"3-5% of people are responsible for 39% of our spending."This is your NHS folks. The statistic comes from Bradford's three Clinical Commissioning Groups at a meeting today. Dwell on that statement for a second or two - here in Bradford just 15,000 or so people use up 40% of the money we spend on health care. Out of a population of 500,000.
There are lots of reasons for this situation and for the continuing pressures created by expensive treatment. Most of those 15,000 are elderly and in that stressful and traumatic end-of-life situation. Nobody is saying that we shouldn't spend the money we spend on that treatment.
What bothers me is that, time and time again, I'm told that the answer to this concentration of costs is to shift money from acute care into 'prevention' (or 'Tier 1' in the jargon). This is lots of jolly and cuddly stuff like fat clubs and smoking cessation clinics plus a whole panoply of annoying fussbucketry wrapped up in a thing called public health.
Think about this for a second and you'll realise one of two things:
1. This fussbucketry and huggery doesn't make a blind bit of difference. The money is wasted but also loads of people are irritated, businesses are shut down and products banned.
2. The fat clubs and advertising bans do work and people live longer. The money wasn't wasted but we still have to spend loads of cash on that end-of-life stuff. We just do it at 85 instead of 75.
For what it's worth (and this being the NHS it's worth a fortune) there is pretty much no evidence at all that tells us 'Tier 1' investment works (except in the economic sense of price hikes, bans and other restrictions impacting consumption). Yet we continue to spend millions on this - something like £10 million in Bradford alone - while moaning about bed-blocking, shortfalls in social care funding and hospital overspends.
Scrapping this sort of public health spending wouldn't solve the problem of funding care and the NHS. But it would be a damned good start.