Don

The figures are to within a couple of percent NAO figures and having chaired a board spending a representative chunk of it, where budgeting is based on public health input of need, I'm not sure it's a debating point, just a raw fact with no spin.

What is management cost? How do you split it? Hospital doctors are paid in sessions, some of which are admin based. So 10% of doctor salary are part of your bureaucratic management. In year one of our trust, our director of public health had his salary classed as clinical. The Treasury changed the rules and come year two, his salary was based as management, despite still spending the vast majority of it as a consultant.

When GPs were asked to help run The NHS, ( not the new health bill but the PCTs which originally were GP led in decision making) if you had a GP spending a day a week being a clinical decision making lead, you lost 20% of his clinical time and advanced management overhead by 20% of his time, all of which goes into the figures you allude to.

Let the doctors and nurses run things? Yes, it sounds good and is good. But less clinical time means more management time, you can't have it both ways. NHS trusts are beginning to crumble and patient care is starting to be compromised because back room functions are falling victim to the cuts. It sounds great to get rid of clip board merchants but that process, despite successive ministers wanting to take the credit, has been going on for some time and many unnecessary tasks are long gone, so now the cuts to meet the £20B savings are starting to affect patient care.

£100Billion is a lot of money to administer, and there is a point where not enough people managing it is as wasteful as too many.

Trevor, rereading my comments, I accept I went for the jugular and that isn't always my way. I apologise for that. That said, NHS funding does not rely on perpetuation of life compromising purchases such as tobacco or alcohol, nor indeed poor dietary food. The figures (available on Royal College of Public Health website) show the small increase in Treasury receipts is dwarfed by the huge increase in problems.