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

For what it's worth I am in favour of an nhs that is free at the point of use.

But in practice what that means is that treatment is rationed via GPs.

30 years ago my GP would not even refer me to be put on the waiting list for endo surgery, my grandparents paid and I was treated.

It's no use it being free if you cannot access it.

In my view the best solution would be a European model as the nhs has always run by rationing treatment by time (waiting lists) and gatekeepers (GOs). I don't like the alternative of rationing treatment by whether you have money but that is what we seem to have at the moment.

These threads make me despair. 😩

Posters: The NHS is broken. We need to learn from France, Germany, Switzerland, Australia etc.

Me: I agree. We should be investing as much money into healthcare per capita as they do.

Posters: No, we don’t mean that! We need to bring in more profit-making middlemen, AKA insurance companies! That’ll fix it.

@TammyOne

As another pp pointed out, we already pay insurance but I would increase NI with a ring fenced NHS tax to be spent on a)overhauling all the processes and systems and b)more equipment and frontline staff.

Blair/Brown did the increase and ring fence thing and it didn't work. The money was immediately spent and then another increase in NI was needed.

And, on this topic, if it's to be NIC that pays for more NHS spending, then EVERY taxpayer needs to pay NIC, not just workers! It's grossly unfair to tax a worker more than, say a pensioner or a landlord with the same income!

NIC isn't an insurance scheme anymore it's just morphed into another tax, and because of that, it should be paid by everyone.

@GKD

Many NHS services are already expensively privatised anyway, look closely and you’ll see ‘proudly providing the NHS service’ everywhere.
The cost just hasn’t yet been passed on.

That's the exact problem of pretending the NHS is salvageable in it's current form. Using expensive private providers is a short term sticking plaster over a gaping wound. What we need is a long term plan where expensive short term fixes aren't needed.

Take hearing tests, Specsaver are, by and large, doing a good job of picking up the slack from NHS audiology departments via what I believe to be a national contract. They can still make money by being more efficient. But, what it needed was a long term contract so that Specsavers could change their premises to include hearing test rooms, equipment to do it, recruit and train staff to conduct hearing tests, discuss options, and fit aids, etc. If instead, a specific audiology department had a short term problem and called in a short term fix, it'd cost them shedloads more money, i.e. a mobile hearing test trailer with locum/contractor audiologists.

Nail on the head. Politicians are scared of saying what needs doing because they know the voters won't like it. So they just continue to kick the can down the road and hope to leave their successors to deal with it.

Not helped by the politicians of both major parties "weaponising" the NHS in elections over the past 20-30 years forcing the other party to commit to continue throwing ever more money at it without actually dealing with it's fundamental problems.

And that attitude is exactly why the NHS will ultimately fail and we'll be left with an expensive private medical system!

We need to be realistic and move to an insurance based model (akin to Germany maybe) with contributions, co-payments, options, etc. If we plan it over many years, we can transition over to something that is actually sustainable and affordable.

If we keep pretending that all the NHS needs is more money, then it WILL ultimately fail as it's a bottomless pit, a leaky bucket.

We need to have a serious conversation about what services the NHS provides for free. Difficult decisions need to be made, so no party wants to be the party to do that. Its not a case of a 'properly funded' NHS with more money, the NHS will consume as much money as we want to throw at it and still need reform.
The growth alone in diabetes since 1970 is projected to seriously test the NHS, if the rates carry on increasing at the same rate.
We are living longer, but not healthier. Very difficult decisions need to be made.

I agree,

I think the main problem with many systems in this country are that they are political. Decisions are often made because of votes and keeping big businesses happy rather than what is the best plan.

Can anyone explain how a partial insurance model will help healthcare and for whom?

It appears to me that there’s just not enough resource/man power, surely the private sector will start to slow if we move to insurance model and if not why can we not adopt the same expansion in the NHS.

How will partial insurance benefit ppl who cannot pay for the insurance?

Many NHS services are already expensively privatised anyway, look closely and you’ll see ‘proudly providing the NHS service’ everywhere.
The cost just hasn’t yet been passed on.

Kendodd · Today 09:10
I think we need to stop preserving life at all costs.

Definitely this. Most people can’t afford to go to Dignitas in Switzerland, but even if they can but need assistance to get there, then the assisters are questioned by the police when they return.
My mother had dementia for four years. She screamed and sobbed for much of the time. I dread this fate more than anything.

Fucking hell. I didn’t read OPs question as one about insurance/ privatisation vs NHS… I read it as a question about the operational plan of how to get the system working (eg different systems in different departments aligning, waiting lists cut)
Im a patient currently. A lot of the glitches in the system are logistical ( patients passed from clinic to imaging for example but different systems for booking and scheduling). The other central problem that I can see is just not enough equipment and not enough boots on the ground staff to operate it (hence delays).
But here we are, a raft of posts blithely telling us we can’t expect to keep ill people alive and hey, everyone has a car and can afford £20. Its really easy to write old or ill people off and think that because you have savings and the wherewithal to pay for private insurance everyone should but that’s not who we should be aspiring to as a country. Wtf happened to Fair Play? Compassion?
As another pp pointed out, we already pay insurance but I would increase NI with a ring fenced NHS tax to be spent on a)overhauling all the processes and systems and b)more equipment and frontline staff. I would increase wages and training for admin staff too, and make sure they are excellent at their jobs as they are central to the organisation of it all.

I think there are a few elephants in the room that no politician will want to address.

The first, is that there is a proportion of the population that will require an incredible amount of money if we are to keep them healthy or even just alive. We simply can't afford this whilst offering a reasonable level of healthcare for the rest of the population. Look at Kate Garraway's husband's care bill and it quickly becomes obvious how it doesn't take many people requiring this level of funding before the whole system is bankrupted. It is obviously deeply controversial issue and linked to all sorts of sensitive areas such as disabilities, personal responsibility, increasing life expectancies and poverty, but the reality is that the costs are a huge burden on an already struggling system and we can't pretend this isn't a massive part of the problem.

There is also the issue of whether those who have money should be expected to not only fund a supposedly 'universal' system but then also have a moral obligation to pay privately where possible. A small minority of people in the UK are net contributors and they are realistically the ones funding everything for everyone else. Is it fair that they do this and then people also expect them not to use any of the services they pay for? I think there is an assumption that the rich must pay for the poor and that the poor should be entitled to the same level of healthcare as everyone else. This is an anomaly in a capitalist society where almost every other aspect of life is dictated by someone's wealth.

The US system needs no reform to happen. It just needs constant neglect, forcing people into private healthcare, creating a two tier system.

We’ve already sleepwalked half way there.

Anyone saying “but we don’t have to have the US system” is delusional. Under the Tories we do.

The problem is the people who think they have paid for everything vote.

By and large they are the older generation who remember the earlier days of the NHS.

Any party suggesting major reform will be voted out. So no party dares.

So you get creeping privatisation because nobody dares change things because they'll get voted out.

It needs to switch to a European insurance model. People see the word insurance and think of America but it’s nothing like that and works very well, ensuring everyone can have healthcare and patients can have genuine choice.

A huge centralised system like the NHS no longer works in a world where medical care have progressed so much. If we want to keep the NHS as it is, it will have to be for basics only.

@Earwiggoearwiggoearwiggo Exactly. We cling to an outdated system. The idea that the elderly have paid all their lives into an insurance scheme and then deserve nhs mcare because they have paid up is ludicrous. My DM barely worked as married didn't in those days. All taxes, and NI is a tax and not ring fenced, are paying for services at the time the services are delivered. There is no insurance pot of money. Post retirement, people don’t pay NI. Even if they work. Yet we all know they use services more. We need to stop calling this tax “insurance”. It isn’t.

I don’t agree with piecemeal privatization: I also don’t like the USA system. European systems are better and we need to see how they can be applied to us. Where resources are scarce, (nhs dentists) there needs to be fair rationing. Wealthy pensioners should pay and not cling on to services at the expense of others. There’s insufficient dental places for the poor so we need to regulate who gets the resources.

We must move away from people thinking they have already paid for everything - they haven’t.

To be honest I'll only use a private GP now. My NHS surgery has failed three members of my family in three years, one died and two nearly died because of their incompetence

Its deliberate to get people calling for privatisation.

There is money to save it, it just needs to stop being spent funding the worlds wars and god knows what else and be spent on the NHS. They managed to find billions to send to Ukraine.

They also need to cut out a lot of the unnecessary bureaucracy and 'managers' and go back to some of the older ways of doing things.

As well as only treating people that are entitled to it. In some places in Europe you have to show a card that they scan that is directly linked to your social security. If you haven't paid in enough, or are not currently paying in, or are not a citizen, then you don't get free care. They also have the same system for benefits, if you haven't paid in enough, then you aren't entitled, simple as. That would save fortunes.

How can we propose bringing in a paid for service for everyone while still dishing out care to those not entitled to it? Other countries have no issue protecting their services, I don't know why the UK can't.

They also need to stop companies raping the arse out of the budget and get the procurement under control. I've seen a company charging £20 for a box of biros, because its the NHS. And that was a LONG time ago so its probably all even more exepnsive now.

For at least the last 30 years it has been the case that for some treatments/illnesses people could choose to go private.

30 years ago I was told I wasn't ill enough to be put on the waiting list for a laparoscopy to be diagnosed with endo and a grandparent paid for me to have the operation privately. I then got treatment.

Now with much longer waiting lists for everything, private organisations are really expanding. Private GPs are available through private medical insurance, lots more companies are offering private GP services - my school joined a scheme where you paid 20 pounds a month and got access to a private GP.

So many people can't see a GP for minor stuff (chest infections, ear infections, etc etc) that they are happy to pay a bit for an appointment. I couldn't get in to see my GP recently with a bad ear infection, and they sent me to my pharmacy but my pharmacy isn't funded to see adults with ear infections so they wouldn't see me. I ended up at the walk in, but if I'd had a private GP closer than 20 miles away I'd have gone to him.

The government has plans to let pharmacists diagnose and prescribe for these sorts of things which I think is a positive step the problem is you don't know who to go to. Is your pharmacy funded for your problem for you?

In the meantime, as more people are in the situation where if they pay for the private operation/appointment etc they will be back at work/back at school quicker then more of them will pay.

So the private sector will expand.

Realistically the NHS will become an emergency service - if you have an RTA or similar then you are going to A and E, and the planned side will have fewer and fewer resources and longer and longer waits so people choose private if they can.

If my state school is offering a private GP service as a benefit then other organisations will as well. So I'd guess that more and more companies offer private GP/private medical as a benefit and slowly we move towards the American system.

Why? The NHS is on its knees with staff leaving in droves for various reasons. Keeping it free at the point of use is unusual compared to other European countries who do charge to see a GP I understand.

It certainly can't carry on as it is, there won't be enough staff left soon.

They have to find a way to retain their staff and keep them happy. Money is a part of that, but work culture and management attitudes are big factors too and of course the service users attitude. Many of us will have observed the way some people behave and made our own judgements on that.

NHS dentistry should change. Make it free for kids and retired people . Everyone else should pay partial insurance .
I pay private dentistry because there are not enough spaces but there should not be such un fairness

A general perception that America is the world and so an insurance based system means something like America where you can end up in tens of thousands of debt if you get hit by a bus.

A general unwillingness to acknowledge that Europe exists and that lots of European countries have insurance based systems that are very good, and protect people who are not in work.

The elevation of the NHS to God like status, bearing the whole weight of national identity.

An unwillingness by those in power to risk the public wrath (due to the above) caused by pointing out Britain's current huge, fat, ailing, aging population doesn't really resemble the public of the 1940s the system was designed to serve.

Plenty of people can afford to pay eg £20 to see a gp.

True. But I suspect that telling people that they need to pay tax and NI for other people to get a service for free that they themselves have to pay for is not going to win any political party votes at the ballot box.

We have an additional tax on workers that's labelled "National insurance". It's no more insurance than a fish has fingers.