Why doesn't anyone have a proper plan for the NHS?

Just adding that I live in an area where life expectancy is not great, wages are very low compared to national averages. Recently recorded my blood pressure score with a nurse who practically cheered when it was "normal/healthy"; I find that level of acceptance of poor health as normal (I'm 67) a little bit problematic.

That has to hit rich people much harder than those at the lower end because there isn't much slack for the majority ; which is problematic and why I think inheritance tax is the easier way to raise taxes - hitting rich and wealth - not hitting your ordinary week by week living

I agree, the majority of people: you've said everything necessary. The majority of us should be coaxed into a mindset where paying a fairly modest contribution for the care they need or want, THAT ISN'T AN EMERGENCY OR CRISIS, whether it is simply paying for a more convenient appointment time so it doesn't eat a whole day's work is normal and routine.

Inheritance tax is fine with me too. It will hit my DC harder than me, but given my DM89's house is a 2 up 2 down terrace in a Midlands town valued at roughly £200k after her equity release, and that's her total estate, it won't even trigger the £325,000 threshold. But when you look across most of the UK, there are far more 2 or 3 bed terraced houses valued below £300K than anything else in the housing stock. So I think the hammer the inheritants is also a hiding to nowhere. There are not that many estates (less than 5%?) that generate inheritance tax.

Charge for appointments not attended... can go with that too. Children always free to 18. I would be cautious about illness and disability exemptions. The ramp up in mental health conditions and claims currently being reported is concerning.

I am quite happy for proportionate method of paying more

That has to hit rich people much harder than those at the lower end because there isn't much slack for the majority ; which is problematic and why I think inheritance tax is the easier way to raise taxes - hitting rich and wealth - not hitting your ordinary week by week living

Along with a rethink about preventative medicine not just reactive - which means a change in the relationship between NHS and pharmaceutical development

And I'm open to charges for no shows, and full charges for violence against staff etc

@midgetastic what's your solution?

As it stands, the current system isn't working. Healthcare with all the research, development and gadgets is very expensive.

Paying a % of your wages towards your health care in form of insurance & slightly higher taxes is an appropriate solution.
Obviously, nobody wants to pay, so hit me with something that doesn't involve paying more!

I'm on a low income (actually just outside qualifying for benefits) yet my health is important to me.
Having a healthy lifestyle isn't expensive, as long as you have the ability to do what's necessary... and that's the real sticking point, not the income. Insurance companies could be there for help and advice in preventing certain illnesses and conditions.

The less well off you at the worse your health tends to be

So even if it's in proportion to your income ( say 1%) that will still hit the less well off the most

If it's not , then the squeezed middle get squeezed more

And if it's proportional to income why. It just increase income taxes ?

It could work, either through % of income and/ or say a quarterly fee to acess a GP. So you'll pay say £50.- in a quarter and can see your GP as many times as necessary within 3 months.

Similar for consultants referral.

Long term illness once diagnosed, like cancer, should be treated as disability and exempt. So you'd only pay once.

We already pay for prescriptions and have bands for dental work.

Obviously certain groups will be exempt, same as now.
Emergency care should always be free at point of access. But if further treatment is necessary, eg broken leg needs physio, then a one off small free could be paid.

Something like this can be partially funded by government through general taxation and insurance contributions (% of income).
This wouldn't be cheap, but might be more in line with real costs of healthcare.
I would also hope that people would be more aware about making healthy choices- I'd think insurance companies would focus on this as avoidable expensive treatments eat into their profits.

How has 'part pay' worked out for dentistry?

So @midgetastic , those with the broadest shoulders should pay more... like income tax. If you can, I think you should.

Part pay - an approach favoured by someone with clearly a lot more money than average !

I agree. Trusts were set up to foster "competition" but it's failed miserably as in lots of areas, there simply isn't any competition. Same happened with the railways when the govt still control which operators can use which routes and stations!!

I can't change GP surgery even though it's absolutely crap because there is only one in our town - it's a group who've expanded to take over all the other surgeries, so now it's the same group, just different branches, and you've no choice of branch, you're allocated what's available at their choice!

Same with hospitals, we're in a rural region, so there is only one hospital within a realistic travelling time. Hence no competition!

Even when there is competition, it's artificial, as it's still the NHS funding it, controlling who gets what treatment by centrally determined criteria, etc., access still controlled by GPs, etc.

A lot of the managers and administrators won't have ever worked anywhere else, so will be blind/blinkered to how things are done elsewhere. But the same will be said of doctors too.

Chatting to my oncology consultant friend, she was saying that it's not the norm (and considered a bit disloyal) to move trusts once you're at a certain level. Surely this can't help fostering a transfer of best practice which comes with working in a variety of hospitals?

Inheritance tax isn't the answer. Bluntly I've paid income tax when I earned it, income/capital gains tax on most of my investments and 40% of what's left after tax relief in IHT. I also pay for private healthcare as the NHS scares me at times. If IHT was raised to fund the NHS, I suspect net receipts would fall as people squirrel their money away in trusts and limited companies.

Vote for a part pay model from me too. It's not just about injecting money, it's reducing waste as people would be less likely to miss appointments and undergo unnecessary treatment. Plus it encourages the underperforming hospitals to shape up or patients will choose to go elsewhere (which I gather happens in some European countries).

I agree with everything except car parking costs. It just drives even more people to online shopping and out of town retail parks and is ruining town centres.

But a massive yes to healthier lifestyles, healthier eating/drinking habits, etc. But the answer to that is as much education and opportunity rather than the lazy option of higher taxes which barely ever works.

More carrot and less stick in all areas really, whether it's to encourage people to walk instead of using buses/cars, or to encourage people to make healthy eating choices.

Just look at the "sugar tax" on soft drinks. People are still drinking the unhealthy stuff and shops (Co Op, I'm looking at you) have reverted to charge the same for full strength coke as for diet/lite coke. Same with lots of restaurant chains who charge the same for low sugar/diet soft drinks as they do for full sugar equivalents.

If prohibitions and taxes (to make expensive) worked, we'd not have problems with drugs, underage alcohol, smoking (proper) cigarettes, etc. There's a limit to how much you can change behaviour by price alone (tax). It has to go and in hand with reasonable changes to opportunity and also much improved education right from the earliest years (i.e. scientific and logic based education not just all the "preachy" stuff we seem to suffer today).

And we must move away from reactive to preventative care

Which means tackling obesity and lack of exercise

Sugar taxes , UPF taxes, car parking costs increased

Which is hugely unpopular

Which is why no politician will promote it

Many doctors working for the NHS are on visas and are brought in by hospital trusts, but unfortunately, they're often treated poorly. It's not a career many would choose willingly; it feels like committing slow suicide. The hours are long, the responsibilities endless, and patients sometimes use up precious admin time with trivial complaints. It's a relentless cycle of non-stop clinics without breaks for lunch, coffee, or even a visit to the restroom.

We need people to stop acting like the nhs is some special thing to protect at all costs. We need to m or to a European system and stop the waste.

Pensioners may not pay NIC but I'd rather we focussed getting the millions who are not working (I'm not talking about those genuinely unable to) back to work and paying tax and NI. By the time I retire at 67, in 8 years time, I'll have paid over 50 years of NI contributions and I'll continue to be a taxpayer. I think over 50 years of contributions is enough.

Instead of focussing on taxing income look at inheritance taxes

Inherited wealth isn't earnt by the person benefitting but does screw the housing market

If instead of 3% of estates paying inheritance knock it down so the 20% biggest estates need to pay the tax

I mean people will still get hundred of thousand of pounds

The point is they don't pay NIC. Only "workers" pay that which is why it's so unfair to burden the people who are actually productive. Landlords, pensioners, etc., don't pay as much tax on the same level of income because they don't pay NIC!

I assure you that pensioners in the UK pay income tax once their income goes over £12,570 -- at the same rates as the rest of the population.

Sweden does not have a nhs though. It has huge taxation for individuals. We are never going to be able to introduce that to a nation that has been used to something for nothing. We have too few people paying tax now. We have part time working. Millions not working at all and engaging population. We have higher mortgage rates and child care costs than people are used to. Maybe Swedish old people continue to pay a full tax rate - they don’t here. They don’t pay NI. Maybe that should change but I don’t know what the revenue would be.

You don't any more. You just call your insurance provider, have a chat, and they issue you with a treatment code. Alternatively you can just book a same day appointment with a private GP, via the insurer, and they refer you. It's pretty much a direct system.

@taxguru I think there does need to be a mix of skills in the NHS. It’s a massive employer but I think lots of savings could be found. Plus working more efficiently and improving life/work balance for employees. Bringing in top managers from elsewhere could bring a fresh perspective. Changing anything is very difficult though as there are entrenched views.

I am well aware many work for nhs and private clinics at the same time. They are not necessarily full time private. Many use nhs facilities when nhs isn’t using them. For me it was an eye operation and my consultant had nhs patients and private ones. Nhs operating room was used by him for private patients on a Saturday. This was in addition to his nhs workload.

No system is perfect but we have gone from 75% thinking the nhs is good to 25% in 5 years. So clearly post covid there’s a lot wrong.

@GrumpyPanda Thats very interesting. Yes of course there will be much better models i dont know about.

I think my love of the german system was just cos i got good treatment there compared to in the uk.

A lot of the managers and administrators won't have ever worked anywhere else, so will be blind/blinkered to how things are done elsewhere. But the same will be said of doctors too.

It really needs a more diverse workforce, and I'm not talking about race, sex, etc., I'm talking about attracting far more staff from outside the NHS who can bring different skills and experience into it, and more importantly, the NHS actually being willing to listen, learn and change.

Someone with, say, 10 years experience of working in 3 different organisations has a lot more experience than someone who's spent 20 years working in the same one!

Yes of course, if you put it that way it makes no sense to train doctors for them to move onto the management. Although, the doctor that have been trained are either leaving or going private 🤷🏼‍♀️ Without going into nitty gritty, like I said below, I do wonder if many problems could be fixed if they are looked at/managed by people who are in the heart of it 🤷🏼‍♀️