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

So there has been proper research and statistics then? I.e. patients contacted after the DNA to find out why they missed? And broken down into the different patient categories, i.e. by age, disability, etc? I'd love to see the statistics if you could point me in the direction of where they're published.

Maybe AI scribes will help here.....one day

Can you believe that pilots have been done where people are called to remind them of appointments and DNA still occurs?

There are definitely DNAs due to poor administration (including changes to digital appointments which patients can't open for example or letters arriving after the appointment). But the rates due to late cancellation or not bothering to cancel are significant

So many inefficiencies in the nhs.

I'd start by scrapping PAs and giving every consultant an assistant capable of doing all their admin, scrapping revalidation and appraisal and massively reducing the burden of annual mandatory training.

I trained for 20 years to become a surgeon. The amount of paperwork and lack of theatres means I operate on 35 days in the year. Surely there's a better way?

@taxguru I don't know. Like I said, there are probably many flaws to the idea but it's just something I thought about when reading through all the responses on here.

I agree that more taxes would be unfair.

OAPs are a grey area really because some of them are quite well off but of course there are others who are struggling.

You do mean in return for tax/nic reductions I assume??

It's completely unacceptable for even more taxes/costs to be put upon the already over burdened workers.

I guess you'd exempt children and OAPs automatically wouldn't you, then exempt the disabled and unemployed, so you're (as usual) left with the rump of workers to carry the can. Again.

@newmummycwharf1

given the attitudes to healthcare use by the public (10-12% DNA rates for example)

First, we need to evaluate how many of those DNAs are actually the fault of the patient and could have been avoided.

Many reasons for DNAs.

I.e. confused elderly people who forget, patients with chaotic lives due to mental health issues, those where the patient never got an appointment letter, etc.

I'd hazard a guess that genuine DNAs from people who literally couldn't be bothered or decided they were busy doing something else is very small indeed.

For my own and OH's point of view, and our son, we've never deliberately missed an appointment that we actually knew about and hadn't cancelled. Yet, there are several instances where we'll have been put down as DNAs. Only a couple of weeks ago, my OH missed his "appointment" at the oncology department to pick up his monthly drug package - he knew nothing about it - they'd made an appointment and hadn't told him! - he didn't expect such an appointment anyway as it was the wrong week to pick up his drugs - they'd fouled that up as well! When DS was young and had a GP appointment, we had to phone to cancel and re-arrange as it clashed with a hospital appointment - at the re-arranged appointment, GP was livid and challenged us why we'd missed the earlier appointment - the receptionist hadn't cancelled it when giving us a new appointment. Many other instances in a similar vein.

Before we even think of charging for GP appointments or DNAs, there needs to be some proper research and statistics as to "why" the DNA occurred. I know the NHS loves to "patient blame", but a lot of the time, it's their own inefficiencies that cause the problems, not the patients!

There are probably many flaws to this idea but what about a healthcare model that was means tested? So those that can afford healthcare are required to pay but those who can't afford it will still receive treatment.

I think this is true. A few years ago, I read of a study which found that moderate physical exercise could reduce the risk of breast cancer recurrence by as much as 40-50% (another study found a more modest reduction of of 20-30%). If this was a drug, it would surely have been greeted with great excitement and hailed as a breakthrough.

There are many ways of measuring/considering healthcare funding. I use the benchmark model (not perfect but none of them are). If we say the NHS was appropriately funded in the 90's, early 2000s, healthcare spending in the UK grew by 3.5-4% year on year then.

Between 2010 and 2019, healthcare spending in the UK grew by <2% per year. So relative underfunding.

However - given the attitudes to healthcare use by the public (10-12% DNA rates for example), even with that funding plugged - we would still be underperforming.
The workforce situation is complex. Training a specialist takes a decade but in that time, the resident doctors are delivering the bulk of the care at cut-rate prices. The training could be compressed. It doesn't need to take that long but the government then has to deal with paying consultant pay for many more medics exponentially

There is poverty in the UK (for a G7 country, the levels are ridiculous) - and economic growth is the answer. However, most people are able to afford to pay towards their own healthcare. £10 for each hospital appointment, £5 when you see a GP - I bet the DNA rate tanks - that is 10% more appointments almost immediately.

Increase in tax across the board may work but that does not foster personal responsibility for one's own health. Just pouring more money into this basket of holes won't work

Wes Streeting already intimated that more money is not what is required to improve NHS productivity. Looking forward to Lord Darzi's review - let's see what he finds

@newmummycwharf1 "The difference per capita is more than that. Try 10/16% in 2022 and 2023...."

"The answer is not more money - the government has invested. The NHS is underfunded but if you look at the data, the difference in funding over the years is much less than you would think. Health foundation report (attached)"

We're splitting hairs - the point remains that some countries spend far more per capita on healthcare relative to their GDP per capita. Even if Germany's GDP per capita is 16% more than the UK, Germany still spends over 30% more per capita on healthcare - i.e. it prioritises healthcare investment higher than the UK does.

There's nothing in the report that supports your statement that the difference is less than one would think - in fact, the report points out that France, with a similar GDP per capita, invests 26% more per capita than the UK. The difference is significant and the impact is cumulative - every 3 years the UK falls an entire year behind Germany, and every 4 years it falls a year behind France. Hunt's years as Health Minister were a disaster, and as you point out, the impact of under-funding is clear to see - "There are over 7 million people - 7 MILLION! on waitlists" (and that figure is just for NHS England)

"More money is needed but how that money is raised and how it is spent is really key. If people paid directly for aspects of their own care - use and waste would reduce and personal responsibility for health would improve. As Bevan said - we have to continue to re-evaluate."

So you agree, despite what you wrote in the first quote - more money is needed? More funding is not the only answer, and it is not the magic bullet solution, but some of the problems are simply down to numbers. The UK has fewer doctors per capita than most EU countries, but recruiting and training new doctors takes 7-10 years. Then there is the need for more nurses (thousands of nurses are part of the tail end of the late 1950s / early 1960s baby boom and are due to retire soon) and training takes time. Ditto for technicians, lab staff, physios etc. Meanwhile many hospitals are crumbling and outdated, and much of the equipment is likewise obsolete or in need of repair. Even if the government decided to start tomorrow, it will take a decade or more before the damage done by the last government is close to being repaired.

As for people a contribution paying for their own healthcare - millions are living in poverty and can barely pay the rent, heating and food bills (and these are also the least healthy people in the population) while thousands of others (many of whom are posting here) are happy to pay hundreds a month into schemes so that they get priority private treatment, but seemingly don't want to pay more tax so that everyone has the chance of better healthcare.

In that case, the solution must be for GPs to stop prescribing things that can be bought cheaply and easily elsewhere. It's human nature for people to take the piss and get things for free, so we need to stop facilitating that kind of behaviour.

I was asked if I could get my own paracetamol when leaving hospital as it was far more expensive for them vs me buying it myself. Why doesn’t NHS procurement have the same buying power as a retailer? I was pissed off tbh, not because it wasn’t free but because 24 hrs after a CS the last thing I wanted to do was stop at a pharmacy!

The difference per capita is more than that. Try 10/16% in 2022 and 2023.

The NHS certainly contributes to the reduction in productivity. There are over 7 million people - 7 MILLION! on waitlists.

The answer is not more money - the government has invested. The NHS is underfunded but if you look at the data, the difference in funding over the years is much less than you would think. Health foundation report (attached)

More money is needed but how that money is raised and how it is spent is really key. If people paid directly for aspects of their own care - use and waste would reduce and personal responsibility for health would improve. As Bevan said - we have to continue to re-evaluate.

Killing the conversation does no one any good. Every option should be on the table and seriously options appraised.

Those systems are not perfect having lived in France and the UK I would choose the NHS system every time

I think your argument is much too simplistic but when taken what you say at face value
What system do you suggest instead then?

A model like the USA where many people can't afford basic health care or medicines? People die because of it and emergency workers take details of a patients insurance before agreeing to treat them

I think the NHS model is the best and there is no where better in an emergency. The problem with the NHS isn't the model it's that it hasn't been funded properly for years. Even in countries like France that rely on an insurance type scheme the Government fund it a higher rate than we fund the NHS. And even then when my daughter lived in France she was told she would have to pay a deposit of several thousand Euros before the hospital agreed to book her in for her necessary C-section because they thought she had the wrong insurance.
I would be quite prepared to pay more tax to fund the NHS better.

DH and I both earn over £100k per annum. Because we are over 60 we get free prescriptions. When we retire dven though our pension income will be significantly higher than the national average we'll still get free prescriptions.

In many ways it's payback for some of the poor care we and the DC have received and the fact that pretty basic things have only been available privately: bladder prolapse surgery post botched birth, grommets, optimal osteoporosis care.

We need a system like that in France or Germany. Money has to change hands to get the concept of service back into the system.

@OptimismvsRealism
Hello Tory leadership hopeful.

(You're welcome, @Dymaxion :) )

Exactly, that's how it works in my European country. Free choice of doctors/care providers is a principle enshrined in the system. When my gynae performed a smear on me without my consent in my second pregnancy and possibly caused a placenta previa bleed, I didn't go back and went to another one (should have reported her too, but oh well). I've had a succession of minor surgeries recently that have failed - prob not due to the care, but I still chose to have the last repair done in hospital rather than at the surgical practice I had used previously. I don't need to justify that to anyone, and there's no upfront cost to me (beyond what I pay monthly to my insurer, obv). I also didn't have to wait. With the last surgery, op date was a week (!) after the initial appt (which I'd waited maybe 5 weeks for). And this wasn't a particularly urgent thing - needed doing, but I wouldn't have died from waiting another few weeks.

Yes, obviously when something is otherwise restricted but a patient needs it in bulk, then some provision has to be made. Pretty easy to make "bulk" purchases only available at pharmacies backed up with some kind of approval from a GP such as an authorisation card/letter. But as per my idea, a small charge per item would help people think about whether they actually need it or not which has to be a step in the right direction.

Yes, and TBH I was pleasantly surprised when my GP told me I could buy the necessary stronger painkillers at the Boots pharmacy counter when I’d just been diagnosed with shingles - though thankfully not too bad a case.

Ideally though things like paracetemol could still be prescribed in some way so someone could buy more than two boxes at a time.

In that case, the solution must be for GPs to stop prescribing things that can be bought cheaply and easily elsewhere. It's human nature for people to take the piss and get things for free, so we need to stop facilitating that kind of behaviour. We probably need to do it by "stealth", i.e. little and often rather than a massive change which would cause a backlash. Perhaps start charging a nominal fee per item with no exemptions, i.e. 50p or £1 per item prescribed, regardless of exemption/prepayment, etc., to start to change the mindset.

@taxguru, I fully appreciate what you say. However a good many of the items stockpiled by our friend were things he could easily have bought in Boots, e.g. a bath preparation (more than once he tried to pass a few to me) and a good many packs of paracetamol, which you can buy anywhere for relative peanuts now. (In the U.K. you can anyway, in France you have to go to a pharmacy, which is bound to be closed when you need something now…)

Yeah, the high-tax payers won't leave the country but a lot of people don't understand that the solution isn't just to 'tax the rich more' because doing so won't really make a dent.

It's the middle classes and working classes who will be primarily effected. Like the pensioners losing the winter fuel allowance already are.

High tax payers won’t all leave the country. That’s a tired old threat that the wealthiest trot out to keep the least wealthy in their place.