There have been no cuts in NHS service. Sometimes I think I need to assign this to a keyboard macro because it's such a frequently repeated myth. The NHS has more funding now than it's ever had, it has been explicitly protected from budget reductions when every other government department has seen massive real cuts, and just last year has been given enormous spending boosts. NHS "cuts" are a bit like the gender pay gap - they exist only when statistics are abused to meet political and ideological agendas.

Or, you could equally ask why Germany and the USA seem to spend so much on healthcare. After all the UK spends about average for the OECD. And the USA spends the most of all by far so it should barely notice COVID-19 compared to other countries? I guess we'll see.

Addenbrookes Hospital in Cambridge (technically Addenbrookes Hospital Trust, comprised of several hospitals on one site) is the largest hospital in the UK. For the tax year 2019/2020, the available budget for capital expenditure (building, large equipment like MRIs etc.) was £0. (accurate prior to Covid-19)

Occasionally as a result of political manoeuvering (General Election campaigning) pots of money for very narrow purposes with a limited time window on them appeared, but in general things like ward refurbishments have been funded by charitable donations. Most worthwhile capital investments take more than a year, so a predictable capital budget is necessary to implement programs. Having no money for CapEx is not how you maintain a health service long term.

Yes, this is how such threads always go. It's a simple three step process:

1. Someone claims the NHS funding has been cut

2. I point out that's a lie, no such cuts have ever happened and in fact the budget has always gone up

3. Somebody else replies with: but it should have grown even faster.

The point I'm making is not about the correct level of healthcare spending, which is arbitrary and values-based as healthcare systems will consume however much money is given to them. Rather the persistent level of outright lying that accompanies any discussion of the NHS in Britain. It's absurd and quite obviously linked to a belief that misleading people is fine if it's for a 'good cause'.

But this behaviour has to stop. It isn't OK to lie even if the outcome might appear to be desirable (more political pressure for higher healthcare spending). People learn that they're being manipulated and support for the desired cause can collapse.

Having no money for CapEx is not how you maintain a health service long term.

I'll repeat this until I'm blue in the face. The NHS has more money now than it's ever had. Not only does the NHS have money for capex but it's been repeatedly allocated money specifically and only for capex, because NHS managers have a long history of preferring to divert spending on upgrades to other forms of spending - frequently salary increases.

It's bad management. The government attempts to combat this lack of forward thinking by earmarking of money specifically for upgrades (what you criticise here as "pots of money for very narrow purposes"). One of the first things Boris Johnson did is allocate a billion pounds to the NHS only for capex. Unfortunately it doesn't work:

https://www.hsj.co.uk/technology-and-innovation/exclusive-qu...

"Capital spending was particularly tight with only £150.3m spent from £354.1m of allocated funding ... funding to help NHS trusts to become more digitally advanced accounted for most of this capital underspend. The DH planned to spend £116.2m of capital on these trusts in 2016-17 – instead it spent nothing."

The idea the NHS doesn't have money for capex is just another piece of misdirection. It refuses to spend on upgrades even when central government is trying to force its hand, because it knows that the result is No 10 will blink and give up, which is what happens:

"The money was not allocated elsewhere but “as with all Department underspends, was available to offset pressures in other parts of the system”, she said."

Doctor and nursing salaries are pretty low in the UK, if management is diverting capital expense money to salary increases, they are doing a poor job of it.

https://fullfact.org/health/spending-english-nhs/

"Looking at the wider UK, the amount spent on health has been increasing over the long-term. That’s true whether it’s expressed in cash, cash adjusted for inflation, per person, or as a proportion of the size of the economy."

Population growth puts pressure on public services. The British people have been asking for reduction in population growth for a long time, partly out of concern for the state of the NHS, yet of course have been repeatedly denied by the EU and their own political classes. 4 years after voting to leave the EU largely to get a grip on the ever-increasing cost of public services they still haven't been allowed that.

Doctor and nursing salaries are pretty low in the UK

They're extremely high. The average pay for specialist consultants in the NHS is £120,000 or approximately 6x the average salary. This is dramatically higher than in say, Germany, where specialists earn 80,000 Euro on average. That's £71,600 or a bit less than 60%.

https://www.google.com/search?hl=en&q=average%20salary%20for...

https://www.medscape.com/slideshow/2019-uk-doctors-salary-re...

if management is diverting capital expense money to salary increases, they are doing a poor job of it.

They've done an excellent job of it. From 2010:

https://www.telegraph.co.uk/news/health/news/8206972/Billion...

"Billions of pounds spent on improving NHS hospitals has mostly gone on staff salaries while productivity has fallen over the last decade, a key National Audit Office (NAO) report has found."

"Between 2000 and 2009 the NHS workforce grew from 1.1 to 1.4 million - almost a 30 per cent rise. That included an extra 12,500 consultants, whose average pay rose from £71,900 to £120,900 over the same period - a 68 per cent increase. Doctors' pay rose by 48 per cent, nurses' and midwives' by 36 per cent and managers' by 34 per cent"

Health costs have been rising everywhere in the world and this has little to do with population growth (that's actually good because young people pay taxes), but more with rising life expectancies and the resulting average age. Every country has been experiencing the same trend (the US being an exception likely because of privatized healthcare): https://en.wikipedia.org/wiki/Healthcare_in_Germany and those country have pretty different population developments.

Also you are comparing a Facharzt salary to a consultant, that's not a fair comparison. You should compare to a specialist and look what do they earn in the UK? £40,037 to £74,661. https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-d...

That looks awfully similar to what a Facharzt earns (actually with the current rates the German earns significantly more more): 70.000 – 95.000 Euro https://www.praktischarzt.de/arzt/gehalt-arzt/

Please, just stop this. Departments asking for more money than they know they'll be allowed and then getting less is a universal truth of organisations, both governmental and corporate. It's called negotiation. Being given more money than you had before is not, and never will be, a "cut" in the English language. That word has a precise meaning and it simply doesn't apply here.

Likewise the NHS wasn't asked to find 20 billion in "cuts". That doesn't even make sense. You can't increase your own budget by reducing it. They were told that if they really needed that much they would be expected to find it through increased efficiency. Keeping a check on NHS waste is a key function of elected governments which voters expect them to fulfil, simply writing them blank cheques has been tried before and didn't work (as in costs went up, but healthcare outcomes didn't or didn't by anywhere near as much).

Health costs have been rising everywhere ... more with rising life expectancies and the resulting average age

And the NHS budget has been rising too.

Also you are comparing a Facharzt salary to a consultant, that's not a fair comparison

Alright, fair enough, then focus on the original statement - doctors and nurses get anywhere between good and extraordinarily good pay relative to the average salary in the UK. There are doctors in the UK earning significantly more than the Prime Minister, and their pay went up significantly during the last Labour government (not sure about this one, didn't look, but I assume pay inflation has been only slightly lower).

The point is that significant amounts of the money given to the NHS ended up being spent on increased OpEx like salary increases, rather than CapEx like capacity increases or efficiency improvements. Obviously the NHS must raise salaries at least in line with inflation, and really more in line with global healthcare inflation to avoid brain drains. But the idea its hospitals are run down because evil central government keeps cutting its budget is just far wrong.

Plus Britain is getting somewhat older, and somewhat sicker (partly because of medical advances meaning that previously-fatal conditions are now chronic and need ongoing treatment). And we can treat more now, so there is more demand.

Bluntly, the proportion of GDP which needs to be allocated to healthcare to maintain a good quality service is rising unsustainably in all countries. The NHS is beating CPI inflation (and in doing so doing way better than other parts of government: local government has seen >25% real terms cuts, which has trashed the social care system amongst other things) but not nearly enough to keep up.

If Germany have provisioned 5 times more ICU beds than they generally need, I can see why their costs might be higher

-Under provisioning for surges (not even Covid, even just a sudden emergency of another sort, a bad flu season, big accident, terror event, whatever)

-Going longer between maintenance intervals than is recommended

-Delaying ICU admission longer than is strictly recommended

-Relocating ICU equipment as needed more than other countries feel comfortable doing

-Using more reliable ICU equipment (does the German figure include any older and potentially less reliable gear in the former communist east?)

-Have less need among population for ICU

On the last point, Germany has accepted by far more refugees from MENA war zones than any other European country and I would not be surprised if this resulted in higher emergency medicine use.

Also a quick Google shows Germany is a bit older with 22% of the population over 65 vs 18% in UK.

None of this is to say Germany isn’t over provisioned but it is probably not 5X over provisioned, if it is.

However, let's not forget historical factors and was case of many countries having armies in Germany for legacy war reasons and that may well of seen the mentalities to have a higher number of such beds than most places.