Outside the marginals

A commentary on the politics that followed the UK 2010, 2015 & 2017 elections

NHS Overspend: Truth or Dare?

What does [the overspend] mean for patients?

Patients can expect the same level of emergency and urgent care and there is no suggestion this will be compromised by the financial plight of trusts.

But as the year progresses and if financial problems persist, hospital chiefs may decide to allow waiting times for elective care and non-urgent procedures to lengthen.
BBC News Website, 9 October 2015 : What’s gone wrong with NHS finances?

But what does that mean for the finances?

“Allowing waiting times … to lengthen” does not directly reduce costs – unless you are cynically saying “Allowing more patients to die on the waiting list”. The work still needs to be done, the costs still need to be incurred.

Postponing those costs is window dressing and if patients deteriorate due to waiting the costs increase.

The costs to society of possibly requiring additional social care are even higher – as are the costs of having sick wage earners unable to fully perform.

So what gives?

Either you increase the revenue line or you decrease the cost line. (Micawber Book of Economics).

Because of suspicion of waste (strongly stoked by the more conservative elements of our political system) the option to further increase revenue is unlikely and the electorate will not support higher taxes until they are actually fearful that they or their families are dying due to underfunding.

Which leaves costs – these can be looked at from three directions:

  • Excess costs due to structural problems – such as having to pay premium rates for agency staff due to failure to adequately plan staff requirements. (Agency staff will cost more because you in effect double the admin costs – NHS and the agency – and if you are on a casual contract it is probably reasonable to expect a higher rate than that earned by your compatriots who know where and when they will be employed next month.)
  • Excess costs due to “lumpy demand”. Some smoothing is reasonable in this case – but should be short-term.  Thus if you find that the resources required for patching up drunks are mainly required on Friday and Saturday nights, it is probably acceptable that some of that patching up gets spread across the rest of the week to try and even out the resource demand and use it efficiently.
  • Costs for procedures that possibly we should face up to not being able (or willing) to afford. Should the NHS address every problem that “medicine” is able to address?

Are we dodging a key question because of our affection for the NHS?


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