Let me just say that managing a budget in NHS is not easy as the main component in a caring profession is the most unpredictable of every thing, humans. Budgeting around unpredictability makes it some what impossible as you just don't know what is going to come through the doors. We do need more money and things do need to change. I've set up costly medicines to give to patients that have agreed to treatment after every thing has been explained and they have given written consent to them changing their minds at last minute, the costly medication has then to be destroyed as once prescribed for a patient cannot be given to another. You can budget for winter only to find the weather has a big impact to the services on offer and staff may not be needed as patients cannot get to the appointments. The biggest waste can be when patients do not attend appointments and do not notify clinics so they can give appointment to waiting patients, this costs NHS millions as staff are waiting around and ancillary services, electricity for heating and lighting, etc wasted as are on for no one. Ambulances are inappropriately used, A and E are used for none emergency reasons when other more appropriate services like Pharmacy, Dentist, etc could be used. Budgeting is not easy as people's expectations are high. I'm not saying your sister is wrong, but what I am saying is that there is more to things than she has knowledge of and Yes I have worked for NHS for 40 years, including having to learn Budgeting.