When is a cut not a cut?

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When is a cut not a cut? Anyone working in the NHS could answer that one... when it is 1) an 'efficiency' saving', 2) 'natural wastage' 3) reorganisation. What's in a name eh?

"For the Tories the promise was a piece of political symbolism - evidence, they hoped, of the values of the "modernised, caring and compassionate Conservatism".

Exactly right. One less corn-doll to scare the natives with.

Let us also not forget that they intend to replace the rather successful NHS Direct line with a new line that is less well staffed with less medical professionals available.

This government is incapable of doing anything right. The sooner the coalition falls apart the better.

"...up and down the country. "

Which country Nick?

Health is a devolved issue - you're talking about England here aren't you?

Here's a link to the BBC College of Journalism's article on the King report https://tinyurl.com/27y5mba

In my opinion this is not much of a blog Nick given that, as I understand it, you are the BBC's political editor.

Seems more like an advert for some background pieces you are doing for the television news.

And I still don't understand why you are asking people about cuts now. Too late to have any influence on what the government does and too soon to discuss what they have decided to do.

I would have thought it obvious that ring fencing spending did not mean simply continuing to increase it at the prevailing inflation rate of healthcare which is far in excess of cpi so nothing changed. Economies which in a service where the majority (60%+ ish) of it's costs are labour inevitably meant job losses - whether this will impact level of service depends on how good the managers and clinicians are at organising it better. As with any organisation it is the managers job to manage and they fairly infrequently manage to make themselves redundant as part of the process, it is Andrew Lansleys job to ensure they are not ringfenced.

Holding the budget firm in cash terms (or even letting it increase by less than inflation) and letting inflation trim it's percentage down is just the route used previously by Conservative cuts administrations so it is no great shocker.

It was known well before the election that there were savings and job losses coming irrespective of who won the election, the scale would depend on who. It is just politics that Labour novices would jump up and down about it - they would have been in exactly the same position had they won and the Conservative novices would have been jumping up and down pointing to their commitment to ringfence and this would never have happened if they were in charge(and ignoring inconvienient facts like err actually it would).

Would you like to be bored or punched is the typical twisted question. Can we not have challenging reporting on the need for cuts when we have a government that turns a blind eye to the Aladdin's cave of tax avoidance and evasion?

The cut or tax argument is not over!

The proposed cuts (and note 'proposed'!) are unacceptable - so the public must be being softened up for tax increases, mustn't they, or the Civil Service is being softened up for actual pay cuts?

Are there any other alternative?

Why have many other countries cut the pay of civil servants and this is not even (apparently) on the agenda in the UK? (Even though historically in the 1930s this is exactly whet 'they' did?)

Does this not also mesh into the Fat Cat banker discussions?

Sorry about all the questions - but we have, I think, been conned and manipulated into ignoring the other ways to solve the deficit!

8#

Just like the last one did, Watty. Unfortunately, it would take more than all that recouped, avoided and evaded tax revenue to plug the hole they left behind.

Is it not the case that Nick is talking about a cut in the rate of increases in expenditure. So there will be increases in the NHS budget but that they will be limited to the rate of inflation. NHS costs may not rise at that same rate, so it must be for the NHS management to manage any increased costs within those limited increases.
On the need to reduce the level of deficits, is it not the case that successful private companies have had to review how they are organised to identify cost savings. For years govt departments have been subject to targets and "new initiatives" and have probably grown in a less than ideal way. Is now not the ideal time to have such reviews in the public sector? Work out what needs to be delivered and then how best to do it.

9#

Probably because the public sector unions would be up in arms about it John. Those who are in the private sector who had to accept wage reductions or get chucked out probably dont have union representation and just had to lump it.

The NHS is a tricky one. It could be that the most sensible way to cut costs is to reduce the number of nurses but the public will be looking for a cull of managers. I guess if the plan is to push a lot of that activity onto GPs then such a cull might be made easier. Wonder if the GPs will be up to it, though - management in the health sector is quite a skilled job; probably more so than being a GP. What may well happen is that the diversion of GP time into management leads to surgery bottlenecks. Maybe this could be alleviated if some of the displaced managers were to retrain as doctors but it will take time.

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In response to some correspondents who refer to this or that government "doing something right" - governments of any colour are lead by people who are MPs because they either lack the skill to other things or have a greed for self agrandisement.

Nothing in politicians make up is about competence. Hence we have a chancellor who is not an accountant and a health minister who is not a doctor. Bizarrely, we have a Defence secretary who is a doctor but is not trusted to do anything in relation to health - what he was trained for one might suppose.

Against this you have the cuts - these are needed because the previous governement could not add up or plan for the future. Now this government with its limited skill set will have to try - god help us.

Like many others I don't understand/agree why this subject is being given so much resources. Surely this should be discussed when we know what is likely to happen? This feels at best like 'psychic news' "a minister is expected to say..." and at worst an exercise in 'buttering up the public' for a very dangerous set of policies. I don't understand why the BBC is doing this - this is overtly political.

The ConDem government has been a little economical with the truth.

They may not be cutting NHS spending in absolute terms - as they intend to do, for example, by cutting the ministry of justice budget and freeing thousands of criminals.

However the NHS has an unusual inflation, increased by the cost of new treatments and an ageing population. In real terms, this is a cut, but still not as disastrous as other departments.

Two changes are needed to make the NHS viable long-term. Firstly, a more ruthless emphasis on preventive medicine and patient responsibility, which will inevitably mean charging people for healthcare if they fail to lose weight, give up smoking, etc. Secondly, some kind of firewall between patients and doctors. This could either mean that all initial GP visits are to a nurse, who refers patients on to the doctor only if necessary; or it could mean that all GP appointments are made via a phoneline which attempts to deal with the patient's problem, along the lines of HNS Direct.

I'm not rejoicing in either of these developments but I think it's the way things are going.

watriler @8
Quite. Discussion seems to have centred around what cuts and how deep to the exclusion of all else. The problem is reducing the deficit. Quick and deep cuts is only one possible solution but serious discussion of the many possible ways of achieving this and over what timescale has never really happened.
The current tax regime is unfit for purpose (according to Michael Fallon et al). Uncollected tax for the last year I could find was 19 bn. Closing avoidance loopholes and toughening up on evasion could raise - well take your pick as estimates vary between 20 and 120 bn. True you could never be efficient enough to recover it all but it would make a sizable contribution to deficit reduction and considerably reduce the percentage cuts we are told are unavoidable.
The only real reason for cutting quickly and deeply is to gain advantage at the next election. At best this is a gamble and could turn out as badly as the ones taken by many banks and finachial organisations not too long ago

A budget cut is an actual reduction in the sum of money available to conduct a defined set of services. A budget is the agreed financial means to provide a given set of outcomes. If then a budget is cut then so will the outcomes whether that be in services or something else.

However, a flat budget means that there is an expectation that the same services or outcomes can be provided for the same defined sum of money.

The one big word missing from all this is productivity.

An increase in productivity by performing a certain task or tasks in a different way can overcome the performance issues arising from a flat or a reduced budget. Management should be facilitating productive change in the public sector and the NHS to see if the taxpayer can get a bigger bang for their buck. If they want to know how then it is all in the figures, sorry, budgets.

13. At 12:42pm on 08 Sep 2010, sagamix

If they replace one PCT with 4-5 GP consortiums then the number of administrators required may well go UP. Certainly it is both unlikely and inapropriate that my GP will be sat for hours over a spreadsheet, chasing up payment for some obscure treatment or negotiating a service level agreement with the wheelchair service.

More likely is private sector health and/or accountancy firms recruiting the displaced PCT/SHA bureaucrats and selling their services to the GPs. Obviously the profits made will fund kick backs to the tories by one means or another.

NHS trusts are already being told to stop advertising empty posts so that PCT/SHA staff can be slotted in without redundancies. Great for the bureaucrats, not so hot for young people looking for a job. Biggest job losses will be people in the so called 'private sector' - eg the brick layer who would have built the new ward, which has now been cancelled. This is already happening.

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"Maybe this could be alleviated if some of the displaced managers were to retrain as doctors but it will take time."

Too right it would. Four years, minimum. Not decrying the managers concerned Saga, but not all, if any of them would have the aptitude or attitude to become clinicians. Or the desire for that matter.

For what its worth, the NHS, IMHO has two things that I can think of straight away that it must deal where it can and should save cash to be able to ensure front line health care is as good as it can be.

One, the price it pays to big pharma for prescription drugs. That has been an ongoing scandal for years and these guys have been ripping off the NHS big time. Shame that whilst NICE can decide whether a patients life is worth it compared to the cost of the drug concerned that it cannot and does not take any part in telling the pharma's that the product is too damned expensive. Even following recouping of development costs, I would venture that the price charged to the NHS is what the NHS will tolerate rather than what is a fair price.

Two, it cant be that short of cash if it can afford to fund lobby groups in order to push a political agenda. The organisation that recently campaigned for a per-unit minima price for alcohol was funded by 24 trusts, to the tune of 850,000 over two years. Now, compared to billions, this is but a demitasse coffee cup's worth of money, but none the less, that is money given by the tax payers for healthcare not political lobbying to keep a bunch of failed PPPE graduates in work.

And with respect to healthcare management professionals, I beg to differ. Not slighting them, as they have as you say, a specialised function to fulfil, but this type of management is not a patch on the clinical skills necessary to function as a GP or as any other kinf of front line specialist medic or consultant. Most of us, with a reasonable amount of training could be expected to perform a typical healthcare managers function as it is largely (if not exclusively) administrative. Thats not to say its not needed, it is. But lets not make it out to be something that it isnt. Whereas, I would venture, there are vast numbers of us who could not, even with one-to-one intensive training over 4 years or more develop the physical, mental and temperamental skills necessary for carrying out surgery or saving peoples lives.

Unfortunately, it has been assumed that more money going into the health service has automatically equated to a better service. I regret to say that in my family's bitter experience that this has not been the case. The improvements have been incremental and not proportionate to the level of expenditure. I'm not saying that it has to be cut, but like every government department, they have to find ways of spending what they are allocated better, more wisely.

I dont hold out a lot of hope though....

Again I have to mention the word perseption for I clearly remember the Conservatives saying they would ringfence the NHS but again clearly heard them say that cost savings would have to be made in some areas so that more money could be spent on Care for the Elderly.

This is restructuring which is somethimg efficient companies do all of the time.

We can be as pedantic as we like and say that every paper clip saved is a cut but in the real world ongoing efficiency should be an everyday aim.

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#14 PD

I would agree with both of you! to certain extents......but I think both definitions create wealth

#18 - Good comment. Both sensible suggestions that should be investigated.

As I work for an NHS organisation, I can say that where I work we are facing cuts. Therefore, it was never really going to be possible to prevent cuts to the NHS, all that was ever said is that they will maintain the budget as it stood previously, which is effectively a cut but that all depends on the wording you want to use.

All I have to say on this simple matter is that I can foresee a day when there will either
a) be no such thing as the NHS
OR
b) the NHS will solely be in the hands of the private sector

and I fear the day will be coming for either of these options sooner than we would probably like to imagine.

I can understand why the government wanted to try and make an attempt to reduce the cuts on the NHS but considering the state of the country's economy, it was never really going to be a viable option.

The real questions should focus on, for example:
If you were earning £25,000 per annum and you were running debts on credit cards of £100,000 then what would you do? How would you change your life to accomodate the costs of servicing that debt? Would you want to deal with it sooner? Would you want to invest in yourself and your skills in the hopes of getting a better paid job or a salry increase to deal with your debt at a later date? What if you had kids and they needed new clothes, shoes, etc.? What if you had a sick elderly relative that depended on you?

All we ever get is a general conversation that doesn't really spell out the perspective to what an individual can properly comprehend in terms of a comparison to their lives if they were in the same financial situation that our country is in.

If you run a business and you decide to increase the amount you charge consumers, then how will that affect your business if the consumers can't afford it or have to forego something else that could cause problems to them? Does it concern you or are you merely happy with simply charging whatever you want?

There are many paths that can help facilitate a solution to this mess but every decision leads to an action that has a consequence. If you tax people more, you severely deteriorate the quality of lives of countless thousands among our population already struggling to cope with what little money they may have. If this allows you to spend a bit more on the public sector, then think of the extra costs you're incurring by putting many more people in to worse positions they most likely can't cope with. The most poor in our society already account for the majority of certain public expenditure, so do you really want to increase the number of people in poverty?

At the same time, increasing tax only makes wealthier people consider moving to a different country with a lower tax rate. Wealthier people generally seem more concerned with maintaining their wealth rather than helping the less well off so if you scare them off, you not only dent the economy in terms of their investment but the burden of the gap left by those people falls on to the shoulders of people who are in a worse off position that can't afford it. Therefore, would you be prepared to tax the rich more to encourage their money to leave for other countries?

We could put off dealing with the debt and let growth do its part but what would happen if growth didn't work out or another national economic problem occurred that plunged us in to bankruptcy, how would that affect the people? The burden of it all would once again fall on the shoulders of those who are least able to deal with it while the wealthy move away to take care of themselves. As I can't see the future, I can't say what the future holds but I would rather face the future knowing our country was dealing with the problem rather than living in a state of denial over it.

Considering the state of the mess our country finds itself in, our best chance of moving forward in terms of longer term stability is to deal with the deficit as quickly as possible. Does this mean I agree with what our coalition government is doing? I don't know, I don't have their level of information or attend their discussions but I agree that it needs to be dealt with though I have no idea if the coalition government have got their figures correct and have been able to balance things out to be able to deal with it effectively.

Unfortunately, cuts are the most sensible way to deal with the mess, I'm not saying it has to be the only means but it should represent the majority. Our country's public sector has grown in to a wild beast left to go out of control. Our entire state has simply let things slide downwards faster and faster and now we must take charge of the beast and attempt to tame it. All Labour ever did was simply pump money in to the system assuming that problems would be fixed but problems only got worse and root problems were never tackled.

If we want to progress past this point, people need to realise that we can't simply throw a finite resource around as if it is infinite. The country has had years to try and deal with problems but even in the times of Labour waste, we never even came close to resolving all the problems this country has because it's been left in such a bad state for decades. As nobody has ever wanted to deal with the problems, we reach a point where the country has no money and all people do is complain about themselves and the problems affecting them.

There are countries out there without even buildings to use for schools and all we get is constant whining about the fact that the government has no money to repair some schools. If it's that much of a problem, then get yourself an apprenticeship and go fix the school yourself once you're qualified but stop whining and complaining about it when the country barely has enough money to pay for anything. If you're that concerned, go and put the costs on your credit card.

If you don't like what the coalition government is doing then feel free to max out a few credit cards and donate the money to the Treasury. Me, I would much rather taxes be minimised to keep money in the pockets of people and that the rampant beast of the public sector be brought under control.

Like all things, the future stems from the present and if you allow a continual unstable present to dominate then we will only have an unstable future to look forward to. What we need are good solid foundations put in the present so we can create a secure and sustainable future which we can all work towards.

For too long, we have all been allowed to wander as if there's nothing wrong and that the government can simply solve all our problems by throwing money at it, even if they didn't have any. Now we must all pay the price and realise that the country has no money, people struggle to get by with what money they do have (except for those minority of wealthy people who account for the majority of this country's wealth) and that cuts are inevitable.

And to top it all off, what we should all be angry about is the constant bombardment of lies brought to us over 13 years of New Labour and how they kept so many people ignorant while they wasted the money of generations to come.

I WILL NEVER AGAIN VOTE FOR A LABOUR GOVERNMENT!

18#

The firewall is an interesting concept. How would you deal with patients who'se condition is either one that needs regular monitoring and managing by a GP (nurses not being allowed to diagnose or act on diagnosis) or for those who may initially present with symptoms which to them are urgent, but not quite at "sit in A&E for 4 hours" bad?

The charging aspect is an interesting one as well. I dont fundamentally disagree with it, but how would you make it work? Given that obesity, poor diet, smoking, excess booze etc, if we are to believe that tome "The Spirit Level", are more prevalent amongst those suffering monetary "inequality", ie the poorest? Is it possible to - and does it make financial and political (not to say moral) sense to penalise/demonise them further?

Given how much of a hot potato Alan Johnson found it when he was adamant that if you decided to "top up" cancer treatment on the NHS by paying for your own drug supply (because NICE wasnt prepared to and didnt think your life was worth it), you'd end up with no treatment on the NHS at all - he defended this practise saying that to allow people to contribute to the costs of their own care would create a two tier health service penalising those least able to pay - this would be a very sensitive political matter.

Or would you only expect the middle classes to pay for such transgressions? Would this be part of the healthcare post code lottery? The south east gets fined whilst Manchester, Liverpool, Newcastle, etc, do not?

When is a cut not a cut?
When the Coalition Government says it’s not a cut.
When The Coalition Government decides to call the cut something else, like efficiency changes.
It was a mistake for David Cameron and George Osborne to have promised to protect the NHS from spending cuts. How could they know with absolute certainty that nothing would come up that needed to be cut? It was (Pardon the pun.) - careless.
I've been reading a report that confirms that the SKINT Health Board Chiefs payed £70,000 for 27 tea trolleys. So are these Board Chiefs living in the same world as the rest of us?
Cuts worth @ £35M have been undertaken in the NHS - abandoning medical centers, doing away with plans to offer 350 workers voluntary redundancy, and likely much more of which I have not yet read.
Back to the trolleys: ordered by the NHS Grampian, used to serve hot drinks, toast and cereals. Individual cost/trolley £2,500. Purchased from Bristol-based Bridge Valley Beverages.
Tory Alex Johnstone: “Every bit of NHS Grampian spending must be justified by how it delivers better healthcare. I don't believe these trolleys can provide a matching level of improvement". So, what are you going to do about it?
Health Spokesperson, Mike Rumbles said that he doesn’t think that level of spending is required at this time. So, what are you going to do about it?
The order for these royalty carts was sent in AFTER the health board scrapped plans to offer 350 workers voluntary redundancy. It even has to cut down its building budget by £100 million in the next five years.
When is a cut not a cut?
When people talk the talk, but can't seem to walk the walk.

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When is a debate not a debate?

Has the BBC voluntarily relegated itself to being equal only with the (now defunct) GMTV sofa level of discussion about important issues?

Is there ever going to be a discussion about just how much we are spending relative to earning? How if we go on like this we just accumulate bigger and bigger debts? And are we actually getting value for money from our public services?

This is not a debate, it's a an agony aunt cum daytime tv show.

Even Her Majesty's Loyal Opposition can do better than this.

It's a great time to be a tory...

And as evidence that HMLO can do better.. see the ex leader of HMLO recent somments on the provision of public services in the developing world...

Is China looking to emulate the NHS? is India? Is Brazil? Is anyone? No-one on any newly emerging economy is looking to emulate the garganutan super structures of the developed world's public services...and for a good reason; they are unaffordable.

It's a great time to be a tory...

PD @ 18

I agree with your second point (the firewall) but not so much the first one. Would like to think (perhaps optimistically) that we won't need to go down that route with health care. Your (ex) 14 ... yes indeed. Was surprised at the Doc there. Muddle up between creating wealth and becoming more wealthy; in a perfect world the same, in our world anything but. Similar confusion arises with the term "the wealth creators" often being used to mean "the wealthy". I'd best leave it there (seeing the fate of your post) but no doubt the topic will recur. It's that sort of topic.

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#18. #19. #20.

All good posts with one thing in common... it shouldn't only be about CUTS. Explore every alternative before making CUTS.

But CUTS makes a great headline, particularly when used in conjunction with deeper, faster, discriminating, unavoidable, painful, crippling or fatal.

Some suggestions for the coalition to sell CUTS:

I've seen the future. And it's CUTS.
Things go better with CUTS.
CUTS. Just do it.
Vorsprung durch CUTS.
Aaah... CUTS!

Some choice you've given people there...Who to kick hardest the weak or the sick? Another perfectly reasonable choice would have been to ask if people wanted the cuts all at once over one five year parliament, or spread out over two with rising growth and tax revenues cushioning the cuts to public services of all kinds? But its clear the BBC has been told in no uncertain terms by Downing Street that choices like that are to be kept well away from the 'open public debate' the BBC will be having with us licence payers over the coming few months...Go on Nick, prove me wrong.

23. At 1:21pm on 08 Sep 2010, Fubar_Saunders
"One, the price it pays to big pharma for prescription drugs. That has been an ongoing scandal for years and these guys have been ripping off the NHS big time.... Even following recouping of development costs, I would venture that the price charged to the NHS is what the NHS will tolerate rather than what is a fair price.
==========================================================

This is called market forces. What is this silly concept 'fair'? The price for anything is what someone will pay for it, this is the free market at work.

Surely you are not trying to suggest that your beloved private sector is ripping anyone off?

I thought the private sector was super efficient and the answer to all our problems?

I can't help but feel that the whole question of which cuts are acceptable and which aren't is fatally flawed given the macroscopic viewpoint interviewees are asked to operate at. With reference to an item on the BBC website today (Beware the 'don't know' brigade), the most sensible answer will be along the line of "I don't know", or "It depends", as there is patently insufficient data to provide a meaningful (or for that matter, sane) response.

We do not live in a simplistic world, where simple answers provide for any sort of realistic solution - however much any politician may try to persuade you to the contrary. Therefore subtlety is required, of which I observe little in most reports in the visual and print media, and in the responses of the general public to them.

There seems to be scant discussion of what the purpose of the cuts are intended to achieve other than the generalised assertion that "the books must be balanced". To respond in an equally straightforward manner, make all the necessary cuts now - that's what one's local bank manager would say to a recalcitrant spendthift, or an over-leveraged business.

However, the coalition are not doing that. Hence other factors must be involved, but we the public are not privy to them. Are they political, economic, pragmatic, or idealogical - to which the obvious answer is - a combination of all four, but wherein lies the dividing line.

No party at the last election was willing, or able, to present their answer to that question. For my two penny worth, I would guess ideology is more prominent in the mix for this government than its predecessor. Is this acceptable to the population at large, or is there scope for discussion? Does it seem appropriate that the ability to influence, let alone debate, such deliberations is restricted to placing an "X" on a piece of paper once every four to five years.

So - the issue of NHS spending, and the alleged ring fencing of its budget is a purely political one. It treats the topic as if the decision surrounding the budget is an "all or nothing" question, and avoids such tricky questions as "where is the budget actually spent", and are there procedures, therapies, interventions etc that are deemed desirable, but not essential, that can be cut in the short to medium term.

Taking this approach across the board would demand greater clarity in where money is presently spent, and with what aims and objectives. That in turn demands clarity from those making the decisions in both their aims and objectives.

As an example of how such a process could work, look at the apportionment of the sports budget wrt the last olympics. The nation saw success in cycling and swimming, but not athletics. Does this mean we should preferentially fund winnners, and cut loose the losers? Should the chancellor take such an approach to apportioning government income? If yes, should we cut funds to life's losers (ie - welfare), and only reward life's winners (ie - lower taxes for successful entrepreneurs)?

To begin to answer such a question requires one to reflect on what sort of country we want for ourselves and our families, and what we wish to bequeath to future generations. Do we go for "private wealth, and public squalor" as our talisman when deciding where to cut, or do we take a more inclusive approach, and think of ourselves as a society of individuals that are, nonetheless, all in this together.

Until the debate is opened up, all is smoke and mirrors, and the basis of this government's - and for that matter, every other previous administration's - approach to budgeting realistically falls into one of two camps: 1. The public are not capable of providing any form of meaningful input; 2. The public can not be trusted.

I don't accept that, and neither should anybody else.

It is impossible, I feel, to make sensible headway in spending cuts without cutting the NHS budget extensively. In fact it is this service that should take the biggest cuts. There is waste, unnecessary services and treatment of those who have contributed nothing to qualify for treatment, to start with. Furthermore the NHS should be streamlined into the proper service it was set up to be. A great majority of NHS work now undertaken, would be classed as unnecessary in the past and merely feeds the publics need, not for good health, but to be there as a prop, instead of taking responsibility for their own lives. The really important service of protecting people from untimely death, on average, is poor in comparison to other civilized countries. This then is an opportunity once and for all to sort this mess out and produce a much better service.

Overseas aid should be the next big cut, why is Britain giving aid to Countries which are now potentially richer than we are?.

Welfare should then be the next target. This no longer helps the poor in the way it should, it traps them in a never ending cycle of being inactive. The poverty trap can only be helped by making work pay and creation of jobs in the private sector.

The principle should be to create the wealth in a Country first, keep taxation low to encourage more growth, then spend on services. Unfortunately for us all, the Labour Government decided to do this the other way round. It is therefore going to be a massive task to redress the balance needed to the economy. As the need for cuts on this scale were not faced up to by any of the Political Parties before the election, it may prove impossible to gain the public support now needed to carry these policies through.

Fubar @ 29

The 'firewall' would result in some serious cases being missed, I expect. However, so do longer waiting times, shorter consultations and overworked GPs. It is potentially a more efficient system as it would mean those simply wanting human contact and sympathy (quite a big percentage) can get it more cheaply, since nurses are cheaper to train and employ than doctors. Of course, some patients will have serious medical conditions which require regular GP visits, as is the case now. It wouldn't be a perfect system - no system is - and could be undermined by hysterical media coverage of even a tiny number of mistakes.

I accept your comments about the political problems of charging for healthcare (hey, haven't we swapped roles here?). But with an ageing population, the importance of self-care and preventive measures - mainly a healthier lifestyle - will become paramount. I believe some hospitals refuse to give liver transplants to unreformed alcoholics. This is (to use a phrase I hate) the thin end of the wedge. The next step will be to charge A&E patients whose injuries are the result of drunkenness. Then people will question whether NHS resources should be devoted to smokers who refuse to give up.

Advances in medical science will mean that fewer and fewer conditions are necessarily fatal. Doctors will essentially be able to keep anyone alive, but not everyone, because resources will not be endless. So they (or society) will have to choose who to keep alive, and the best candidates will always be the people who look after themselves best.

Who referred my #25??

There was nothing in that but extra info for Jon (from a discussion yesterday albeit)

and also PD at #14, nothing in that either! a sensible comment!

Some people just can't help themselves it would appear, PD is certainly not one of the bloggers here who posts offensively!

Never mind...

We need a snappier name than "firewall", what about TRIAGE?

My comment at 22 was also removed.

I suspect it was Fubar who referred it to moderation on the basis it was said to not be on the particular topic that Nick has chosen to write about.

alpha phantom @ 28

Yes it's good to look at things that way. You can do it for both the government and (not the same) the country.

With the govt, their income is tax revenue and their debt is o/s gilts. They have assets too (about £350 billion). They can print money - create an asset (but not wealth) out of thin air.

For the country, you have to bring in all the rest, the people and the businesses. Income is now GDP and debt is gilts plus corp plus personal debt. Assets much higher too (many trillions). Need to avoid double counting - e.g. gilts held by UK investors.

You get a comparison (in your terms) approx as follows:

Govt:

Has a rock solid job paying 100k and is 175k in debt. Has assets of 75k so net debt equal to income. Income flat but expected to commence annual rise from next year. Debt rising by 25k a year but this expected to reduce to nil in 10 years when debt will have increased to 300k. Income by then will be 150k. 10 more years to pay aggregate debt down to target (100k). At which point will equal assets (having grown from 75k to 100k) - (net) debt free.

Country:

Working on this one - I think will look more rosy but let's see.

"And as evidence that HMLO can do better." @ LP

Government In Waiting, Robin, I think we agreed - "GIW" if you must.

jon @ KOTD,

Mmm, dog's breakfast. Surprised they're messing around with the model (which has bedded down and is working pretty well). No mention of it pre election. I forecast trials and tribulations - an upheaval which detracts from patient care. I do, however, accept the need to keep a grip on health costs. The NHS shouldn't be a sacred cow or an economy unto itself.

The BIG problem GPs will have with the proposed abolition of PCTs is that they'll no longer have anyone to blame when they refuse to operate on someone. Up to now, they can blame the PCT, but under the new regime the GP himself will make the final decision and have to carry the can for it.

And just because PCTs are being abolished, it doesn't mean the work they do will magically disappear.

38#

{.....here we go again....}

Pharma's have been charging the NHS what it will tolerate. If you dont want to call that "ripping off", then fine. Call it what you want. Eitherway, the NHS, like other government bodies, is paying through the nose for goods. It wouldnt surprise me if the NHS's procurement system was as rotten as that of the MOD. If you want to call that "market forces", fine.

What I mean by a fair price, is obvious. Initial costs per unit for new items, whatever they may be, tend to be higher, because of R&D costs, etc which companies will seek to recoup. These, as the products mature, and there are economies of scale, normally come down. A similar analogy could be made about music CDs. The record companies chose to sell them to you at between 12-15 quid a throw because they knew that was the optimum at which the market would tolerate it. Except, when downloads came along, sales of CD's fell through the floor a) because people wanted something for free and b) because they'd been ripped off paying a premium price for a product whose monetary value, that it cost to produce in no way reflected its eventual price.


Now, if thats market forces and the dirty seedy underbelly of capitalism, then fine. Short of everything being nationalised, its where we're at and the situation still exists and something should be done about it.

fubar @ 23

"Not decrying the managers concerned Saga, but not all, if any of them would have the aptitude or attitude to become clinicians. Or the desire for that matter."

Exactly. Wonder if it's easier for a doctor to be a manager or a manager to be a doctor. Equally difficult, I'd say. Guess the former switch is a touch less risky, though - better to waste billions of public money (even in these days of deficit) than to accidentally cut someone's big toe off when they're in for shingles. Or is it?

@ #39 PaulRM

I think we can all agree that the government don't want to involve the public in anything. It's all part of the 'Knowledge is Power' mantra. As long as the people are kept ignorant then we can never actually do anything for ourselves without the help of those who possess that knowledge. This is why the MPs live in their own little worlds and rally together over the slightest leak of information to the public, so that we are all kept in our place and under the thumb of the government who manipulate and control us through only telling us what they want us to hear.

The media are all part of this too, their entire market is about providing material that people want to read about, whether it's fact or fiction, as long as it sells. They claim to be objective and independent yet they all scurry around the feet of the politicians for their stories, no matter which party they claim to support.

Even now, we're all commenting on this blog and what will the government ever know about our views and opinions expressed here? Most likely, this is simply a media filtering centre to pretend to give us somewhere to voice an opinion if only to stop us going out and actually taking action on the streets against the government.

I did read that article and can acknowledge that everyone here lacks the information the MPs and our government have but does that stop us from voicing an opinion. We may not know exact details or information but we are aware of the state of the economy and some of the measures being put in place by the government to control it. I think we can all agree that something needs to be done and we are merely expressing a view on the direction we would like the government to take based on the limited information available to us combined with our own personal experiences and perspectives on the matter.

If you were asked to express your opinion on what to do knowing full well that you would never have the appropriate information, would you still choose the path of saying "I don't know" or would you decide to give an opinion siding more towards one side of the fence or would you just simply continue to sit on the fence letting the world pass you by with your voice unheard while the government simply do what they want anyway.

The chances are that the government will not give much notice to what people say but should that simply prevent us from expressing an opinion?

If you want to attempt a Freedom of Information battle against the government to obtain that information then Good Luck to you. Otherwise, I would rather give an opinion on a matter that affects us all like this without a decent level of information than express no opinion at all.

Also, the fact that you can't accept your last two points only proves to those in power that you can't be trusted as you may be likely to disagree with them. Better to have a disagreement by somebody less informed than you are who you can easily make to look foolish to the ignorant masses than attempt to argue with someone who has the same information you do and disagrees with you.

pdavies 41

Where have you guys been this already happens in a lot of surgeries up and down the Country. Nurses in a lot of instances are taking a lot of work on, that used to be the GPs. Also in a lot of instances you are offered a phone call from the Doctor instead of an appointment.

Overworked GPs in your dreams, they are paid too much for doing less and less work.

I also disagree with charging for treatment this is not necessary. No health service should pick and choose which people it treats for free and those who should pay. It is either free for all or insurance based. If the NHS were streamlined into being a service that provides the necessary services instead of being a treatment base for anyone in the World who decides to wonder through its doors. Or anyone who does not like the way they look, there would be plenty of money. As far as the NHS is concerned, as a service in its present form, the Government may as well just pour money down the drain.

41. At 2:38pm on 08 Sep 2010, pdavies65 wrote:

Thanks PD. Some interesting points.

The 'firewall': OK, points accepted. At least its an idea. Isnt that though part of what NHS Direct, or its successor is meant to be about? I'd be interested to see how it would/could work, short of putting security guards on surgeries... and how the profession itself would respond to it. A political solution to a medical problem, or the reverse?

"I accept your comments about the political problems of charging for healthcare (hey, haven't we swapped roles here?). But with an ageing population, the importance of self-care and preventive measures - mainly a healthier lifestyle - will become paramount."

Fair enough. I can accept that.

"I believe some hospitals refuse to give liver transplants to unreformed alcoholics. This is (to use a phrase I hate) the thin end of the wedge. The next step will be to charge A&E patients whose injuries are the result of drunkenness. Then people will question whether NHS resources should be devoted to smokers who refuse to give up."

Much as it pains me, being a smoker, I have to agree. Although, I have to say, considering how much duty is paid to the revenue by smokers (and drinkers for that matter and not every drinker is an alcoholic), strictly speaking, if these substances are deemed to be as harmful as they are alleged, then they should be banned altogether. I dont think its the place of the NHS to play lifestyle God and say "you're a drunk or a smoker, therefore your life isnt worth saving". Granted, those who indulge should do so in the full knowledge that it is likely to have a shortening effect on their lives (at minimum) or other serious consequences. I fully concur though on the A&E alcohol issue. Not only a danger to themselves, but also to A&E staff. Maybe if we hadnt relaxed the licensing laws trying to emulate the Tuscan Chianti culture this wouldnt be so prevalent.

"Advances in medical science will mean that fewer and fewer conditions are necessarily fatal. Doctors will essentially be able to keep anyone alive, but not everyone, because resources will not be endless. So they (or society) will have to choose who to keep alive, and the best candidates will always be the people who look after themselves best."

Am I sure I'm reading this right? A socialist actually acknowledging, if not openly advocating "survival of the fittest"???

Surely not!

44#

I hope you can substantiate that allegation.

When I refer someone, I dont hide from them. Ask Saga or PD. You know - or you should know by now - what moderation is like on here. If you're off topic and they chop you, get over it and stay on topic instead. They have the power, not me.

Or are you advocating selective moderation of everybody but the left? Keep them damned tories out, eh?!

"cuts in the NHS are coming and are needed merely to cope with going from huge spending increases to budgets that are flat in real terms"

So what you're saying is that these aren't actually cuts, they're simply a slow-down in the completely insane and unaffordable budget increases that labour had promised? That's not the same as a cut.

To simplify things, here's an example:

A cut is where you're given a budget of £1b in 2010, and a budget of £0.8b in 2011. (or, where your budget stays virtually the same but inflation makes it worth less than it was the previous year).

The situation here seems to be more like having a budget of £1b in 2010, being promised a future budget of £2b for 2011 by labour before they left office, and then being given £1.1b in 2011 instead of £2b in 2011 by the new government.

That's not a cut of £0.9billion; it's an increase of £0.1b and is still an increase even in real terms.

John Redwood has also pointed out this logic; the overall amount of public spending on the NHS (and most of the other services) isn't really being cut at all; there are virtually no cuts; it's just that the future increases that labour promised have been replaced with smaller increases by the new government.

The cuts that the BBC keep going on about are not real cuts. What's happening is that the public services have a simple choice:

1) Continue with bad practices that are inefficient, and cut front-line services to pay for their negligence in management.
or:
2) Reform how they do things; spend their money better; actually end up with better front-line services for little or no extra cost.

The BBC clearly wants to continue with point 1 and then blame the tories when front line services go to the wall.

The private sector is constantly doing point 2, and always has done, because if they didn't they'd go bust.

The coalition are telling the public services that they can't just burn money; they have to spend it wisely and manage things properly, and to me that's fair enough seeing as it's not their money in the first place; it's money that's 100% been earned by hard work and strong/good capable management by the private sector.

Instead of blaming the tories for vanishing front-line services despite budgets being fully protected in real terms, I'd be more inclined to ask the quangocrats why their front-line services go to the wall despite their budget not being cut in real terms.

We're still overspending by at least £100billion/year; the only difference between what labour had promised and what the coalition are doing is that labour wanted to pretty much maintain the level of yearly overspend and just hope that growth would get rid of the accumulated debt, whereas the tories, unlike labour, understand basic maths and know that labour's plans would mean complete bankruptcy because without decreasing the annual overspend it'd take about 100 years of 10% growth to start eating away at the accumulated debt (after the first year the maths would have been irrelevant as we'd no longer be able to borrow the money anyway because china and the rest of the world would have thrown in the towel and told us we're on our own; they're not going to lend money to a country whose economy is 100% destined for bankruptcy with insane labour plans), and so the coalition are trying to reduce the annual overspend until it gets to a stage where growth will start to eat away at the overall accumulated deficit.

Labour and the BBC constantly moan about "cuts" - firstly, these are not cuts, and secondly if you didn't slow-down the increases, or decrease the budgets, then what do you think would happen? Do you think you can spend 10% more than you earn forever? Do you understand basic maths at all, or are you in the Gordon Brown "doubling the tax rate of the poor doesn't hurt anyone on low wages" frame of mind?

49. At 3:13pm on 08 Sep 2010, Fubar_Saunders

It's you that called it a rip off -

"these guys have been ripping off the NHS big time"

in #23, it's there in writing, have a look.

I thought you were all in favour of private sector efficiency?

In your hysteria, are you posting so much that you are losing track?

The NHS budget should never be treated as a sacred cow but subject to the same discipline as all other govt budgets.

What we should never compromise on is the principle that healthcare should not depend on someone's ability to pay but should be based on medical need.

I have long thought the NHS were an incredibly stupid way of organising healthcare in a modern economy yet we are incapable of looking at other countries because as soon as anyone talks about reforming healthcare up jumps the doomsday brigade spouting some nonsense about this is nothing more than a way of introducing an American (failed) systems. No one in Europe organises healthcare they way we do, it may be that they have a better system

42. At 2:39pm on 08 Sep 2010, mightychewster wrote:
Who referred my #25??

There was nothing in that but extra info for Jon (from a discussion yesterday albeit)
==========================

Not me, my friend.

I would have been interested to read. Although I guess I would still have been saying I would not discuss capablilities more recent than about 10 years ago. For some reason I'm confident the issue will come again.

Nonetheless, better quality of debate than old fubar endlessly banging on.

This blog does seem to be quite tough on moderation if you go off topic.

Susan @ 52

Thanks for your contribution.


Fubar @ 53

This is how I believe healthcare will develop in the relatively near future. I don't necessarily like it! Certainly, new ethical questions will emerge as science progresses, one of them being whether it's desirable (assuming it becomes possible) to keep people alive for ever.

54 - I can certainly substantiate my suspicion that you referred my comment to moderation. If you say you did not do that I will of course accept your assurance.

I thought you said yesterday you were a UKIP voter not a Tory. Of course it is your prerogative to change your mind.

One thing I am sure we can agree upon is in passing on commiserations to the Cameron family.

sagamix...

that is exactly the problem with the new/old labour party. The more they and their supporters pretend they are not Her Majesty's Loyal Opposition but pretend to be a government in waiting... the more they fail to acknowledge what an unholy car crash they have bequeathed this nation.

This is not a strategy; at best it looks like sulking, at worst they are accusing the electorate of having made a grave error. Not a good thing to say to the 60% who voted for the coalition... and please don't tell me people didn't get what they asked for; they wanted rid of Brown and they rejected statist solutions. Exactly the kind of statist solutions the labour party is proposing.

Until labour can swing back to the centre they are doomed to years on opposition and with Ed Balls and you busy preaching that we need more of the spending we know didn;t work that is unlikely to happen.

Welcome to the world of Her Majesty's Loyal Opposition.

It's a great time to be a tory...

49. Fubar_Saunders

I agree Fubar, procurement should be the first place that the NHS, MOD etc looks at to reduce costs.
Many drugs are supplied by companies that have a monopoly, so getting costs down here will be very difficult because they effectively have the customer over a barrel, but other items could be brought for less.

I have a friend who is a Senior A&E nurse and is often put into Triage because the other staff know she will help empty A&E by telling people "how it is".

I'll give you an example. Little Billy comes into A&E with his mum off a local campsite because he is crying and moaning and the family can't sleep - he's teething, but the parents did not bring any Calpol or equivalent on holiday with them and expect the NHS to provide, even though the drive from the campsite to the hospital takes them past 3 major supermarkets with chemists and a large Boots.

If Billy is treated, all his records have to be taken; just think of all the middle managemement that will be needed to process the data, let alone the frontline nursing and drug costs.

With my friend in Triage, he is checked, then he and his parents are sent away with a flea in their ear and instructions on where to get the drugs needed.

That's what Triage, whether at A&E or at GPs, is all about, sorting the wheat from the chaff, cheaply and easily, to reduce the overall cost.

It's a similar problem with policing. A clip round the ear or a small fine at the time of the offence will be a far better solution than mountains of paperwork, magistrates courts etc.

# 5 englandrise wrote:
"...up and down the country. "

Which country Nick?

Health is a devolved issue - you're talking about England here aren't you?

Here's a link to the BBC College of Journalism's article on the King report
https://tinyurl.com/27y5mba

The link you give has the BBC talking about "its coverage of the UK nations"

I think calling Scotland a 'nation' is possibly going a bit far. A real 'nation' does not normally have its elected representatives sitting and passing laws in the Parliament of another nation. While Scottish MPs sit at Westminster, passing laws that effect England, I think it is perfectly acceptable to refer to 'the country' as a short hand for the Union and its one-sided devolution.

However you are quite right that Health is a devolved issue - and England continues to subsidise health care in Scotland.

https://www.scotland.gov.uk/News/Releases/2010/01/06112755

#51

My deep felt hope is that more people would have an opinion, and by extension, demand more information and greater clarity from those who so jealously guard it. How else can Nick's question generate a worthwhile response?

Perfect knowledge does not exist, and those we elect to make decisions often have to do so knowing that there are known unknowns, and probably a few unknown uknowns. Nevertheless, a greater understanding of the limitations facing those making such decisions would, hopefully, engender a greater degree of respect, and acceptance, of the choices thus made.

Such an outcome will only be achieved by putting pressure on those who manage the data to release it as a matter of principle. I found it deeply dispiriting to hear Mr Blair bemoaning the outcomes resulting from his government's enactment of a much watered down FOI bill promised before the 1997 election. His later attitude more than adequately demonstrated over the "dossier" incident.

I find the BBC blogs the only sane place where some form of discussion can take place, and admire the team of specialists (Stephanie, Nick, and Robert) that attempt to keep us informed. Even so, in trying to make sense of current discussions on national debt, GDP etc, I find I have to trawl through multiple sites to create something of an overall picture. At the momment I have 4 tabs open just on GDP levels since 1948 and relative debt levels in an attempt to understand what is going on, and that doesn't include the many others I consulted trying to find useful data.

Personally, I treasure ther BBC and its news output, who else comes even close to its breadth and depth of information. However, I am afraid that past and likely future encounters with the bean counters in government mean that the degree of self-censoring is becoming worrisome, and the likelihood of the BBC being allowed to collate and display pertinent data in one place, that all governments would prefer scattered to the four winds, to be incresingly remote.

Love or hate the BBC, it needs to be completely free from government interference if we are to allow the opinions of the many to be heard. Then, may be, those who so jealously guard their access to our information, will be less cavalier in its use.

52. Susan-Croft

Think it’s worth remembering that the NHS is insurance based; I pay National Insurance every month.

A full review of the NHS services available for free (at the point of delivery of course – it’s never been free) should of been placed firmly on the table by the Coalition from day one instead of playing silly games with words regarding cuts (or not).

Something has got to give if we are going to make any headway with the countries financial woes.

"We're still overspending by at least £100 billion/year" - bankrupt @ 55

Perhaps more accurate to describe as a mix of overspending and undertaxing. Chancellor Osborne, in going for 80% spending cuts to 20% tax rises, is saying there's four times more overspending than undertaxing. I suspect that his equivalent in the GIW (Ed Balls) would say it's the other way around. There's a debate there, a debate which hasn't yet fired the public's imagination. Small state or correctly sized one? Low taxes or a nice country? Money talks or muffins for all? Perhaps a referendum with these questions, get it sorted once and for all what sort of place we want to live in (although I'm not normally a fan of refs).

pdavies65 59

You are welcome. It is always wise to ignore posts which tell you that what you are suggesting is already in operation in a lot of surgeries already, good strategy, might even adopt it myself.

Forgotton 66

I agree, I made the point myself about making headway with the cuts and the NHS should have been included in this at 40.

robin @ 61

"Not a good thing to say to the 60% who voted for the coalition"

I haven't come across a single person who voted for the Coalition. Nor have you. This tory lib mix is not the "will of the people" although, the parliamentary arithmetic being what it is, I'd stop short of calling it illegitimate. Considering at least 80% of lib dem voters are centre left, there's a case for saying a lib lab administration would have a stronger popular mandate. Still, we're stuck with it for a short while, no point whinging. Labour don't need to do anything radical (although I hope they will) to regain power - there's an awful lot of affection for them out there. It's true that a fair amount of the affection has gone latent but this is only natural after such a long stint on stage. Good gig (four stars?) but people get tired, both act and audience. I remember seeing one of my all time faves a few years ago - Hall & Oates - and it went on a bit. Was happy enough when they wrapped it up. Think most of those there felt the same. Didn't mean we weren't jeering and catcalling, yelling for our money back, about 10 minutes into the next turn (Nik Kershaw, as it happens, but that's not the point).

67. sagamix

"We're still overspending by at least £100 billion/year" - bankrupt @ 55

Perhaps more accurate to describe as a mix of overspending and undertaxing.
====================================================================

There is also a third aspect to this in addition to the two points you (reasonably) make - and that is efficiency.

I can see what you are saying by the concept of "undertaxing", but as a concept for people to rally around it will never catch on whilst there is such massive waste of the level taxes we are already paying.

Central to this over the past 13 years or so has Gordon Browns belief that all the money we earn belongs to the state, and we should be grateful for the pocket money that he allowed us to keep to live on. We should be grateful that we were not taxed even more ! This was supported by his belief that he could spend our money better than we could.

This problem is exacerbated further by his vision that everyone should work for the state, and everyone would be grateful to him for creating the jobs we have. I beleive that this explains the ballooning of the public sector employment levels in all sorts of ways during his tenure as chancellor and PM. This wasn't help by the standard New Labour method of addressing any problem or issue was to hose it down with money. New offices, website, corporate logo, catchy soundbites, managment consultants, facilitators etc. The question now is that how many of these jobs in the public sector are now really necessary ? Why do we need so many more people to run the country than we did 15, 10 or even 5 years ago ? This is where the real problem lies I think.

The other problem with undertaxing as you describe it is that Gordon Brown made the taxation system far too complicated, and actually changed its prime purpose away from simply collecting revenues to becoming a method of re-distributing wealth using tax credits etc.

I genuinely don't really beieve that people would mind about paying a bit more in taxation if it was going to be used to improve things - I certainly wouldn't. But at the moment, there's no chance of any one supporting "undertaxing" whilst money continues to be wasted on politically correct non jobs, and given away in benefits to the point where benefits levels have no reached the point where it can become a lifestyle of choice.

Gordon Brown has now gone, but his legacy of inadequacy will be with us for many years to come. And it will have to be dealt with somehow, lets cut the real waste and inefficiency. Without doing this, "undertaxing" will never catch on.

StrictlyPickled @71
Your arguments would make more sense if it were not fact that New Labour and Gordon Brown actually reduced Income Tax from 23p/£ to 20p/£. While I, and possibly others, might regard this as unwise (with hindsight) it does rather negate the thrust of much of your post.

SP,

This sentiment ...

"Central to this over the past 13 years or so has been Gordon Brown's belief that all the money we earn belongs to the state, and we should be grateful for the pocket money that he allowed us to keep to live on."

... I find strange.

We're not a particularly highly taxed country (by Western European standards) and New Labour shied away from changing that.

Nick
I've seen people in your reports suggesting that benefits need to be cut. These will be the same people who end up in my office when they have been made redundant and want to know what they are entitled to. I ask their circumstances Mum and Dad have both lost their jobs so are entitled to JSA contribution based of £65.45 each so thats £130.90 per week, as they have 2 children and their projected earnings have dropped substantially the may be due child tax credits of £98.85. Normally when I explain that the government has deceide that at £130.90 they have too much income to get income support they want to know how do they afford their mortgage, insurance, fuel bills. I have to explain that these are not included - you might get mortgage interest payments after 13 weeks but only when you have qualified for income support. insurance is not classed as essential and you won't get help for fuel bills. The government says 2 adults can live off £102.75 per week.
If your commentators think that is too high consider that of of that you have to pay Gas £15, Electricity £10, water bill £10, food £45, TV £6.50 license, phone £5, travel £8 - thats £99.50 so far and any bills you may have from the outstanding £3.25 you have left. I really hope that people who want beenfits cut never have to live on them because I get fed up with trying to explain that living a good life on benefits means living with debt, debt collectors, and if you have ill health constant fights from the DWP to get the health benefits. To drop from an annual salary of even £17K pa to £3403.40 pa is s avery large drop and I doubt any of your readers would adjust easily

72. Idont Believeit wrote:

"StrictlyPickled @71
Your arguments would make more sense if it were not fact that New Labour and Gordon Brown actually reduced Income Tax from 23p/£ to 20p/£. While I, and possibly others, might regard this as unwise (with hindsight) it does rather negate the thrust of much of your post. "
===============================================================
I agree, he did indeed reduce income tax as you stated, but these were basically politically motivated changes which are isolated blades of grass in vast fields of stealth tax increases. He gave with one hand, and took back even more with the other. He was playing to middle England with his bold income tax pronouncments, and hoped that no one would notice the stealthy and devious changes which would claw it back - and then some - hidden away in the details.

I don't think these isolated instances do not detract from the overall thrust of my post - is anyone seriously suggesting that individual levels of taxation reduced under New Labour and Gordon Brown ?

SP @75
Agreed. Lowering Income tax rates was a 'political' move to attract votes. However total tax receipts (inc NI) as a %age of GDP were actually more or less the same at the end of the New Labour years as at the beginning (about 34%). You wrote:"He gave with one hand, and took back even more with the other." Doesn't seem to be supported by the evidence.

"When is a cut not a cut? Anyone working in the NHS could answer that one... when it is 1) an 'efficiency' saving', 2) 'natural wastage' 3) reorganisation. What's in a name eh?" (celticchick @2)
.............
When is a Cut not a Cut?
Why, when it's an Investment In Future Viability.
.
Oh, my God! I've just dropped into Brown-speak! Uuuuuurrrrggghh.
.

Under Thatcher, the Government cut taxes and managed to increase public spending. They could have increased public spending more by increasing taxes. That's a political debate.

Currently, the Government is having to INCREASE taxes and CUT spending.

That's the measure of the shambles left by Labour.

Anyone unable to grasp this or accept it is living in denial.

Nick,
Re your PS:
Hertfordshire is one of the wealthiest/affluent/prosperous counties in Britain. I hope you are asking the same question in the poorest counties of Britain and also in those in between.

re #76
The total tax take tells one story. Where the tax burden falls tells another.

The burden gets shifted around. On RP's Blog the future debt for our children is under discussion. The tax burden for higher education was shifted from the income taxpayer, especially the higher rate payer, onto the student as future debt.

Hey! Let's be careful out there, today.

AndyC555 @78
Oh dear! The memory does play odd tricks.
Highest tax take under Mrs Thatcher 38.2% (of GDP). Highest tax take under New Labour 36.4%. For 7 of her 11 years Mrs T's Tax take was higher that the highest level it reached in the New Labour years.(source:https://www.guardian.co.uk/news/datablog/2010/apr/25/tax-receipts-1963
Still for a Conservative it probably 'felt' different.

Nick,
As you have made this a party issue by reference to 'caring, compassionate, conservatism', I mention by way of balance that, not so long ago, New Labour were threatening PCTs with bankruptcy and forced them to make severe cuts to get back in the black.

No78 Andyc555.
The policies pursued by Thatcher did not seem to do her much good. You will recall that the people that knew her best, Tory MP's, stabbed her in the back, booted her out and stamped her out like a beetle.
You may also recall that the two ex members of the thuggish Bullingdon Club, now residing in Downing Street, now often referred to as 'Hackers Haven' a short time ago were boasting about matching the last government's spending plans. If that is true, with all other things being equal,would the 'shambles' have been the same?
Do you have any view on the reason why the army of politically thick Tory bloggers are out in force on this issue?

Its pretty irrelvant whether you believe Britain is a high taxation Country or not, the situation is that we are spending more than we earn as a Country. During the Labour years taxation direct, stealth and NI went up and very little improvement was seen for the money spent. Certainly growth was not evident as the money was spent in the public sector.

The high earners have already seen the introduction of the 50p tax and loss of their personal taxation allowance. 2011 will see the pensions grab on these people, as well, if the Government does not see sense. Therefore those who create wealth in the private sector will begin to leave the Country, as they are doing already, stop any expansion of their business, creating jobs, not enter into any enterprize which is subject to tax and cut their hours. The net result will most probably see less taxation collected. High taxation has been tried before and has proved to inhibit growth in the private sector, the very thing needed for recovery in our economy. Even if the high earners are taxed to death this will not touch paying down Britains debt. Labour introduced the 50p tax out of spite rather than necessity, knowing it would appease some of the public and increase their votes at the time of the election.

The situation the Coalition have been left with, by Labour, is either to allow taxation to drift upwards for everyone, knowing full well that growth will elude them. Knowing full well that Britain will still be spending more than it earns and evenually a sea of debt will bring the Country down. Or they make cuts and some tax rises for all.

A quick sharp shock to the economy by massive cuts would probably be best, this would be very painful for all, but would see growth return pretty quickly. The direction of travel should be to get taxation down for workers and business, so that people have more money to spent in the economy and business expands and comes and stays in Britain.

As it looks at the moment, the Coalition have decided on this half-way house which will mean neither cuts nor growth will probably be successful, leaving the economy flat. This is most likely out of fear of the publics reaction to the measures needed. However the Lib/Dems and Conservatives should have set out the need for harsh policies before the election, so that the public did not live in denial. However as we all know, if they had, they would never have won the election.

No84 Suzie.
Another post of hilarious absurdities.It is clear that you have learnt very little in the last few months. Have you considered evening classes?

#67 Sagamix
#71 Strictlypickled
I agree with Sagamix that the ratio of spending cuts to tax increases needs consideration. Although my understanding is the the ratio is 3:1 (or more accurately 3.5:1 rather than the 4:1 quoted.
However before we get to consider that conundrum, should govt not be first considering what services need to be delivered, then how can the necessary services be delivered to achieve best value for money and only then calculate how the efficient, necessary services can be funded from taxation. Surely there should have been a Comprehensive Spending Review last year?
One problem with taxation as I understand it is that the huge sums that might be required can realistically only be raised by increasing VAT or Income tax and NI (or both). We know that a further increase in VAT from 20% will be most unwelcome, will attract many cries that the less well off are affected most, and that it is likely to reduce demand and could trigger the dreaded double dip. Whilst an increase in taxation (probably aimed at the highest earners)may be the only alternative, we should recognise that the higher paid are those best able to legitimately avoid paying more tax. So the scope to bring in significant additional revenue may be very limited in practice.
Yet this needs to be balanced against the job losses that will likely occur in both public and private sectors.

"That's the measure of the shambles left by Labour." - Andy @ 78

This is Conservative political narrative - the root cause of our "shambles" was deficit spending under Gordon Brown. It's not true. Going into the banking meltdown and credit crunch, we had debt at 43% of GDP and the deficit at 2.8% - nothing to write home about, but fair comment to say the comfort of the position was overly reliant on growth continuing at the levels we'd got accustomed to. Also fair comment to say the public spending was needed and mandated; albeit too much late splurge and a reluctance to tax enough to pay for it there and then. This is where we were - not in any sense a crisis. Absent the global crash (to which Labour policies were not a material contributing factor), it's where we'd still be.

Susan-Croft @ 84 wrote:
A quick sharp shock to the economy by massive cuts would probably be best, this would be very painful for all, but would see growth return pretty quickly.

>>

Can you cite any evidence to support your view that sudden massive cuts would simulate growth? An example or two from the past, please.

Given that GB ordered the 2 carriers nowing that there was no money left was this not one of the greatest sinical act of the last regime at N10 , leaving to the next to have to make the painful decisions ?

IPGABP1 85

Ok Scouter instead of shouting from the sidelines let us hear your way forward for the economy. You see Scouter, the problem for you is this, it does not matter whether you are Labour, Conservative, Lib/Dem or a monkey, Britain is in debt spending more is not an option, there is no more cash. Going over the past such as Thatcher is not going to change a thing. Insulting people is not going to change anything either, you are just shouting into the wind.

You are the past and I feel sorry for you.

No88 pdavies,
Evidence from Susie? Are you joking?
She probably thinks manuel labour is a Spanish waiter.

pdavies 88

I have already explained how cutting helps growth, read the post.

Furthermore the G20 nations decided to cut the deficit because they came to the conclusion it was inhibiting growth. Unless you have had your head in the sand, as you obviously had over the subject of what happens in surgeries in Britain, you will know this. Also Countries which adopt flat tax see much more growth, look it up for yourself. Stop living in denial.

Other than that thank you for your contribution, which was the way you treated my post, because you did not want to acknowledge its contents.

"the tories a short time ago were boasting about matching the last government's spending plans. If that is true, with all other things being equal, would the 'shambles' have been the same?" - 83

It's a "Yes", isn't it? This is the point that, perhaps above all others, shoots down the "clearing up Labour's mess" narrative. Reveals it as politics and nothing but. Just pre crash (with our fiscal position as per 87 above), the Conservatives were in agreement with spending levels. Since they are not the most natural of tax raisers it follows that they were comfortable with the debt/deficit at this point. It further follows that it's recent events (the banking meltdown and its ramifications) which have caused the acute concern around our public finances. Very few people would argue that Labour policies were responsible for the global financial crisis (indeed most accept they handled the post crash scenario well), thus we arrive at our consensus conclusion: the "mess" is not a Labour creation.

Susan-Croft @ 92

I was specifically asking for an example of a country which made sudden massive cuts of the kind you advocate and by doing so, stimulated growth. Can you give one? It's a pretty straightforward question, no need to go round the houses with flat tax rates and doctor's surgeries

If you can't give one, just admit it.

"the situation is that we are spending more than we earn as a Country." - 84

I was working on this one, Susan - pls see 45 - and now here you come trying to steal my thunder. Only fair for you to tell me how you've done your calculation (for the country, I mean, not the government) so I don't end up reinventing the wheel. Don't need your exact numbers (I'm not one of those tiresome auditor types), just your broadbrush methodology would be fine.

IPGABP1 91

Rather a silly post from you Scouter considering you reckon you know the way forward and do not need any input from me.

I am still waiting however for your way forward for the economy.

87 sagamix

An hilarious post hoc analysis by sagamix and exactly why Her Majesty's Loyal Opposition will remain on their side of the house for some time to come.

This is like saying you'd be phenomenally wealthy still if house prices had kept on rising and you hadn't lost your job.

You have to prepare for the unexpected and newlabour carried on spending, adding to PFI, increasing the public sector workforce, increasing salaries in the public secotr, increasing the public sector pension liability without a care in the world for how it was ever going to eb paid for.

This is before the multiple restatements of whne exactly the business cycle began which was just another fudge for spending more money.

If you want a proper analysis of the state of the national acounts after ten years of Gorodn Brown you need to look to Alistair Darling who was truly horrified by what he found was bequeathed him.

Socialists never learn that money does not grow on trees.

If you want to carry on spending and refusing to acknowledge the deficit then you are welcome to Greece's interest rates of 11.75% - still not coming down despite numerous attempts by the Eurozone to calm troubled waters.

It's all very well trying to speak the language of Beelzebub to the electorate by wooing them wioth this talk of giving us another go with more spending not cutting but it won't work econmically and it didn;t work politically.

As for you ludicorus prior assertioon that nobody voted for the coalition; this is as absurd as they get. 60% of votes were cast for the coalition now in power. As I remember the tories had posters in January saying 'We'll cut the deficit not the NHS' and Nick Clegg spent all his three debates telling us that no-one was being straight about spending cuts. Anyone who seriously believes they have not got what they wanted can only be a newlabour voter. That's you, I believe - one of the 29% who voted newlabour. That's 29% down from 35% in 2005 and 35% with which you 'governed' the UK for 5 years.

I find it hard to argue with the coalition's 60% because they are truly more representative than any government we have had for more than fifty years. And therein lies the rub; they just don't represent you.

It's a great time to be a tory...