To think the time has come to abolish the NHS healthcare model

In your opinion funding isn’t broken. And yet clearly it is.

Please explain how this clarity is manifested.

In your opinion funding isn’t broken. And yet clearly it is. You believe that there can never be ringfenced funds. And yet other countries have systems that do ensure ringfenced funds and long term security. Why are we not entitled to the same? Why not learn from what works. To willfully chose not to is either arrogance, ideology or ignorance. Or perhaps, just afraid of change. I have sympathy for the latter…but none of the rest.

I gave up smoking in 2005 Last time i bought a pack of cigarettes they were £3.65 I have no idea what they cost now but i do know a few hardcore smokers who for constantly increasing the price has made no difference

I fully agree. I was just making the point that increasing the cost of unhealthy food won’t change behaviour of those either with money or those using food banks. I agree far better health and lifestyle teaching is needed in schools, but I also think schools need to improve their piss poor teaching of DT too as it often puts people off manual skilled works and trades.

@taxguru regrettably the food banks have to provide food that keeps and that tends to be tinned meat, fish and veg, and of course beans but probably baked. They also have no idea of people's individual cooking skills.

Personally I would prefer schools to support learning around money management and cooking rather than the obsession with art and DT.

A good start would be a higher rate of vat on fast food, takeaways, crisps, chocolate bars, fizzy drinks, pies etc. Plus remove zero rate vat on cakes and other high sugar, high fat processed foods. Only keep zero rate vat on basic foodstuffs such as fruit and veg, raw meat and fish, bread, milk and cheese, etc - basically perishables only, anything that needs to be stored in fridges or at lower temperatures is zero rated. Make healthy options cheaper than unhealthy.

Of course, the public won’t stand for that. Just look at the pasty tax fiasco where a perfectly reasonable suggestion of vat on Cooling pasties was suggested. Had to be overturned because of the backlash.

Anyway, when food banks are happily handing out high fat, high sugar, heavily processed tins and packets full of additives and preservatives, any vat increase won’t change behaviour will it, because the food bank users aren’t paying, so maybe better to ban food banks from handing out the crap heavily processed stuff.

Regrettably that isn't the case @FixTheBone. I have severe osteoporosis, probably arising from a combination of genetics and severe and late diagnosed Graves in my late 20s, six fractures in six years. The optimal treatment is teriparatide daily injections for two years at a cost of £2,400. Nice guidelines do not allow it because I am under 65. I had to pay. Admittedly insurance didn't pick it up either. It had a significant positive impact.

Re the graves I want to the GP three times in 18 months feeling rotten. Three times I was dismissed. Eventually my lower legs swelled and the HR person of the bank I was working made me an appointment with the company Dr. 24 hours later I was diagnosed and on my way to a specialist as there were concerns for my heart. The NHS did not then offer sub total thyroidectomies to women planning families. The optimal treatment was available privately.

I could provide a longer list.

If, on the other hand I had a BMI of 35 due to gorging on pies and donuts, the NHS would fund weight loss drugs.

Thats the point of national insurance though, it spreads the cost. Some people on minimum wage will never use the NHS and some earning millions will require treatment that even their hefty tax contributions wont have fully covered.

The point is, that the NHS probably only gets a fraction of £2500 to provide the treatment you had, plus they have to provide it at the same price for everyone else regardless of their comorbidities etc, essentially at a higher cost.

I think you'll only see the value in the nhs when you need a treatment that either isnt available, or that yku cannot afford privately...

I completely agree with you @Nsky62 . Ten percent of the NHS budget is spent on diabetes, mostly type 2, which is mostly related to obesity.

The question is how to motivate fat, and sugar are addictive and carbs are cheaper than lean protein, esp meat, the alternative is pulses.
Some have brought up with parents that over fed, and see it as normal , portion distortions is real

Thank you @JenniferBooth .

Ok fair enough.

If you are thinking of me @JenniferBooth , I would like to make peace with you. We've clashed politically on threads but you always hold your ground with good arguments, and given the situation you described elsewhere, I am better able to understand and respect why you hold those opinions. My experience is different. But .... pax?

Marking this thread ready for the next time someone moans at me for bringing up someones irrelevant posting history and it wasnt even accurate here Seems some can get away with it and some cant!

@FixTheBone I pay far far more than £2,500pa for the NHS. There have been years when our tax bill has been £250,000. In addition I pay £3k for AXA. Via AXA I get efficient, helpful service via the NHS I do not. We aren't all paying 20% or receiving benefits you know.

Agree with every word.

Wonder why if you pay £2500 for something you get happy staff and good service, but if you try and provide the same service for less, it isn't as good....

I recently paid for private surgery, around £2500 including general anaesthetic (day case). I could have it done on the NHS, but the waiting list was over 3 years as although my condition was painful, intimate and embarrasing, it was not life-threatening and so there is a long wait.

So, I saved up - and sacrificed holidays and treats for over a year. I appreciate not everyone can do this, and I'm certainly not rich - average income, not the eye-watering amount some people on MN earn! But I made savings here and there because I could not put up with it any longer.

All done and dusted in less than four weeks!

Week 1, phoned up the private hospital, who e-mailed me a quote next day and a phone number to choose and book the consultant. Week 2, saw the consultant, arranged the surgery for 'the week after next'. Week 3, pre-op clinic appointment. Week 4, surgery day after a bank holiday, done by 3pm.

The irony is that ALL of the staff who looked after me also worked for the NHS. The admin was superb. The accomodation was first class. I was spoken to politely by everyone. I did not have to wait for my prescription, and I had a follow-up appointment two weeks later at a time of my choosing.

No involvement with a GP, who weren't interested anyway ... I'd do it again in a heartbeat if I needed to.

And choosing pensions, another area we fall behind much of Europe, to make the point is laughable.

I didn’t “choose” pensions, they’re literally the only public expenditure with a clear link to NI. No I don’t think it’s sustainable for a healthcare system to operate without long term certainty of funding but your suggested funding model would be no means more certain than the current one.

There will never be ringfenced funds for anything. Decades ago Brown massively increased tobacco duty, promising to ring fence it for the NHS, if that ever happened I bet it doesn’t now.

We should have a better healthcare system and we need to recognise that it requires reform of delivery and the funds to make that happen. The difference between your view and mine is that you want to meddle to fix something that isn’t broken. I want to focus on what is broken.

Well, I fundamentally disagree. Of course there needs to be a link. A properly funded healthcare services needs to be sure that it has ringfenced funds sufficient to provide the needs of the population. And choosing pensions, another area we fall behind much of Europe, to make the point is laughable. Do you really think it’s sustainable for a healthcare system to operate without long term certainty of funding?

If you bothered to understand how other countries do things perhaps you could see beyond the blue and white NHS borders. The role of politicians in healthcare is to ensure that there’s a system that works, and the needs of the population are met. It’s also to set broader policy. It’s not to arbitrarily set budgets based on short term political whims. People who actually know what they’re doing can then work out how much money is needed to fund it, and then politicians can influence where the burden of that cost lies, through the use of varying social insurance contribution scales. The horse trading takes place at that stage as to politically where they want the burden to lie. Because it’s ringfenced they can’t use sleight of hand to use the funds to prop up their own pet projects. The health are system then has medium and long term certainty over funding. The population has certainty, confidence and a choice of where to go for healthcare. And they get better outcomes. Honestly, it’s not that difficult to understand. I’ll ask again, why are we not entitled to a better system?

But, the funding model doesn’t work because there’s no link between NI and the funding for the NHS

There doesn’t need to be. Public services are paid for through a variety of taxation sources. Pensions aren’t paid for by NI, despite the link with qualifying contributions. Quite honestly there would be little point in having politicians if they had no jurisdiction over public spending - do you think politicians in all the countries you use as exemplars have no say in health administration?

To avoid further mistakes, can you please explain why you think the funding model works?

Ah well in that case I apologise. You have been a staunch defender of everything NHS, knocking everyone’s criticism of it so I assumed you were happy with the delivery model. My mistake. But, the funding model doesn’t work because there’s no link between NI and the funding for the NHS. It’s entirely notional, and subject to political meddling, as seen by the recent cuts in it by Rishi, and the abandoned social care increase that preceded it. What NI raises has in no way any ring fenced funding for healthcare. It all comes out of the general tax pot. A proper social insurance scheme is ring fenced funding that can’t be meddled with constantly by politicians.

I come back to the same point. Other countries do it differently, and they do it better. Patient outcomes are improved. Political interference is less. Why are we not entitled to a better system? Is it because the bristish just don’t like change? Or is it old school British arrogance, against all evidence, that the NHS is a better way than most of the rest of the world. I reckon if it was, at some point over the last 70 years more countries would have copied it. And they haven’t.

We won’t sleepwalk into anything if the we stay true to the basic tenets on which the NHS is formed. Start fucking with the funding model and there will be no service left at all in the wake of years of chaos.

We cant afford Not to upend the funding model! Otherwise we’ll sleepwalk to the USA system.