Report details per head NHS spending

A new report by the Public Accounts Committee examined total funding for a area and calculated the amount invested per head based on GP lists. The Telegraph badly misquotes the report but the essence of it is that given a par value of £1400 per head:

The committee had found “huge variations” in funding with people in Corby receiving £137 per person [below par] compared to £361 per person  [above par] in west London.

If you had employed a doctor directly then that money pays for 46 hours of his time per year – an ample quantity – the problem is that funding really pays for all hospital care, all medicine, all surgery, all rent, heat light and power   for your GP office and the hospital,  and all staff costs at both sites too, presumably including their pensions and taxes. In actual fact your GP is paid about £80 for his labour and a selection of expenses excluding rent. Much less than the price of veterinary insurance for a hamster. If you are in an area with sub-par spending then funding for basic medical help is going to be squeezed unhealthily.

Libertarians do not often talk about policy, not of the kind you might put in your first manifesto, but it is my humble suggestion that patients should be able to top this up. Fortunately it is quite feasible to do that in the commercial or not-for-profit sector without modifying the NHS, and so without the need to win an election. You can register your interest in such products on this site.


  1. The Corby figure is wildly misleading (I know – I live only a few miles from Corby), there is no major hospital in Corby, people just go to Kettering General Hospital (they do from Wellingborough and the other towns near by also). Kettering General does not just serve Kettering – it basically is the only real hospital in all of north and east Northamptonshire.



  2. Talk of rates vs cost of living would help. West London property, rentals and staffing vs Corby, for example.

    Having a top up is a can of worms for some. Two tier service, you would hear them cry. And what if it results in a national flat rate, so another bias that national pay scales create,making Londoners not only pay more in, but have to pay again.

    On the other hand, a top up might be the Trojan Horse to advance plurality in the service.



    1. My policy ideas with respect to the NHS start with the assumption that no libertarian will get to change it before I am dead, so I am not suggesting a top up within the NHS I’m suggesting going outside it to receive a top up. So, not topping up a budget, topping up on services received:

      Of course it isn’t as simple as that because the NHS does not integrate well – it is ideologically opposed to private care and refuses to work in partnership with it. Zach Cope has written on that problem:

      How this latter problem is not an attack on the sick I don’t know.



      1. There may yet be scope for change in the NHS. Private provision of services is established, although they suffer from the Beauty Pageant fallacy – ie the best bidder wins the contract from a group of ‘experts’. In order to truly unleash the benefits of the market input from the end user as a purchaser of care is needed.
        It seems very doable at the GP level, with a free market in top up costs, and access to NHS services through private GPs or GPs that ask for top ups, but needs legislative change.

        The next challenge is how to focus the consumer preference, at the time the care is needed, on more expensive, complex care, rather than having to bundle up those decisions in a state or private insurer model.

        I keep threatening to release my views on this but being overwhelmed with work never seem to get a chance.

        The concept however is that an insurance system buys treatment options that the patient can redeem if they have the condition requiring treatment. There is a multiplier such that if a patient chooses the treatment costing 100% of the redeemed option, for example a standard hip replacement, they pay nothing. If they opt for a more expensive provider they pay a percentage of the extra cost only, and receive a percentage of the rebate if they opt for cheaper treatment.

        By making the insurers liable for a % of top up payments above the 100% value of the treatment, it ensures that insurers constantly try to set premiums to cover 100% treatments, rather than a race to the bottom for the cheapest treatments only. as they are penalised if enough patients upgrade their treatment at the time they need it.

        Throw in some cryptographic tokens to ensure there is no double counting of options, and the idea is that there will be greater assurance that the care will be available at the time it is needed. One way of funding this would be a mortgage at the beginning of the policy. If a mortgage company fails the houses aren’t taken from the mortgage holders – this would be set up in a similar way so the options to treatment remain with the policy holder.

        Hopefully one day I’ll work this through further but the fundamental principle remains:
        find ways to bring the current decision making of the end user into the market and the best outcomes will flourish.


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