinking, abolish the NHS, and gets voted in on the back of it.

YDG said...

RE: Oli & CU

Oops. Too much ranting and not enough clarity on my part. I'll try again.

I agree that there is little to be gained from trying to reduce the cost of administration. The point I was trying to make was not that the bureaucracy is too large but rather that it is incompetent and, too often, malicious.

There are countless examples of this. As just one example, the scandal at Southern Health Trust saw the Chief Executive forced out of her job ... into a brand new non-job, fabricated by the Trust as an excuse to continue paying her full salary despite the fact that she had completely failed as Chief Executive and wasn't doing anything at all in the new "job".

I understand that there are very real problems with an aging population, a growing population, health tourism, an ever growing range of new "things" that can be treated and probably others. Those are issues that would pose a major challenge to even a competent administration, but that is not what we have.

The NHS bureaucracy is not fit for purpose and hasn't been for a very long time.

E-K said...

Does the impact of devalued Sterling show in this ?

As for health care there is a self inflicted obesity epidemic in the offing and (a police friend tells me) anyone drunk or otherwise intoxicated taken straight to A&E by ambulance as new police policy is to avert deaths after police contact at all costs.

Of course,we can ignore all this and blame it on old Brexit voters.

E-K said...

One should clarify that the obesity epidemic I mention is linked to the diabetes epidemic.

Thud said...

My mother passed away last week from Alz after suffering for several years. The NHS help we received over the years was incredible and I'd guess extremely expensive compounded as mentioned by others by inefficiency and mindless duplication of effort. More research into dementia coupled with better targeted use of resources would go a long way.

L fairfax said...

I would think that maybe investment on new and better antibiotics - on a global scale - and Alzheimer's medicines would help.
I recently went to the GP for an ear infection the antibiotics did not work,I had to go back and get some more.
Apart from the pain etc for me - if the antibiotics had been as effective as 40 years ago then it would have been one visit.
(This has happened before).
Alzheimer of course is a very expensive.

Saying that every time a Doctor heals a patient, they create another in the future. Medical care will always cost more - unless treatments get a lot cheaper.

dearieme said...

The idea that fortunes haven't already been spent and lost searching for cures for Alzheimer's is hopelessly naive. Still, if you have a promising idea just drop a line to almost any pharma company: they are desperate for a novel idea with promise.

Meantime, just to be constructive: divert the whole Foreign Aid budget to Hungary on the deal that they will vote on all EU matters in line with our requests to them.

Thud said...

Dearmie, I'm quite aware of the state of affairs in Alzheimers research and expenditure thank you, its almost as if I had an interest.

Anonymous said...

Just because dementia research is difficult is no reason to give up. Likewise with Parkinson's.

Don Cox

Nick Drew said...

A cure (or cures) for dementia would save a great deal of money. Money invested in medical research is very worthwhile. Think how much we have not had to spend on TB sanatoria

Not sure about this, Don: I'm inclined to go with L.Fairfax above: every time a Doctor heals a patient, they create another in the future

The advances in cancer treatment have prolonged many lives by many years (via costly ongoing medication regimes - have you seen how big are the white paper bags that some older people carry away from the chemists every month??), pushing ever more people into dementia. Fix the latter, and you'll move everyone along to the next unsolved problem relating to even-older old age - involving ever more extended ongoing medication regimes

The answers to cui bono are obvious: (a) anyone who wants to live forever, irrespective of quality-of-life (= most people, when push comes to shove); and (b) Big Pharma

Charlie said...

The Tories would do well to realise that the NHS isn't the sacred cow that the left would have you believe. While the nation may well be wedded to free-at-point-of-delivery care, it isn't at all wedded to the NHS model. Just ask anyone who has had to use it.

I met a German couple during NCT classes (which were a total waste of money, but I digress...). They could not believe the state of our hospitals, the infrequency and brevity of midwife appointments, the lack of scans, and couldn't believe that the UK is proud of such an obviously threadbare service. The Germans have a social insurance model and their healthcare spending as a % of GDP is barely any different to the UK's, once you factor in how much people spend on private care in the UK, because the NHS is so bad.

I could list multiple examples just in my own family where the NHS has either caused someone to die earlier than they would have (diagnosed Parkinsons rather than serial TIAs - rectified by a Spanish doctor during a holiday, unfortunately too late), expected someone to live with chronic pain for 36 weeks (we paid to go private), caused serious head injuries to a baby at birth (due to not scanning when using forceps, too expensive), or left someone with a debilitating condition because the wrong operation was carried out. These aren't newspaper scare stories, they're the experiences of my own immediate family.

I think Boris has an inkling that the public aren't as loony left as the loony left would have you believe - but his constant promises to increase NHS funding, rather than put the dinosaur out of its misery altogether and replace it with something fit for purpose, don't fill me with confidence.

Matt said...

Staving patients is not unknown in the NHS - my great uncle included (3 days without food when operations rescheduled). If they can't even feed people how can you trust them to do the complex stuff?

Sobers said...

"The Tories would do well to realise that the NHS isn't the sacred cow that the left would have you believe. While the nation may well be wedded to free-at-point-of-delivery care, it isn't at all wedded to the NHS model. Just ask anyone who has had to use it."

Its long been my contentions that 'support' for the NHS is paper thin. It exists within the political class, rather like support for the EU does, but the plebs below have very different views, because they have to suffer its tender mercies. And if ever they are given a way of making that voice heard, the screams of anguish from the same people howling about Brexit will be thing of beauty to behold. They literally won't know whats hit them. How can people vote 'against' the NHS? Its untouchable, a shining city on a hill, who other than malevolent evil-doers could think otherwise?????

Sobers said...

"(diagnosed Parkinsons rather than serial TIAs - rectified by a Spanish doctor during a holiday, unfortunately too late)"

A friend of mine suffered what was thought to be a TIA by A&E, but was told by the consultant she subsequently saw that she'd only had a aural migraine and it was nothing to worry about. Her GP then demanded brain scans which showed that she'd actually had a very minor stroke. Even then in another meeting with my friend the consultant repeatedly told her that it 'could have been an aural migraine'. No apology was ever given, and this consultant is still working in the NHS today. God help anyone who comes into contact with him. He's not British of course.......

Scrobs... said...

Several years ago, I heard a statement from a promising graduate who was applying for a research job with a major pharma company.

The general gist of the HR's reply to the graduate's questions concerning ethics etc, was "We are in business to make profits. If people get better, that's not our problem"!

I've often wondered what happened to him!

Anonymous said...

"To some extent, pensions and healthcare can be added together as "old people", since the major consumers of healthcare are the old. In an ageing society --- and societies are ageing worldwide --- this is perhaps inevitable."

It wasn't inevitable that we imported millions of people who get type 2 diabetes at 2.5 times the rate of the natives (they have more heart disease and strokes too). Diabetes is a huge NHS cost (10% now) to both hospital and GP budgets.

"Approximately half of all South Asians, Africans and African-Caribbean people in the UK will develop the disease by age 80, compared with only one in five of European descent."

“The number of people diagnosed with diabetes in the UK has more than doubled in the last twenty years, according to new analysis released today by Diabetes UK. The new figures show that there are now almost 3.7 million people living with a diagnosis of the condition in the UK, an increase of 1.9 million since 1998. The data also shows that the number of people diagnosed with Type 1 or Type 2 diabetes has increased by almost 100,000 since last year – from 3,590,501 to 3,689,509. The West Yorkshire city of Bradford has the UK’s highest prevalence of diabetes, with more than one in ten people (10.4 per cent) living with a diagnosis. Conversely, Richmond in London has the lowest incidence, with 3.6 per cent of the population affected. The national average is currently 6.6 per cent.”

CityUnslicker said...

OK great comments!

Given my proclivities, I would scrap the NHS and replace it entirely with a private insurance service and learn the lessons from Germany and Spain who have far superior provision to us.

However, the big issue is th Union vote. Nearly 4% of people work direclty in the NHS and then there are the suppliers to it which is another maybe 2-3%.

You would shin 7% of the working population if you suggested reform, absolute poll disaster for the party that did it, Especially if it was the baby eating Tories. So much as it would be nice, there are no votes here and only if something wild happened like Farage elected would it ever be countenanced, more's the pity.

BlokeInBrum said...

Politically, the NHS is a live rail. Meddle with it at your peril.
No politician of the modern age has the cojones to really do anything approaching fundamental reform. So what then?

The only way forward that I can see is to implement a parallel insurance based system that is more market (ie. consumer) driven than the current model.

Many working people like myself would be willing to pay towards a system that was cleaner, faster, more responsive than the existing provision.
If people were given the option of withholding NI contributions / a tax advantage in return for private insurance many would jump at the chance.

Supplanting the NHS in such a way looks to me like the only way to get round inertia that exists in the current system. Let the NHS wither and die as working people move over en masse, and let the old system deal with the freeloaders and health tourists.

Anonymous said...

Trouble is, BlokeInBrum/Charlie, the NHS spends an awful lot of taxpayer cash and an awful lot of private sector vultures would just love to get their hands on it*. Please don't be under the impression that massive levels of waste and incompetence only apply to the public sector.

I've worked in private sector IT for decades and I could tell a tale or two of disaster projects costing up to a billion. You just don't hear much about them, because it's in no-ones interest to publicise them (except maybe the poor shareholders, but who speaks for them?). Success has a thousand fathers, failure is an orphan.

Little tale - I met a techie who'd spent decades inside the NHS helping develop their data architecture i.e. what's recorded at hospital/GP surgery and how it's stored - the data structure. This is incredibly important, because on this depends an awful lot of medical research and analysis - analysis that can be both life-saving and cost saving. It's also incredibly difficult, because there are loads of old paper records to digitise, it should be done in a standard way, different doctors have different record keeping habits etc, and incredibly difficult because the NHS is continually changing, new treatments/diagnostics/organisation structures etc etc.

Around the time of the abortive Great NHS Interconnectivity Shambles, some bright spark at the DoH had the brilliant idea of selling the intellectual property/database structures to an American company, who in best private/public style would then lease it back to the NHS.

Suffice it to say that their additional development (in order to sell it to big US providers) rather buggered it from an NHS perspective. Not good. I'll leave it there.

* taxpayer guaranteed money, what's not to like?

BlokeInBrum said...

What is needed is to bring about a genuine competetive market in healthcare where there are many providers of a range of healthcare and secondary services and a range of insurers offering differing care levels. All with a profit incentive to compete for business from customers. Some will compete on price, some on quality etc.

How else are we going to incentivise people in the system to cut costs and innovate?
There will always be failures in such a system, just like in the economy at large.
But as long as the end-user has plenty of real choice and protection from predatory practises from the Government, then I can't see how it would be any worse than the system that we currently have.

CityUnslicker said...

BlokeinBrum - it would be far superior that way. Very disappointingly the last Governments since 2005 have been shrinking private health care provision in the UK at the behest of the NHS.

There is one last hope though, WebDoctors and other innovations are going to completely by-pass the system. When people can get good quality diagnosis over the web and drugs delivered to them they will - and this is here already but not well publicised as the current market is only rich londoners.

Anonymous said...

BiB - this market already exists to some extent - if you don't want to wait for a scan, you can get one done pretty quickly. Full brain scan (MRI) with analysis and report by a senior medic is under a grand - of course you have to have that sort of cash.

CU - any view on BUPA, officially a charity, and formed out of the ashes of the old pre-NHS friendly and provident societies, selling all its hospitals to private equity (Spire) and using the money to buy dentist chains? Strikes me the Commissioners need to take a look at it, seems to be run not for public benefit.

Sobers said...

"So much as it would be nice, there are no votes here and only if something wild happened like Farage elected would it ever be countenanced, more's the pity."

So if the 93% were of the mind that the NHS needed fundamental reform, it shouldn't happen, because 7% were against it? NHS workers only get one vote each, just like us cannon fodder (sorry, patients).

You're still in the 'everyone really loves the NHS' bubble. No they don't. There are an ever increasing number of people who would happily raze it to the floor, as one of the most malevolent factors forces at work in 21st century Britain. Plenty more would happily see it fundamentally reformed into something better. But these people have zero voice. No one in the public sphere dares suggest the Emperor has no clothes. So everyone assumes thats the reality when it really isn't. And one day that silent faction will be a majority, and eventually will make their voice heard. And there will be wailing and gnashing of teeth........

BlokeInBrum said...

Yes, a market exists. But rather limited at this point. Some market based reforms have been made with the NHS but only at the periphery.
What's needed is a market in the core functions. The Doctoring and Nursing side of things as well as the I.T. and bureaucracy that holds things together.
It doesn't help that there are artificial barriers put in place that make Doctors and Nurses more expensive than they ought to be. ie. The artificial requirement that Nurses be degree qualified and so on. As for the situation with Doctors? Most seem to be on 100k+ yet there doesn't seem to be that many natives in the profession. It can't be that difficult to train sufficient numbers of them in this country surely?

BlokeInBrum said...

It's in a similar position culturally as the BBC.
There is a rump of people that still cling on to the NHS and the BBC out of some sort of twisted ideology. Unfortunately these twats are the people who have the most sway with the powers that be.
That won't hold forever though. My generation would probably be happy to raze it to the ground, fire everyone and start afresh. My kids and their generation have no loyalty whatsoever to either the NHS or the BBC. When it comes their turn to start paying for it there will come a reckoning.

Matt said...


The difference with waste and incompetence in the private sector is (as you touch on) that its not the public purse that is shafted.

If we are to have money extracted by menace by the government we should expect them to not spunk it away.

Charlie said...

@BlokeInBrum "The only way forward that I can see is to implement a parallel insurance based system that is more market (ie. consumer) driven than the current model."

You'd still get the problem of the NHS' large fanbase screaming "Two Tier System!" and telling the world that rich people will get better healthcare than poor people, all the while completely failing to realise that it proves reformers' points for them.

Anon - early in my career in IT, I also worked for the NHS. I built a web-based reporting system for communicable diseases to replace an antiquated paper and post system. I did everything - building the server, designing the database, writing the web application and even going out to train the staff. And here was where I hit upon the real problem with digitising anything in the NHS. The average non-medical staff member wanted nothing to do with computers, felt completely entitled to dictate every aspect of their working environment and could rely on enormous union backing if anyone tried to do something they didn't like, such as getting them to fill out a web form rather than posting a paper one to a central office which then employed someone to manually key all the data. It was common to hear "I don't do data entry", "This is a secretary's job and they took away my secretary" or " is rubbish, this one will be too."

This was in the mid-2000s, so things might have improved since then, but given that such people tend to stay in the same job for several decades, still whinging about the same thing they were whinging about last decade, I doubt it.