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

@HRTQueen "I would prefer our health system is moved away from politicians making decision as its is always used as a political football"

While I can't disagree with the sentiment, one of the major issues is that the politicians most recently in charge of health and social care (Lansley, Hunt, Hancock, Barclay, Coffey and Atkins) made one bad decision after another, driven by a political view that keeping taxes low was a higher priority than treating patients and the health of the country in general. No country in the developed world has over 10% of the population waiting for an appointment or treatment.

"Labour are in a position to start these changes. Throwing vast amounts of money at the NHS did not work before it shall not work again and at some point we have to learn from past mistakes"

Compared to other European countries, the UK does not throw vast amounts of money at healthcare. The UK does not spend enough money to even keep the service running effectively, safely and efficiently on a day to day basis, and the underinvestment in buildings, equipment, staff, IT and facilities means that there is a backlog of repairs, obsolete equipment and systems and a shortage of every type of staff that can only be addressed by investing more.

I am aware of the vast differences. Changes can not be made overnight and it will take years to implement full changes.

It simply isn't working and has not been for a long time. Radical change has to be made.

I would prefer our health system is moved away from politicians making decision as its is always used as a political football

Labour are in a position to start these changes. Throwing vast amounts of money at the NHS did not work before it shall not work again and at some point we have to learn from past mistakes

Yes, there are doctors who cannot find training places which is the result of the last government's poor decision-making that has created a bottleneck but the NHS is currently short of nearly 11 000 doctors, a 7.2% vacancy rate. The vacancy rate for nurses is 10% - yet there are unemployed nurses and Trusts are having to lay nurses off (or freeze recruitment) because there is insufficient money in the budget.

Even if every doctor vacancy were to be filled tomorrow, the UK would still only have 31 doctors per 10,000 population - far lower than many other European countries. Austria has 54 doctors per 10,000, Germany 42, Spain 45. Belgium has 62/10,000 - i.e. twice as many doctors per capita as the UK.

@FixTheBone @havanananana Whilst I appreciate it may take more than 90 days to bolster resources, I don't think it should take 90 days to learn to say "I'm sorry you have been kept waiting" or to start providing clear communications about the anticipated wait. There is much that better management could put right. Not least the arrogance of some in your speciality.

I don't think an ortho registrar mumbling his name and when asked for it again to say very slowly: WIL EE AM FA ROW BEE (William Farrowby) (obviously not that name) and in response to "my back pain is only responding to naproxen but I have read it can interfere with bone union" to reply "you need to get your head out of the Internet, it's full of nutters" has anything to do with resources. Hopefully it won't take more than 90 days for some NHS employees to learn some manners, if the scummy old public is expected to pay more for their services.

Respect works both ways in my experience and funnily enough episodes like that don't happen when I pay at the point of delivery.

I really don’t understand the obsession with changing the funding model. Surely what we should be aiming for is a functional health service providing high quality and timely care and continuing to be free at the point of delivery.

@Havanananana 1000’s of doctors? My impression was that there are plenty of doctors. Just no training places. There are FY2 doctors with no job. Like now.

@HRTQueen There has to be radical change, Labour have to take the step. They made the radical step with forming the NHS they can be as radical now by working towards a fit for purpose insurance based model (as in France and Germany) new healthcare system that is right for this day and age

Do you realise that the French and German models (and most of the other countries that have public health insurance models) differ from the UK in more ways than just the insurance payments.

Firstly, healthcare insurance is compulsory and is deducted at source (just like UK National Insurance), is ringfenced for healthcare (the German system even operates with a cash reserve fund) and is administered by Health Insurance Funds which operate to some extent independently of the government. The degree of government involvement differs - in France there is more government involvement than in Germany, where the government is more hands-off.

Secondly, the actual healthcare is provided by a number of different providers. There are public hospitals and GPs (just like NHS hospitals and GPs) but much of the healthcare provision comes from hospitals, GPs and other professionals that are not owned or employed by the government or the Health Service - i.e. they are private providers. Most hospitals are non-profit organisations (with some being historically linked to charities or religious groups) but there are also private providers that operate for profit. One key element is that the Health Insurers negotiate fixed rates for various surgeries - so for example they will only pay the providers a fixed sum for a hip operation regardless of whether that is a public hospital, a non-profit hospital or a private hospital or private provider such as a physio. If the patient wants a superior service (better food, longer recovery time in hospital etc) then this is paid for separately by the patient, and private medical insurance is available to cover these costs if people want to take this sort of policy.

This is totally different to the situation in the UK, where the government holds the purse strings and is the de facto owner of the facilities and the employer of the staff, and where politics (such as Hunt demanding that Trusts prioritise balancing the books over treating patients) gives power to politicians who are not sufficiently qualified to make decisions and where major errors in policy can take years to rectify.

That's fine, but don't expect it to be sorted in 90 days - only fair that you give them 15 years.

@RosesAndHellebores "In fact next time I suffer severe delays for which there is no apology I may go as far as to comment, "how interesting you are still running 90 minutes behind, despite a Labour government."

Do you really think that the Labour government is going to be able to magic up the thousands of doctors required overnight? Or that the number of nurses, radiographers, physios and other vital medical professionals is going to dramatically increase in the next 3-5 years?

All of these improvements, and the investments required in healthcare facilities and equipment, have a lead time of at least 5 years. Turning around the NHS and getting it to the point where it is functioning well is going to take a decade or more. Getting it to the standard comparable to the leading European countries will take far longer and many billions of pounds of investment.

Well lets hope Labour will not hold back for fear of upsetting many people and they choose to benefit the people rather than keeping votes.

Many peoples attitudes have changed towards the NHS particularly since Covid, they are experiencing too many difficulties access the services and care they need and complaints are at a record high, and many people won't complain

Free at the point of delivery is not worth fighting for when the service provided is not fit for purpose

There has to be radical change, Labour have to take the step. They made the radical step with forming the NHS they can be as radical now by working towards a fit for purpose insurance based model (as in France and Germany) new healthcare system that is right for this day and age

I hope Labour shall be brave enough

Because you live in the UK.

Serious question, why do you not move to somewhere in Europe with better healthcare?If you are very well paid I assume you have highly saleable skills; are they only saleable in the UK?

I have read the report, and for brevity quoted from the summary. The summary conclusion is based on the data. As you say, it says the needs of an aging population need addressing, as do obesity and smoking, and that they were not addressed in that 13 year period. That's a fact. You might not like that, but I can't help that.

13 years was plenty of time to implement things that improved the health of the nation for the long term. But instead they focussed on short term metrics. As anyone who has run a complex organisation know, the only things that get managed effectively are things that get measured. KPIs can be good, but the wrong KPIs drive the wrong behaviour and that was a problem during that period.

I am not biased against the NHS - it achieves a lot. I am biased in favour of patient and long term health outcomes, and I make no aplogies for that. Other systems and countries do it better.

One thing I really hope , now Labour is in power, is if I politely note that my appointment is 90 minutes late or my GP takes 35 minutes to answer the phone, that NHS and associated staff will refrain from telling me it's the government's fault. In fact next time I suffer severe delays for which there is no apology I may go as far as to comment, "how interesting you are still running 90 minutes behind, despite a Labour government. 😀

I don’t disagree with any of that. Reform is essential and I’m really looking forward to Lord Dharzi’s report. That doesn’t mean a new funding model and I can’t imagine for a second that the NHS won’t remain free at the point of delivery. Anything else would be political suicide.

The NHS was certainly performing better but that was 15 years ago it is not relevant now, that time has passed

The pressure on the NHS is far greater now, we have had years of mis management, years of underinvestment, years of privatising areas of the NHS, years of staff leaving in high numbers and on top of what the Tories have done we also have that Labour took out huge loans and were short sighted in how they managed the NHS

We deserve better my colleagues are leaving in large numbers, many are off with stress, we struggle to be able to give the service we should be giving and too often we are not giving the care that should be absolutely expected, not because we are not wanting to but we can only be stretched in our work so far.

Labour need to be honest they need to not fear the publics response of a full reform of the NHS we do not need to follow a US model there are other models that work far better but that means on average we shall pay more and the government certainly need to pay more

Great. The French system is also a statutory insurance and covers most things and on top of that, there are small out of pocket payments to be made. Detailed more eloquently in various posts on here. This is despite them spending more than 25% than us on healthcare.

My point is small co-pays, if administrated properly, not only raise revenue but more importantly change behaviour positively.

Someone will come along and say most people cannot afford to make small co-pays and I beg to differ. Some cannot and they will be exempt but the vast majority will benefit from being empowered around their own healthcare. And for now - money is the currency by which society ascribed value to a service. We pay via tax and we need to pay more via tax but it won't be enough. True reform will be needed to get out of this rut

And the NHS was expecting significant strain as the golden Blair years that people remember fondly were coming to an end - as population exploded and the ageing population increased. Any party would have struggled

@newmummycwharf1 "And yet -despite all that they spend (typically 25% more), there is also insurance based contributions made in addition. No wonder we struggle here."

The figues for GDP spend on healthcare include the insurance-based contributions.

Where I live in Europe, we have compulsory health insurance. But this is not private health insurance, it is a form of National Insurance that is administered by public health insurance funds (Krankenkasse) which operate largely independently of the government. This National Insurance is collected through payroll so it is very similar to paying tax (and it is compulsory), it is progressive (i.e. a % of salary, so the more you earn, the more you pay) and appears a separate deduction on my payslip.

And yet -despite all that they spend (typically 25% more), there is also insurance based contributions made in addition. No wonder we struggle here. Even if we matched their spending, we would still be short of funds to deliver the high quality healthcare expected in a G7 country.

You didn’t read the report, did you? You just read the covering page. it doesn’t say the NHS became less productive, you made that up. It says that the needs of an ageing population continue to be an issue that needs to be addressed and that obesity and smoking present an ongoing challenge.

If you take your heavily biased anti NHS spectacles off you’ll see that by just about every metric the NHS was performing better than at any time before or since. Data is what’s relevant here, not anecdote.

The French government spends more per capita than we do. And has done for a long time.

"To match French health expenditure (in PPP-adjusted terms), the UK would have to spend roughly 21% more per person according to the latest OECD data, or £58 billion."

They also have more doctors, more beds, more scanners & better infrastructure.

www.nuffieldtrust.org.uk/news-item/is-french-style-health-care-the-answer-why-we-should-stop-idealising-other-health-systems

ues its time we let the NHS go many will say well if we have part insurance they it can be saved, but then it’s no longer the NHS

we do not want a repeat of huge high interest loans to prop the NHS up, we do not want more years of it slowly being sold to private companies and we need cross party involvement working together towards a better healthcare system becuase what we have now it’s pretty shameful

France and Germany can manage this as do numerous other countries it can be done but it’s a long process we deserve a better healthcare system

Labour have promised NHS reforms I have no doubt we are moving towards insurance based system they need to be brave enough to say this but people are so attached to the NHS it was at one time a fantastic institution those years have long passed and we have to deal with what we have now rather than and that is a broken system

The French system is mainly delivered by the private sector and funded by a state insurance scheme. It’s streets ahead of the shabby, shambolic NHS. It’s also recognised as one of the best healthcare systems in the world. It also happens to be a broadly left of centre country, not averse to nationalising things. And yet, it never has for its heath system. Why not learn from one of the best systems? Surely no one would let ideology lead to worse outcome for patients just because ‘NHS’?

But in some respects that’s quite damning, if you take your Labour tinted spectacles off. It says despite all that funding the NHS became less productive, that despite having 13 years it failed to do much about the needs of an aging population and, worst of all, public health, especially obesity which is a leading indicator of other illnesses got worse every year from 1997. It’s almost as if they just focussed on the short term, with no thought to the long term term at all. Further evidenced by the corrosive effect of manipulating the spending figures through PFI…

My late husband was a very heavy user of the NHS in that period as a result of chronic long term illness. The KPI focus introduced by inexperienced politicians, and implemented by third rate leaders and managers led to a massive and consistent deterioration in joined up care for him, across several NHS trusts.

No one said self-pay. Co-pay is different to self pay. Co-pay is what happens in other parts of Europe, Australia etc. Even Ireland
It does not preclude investment from the government into healthcare - which is what we see in Germany and France - who invest more in their healthcare than we do and still co-pay!

To all those saying NHS needs more funding like that will just fix it. It won’t. There’s absolutely no point in chucking more billions at it. It needs a total overhaul first. Streamlining, middle managers, money wasting & all the rest of the money & time wastage. It just doesn’t work in its current form & that’s not going to be fixed by more money wasting.