Expenditure is in the news, particularly on Social Care. Two years ago it was predicted: now it is reality ( “Unsweetened medicine” on in economics 5th Dec 2014). InKick-starting the economy, particularly the economy in Wales or Scotland is not easy. NICE which has technically been rationing since its inception, may have to reduce it’s cost effectiveness thresholds if the chancellor has it wrong. Their work has also been undermined by the “cancer drugs fund” (Sarah Boseley in the Guardian 5th Feb 2016: Government has no idea about Cancer Drugs Fund’s impact, MPs say ).
Crossing the line (BMJ2016;352:i1336) written by John Appleby makes it clear that if the chancellor is wrong the “threshold” for “Quality Of Life Years“ might have to be reduced.. His graphics on rationing are at the foot of this post. Rationing by exclusion – but covertly is happening now, but it is addressing high value low volume items. NHSreality wants the nation to address low value high volume items as well.
But income is stagnant or falling and as (arguably more) important.
So we have a deficit. And Social Services takes up more than Health in the first graphic. Savings there are important.
There are complex rules for disabled people getting funds, and their interpretation is different in each region (Post code rationing), especially in dementia care:
The future planned by the chancellor on receipts and expenditure depends on a working population, and in the poorer regions this amounts to public servants. The Greek solution over many years was to appoint more public employees to get short term PAYE tax receipts. Tax avoidance by the self employed and the private industries is an impossible problem there:
The jobless total is falling and the accelerating slope of the curve since 2011 is impressive.
So will “Quality Of Life Years” value index need to be as changeable as the budget? John Appleby’s graphs are below. If we don’t produce, or expand the economy we should all know what will happen. In parts of the nation with highest unemployment votes will go to those who promise more benefits and the nation gets more and more polarised.