Fantasic quality sources there and neither the boob job nor the tattoo removal refered to are cosmetic operations but are done for psychological distress. Rather a large difference and rather a very small % of people who ask for them get them. Needs a consultant psychiatrist to give the OK .

20 million in unpaid bills not 2 billion. most of those are not "health tourists" but people who are here and then get sick.

So you have identified ( rather questionably) maybe 100 million in waste of a budget of 100 billion. Less than a tenth of 1 percent. Thats really going to make a huge difference.

Thats what I alluded to earlier – not that there is no waste but that the amounts are so small as to be insignificant.

And what would you suggest we do with these "health tourists" let them go untreated / die?

9% of my salary. Its not unfunded.

, your contribution is only a proportion of the true cost The public purse makes a significant contribution I would imagine in excess of 25% of your salary on top of that.

Yes there is mindless waste – but its such a small % that eliminating it all will have no effect worth mentioning.

I'm reassured to know that the NHS has the TJ stamp of "efficiency" approval and that even a small % of the massive budget will have no effect

Decisions have been made by the muppets in charge that have placed millstones around the neck of various parts of the NHS, PFI's, out sourced minor surgery and GP's contracts to name a few.

The NHS model of healthcare (free at point of use, no income barrier to care) is one of the better ones, the problem is that without a regular review it grows like any large organisation. The proposition that after the recent massive growth there isn't opportunity to review and improve the efficiency of the operation is farcical.

As for cut the budget and people die. Well they cut the gritting budget and people died. Maybe a "public health" cost benefit analysis needs to be done and a transfer of some ring fenced money.

And what would you suggest we do with these "health tourists" let them go untreated / die?

Let them be treated in their own country FFS!

Stevie.The majority of them are people who are here for another reason and become ill, "health tourism" is another moral panic.

Big and daft – remember that tor every taxpayers £ in the public sector pension pot there is £7 of taxpayers money in the private pension funds pot.

Its nothing like 25% on top unfunded. Not even close. My employer also puts money in – I can't remember how much.

The NHS is the biggest employer in Europe – there is bound to be waste and yes it should be rooted out. However its really really tiny as a proportion of the spending and much of it is hard to eliminate. Thats not to say it is not worth the effort but the simple fact remains that there cannot be cuts on the scale the right wing want without affecting outcomes.

Decisions have been made by the muppets in charge that have placed millstones around the neck of various parts of the NHS, PFI's, out sourced minor surgery and GP's contracts to name a few.

Stupid political decisons that waste money yes.

The proposition that after the recent massive growth there isn't opportunity to review and improve the efficiency of the operation is farcical.

Teh proposition that after 30 yrs of serious underfunding ( and yes it is still grossly underfunded) that there are efficiency savings to be made is not only farcical it is ludicrous.

The tragedy is that people like you believe the lies of an ideologically driven tory party and tory press. These people have a vested interest in the destruction oif the NHS and you are helping them to do so. We should be celebrating the success of the NHS – that provides more healthcare for less money than any other comparable system. It simply is the most efficient in the world. I suggest you go to the USA a develop a chronic condition and see how you get on.

£30,000 each a year for 'Eating more Veg' advisors

Can anyone point out where I can get this job? That's about the same money as an experienced senior dietitian, which is a bit more complicated than telling people to eat more fruit.

Jerry, to be honest you are patronising to the point of insult. Your arguments are nothing but Nulabour propaganda, and almost as laughable as an Ed Balls lie. One day you'll realise that The Guardian lies as much The Telegraph and The Mirror is a bigger rag than The Sun-then you may achieve some balance.

Stevie – you are the patronising one telling me that my experience is wrong. What is your experience of healthcare and health care politics? I have worked in NHS and private healthcare in shopfloor and managerial roles. I have studied health care politics and management ( breifly) at university level.I actually understand what is going on

I do not believe the lies. I knwo the truth hence |I accepted some of the points made by the NHS bashers on this thread – you are the one believing the lies of the right wing press. I hold no brief for the Labour lies but when you rely on the news of the world as a source on NHS and the telegraph with its owners who want to see the end of the NHS then you lose your credibility.

You will see – if the tories get in and make their cuts then you will see problems in the NHS, You really need to open your eyes. The problems in the NHS now are nothing compared to what they will be. Hopefully you will remember this next winter when people start dying for lack of care because every hospital bed is full.

yes it is still grossly underfunded

9% of GDP!

nearly a hundred billion quid!

roughly the entire annual national insurance receipts for the whole country!

How much is a "fully funded" NHS worth then TJ?

12 % of GDP – the same as Germany and France would be nice – then we could get a decent service. 18% of GDP in the states – now that would be good. I'd settle for 11% of GDP tho. a 20% increase in funding would enable a rally good service

http://apurvadesai.files.wordpress.com/2009/07/image16.png%5B/img%5D

TJ wrote

Stevie – you are the patronising one telling me that my experience is wrong. What is your experience of healthcare and health care politics? I have worked in NHS and private healthcare in shopfloor and managerial roles. I have studied health care politics and management ( breifly) at university level.I actually understand what is going on

What a shame that all that knowledge and expertise is wasted on an internet forum……………mind you, if your work persona is similar to that displayed here, you probably spend all day in duscussion/arguing with your colleagues and achieve f-*k all. Perfect qualifications for an NHS managerial role 😆

Just look what they done the last time they was in
And what they done to the rest of the country.

Woody – actually I was a crap manager – hence I went back to shop floor work.

The simple thing is you get what you pay for. We don't pay top money – we don't get a top service.

When labour came to power NHS got under 8% of GDP. Its now around 9%. Germany and France have over 10% of gdp in their healthcare sytem. USA 16% + ( the figures in that graph above are lower than I have seen quoted elsewhere but eh comparison remain valid)

Some of the extra spending went on improving salaries that had fallen well behind, some on buildings and equipment, some on improvements to care.

The NHS is in a far better state for this extra money but if we want a service that matches Germany and France then we need to spend as much money. If we want to spend less money than similar nations then we have to accept a lower standard of service.

While there is waste in the NHS it is hard to eliminate in an organisation of this size and whilst the sums are huge the percentages are not. Elimination of waste is very difficult to do 100% and even if it was we are talking about such a small % of the budget as to make no significant difference. Thee is no way the % savings that the tories say are there can be made without service reductions.

So those of you that want to cut the budget – which areas of care do you want cut?

Transplant surgery? Very expensive and outcomes are not great.

cognitive enhancers for people with Dementia? Again very expensive and needs to be supervised by consultant psychiatrists. The patients are going to die anyway.

Health promotion? Several people on this thread mock the health promoters but all the research shows that this is actually cost effective. Stop one person having a heart attack and you save tens of thousands in treatment and care.

How about the provision of new technology for diabetics? 20+ years ago they got reusable glass syringes with thick reusable needles. Now there are all sorts of clever gadgets that make life easier for them and in some cases make the difference between independence and not. No great change to outcomes for the extra spend but a reduction in complications in the long term and a big difference in quality of life.

treatment for junkies? it is known that every £ spent on treating junkies £7 is saved in the criminal justice system

so – please let us know what clinical areas you want to cut – or how else you will save the money you want to save.

Stevie – you are the patronising one telling me that my experience is wrong. What is your experience of healthcare and health care politics?

My wife is a nurse. I've worked in drugs rehab. So obviously I know jack, hey? All bow down to your all encompassing knowledge, right 🙄 ?

The fact is Jerry, that you often spout outright lies-then run away when confronted with the truth. Not just about the NHS, about politics in general. It's all very predictable.

So Stevie – outright lies? when and where – put up or shut up. Run away? I do not shirk an argument or debate.

You are the one who believes the torygraph and news of the world on the NHS.

I asked you what you experience was as you were denigrating mine – you have told me. Fair enough.

Edit – so please tell me – where are you going to make the cuts?

Cameron and nulab both look like the equivalent of a car supermarket. Except the nhs is the car. If you know what i mean.

Twice you and I have talked politics-and twice you have spouted outright lies Jerry.

You said-

all the proposed tory tax cuts will go to the rich

-that is an outright lie, as I pointed out to you-

Wake up and smell the coffee yourself Jerry. I'll go and put on a pot for you while you tell me how proposing to remove tax credits from those on £50k or more as well as removing child trust funds for the same £50k+ earners benefits the rich.

Your blind hatred of the Tories seems to cloud your judgement but that's not all is it? Who gave you a monopoly on being proud of the NHS? That is arrogance mate. And who said that cutting the ridiculous waste that stains the NHS makes an 'NHS Basher'? I want the NHS to succeed and flourish-surely cutting the waste can only improve the service. As for where the cuts should fall-I've already said. Cut waste, cut incompetance, cut red tape, cut beaurocracy. Improve efficiency. It's that simple.

Official figures from the National Audit Office, as reported by the BBC (who're hardly pro-tory):

NHS is 'wasteful and inefficient'

Spending outstripped improvements
Health service productivity has fallen by up to 8% since 1995, official figures show. The Office for National Statistics found the costs of providing services had outstripped the value of services in cash terms.

The ONS looked at spending within the NHS between 1995 and 2003. It concluded that productivity had fallen by between 3% and 8% during this time, with an average drop of up to 1% each year.

Output grew by 28% but spending grew by 32-39%.

It perhaps would have been better to say most not all on the tax cuts. granted. Every analysis shows that the total package of cuts proposed will go disproportionately to the rich. You have been very selective in what you quote.

Cut waste and incompetence. On the figures you gave ( which are easily disputed) that's a tenth of a percent of the budget. Use the real figures not the propaganda you believe and its one hundredth of one percent.

Of course I want to see waste removed and efficiency increased. However I know that this simply is not on the scale needed to create the cuts you want.

I like the truth – I don't believe any propaganda from any side. I look at the facts and make my mind up

I have already agreed that PFI and other issues have wasted huge sums.

so – stop glibly saying cut waste and incompetence and find some figures. Even on the exaggerated figures you gave its 1/100 of the cuts you want to see. Where is the rest?

So – I ask again – where are the cuts to be made. We have stopped all plastic surgery and all overseas visitors from getting treatment. thats one tenth of one percent of the budget.

What else?

Oh – and you want to talk lies? cosmetic surgery on the NHS – it does not happen. Lie one

2 billion in health tourism. Going to the source you quote its 20 million and that does not split legitimate treatments for people who are her and become ill and those who come here for treatment

Lie 2

TJ – surely the NHS should be able to deliver the same level of service for less money than the other countries?

I mean, they don't have to pay market rates for loans, as the funding is direct from treasury, they have a huge "legacy" estate of land, buildings and facilities that they have not had to pay market rates for, they don't have to employ people to handle payments and paperwork from individuals and their insurance companies, as its all from central government.the collective central purchasing power of a small nation, so surely you're able to bargain better purchase rates than the foreign alternatives, no competitive market rates influencing staff wages due to collective bargaining (realistically, if you're a GP theres not many alternative companies to go and work for who'll pay better are there?)

This was supposed to be the great strength of the NHS – its supposed to be more efficient!

This BMJ report seems to pretty comprehensively shoot down your explanation that the NHS was doing all it could, and that the problems were due to underfunding:

http://www.bmj.com/cgi/content/full/324/7330/135

It's not about cutting particular services but increasing overall efficiency. IT is a good example of that – it doesn't by itself stop any individual services from being provided, but given the sums of money that have been pissed away (and most of the numbers quoted will only cover external costs, so overall costs will be even higher) in recent years then savings can be made there.

There are also enormous inefficiencies in the way GP's and dentists are provided (i.e. they're in-effect subcontracted by the NHS, with the dual layers of admin that entails).

Unless of couse our resident New Labour apologist is saying that every area of the NHS is individually 100% efficient…

Steve – what those figures do not and cannot show is improvements in care. subcutaneous pumps for diabetics. this costs more per person treated. This shows as reduced efficiency as the same number of people are being treated for a greater cost. That is where some of the reduced efficiency comes from. Herceptin for cervical cancer. tens of thousands per year. That shows as reduced efficiency.

Yes efficiency is down – but not by as much as those figures suggewst

right – I am giving up on this debate as it clearly is pointless. I just hope you remember this when the tory NHS cuts bite and the headlines about poor healthcare get worse.

You have been very selective in what you quote

Hilarious hypocrisy! Delicious irony! My God but you have a brass neck.

However I know that this simply is not on the scale needed to create the cuts you want. Even on the exaggerated figures you gave its 1/100 of the cuts you want to see.

See a pattern there? Demonising your opponent is Alastair Campbells method. Everyone who questions immigration levels is a racist. Everyone who wants to see the NHS improve is an NHS Basher. Come on Jerry, surely there's more to you than that. I don't want to see the NHS cut. In fact I don't want to see any cuts anywhere just for the sake of it. However, thanks to one JG Brown Esq the UK is £750,000,000,000 in debt and that is rising at £500,000,000 per day. Cuts are coming whether NuLabour, The Tories or the Monster Raving Loonies get elected. Actually only the Tories have ringfenced the NHS for protection. A fact you have strangely avoided.

Conmpletely agree that cutting the NHS is a stupid idea, we have arguabley the best all round healthcare service for the money in the world, an increase in fuding could see it become the best as well as creating thousands of careers, not just short term jobs to win votes. Unfortunately investment in public services doesn't generate nearly as much defecit decreasing capital as in the private sector. However as we all know there are many other targets for savings such as these bloody aircraft carriers, trident replacement, ID cards etc. We could also up student fees by 100% £3k is pretty token anyway.

Cut waste, cut incompetance, cut red tape, cut beaurocracy. Improve efficiency. It's that simple.

What waste? we have a massively sucessful healtcare system on the whole with universal coverage at a low cost? Sure there are efficieny savings to be made in any opperation but the NHS being run by mere humans coupled with its size means there is going to be a large amount of waste. I dare say some of that waste goe towards helping people in need too. I do take the point that in a non-competitive market efficency and value often loose out but for the money it's pretty good.

Oh – and you want to talk lies? cosmetic surgery on the NHS – it does not happen. Lie one

From the NHS's own pages:

To receive cosmetic surgery from the NHS, you will normally need a referral from your GP.

So your statement that cosmetic surgery does not happen on the NHS is cleary untrue. Now I know that there has to be a contributing reason i.e. mental health issue or it's reconstructive, but your statement is clearly not correct.

The way you say NuLabour and your quoting of the torygraph and the news of the world as accurate sources shows your ideological bias.

You still have not told us where these cuts will come from. How are you going to make them?

TandemJeremy – Member

right – I am giving up on this debate as it clearly is pointless. I just hope you remember this when the tory NHS cuts bite and the headlines about poor healthcare get worse.

The way you say NuLabour and your quoting of the torygraph and the news of the world as accurate sources shows your ideological bias

My political bias was decided the day that NuLabour reneged on it's manifesto pledge to hold a referendum over the EU Constitution. As for the Telegraph-it was the first thing that Google threw up, if you look you'll see I quoted the Mirror earlier in this thread too. And I have said, many times where I think the NHS wastes money. I notice you avoided the FACT again that only the Tories have pledged tp protect the NHS- NuLabour would be the cutters.

You still have not told us where these cuts will come from. How are you going to make them?

Go and read the BMJ report TJ – it really does seem to have some strong pointers towards how you can improve the system!

epicsteve – poor use of words from me clearly. Bang to rights

stevie was saying that people get cosmetic surgery for vanity – I pointed out you only get it to relieve deformity or serious psychological distress

stevie – you want to check the weasel words on that. its been changed since the original pledge and clearly money will be diverted into the private system which increases costs. Keep overall budgets the same, divert money into more espensive areas= cuts in other areas and improivements in care cost money = cuts in other areas.

Zulu – yeas a few tenths of a % of the budget.
That really is my last word!!!

Yeah but reading journals is boring.

If we don't cut the NHS budget what do we do? Cuts elsewhere? Increase tax? What can we afford these days? What's best for the economy and the future?

go on – one more – Zulu – go read the rebuttals of that piece you quote. Its such obvious crap it ain't worth considering.

Jerry-again you seem to miss the point. NuLabour and Brown have bankrputed the economy. We are borrowing five hundred million pounds per day. If that isn't stopped the nations will lose it's AAA credit rating, the £500,000,000 a day will cost double to service, interest rates will rocket and hyper inflation could appear. You know what that means, mass unemployment, mass repossesions etc etc. Whoever gets elected, cuts are coming. Cameron has been lambasted in the right wing press for protecting the NHS budget, did you know that? Yet he is the only party leader to do so.

Mudshark, it comes down to all our own ideologies with what we should cut I guess there's no right or wrong answer. I think bolstering our economy should focus on people not financial institutions who failed us all. We should be taking much more money from the banks profits but then again the less we take the more loans they make, better for buisnesses etc etc.
I don't see the NHS as cuttable considering what it does with its (by our international peer's standards) meagre budget. Here's a really nice series of short documentaries on differnt countries healthcare systems (from the point of view of a curious American looking for another way)http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
Rather than the NHS or primary and secondary education I think coldwar orientated millitaria should be cut as it's just not cost effective or indeed necessary.

Woody – actually I was a crap manager – hence I went back to shop floor work

Well done TJ and thanks for putting a smile on my face. 😆

I would suspect you are unique, as the NHS is a classic example of the Peter Priciple.

go read the rebuttals of that piece you quote

Hmm, people in the NHS not accepting criticism of the NHS – who'd a thunk it?

the circle goes round and round…

Woody – you re so right – thats how I ended up managing 130 staff and a budget of 2 million and got stressed and didn't do a very good job!

part of the issue is people like me don't get trained to manage. Fortunately I value my sanity and the service more than my pay packet so got out.

The fact that you were promoted into that position without the relevant experience or training is an indication of one area that's wrong in the NHS. It's not a question of whether there are enough managers, it's whether they're any good at it.

The experience I've had working with the NHS has been that the managers are generally not competent.