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

Most of Europe has universal healthcare without an NHS. Australia has a tax incentive on private health insurance to reduce the burden on the state / BGS equivalent. There are a lot of different models to investigate and use as inspiration. None of them routinely leave people waiting 9 months for a 15 minute telephone appointment.

It’s actually been working pretty well since it was established. Established so that those with less money would still have access to medical help. Whilst there is always room for improvement, and it’s been severely challenged by covid and austerity, most of the time it provides decent healthcare that is free at the point of access and doesn’t provide different levels of care depending on wealth. Several people around me are alive today, only because of the NHS. Without it they would be dead. I’ve had excellent care and so have many people I know.

I work for the NHS and we provide a great service. I’ve seen the NHS go through changes over a period of 30 years and there are ups and downs in terms of how well we can provide services but generally speaking it is filled with highly skilled and knowledgeable people, working exceptionally hard to provide better and better care.

Even if you are privileged enough to be able to afford private health care, you still will need emergency services.

The problem isn’t the model, the problem is complex and not fixable just by throwing more money at it or ditching it all together, but by tackling the causes of ill health and building health and well-being. That is a multi level and complex endeavour.

One example: A huge amount of money is spent on avoidable diseases but to turn the tide on that would require much stricter controls on industry. Something the last government wouldn’t have done. May be this one will.

Are you implying that everyone paying for all their healthcare for all is better than providing free healthcare for all but with a few limitations on some treatments that aren’t judged to be cost effective?

Those countries are richer than the UK. Germany's GDP was over 4 trillion in 2023 versus over 2 trillion for the UK in the same time period. I have no doubt our government could make different choices with the money we do have - but just to say Germany is a significantly richer country

BIossomtoes trouble is now most of the service users aren't, obesity being one of the main causes of many avoidable diseases.

DadJoke,or simply go private.

The fire brigade is no use to you either. Until your house burns down.

I live in a European country, and can see a doctor quickly - i.e. simply by walking in to the surgery and on average waiting for 10-15 minutes. There are very short waiting lists for hospital treatment or for appointments with Consultants or for MRI scans etc - usually just two to three weeks from seeing the GP. I recently had a minor operation just 5 weeks from seeing the GP, with the entire process involving first seeing the GP, then a Consultant, then a follow-up phone consultation and finally the operation.

There are almost twice the number of doctors per capita here as in the UK - because the government and the population realised years ago that keeping people healthy and investing in health care (and social care) pays off in the end, so there has been far greater investment per capita than in the UK, raised through income taxes, "national health insurance" that is ringfenced for healthcare and from taxes on employers. Overall my taxes and deductions are similar to what I'd pay on the same salary in the UK.

A country like Germany invests the same per capita in healthcare in 3 years that the UK invests in 4 years - so every 3 years, the UK by comparison is missing an entire year's worth of investment. This has been happening for the last 20 years or more, but accellerated in the last 14 years as the politicians in power made a conscious decision to underfund the NHS. Remember, when politicians (of whatever party) say that the country cannot afford it, what they really mean is that they have decided that they will not make the required investment.

Goodness, you're a real charmer aren't you.

Be thankful that your genetics don't put you at a risk of cancer (like mine did). If it wasn't for the NHS, I would be dead as there is no way I could have afforded to not only pay for my cancer treatment, but also the genetic testing that revealed not one but two genetic mutations that resulted in me getting cancer before I was 50. And believe me, I looked after myself, and made all the so-called correct lifestyle choices - didn't smoke, drink, eat in excess, exercised regularly, good weight, low body fat etc. etc. yet I still got cancer.

The NHS needs fixing. Yes, that is undeniable. Get rid of all the layers of middle management for starters. But ditching it completely for an entirely different model isn't the answer. For me, the NHS has been nothing short of miraculous. I owe it my life and am incredibly grateful to have it, flaws and all.

Edited for typo

I will also say there are a lot of options to be seen by a doctor/Nurse practitioner. That isn’t a traditional setting.

A lot of our pharmacies have ‘minute clinics’ staffed by a nurse practitioner. Great for quick things that pop up at unexpected times. I used one with suspected conjunctivitis on a Sunday morning. Walked in signed in and had a script filled in the pharmacy. I think I paid $10 for the visit + a $10 prescription copay. All in I think it took an hour, including travel time. My insurance company has a 24/7 online service available (without copay I think). Great for those things you need taken care of but don’t want to screw around with an in person visit.

My husband works for the city and they have a walk in clinic for city employees + family. They save a ton of money in their health insurance premiums by offer this clinic staffed by nurses employed by the city anyway for community health. So free visits + free common prescriptions (asthma inhalers, antibiotics, birth control). A lot of employees use this for their kids school and sports check ups and repeat medications. Now his city is a little unique in this but a lot of cities run wellness clinics especially this time of year for back to school.

I always thought that was a really smart idea. My DH used them recently for a dodgy toenail… they tested for the usual things and determined it was likely an injury. They hooked him up with a podiatrist and week later he’s minus 1 toenail

All of these things relieve the pressure on doctors offices so you can get in when you need to physically be seen.

How much more would you be prepared to pay than you are currently paying?

From tax basically. We need total reform of the NHS with an absolute hard line on waste (yes rainbow lanyards and endless layers of management) and THEN a lot more cash pumped in.

A focus on primary and preventative care would help too, including massive taxes on junk food and obesity management. Type 2 diabetes is singlehandedly enough to bring down the NHS if it continues to rise.

From users - through social insurance. In addition to current taxes. That is one option....

Most of the countries that spend more are wealthier than the UK (eg Germany and Netherlands. Even France GDP is slightly higher than ours).. We need economic growth and increased productivity to invest more in healthcare or we need to get used to the current level of service.

Also wise to focus on healthier behaviours - which is in our control (for many people) - to reduce likelihood of needing the NHS

@HollyKnight

In France you do just choose your specialist and make a rdv. They are basically all self-employed, they don’t generally work through a referral system. It’s often good to see the GP first as it increases the level of reimbursement that way.

So I had an odd thing on my leg that was like a very weird mole. I went to my GP, showed it to him, he agreed I needed to see a dermatologist. He wrote a letter explaining my situation, and hands it to me. I then got on my trusty Doctolib app, find a rdv with a dermatologist that suits me (place, time, date). I trot along to the rdv at the dermatologist a few days later, hand over my letter, explain my thing. She decides it’s not serious but should be removed and biopsied anyway, so she just does that there in her surgery.

The dermatologue consultation and minor surgery costs €75. I pay upfront. I give my health card to the secretary. With days I am reimbursed the govt amount (about €40) and my mutuelle reimburses the rest.

Is that true wait lists, or the 'massaged' wait lists. I started in nhs in 2002, and remember being taught how to adjust the wait lists to make wait times seen shorter. A quick call by a clinical staff member to check a detail on the referral 'stopped the clock' and the patient was moved off the recorded wait list to a 'sub wait list', it looked like their treatment had started when it had not.

And where do you think the money’s going to come from? European countries spend far more than we do on healthcare.

I’m glad you like the analogy.

Tell us you don't understand the theory behind the Laffer curve, without telling us......

Seriously.

What shape is the Curve for the UK economy? Where is the apex? Where are we sitting in comparison?

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The NHS is broken. I would much rather have a Euro style health insurance system with affordable fees and better access to care.

We also need to finally fund social care properly. Anyone who has been in hospital in the last five years will tell you that wards are often half full of medically fit dementia patients with nowhere to go. It is breaking the NHS.

this is correct. No pre-existing conditions and there are a multitude of different insurances available so they are pretty competitive. In France there are really good value / subsidised ones for specific ‘trades’ - probably a hangover from the strong union movements. So there’s specific ones for teachers / farmers / post office workers / civil servants / administrators etc.

As for teeth - despite being a big cause of ill-health and also now affecting people's employability - the NHS system is well and truly broken.

As you can't even get a private dentist for many miles round these parts you can now start to tell who the poorer locals are compared to the better teeth of those moving here for a better quality of life (SW England).

And guess who is more likely to be employed for the rare decent jobs that come up?

@HollyKnight I should add that -as far as I know - the complementary healths insurances you pay for and access through your employer or voluntarily, have a completely different status to health insurance in this country. For example they can't refuse you, or charge you more on the basis of a health condition. They are more akin to the Welsh system of health insurance that pre-existed the NHS.

As stated in the quote I shared - indeed. And there is ongoing expectation that more will leave with changes to non-dom and a generally more hostile environment. So best to look in each other's pockets!

Then you will have to accept things are they are, sadly, and keep gently pushing with the powers that be.

For a start because your private insurance / private hospital almost certainly wont cover any serious emergency, or have intensive care facilities.

In fact many won't even cover complications of their own procedures. Hip replacement you had done last week infected or dislocated? Off to A&E with you for the nhs to sort out...

Post op heart attack or stroke, better call an ambulance...