Rachel Reeves' latest plans - 5% efficiency savings (cuts) across all departments and budget panels of ex-bankers to determine necessary spending


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No, please don't. Start somewhere that actually matters.

Look, I get that spending of that kind is ridiculous and it shouldn't happen, but it has nothing to do with the current state of public finances and is just headline bait. More of your taxes will be spent on handling all the media queries about those folders than on buying the folders themselves.

Start on chronic underinvestment in IT, or on duplication of common processes, or unadventurous recruitment, or horrific inefficiencies in government property, or inadequate management skills, or short-termism in funding, or countless other things that actually have an impact.
 
No, that's the point, them running themselves could largely the problem. If something is being badly and inefficiently ran then it doesn't matter how much money you throw at it. You shouldn't throw money at something being ran poorly, you should fix why it's being ran poorly and then decide where the money needs to be spent.

But the government should also take a big hit, they're the top of that pile of managers. Take covid for example, they chucked a load of money at that, more than any other EU country but chucked it in the wrong places, that still needs to be paid for. I think local NHS were buying in PPE themselves too from unknown sources, which they were seemingly not qualified to do but went for the anything is better than nothing approach (understandable, but preventable), which is why my mum had a duff mask and a bin liner to treat people on the covid ward etc.

Like you said, if the government were not making decisions then who were those telling them to get rid of the admin staff, that will have been the idea of whoever analysed this poorly, upper management or possibly them implementing this poorly. It's the same as sacking all the ground staff and leaving only the supervisors, it will collapse from the bottom up, as there is no lower level support.

Yes, admin is legally required, but who makes those laws, government, we can change those how we see fit. I see the same dealing with councils or anything for that matter and I've dealt with all the public services when they're clueless clients. That includes hospital sites where they just blow cash all over the place in bad organisation, time management, over-spec in areas which don't need to be, and under-spec in areas which do. Then they do daft crap like getting in terrible companies like interserve to be their PC, it's nuts. We worked on the James Cook refurb and it was like a circus, in the end we pulled out half way through as interserve were going broke.

It's the same in my other fields too with construction, it's the law to need a 200 page report and blow 30k on nothing to put a pipe across an A-Road, all it does is burn cash for no gain, and it gets dressed up as "health and safety", it's not, it's bloat. HS2 was littered with it, which is why the budget went through the roof. There are easier ways to do things cheaper and quicker, which achieve 95% of the original aims. I'm not talking about not taking patient notes, and booking in patients, but I'll bet my life it's not being done efficiently. Same with rota's, that's been computerised and automated in many other sectors for a decade, and even before AI came in. I'm talking about the thousands of meetings higher up the chain that I'll bet my life exist, it's the same in anything public or private sector. The UK is one of the least efficient/ least productive nations on the entire planet, because we largely tie ourselves in knots or put people into managerial positions who are terrible managers, and they only get there due to time, not ability. It's a bit like the forces too, where good lads end up waiting too long for promotion, so they can promote all the longer term idiots first.

Yeah I get the not enough managers thing, but why is that? Are the roles not there or do people not want to do them?
You're never going to get the best people unless you pay them well enough, they will just do something else, then it will just leave less managers and all those left will be the incapable, or those willing to self sacrifice themselves in a burning building.

I get that you say there are not enough managers, and there are not enough admin as we got rid of those, but if that's the case where is the money being spent as we don't have the bed numbers, doctors or nurses we should have for the money we're spending. The money has to be going somewhere?

100% definitely should not be having key staff doing non key roles, loads of companies struggle with this too, as the management and middle managers don't trust their lower level staff to do it or don't get the staff to delegate too. You end up with £100/hr staff being tied in knots doing crap like expenses, filling in milage forms or whatever.

What role do you do, if you don't mind me asking?

There must have been some things in your line of work which you've spotted are horrendous, have you flagged these up the chain? What are your managers and their managers like (as managers, not as people).

Yeah, Blair funded what the Tories neglected, and then the Tories under funded it again. The thing is Labour could grow the economy and had lower debt then (30-40% GDP, it's now 100%), so it was a much easier task then. Now we're crippled with debt and don't have growth to bail us out (growth bails out debt), and can't get rapid growth outside the EU. We can't go back inside the EU or Labour would get voted out again and then the NHS gets raped again. It's all one horrible catch 22, there's no easy fix. It's going to be a long term gradual grind, to get better, but if Labour get voted out again it will all get much worse.

It's easy to say invest more, but from where, and which way which does not guarantee a tory/ reform win next time around? We're already at 100% debt GDP, and GDP is not going to go up rapidly in these economic conditions, to reduce that % figure. With a 2.5tn GDP, we're going to be spending ~£125bn in interest payments this year, that's 3/4 of a whole years NHS budget.

100% about the population going up and being top heavy, but we can't prioritise the old at the expense of the you either as they will just have less and less kids, like they are doing, which makes it worse and worse. We need a **** load more young people to balance this all out again, and as we don't we have our own, we need to be importing people. Problems is 50% of the UK hates immigration, and it's largely the older half who should want immigrants more than anyone.

Sorry about that being so long!
Who is going to run it if they don't run it themselves? The government are not qualified to run it, that's not their job. NHS England run it. The people running it are government are people like Streeting, Hancock, Hunt, Coffey and Javid. They have no idea about the way a health service runs. They have no experience of working in a hospital. NHS England is full of civil service staff and they have no idea how a hospital runs either.

The government don't make direct decisions but they influence decision making at Trust level via the way they pay Trusts. Currently the waiting list is the focus so we get a block payment for non-elective work and we get paid per case for elective so it incentivises us to focus on that. Of course, we can't do anything about nonelective demand, it is what it is, so it doesn't really achieve anything.

Changing the admin regulations would be impossible. It's about patient safety. You can't just not do it. If something goes wrong with a patient and there's no documentation to say what happened and who treated them them there's no accountability and it's a massive safety issue. Managers at the top have a lot of meetings, and not always necessary, but that isn't impacting patient clinical time, that's what they are there for.

There aren't enough managers because the positions don't exist. There isn't enough funding to have the required number of managers and doctors are doing a lot of the managing, which is a waste of time and they are not always any good at it anyway. When the positions do exist is difficult to get staff because the money isn't as good as the private sector for the level of responsibility. The public think all public sector workers get paid too much but an NHS chief exec of a midsize NHS trust is on £200k which seems like a lot but that's a £500m a year budget and 10k staff. Compare that to a CEO of a similar size private business. The Thames Water chief exec got a bonus of £200k after only 3 months in charge of a failing business for comparison. The agenda for change payscale really restricts some departments paying market rates. IT for example pays peanuts but because of the hierarchical pay structure hands are tied. It's not value for money. You get what you pay for.

I work in finance. I see a million things that aren't right. A lot gets fixed but not all. I also see massive differences between well and badly run services.

You can't get growth without investing. That's the bottom line. Asking people to do more with less leads to overworked, demoralised staff which reduces productivity. That's what we've seen over the last 15 years and I was hoping it wouldn't continue with Labour but all signs so far indicate that it will.
 
Who is going to run it if they don't run it themselves? The government are not qualified to run it, that's not their job. NHS England run it. The people running it are government are people like Streeting, Hancock, Hunt, Coffey and Javid. They have no idea about the way a health service runs. They have no experience of working in a hospital. NHS England is full of civil service staff and they have no idea how a hospital runs either.

The government don't make direct decisions but they influence decision making at Trust level via the way they pay Trusts. Currently the waiting list is the focus so we get a block payment for non-elective work and we get paid per case for elective so it incentivises us to focus on that. Of course, we can't do anything about nonelective demand, it is what it is, so it doesn't really achieve anything.

Changing the admin regulations would be impossible. It's about patient safety. You can't just not do it. If something goes wrong with a patient and there's no documentation to say what happened and who treated them them there's no accountability and it's a massive safety issue. Managers at the top have a lot of meetings, and not always necessary, but that isn't impacting patient clinical time, that's what they are there for.

There aren't enough managers because the positions don't exist. There isn't enough funding to have the required number of managers and doctors are doing a lot of the managing, which is a waste of time and they are not always any good at it anyway. When the positions do exist is difficult to get staff because the money isn't as good as the private sector for the level of responsibility. The public think all public sector workers get paid too much but an NHS chief exec of a midsize NHS trust is on £200k which seems like a lot but that's a £500m a year budget and 10k staff. Compare that to a CEO of a similar size private business. The Thames Water chief exec got a bonus of £200k after only 3 months in charge of a failing business for comparison. The agenda for change payscale really restricts some departments paying market rates. IT for example pays peanuts but because of the hierarchical pay structure hands are tied. It's not value for money. You get what you pay for.

I work in finance. I see a million things that aren't right. A lot gets fixed but not all. I also see massive differences between well and badly run services.

You can't get growth without investing. That's the bottom line. Asking people to do more with less leads to overworked, demoralised staff which reduces productivity. That's what we've seen over the last 15 years and I was hoping it wouldn't continue with Labour but all signs so far indicate that it will.
I mean they can run it themselves but maybe some better/ different people, or it needs to be ran differently with a different focus? A lot of other nations do a lot better with a lot less cost, but it's not just the NHS, it's the same in a lot of areas. There must be a reason why we're quite bad at running things?

Yeah 100% on the top government clowns who don't have a clue but I wouldn't include Streeting in that yet, although he's a bit too young I think. Not sure what he's done to prove he can run a business, never mind a health service, but I think his intentions and Starmer/ Reeves intentions will be better than what came in the 14 years prior. I don't know whether it's a good idea to give Streeting a few years and see what happens or try and find someone better. The NHS is pretty much the one thing Labour need to get right to have any chance of getting a second term, and they will need that continuity to make any sort of progress. Like I say though, it's an extremely tough job now though, tougher than it's ever been.

Changing admin regulations is not impossible. Yeah 100% on the safety, but it needs to be cost effective. There's no point going OTT and spend £1bn to improve outcomes 1% in one area, if you can shift that £1bn to some other area and get 2% better outcomes. There should be enough funding to get more managers, doctors, nurses, admin or beds, to get better outcomes, as others do it, we're an outlier on a lot of metrics. If you're an outlier then generally something is wrong. Yeah, most doctors are not going to be good managers and they should stick to treating patients. Same way a good manager isn't going to be a good GP or Surgeon. You don't need to totally understand how to be a doctor or nurse, to manage them though, but so many sectors get this wrong.

Yeah, 100% on the pay needs to be enough for the level or responsibility, and to be able to compete with the private sector, maybe with the pay rises to try and get that back on track it will help in some ways. They're still not getting enough from what I can see though, but where does the money come from to pay them more? 200k to run an NHS trust is not a lot at all, not for that level of work and responsibility. There will be plenty on this board getting similar money or near that, with far less responsibility. I wouldn't do that job for 200k, there are far easier ways to make 200k. The problem we have is the public have a big problem when they see that someone is on 200k, as they don't really think what that involves, they just think "that could be 5 nurses" or whatever, but it doesn't work like that. You need good people all through the higher levels or what is at the lower levels ends up being like a ship without a rudder. You're right about the other daft **** going on like a TW boss getting 200k bonus for something which is being ran poorly, but not sure how much of that is his fault.

Yep, IT is critical, another sector which can't be skimped on or it will make life hell for anyone using anything IT related, which is probably nearly all of them.

Of course you can get growth without investing if you're not doing things properly with what you have. I think they're more looking at seeing what they can get with restructuring where the money goes. Some of that NHS budget will be on investing though, but it's likely investing in things which need replacing. That's another problem we have, a lot of things are now really old and nearing end of life and cost a fortune to replace. That's a problem a lot of the water companies are having now, having to replace the 100-150 year old water and sewer pipes etc, which is literally like a minefield.

But sure, investing does help too and they would do better with more money too, usually anyone would, but it still needs to be value. Throwing money at a problem won't fix it, if you don't know what the problems are, it just ends up like a band aid, and eventually the band aid falls off and you're back where you started.

Like I keep saying though, the country is skint, economic conditions look terrible, so GDP growth won't bail out debt, debt is high, interest payments are high. You work in finance, and you're clued up, you know all of that is a recipe for disaster. It's not like we're going to increase GDP by 10% so can increase NHS budget by 10% and whittle some of that debt off. The main ways to increase GDP are going back into the EU, and the main ways of increasing funding for public services is taxes or hitting pensions, but you know that's a road block for Labour as far as getting re-elected goes, and you know the tories are going to be a lot worse, as proven.
 
I mean they can run it themselves but maybe some better/ different people, or it needs to be ran differently with a different focus? A lot of other nations do a lot better with a lot less cost, but it's not just the NHS, it's the same in a lot of areas. There must be a reason why we're quite bad at running things?
This is the main point and it addresses all the others. Other countries don't run things at less cost. They all spend more of their GDP and have higher per capita spending on health. We get poor outcomes and miss targets because we're massively underfunded.

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Investing in the Health Service, and other public sector services and infrastructure grows the economy. The economy slows down when more people are sick, unsafe, overworked, unskilled and under-educated. All those sectors need huge investments, not more cuts. Labour have been, rightly, opposing Tory austerity for the last 15 years but now they have the power they are continuing with austerity and trying to tell us it is the right and responsible thing to do which is exactly what Cameron and Osborne said. At some point the Tories get back in and if they implement more cuts post-austerity then how bad are things going to get. Labour have to be offsetting the 15 years of under-investment and they have to start immediately.

There is plenty of money. It's just concentrated in too few hands. Do something about it and defend it when the media start slinging mud instead of kowtowing to the billionaires and right-wing media.
 
This is the main point and it addresses all the others. Other countries don't run things at less cost. They all spend more of their GDP and have higher per capita spending on health. We get poor outcomes and miss targets because we're massively underfunded.

View attachment 84407


Investing in the Health Service, and other public sector services and infrastructure grows the economy. The economy slows down when more people are sick, unsafe, overworked, unskilled and under-educated. All those sectors need huge investments, not more cuts. Labour have been, rightly, opposing Tory austerity for the last 15 years but now they have the power they are continuing with austerity and trying to tell us it is the right and responsible thing to do which is exactly what Cameron and Osborne said. At some point the Tories get back in and if they implement more cuts post-austerity then how bad are things going to get. Labour have to be offsetting the 15 years of under-investment and they have to start immediately.

There is plenty of money. It's just concentrated in too few hands. Do something about it and defend it when the media start slinging mud instead of kowtowing to the billionaires and right-wing media.
I covered that above, from 2010-2019 we spent ~10% less than the EU 14, but had 30% less staff and beds than the EU 14, so where is it going? Seems to be a 20% disparity there? We've clarified it's not going on managers salaries, IT, admin etc, and we held wages for ages, so where is was it going?

This chart is more relevant, why didn't you post this one from the same page?
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We spent 15% more during covid (more than anyone else in the EU) and haven't dropped that funding down as rapidly as others, and we had no better outcomes.

Difficult to use charts though, as we know the NHS has also been abused for 14 years, it's going to take a similar time to identify the main problems and sort out a way of getting more funding to get that back, that's if it's even possible.

The US gets raped on costs, we all know that, they're a brilliant example of where spending more money doesn't help. Switzerland is tiny and rich. Germany is richer than us, and got a better and more stable economic future, we're not competing or comparable to any of those on the chart. We're likely going to be bottom of the G7 in GDP per capita, if we can't change something with the economy, and we're already bottom as far as getting value for money on anything goes.

Yeah, I would 100% love to chuck more money at everything, but where does it come from? Debt/GDP is 100%, we're paying £125bn a year in interest already. Where does the growth come from to bail out the debt? i.e if we grow 10%, then 100% debt becomes 90% debt etc (very roughly). Growth is what has bailed out debt prior, but how do we get growth with a population getting more top heavy by the day, and dead set against immigration or having a free trade deal with our biggest trading partner?
Obviously you know the birth rate is through the floor, I've seen you mention it a few times I think, it's a massive factor too as you know.
We can't make the changes we want/ need to, when a large portion of the country vote you out if you even think about it. Look at how much everyone kicked off about removing WFA, even though pensions still went up with the triple lock, like they have done every year for ages. To invest in all the areas which need help might but up debt by 20% after one term, if Labour did that they stand zero chance in the next election and then all those investments would get reversed and we would be in a worse position than we are now.

Everyone should have known things were going to need to be stabilised for a decade before they even start to improve, but it seems not many understand this, and are expecting instant miracles. We're in **** creek without a boat, never mind having no paddles.

I'm defending Labour, they need time and a chance, digging the ground out from underneath them isn't going to help, it's just going to give the other side a much better chance.
 
I covered that above, from 2010-2019 we spent ~10% less than the EU 14, but had 30% less staff and beds than the EU 14, so where is it going? Seems to be a 20% disparity there? We've clarified it's not going on managers salaries, IT, admin etc, and we held wages for ages, so where is was it going?

This chart is more relevant, why didn't you post this one from the same page?
View attachment 84408

We spent 15% more during covid (more than anyone else in the EU) and haven't dropped that funding down as rapidly as others, and we had no better outcomes.

Difficult to use charts though, as we know the NHS has also been abused for 14 years, it's going to take a similar time to identify the main problems and sort out a way of getting more funding to get that back, that's if it's even possible.

The US gets raped on costs, we all know that, they're a brilliant example of where spending more money doesn't help. Switzerland is tiny and rich. Germany is richer than us, and got a better and more stable economic future, we're not competing or comparable to any of those on the chart. We're likely going to be bottom of the G7 in GDP per capita, if we can't change something with the economy, and we're already bottom as far as getting value for money on anything goes.

Yeah, I would 100% love to chuck more money at everything, but where does it come from? Debt/GDP is 100%, we're paying £125bn a year in interest already. Where does the growth come from to bail out the debt? i.e if we grow 10%, then 100% debt becomes 90% debt etc (very roughly). Growth is what has bailed out debt prior, but how do we get growth with a population getting more top heavy by the day, and dead set against immigration or having a free trade deal with our biggest trading partner?
Obviously you know the birth rate is through the floor, I've seen you mention it a few times I think, it's a massive factor too as you know.
We can't make the changes we want/ need to, when a large portion of the country vote you out if you even think about it. Look at how much everyone kicked off about removing WFA, even though pensions still went up with the triple lock, like they have done every year for ages. To invest in all the areas which need help might but up debt by 20% after one term, if Labour did that they stand zero chance in the next election and then all those investments would get reversed and we would be in a worse position than we are now.

Everyone should have known things were going to need to be stabilised for a decade before they even start to improve, but it seems not many understand this, and are expecting instant miracles. We're in **** creek without a boat, never mind having no paddles.

I'm defending Labour, they need time and a chance, digging the ground out from underneath them isn't going to help, it's just going to give the other side a much better chance.

I didn't include that graph because it's not the most relevant. Per capita spending is the important one because it's measured against the number of people we need to provide care for.

Even so, it shows that we spend 1% of GDP less than the average. That would be an additional £20bn for the NHS to spend per year, or an increase of about 15% of the NHS budget. You're also underplaying the UK because we have the 6th highest GDP of any nation in the world so we can compare against those countries. We're a long way behind the US and China but not anyone else. Anyway, as the chart below shows it is not just Germany. We're well behind a lot of smaller countries as well.

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We borrow to invest, like every government in the world does, like every business in the world does and even like every household in the world does. Borrowing for things that return more than you spend borrowing is a positive. The Tories borrowed record amounts and spent it on things that made them and their mates a load of money instead of things that we needed. Borrowing to invest in services and infrastructure is not the same thing. It's a positive. If we're not going to borrow then we tax. Tax the right people, those with all the money. Stop wasting spending on things that don't have a return, like triple locked pensions. It's madness that we have triple locked something that has zero return on investment and expect the working population to contribute more to cover it. You are never going to get growth as a national retirement village. We need to be real and accept that wealthy retirees are included in the wealthy and start taxing wealth, not just income. I know not every pensioner is loaded but when we talk about the broadest shoulders that shouldn't just mean income.

The alternative is not investing but you have to flip expectations. There will be no improvement without additional investment. If you are in debt you wouldn't quit your job to save money on your commute, it's a false economy. That's what austerity is, the same false economy.

As for where the money went during covid, we were severely under-funded for a decade so we were unprepared. We had to play rapid catch-up and that meant a big increase in spending. Going from under-staffed to less over-staffed doesn't see a huge return on investment. Paying premium salaries as agency/temporary means costs are also higher. We've decimated social care so we're spending a fortune keeping people in hospital beds because there's nowhere for them to go, which means we have reduced capacity for electives so productivity is down. Beds aren't the only measure of a health service. We have community care and outpatients and I don't know how other countries operate. We reduced bed sizes during Blair's time and increased community capacity (it's cheaper to look after people at home than in hospital).
 
I didn't include that graph because it's not the most relevant. Per capita spending is the important one because it's measured against the number of people we need to provide care for.

Even so, it shows that we spend 1% of GDP less than the average. That would be an additional £20bn for the NHS to spend per year, or an increase of about 15% of the NHS budget. You're also underplaying the UK because we have the 6th highest GDP of any nation in the world so we can compare against those countries. We're a long way behind the US and China but not anyone else. Anyway, as the chart below shows it is not just Germany. We're well behind a lot of smaller countries as well.

View attachment 84409


We borrow to invest, like every government in the world does, like every business in the world does and even like every household in the world does. Borrowing for things that return more than you spend borrowing is a positive. The Tories borrowed record amounts and spent it on things that made them and their mates a load of money instead of things that we needed. Borrowing to invest in services and infrastructure is not the same thing. It's a positive. If we're not going to borrow then we tax. Tax the right people, those with all the money. Stop wasting spending on things that don't have a return, like triple locked pensions. It's madness that we have triple locked something that has zero return on investment and expect the working population to contribute more to cover it. You are never going to get growth as a national retirement village. We need to be real and accept that wealthy retirees are included in the wealthy and start taxing wealth, not just income. I know not every pensioner is loaded but when we talk about the broadest shoulders that shouldn't just mean income.

The alternative is not investing but you have to flip expectations. There will be no improvement without additional investment. If you are in debt you wouldn't quit your job to save money on your commute, it's a false economy. That's what austerity is, the same false economy.

As for where the money went during covid, we were severely under-funded for a decade so we were unprepared. We had to play rapid catch-up and that meant a big increase in spending. Going from under-staffed to less over-staffed doesn't see a huge return on investment. Paying premium salaries as agency/temporary means costs are also higher. We've decimated social care so we're spending a fortune keeping people in hospital beds because there's nowhere for them to go, which means we have reduced capacity for electives so productivity is down. Beds aren't the only measure of a health service. We have community care and outpatients and I don't know how other countries operate. We reduced bed sizes during Blair's time and increased community capacity (it's cheaper to look after people at home than in hospital).
We're spending fairly equal as much as our GDP goes though, if that goes up, then other things come down. Per capita matters, or course it does, but loads of nations are miles richer than us per capita, and it drags up that average. Switzerland and the US probably make double per capita per person, so of course they're going to be able to spend miles more per person, Germany's ~20% more. We're 27th on the GDP per capita list, so shouldn't expect to be up with the G7 or per capita health spend, unless we're diverting money from elsewhere, but every public service seems screwed.

From your chart there we're losing ground economically compared to those spending more, we're more like the countries spending least nowadays (we're more like Spain, Italy, Portugal, than we are Germany, Switzerland and the US). Include Ireland, Netherlands, Denmark, Norway, Sweden, Belgium in that latter list too, the all bring in far more per person, so can spend more per person. We do have the 6th highest GDP, but for the G7 and developed countries we're not doing great and losing ground on that also, with no signs of reversing that. Obviously before voting out we were top of the G7 for growth, but we all know what happened there.

Yeah, they all borrow, but how many are borrowing more than 100% GDP, that have a worse chance of growth than us? Maybe Japan, but they overspent and lost their way, and they've been paying for that for 20 years.

Yeah agree on Tories borrowing and spending on their mates, maybe if we cut that spending to tory mates and spend it where it should go then this will do better with the same funding, agreed?

Agree the triple lock needs to go, and should have went ages ago, but we know the tories rely on old votes. We need some sort of wealth tax, but in reality we know that's an election loser as well as hammering pensions, it's tough to win and get in enough tax with such an old population.

I'm not against investing either, it's not dead money if it brings a return, same as like spending money on HS2 or whatever, that £100bn isn't down the drain, it's giving people jobs and paying tax etc, but it was in no way good value, it's laughable where that money was going. Spending 100bn on infrastructure is good, but when that 100bn is going on 50% infrastructure and 50% bull**** it doesn't make much sense.

I'm not blaming the NHS for covid, nowhere near, but it's an example of where you can't underfund something and then throw money at it in a lump, and expect that to work, especially if you throw money as defunct PPE and nightingales which you don't use, and I bet all of that was out of the NHS budget.

100% agree social care has been shafted too, and caused us a massive bed blocker problem. The NHS needs social care to function, or the NHS will never work as well as it can.
 
Anyone have an answer as to why we had the torys for 14 years 🤷‍♂️
Yes.
First five years - the Lib Dems
Next nine years - the fruits of Cameron’s tactically astute but strategically disastrous Brexit referendum gambit and the failure of the opposition to be anything other than utterly incoherent in response.

Edit - for the record my reference to tactically astute but strategically disastrous for Cameron‘s referendum stunt had mainly in mind, and stands on, the disaster it was for him politically (and ultimately I suspect for the Conservative Party). Whether it was a disaster for the country would depend on your attitude to Brexit itself. But I think the former holds whatever your attitude to the latter.
 
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We're spending fairly equal as much as our GDP goes though, if that goes up, then other things come down. Per capita matters, or course it does, but loads of nations are miles richer than us per capita, and it drags up that average. Switzerland and the US probably make double per capita per person, so of course they're going to be able to spend miles more per person, Germany's ~20% more. We're 27th on the GDP per capita list, so shouldn't expect to be up with the G7 or per capita health spend, unless we're diverting money from elsewhere, but every public service seems screwed.

From your chart there we're losing ground economically compared to those spending more, we're more like the countries spending least nowadays (we're more like Spain, Italy, Portugal, than we are Germany, Switzerland and the US). Include Ireland, Netherlands, Denmark, Norway, Sweden, Belgium in that latter list too, the all bring in far more per person, so can spend more per person. We do have the 6th highest GDP, but for the G7 and developed countries we're not doing great and losing ground on that also, with no signs of reversing that. Obviously before voting out we were top of the G7 for growth, but we all know what happened there.

Yeah, they all borrow, but how many are borrowing more than 100% GDP, that have a worse chance of growth than us? Maybe Japan, but they overspent and lost their way, and they've been paying for that for 20 years.

Yeah agree on Tories borrowing and spending on their mates, maybe if we cut that spending to tory mates and spend it where it should go then this will do better with the same funding, agreed?

Agree the triple lock needs to go, and should have went ages ago, but we know the tories rely on old votes. We need some sort of wealth tax, but in reality we know that's an election loser as well as hammering pensions, it's tough to win and get in enough tax with such an old population.

I'm not against investing either, it's not dead money if it brings a return, same as like spending money on HS2 or whatever, that £100bn isn't down the drain, it's giving people jobs and paying tax etc, but it was in no way good value, it's laughable where that money was going. Spending 100bn on infrastructure is good, but when that 100bn is going on 50% infrastructure and 50% bull**** it doesn't make much sense.

I'm not blaming the NHS for covid, nowhere near, but it's an example of where you can't underfund something and then throw money at it in a lump, and expect that to work, especially if you throw money as defunct PPE and nightingales which you don't use, and I bet all of that was out of the NHS budget.

100% agree social care has been shafted too, and caused us a massive bed blocker problem. The NHS needs social care to function, or the NHS will never work as well as it can.
Have you had a look at the GDP per capita listings?

Germany are slightly above us, France slightly below, but their health spending is streets ahead. Perhaps they're not frittering it away on their private health sector?
 
Have you had a look at the GDP per capita listings?

Germany are slightly above us, France slightly below, but their health spending is streets ahead. Perhaps they're not frittering it away on their private health sector?
Both use profit & not for profit private hospitals. About 15% of German & 25% of French are for profit


 
Health care spending - as % of GDP.

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On the admin costs, the UK is below average eg Germany spends around 5% of it's health budget on admin, the UK around 3%. Of course, as with overall spend, US admin costs are the outlier - over 8% ie 2 to 3 times more than the UK. I can't view the report easily on my phone - Admin spending in OECD health systems 2024.

The private/public mix (apart from the US) doesn't vary that much in the G7. From the BMJ 2024:

In fact the OECD documents have shown that except for Japan (84%), the public component of health expenditure in UK (79%) is amongst the highest; Germany (78%), Canada (73%), OECD average (71%).
 
Over the last 14 years council employees have almost halved, yet government employees have gone up from 380,000 to 515,000.
Seems odd that councils have had to cut staff to the bone doing more with less while the Tories in government have been employing more and more to do less.

Looking at tonight's Guardian, it seems the civil service will be shrinking, maybe that's where most of the savings will come from- Starmer could give us a ring, we could show them how it's done, it's not nice, but we was given no choice.
 
.....Looking at tonight's Guardian, it seems the civil service will be shrinking, maybe that's where most of the savings will come from- Starmer could give us a ring, we could show them how it's done, it's not nice, but we was given no choice.
Maybe Starmer, Reeves & Rayner et al, should ask Lord Ali to put his hand in his pocket to help, instead of buying them clothes etc
 
Streeting represents private healthcare interests more than the NHS.
Look at which lobby he speaks up for most and who have donated towards his political career.
No such thing as a free lunch...........

 
Have you had a look at the GDP per capita listings?

Germany are slightly above us, France slightly below, but their health spending is streets ahead. Perhaps they're not frittering it away on their private health sector?
Yeah, I looked at it, but don't remember where the data was from, think it was the IMF, wouldn't have sent it otherwise and it will have been from a reputable source.

I think Germany were ~56k GDP PC and we were ~46k but that was from a few years ago (I rounded that to 20%), I imagine that gap has got wider, not narrower as the last data I saw had ours declining and most of the rest were up about 6%. I imagine that gap will get wider still over the long term. This is the part we need to fix, healthcare is going to be screwed no matter what compared to developed companies if we can't improve growth and wages, and get more tax in etc.

I didn't look at France as they were not in the example list with Switzerland, Germany and USA but yeah, France were just below us on GDP per capita, doubt they are now mind. France spent 12.1% compared to our 11.3% of GDP, but that was based on 2022 data. I'm not sure how will France's system is working either mind, with regards to value, they are next to us on the latest rankings, about 50th. We're both next to Spain who spend <1-2% less of GDP.

I'm no expert on German healthcare mind, but it seems they have a different model too though and requires private health insurance, and you chose either state insurance (comes out your wages and employer pays too) or private insurance. Rich people might even get forced down the private route.

This below is worrying though, it's like we're on our own in that bad quadrant, but it's the same for beds too. I suppose in some ways more nurses can make up for less doctors to a degree, and the other way around, but having less of both doesn't work.


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This below is worrying though, it's like we're on our own in that bad quadrant, but it's the same for beds too. I suppose in some ways more nurses can make up for less doctors to a degree, and the other way around, but having less of both doesn't work.
This is the entire (non-racist part) of the immigration discussion which we used to be grown-up enough to have. Population increasing faster than infrastructure makes everything worse for everyone living here. We don't have enough houses, doctors, nurses, schools, police, social care places, dentists etc. The solution for governments, not just the Tories, to keep us "competititve" is to increase immigration because GDP goes up but it isn't going up by more than the average so our GDP per capita is going down. This doesn't have any effect on the billionaires and businesses getting their cheap labour but it has a massive impact on all the people that need houses and public services.

Productivity is often mentioned as people needing to do more but the reason our productivity is going down isn't because we produce less it is because the way it is measured is GDP divided by hours worked. When we bring someone in from outside the UK to do a job because someone else has stopped working and is at home on benefits, off sick or retired our productivity doesn't increase. It stays the same. If that person is not generating more GDP than the average then productivity goes down. If they generate the average then GDP goes up, productivity stays the same but GDP per capita goes down.

Allowing businesses to bypass training their own workforce in favour of allowing them to import other countries skilled people leaves us with a load of unskilled people unable to significantly contribute to GDP which reduces our productivity. It also reduces our per capita statistics and makes our public services significantly weaker by increasing demand without growing the economy enough to cover the costs of the required investment in public services.
 
I see she scrapped rishi Chess funding aswell that was a decent policy dunno why she done that need children to be playing more games that aren't digital
 
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