People would be happy to pay more tax if it went directly to the NHS

Why not realise that at one level, the issues facing the NHS are purely down to numbers?

Austria has twice the number of doctors per capita than the UK.

To spell out what this means - in Austria there are sufficient doctors to meet the demand, not only of those who need to see a doctor, but also the mythical "worried well" who some people are keen to blame for the NHS waiting times.

To make it even clearer - it is possible to see a GP simply by walking in and waiting for maybe 20-30 minutes. Occasionally there is no waiting time at all. GPs open early in the morning on some days - and on other days stay open late into the evening.
People are entitled to an annual healthcheck - a sort of MOT - and the GP spends 20 minutes talking them through the results and discussing any next steps such as medication, referral to a Consultant etc. Waiting time for a Consultant appointment is a few days. Waiting time for surgery is a matter of weeks, not months.

Healthcare is funded through mandatory deductions from wages, plus contributions from employers - so very similar to "National Insurance". Rates are not much different to what is paid in the UK.

This is surely the level of service that a modern, wealthy country like the UK should be asipring to. That it has not been achieved is not just down to any NHS inefficiencies. It is also down to mismanagement and poor decisions made by the politicians - and ultimately down to the voters who continue to vote for a party that openly declares that it believes that public services are a drain on the economy and that their donors and chums should be allowed to cherrypick the public services that they want to run for a profit, and fleece the taxpayers and population in order to maximise these profits.

We have a lot of people mostly women working long hours in insecure jobs just to keep their family heads above water. These women aren't going to get time off work in the middle of the day and they won't be able to afford a fee. So they will just go without medical care

Yes i do understand that BUT surely the solution is to reduce waiting times?
have better preventative health care measures/information and more, far more, Minor Injuries Units?

I think that trying to discourage people to use GPs etc is, in the long run, going to cost far more.

In regard to your observation on someone with a cough, who is to know that he isn't coughing blood and/or get chest pains, maybe he is weeing himself when coughing... we just don't know!
An overheard conversation in a waiting room is hardly conclusive.

Btw i'm all for home remedies but (anecdotally) having known two GPs for many years, the "worried well" are a very small proportion.
the big issue for the NHS is an elderly (and growing) population, with long term complex needs, my in laws kitchen table after a prescription drop off, looks like the back room of a pharmacy!

Why not make early hours and evening care appointments bookable for a fee? Then the elderly and worried well could turn up and take a ticket in a day time queue as their time has lower/less/limited economic value/work impact.

@Alexandra2001

This is not about being stoic or soldiering on as some kind of martyr. It's about time and money.

Whilst most parents would of course be willing to wait for however long for healthcare for their children, when it comes to themselves it is different.

There are lots of parents who simply aren't able to wait 6 to 9 hours in A&E - who will pick up the children, who will feed them etc. Also in many jobs if you don't work then you don't get paid.

I just can't understand why so many posters think it is wrong for someone to have to pay say £5 for a GP or A&E appointment but it's OK for someone to lose a day's wage of say £100 because of the waiting time.

So that is why someone might choose to strap up a broken toe themselves rather than wait 7 hours in A&E.

@izimbra

Own company, 3 DC and wider family in a different country, so no support.

But I think the same principle on time would apply if I was working on a zero hours contract on a low income. There are a lot of people in employment where if they don't work then they don't get paid.

Having a system where a GP appointment costs say £5 or £5 for A&E would make a difference on demand and it doesn't have to be a large fee to make a big difference (as we saw on carrier bags). Psychologically when it's your own money you are wasting if you don't show for an appointment, then people really do change their behaviour.

The last time I was waiting in a GP with my DC, I overheard a conversation by an older man explaining to someone he knew that he was there because he had had a cough now for nearly a week and thought well it's better to get it checked out and be on the safe side.

I thought to myself that if that was me then I probably wouldn't have gone to the GP (or at least wait a month). But equally if it's free to access your GP then logically he's right to be on the safe side if you have the time and can afford to wait.

In which case with a free at the point of use system all you have done is create a healthcare to help those who can't afford to pay at the cost to those that can't afford the time to wait.

Yes and i'm not belittling the amounts but the costs per year, are in NHS spend terms, small, £2 billion of a £180 billion p.a dept budget.

To put this in perspective, this country is in debt by £2.5 trillion, had these hospitals been paid for by borrowing, we'd still be paying it all off, with high interest charges instead.

Looked it up -

The NHS has so far only paid around £25bn of the £80bn expected total cost of PFI since it was first introduced in 1998, less than a third of the final price. With just under £55 billion further to pay, the NHS will continue carry the burden of PFI for decades to come unless action is taken, according to the report

2019

PFI spend? is approx 2 billion in regard to the NHS, so less than a weeks worth of spend.... not insignificant but equally not a game changer.

Plus the critics of PFI are unable to say how the NHS would manage without these new hospitals nor can that cay how they would have paid for them?
Borrowing or tax rises? both of which have long term negative effects as well.

The slashing of NHS mtce is one reason why NHS productivity is lower than pre pandemic, can't treat people if the building is falling down...

Given your figures I wonder how much PFI mark up to private sector is in comparison

It was and still is billions

In the U.K. we need to improve schools by admitting some behaviour is unacceptable - DCs who cause trouble go to some other schooling sydtem this costs money but overall education would improve - I think we have a self esteem problem in the U.K. -good education for all would improve this.
Good self esteem would help improve self care and diet.
Our class system is partly the cause of this.
Second, Gov gets out of the pockets of supermarkets and enforces healthy food availability , subsidises this and farmers not crap.

The waiting lists for palliative care are very long, most patients never get near a Hospice.

35% of people referred to an urgent diagnosis, wait longer than the the 2 month max waiting time........ just imagine being told you ve stage 1/2 cancer, waiting 2/3 months and then told its now stage 4? (which happened to my former line manager) he even had a further wait as they ran out of the chemicals needed for the 2nd phase of treatment.

This means they are far more likely to need more aggressive and expensive treatments plus of course more likely to die.

Thankfully, whilst MN seems to be against having a properly funded healthcare system, the polling across the UK is very different.

...yeah so you cannot get your shoe on, the impact has not only broken your toe but damaged tendons and a further fracture higher up in your foot.
You soldier on and 6 weeks on, now walk with a limp, you now go to AE or GP and find the true extent of the damage, they stick you on a 18month waiting list to have the foot operated on....... well done you!!!

.Alexandra2001 no I wouldn't stop palliative care.
In fact I'd be start it much sooner in many cases. Thats the point.

Judge J

Has the management structure of the NHS changed markedly and become more top heavy since 2010 when it was functioning at least adequately?

And what's your experience of management structure in healthcare systems in other countries, for comparison?

And lastly - healthcare experts agree that NHS funding hasn't kept pace with growing healthcare costs or the growing healthcare needs of an ageing population. So why are you allocating blame for current NHS struggles primarily to the management structure and not to the acknowledged inadequate funding?

What's your job?

I agree @JudgeJ

What the NHS needs most is to take a long look at how they spend the money they have, especially the top heavy management structure and some of the ridiculous job titles.

@izimbra

"This is absolute nonsense.

People wait in A&E when they have to. I've done it, as has every other working parent I know. "

So let's say you stubbed your toe on a piece of furniture tomorrow morning, it's gone purple / black so let's assume it's most probably broken.

Would you go to A&E for it or just strap it yourself?

I know I would strap it myself because I genuinely couldn't find the time between work and childcare to wait 6-9 hours in A&E.

@Motheroffourdragons

It's to separate the previous poster's post to the response, so the reader doesn't get the two mixed up. But I guess the quotation marks should do that anyway.

This is absolute nonsense.

People wait in A&E when they have to. I've done it, as has every other working parent I know.

"Spending more money on the NHS will not prevent people from going to A&E with sunburn or going to the GP with a cold"

There have always been people misusing healthcare services. It happens in every healthcare system, particularly when people are struggling to access primary care, or are dealing with significant mental health problems.

But this pattern of use didn't always result in vast numbers of people spending days in A&E seriously ill and unable to access treatment or a bed.

The situation in A&E is absolutely dire because of a whole load of things connected with problems in wider social care, as well as things like austerity cuts to addiction services.

Example: 25% of mental health beds have been cut since 2010. You now have a situation where severely mentally ill people suffering from psychosis will be sometimes spending days in A&E on one to one care while an HCP tries to find a mental health bed for them. This is also a huge problem for the police, where you can sometimes get two police spending an entire shift supervising a violent mentally ill patient in A&E when staff can't find a mental health bed for them in an acute unit.

It's an absolute sh*t show.

https://www.statista.com/statistics/283221/per-capita-health-expenditure-by-country/

Suggest you have a look at this.

These are 2022 figures for healthcare spending by country - public and private.

Public spending on healthcare per head UK (in dollars): 4479.
Private healthcare spending per head UK (in dollars): 1013.

Public spending on healthcare per head France (in dollars): 5510
Private healthcare spending per head France (in dollars): 1006.

We already spend similar amounts on private healthcare as many of the other countries you probably hold up as a model of a great healthcare system. What we don't do is spend as much public money on healthcare as many other countries - and that's a problem because we have the fourth most overweight population in Europe and very poor public health.

@1dayatatime "The NHS is one of the very few publicly funded healthcare systems in the world. The majority use some form of combined private / public healthcare insurance system where you often have to pay something for an appointment or operation."

This is simply not correct. While revenue is raised through taxation in the UK, most European healthcare systems operate on a similar basis.

In the UK funds for healthcare come from general taxes and National Insurance. In Scandinavia the system is broadly the same - healthcare finance comes out of the general taxation pool, be it income tax, VAT, Corporation Tax and various other taxes and duties.

In Germany and Austria, healthcare provision is paid for through "Krankenkasse" - mutual insurance funds to which contributions are compulsory and which are paid by employees and employers. The major difference between this system and the UK system is that the money in the Krankenkasse is ringfenced for healthcare and social care. The unemployed and others not in work (students, carers, pensioners etc) have their contributions covered by the State, which also makes up any shortfall in the finances - i.e. the State ensures that as incomes and GDP rise or fall, there is always enough money in the system to pay for the healthcare provision. Some other European countries operate similar systems.

In all these countries, healthcare is free at the point of delivery. Patients do not pay for appointments or for operations - nor do they pay any proportion of the costs.

Without a nominal charge, demand on accessing the NHS will always outstrip supply no matter how much money is put into it. And all you do is regulate access to healthcare by the ability to be able to queue and wait.

That simply isn’t true. The NHS wasn’t perfect but it was light years better in the decade before 2010. Demand outstrips supply now because there are huge backlogs and no plan to tackle them.