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

I think we need to stop preserving life at all costs. The mum of a friend was in a care home for her last five years with increasing dementia and multiple other painful conditions. She spent the last three years of her life screaming in terror because she didn't know where she was or who anyone was. She was also top of the queue for every vaccination going and only had to sniff for the doctor to show up with antibiotics for her. This was because she was deemed vulnerable and small illnesses could kill her. I have no idea why, keeping a very elderly women alive for as long as possible in terror and pain is seen as the moral action. It was absolutely awful for everyone involved.

User - why? Yours is an emotional rather than a practical / logical response. Plenty of people can afford to pay eg £20 to see a gp. The system simply doesn’t work - there are too many elderly people with complicated needs, to mean people in poor health due to lifestyle (obesity) and new technologies/ medicines are very expensive. The NHS was designed for relatively cheap treatments and people to die quickly a few years after retirement, not to linger on for decades in poor health, or give themselves diabetes through obesity.

We have an insurance system now. it's called National Insurance. We absolutely must keep the NHS free at the point of use.

But why should she go private? She is paying the same tax and NI as everyone else and is entitled to treatment. If we are going to say that people who have saved hard for their retirement have to go private then we need to move to a properly resourced insurance based service which gives people options on what healthcare they choose throughout their lifetimes.

This would be ideal, and would be more likely to happen if we were more used to coalitions, instead of the adversarial electoral system we have now. It all stems from that.
On the insurance element, would there be a way we could have a not for profit insurance system? Maybe run along the lines of NS and I? It may also encourage more preventative medicine. I do like Wes Streeting. I hope he can do something without being hamstrung by his own party members, which I think is what will happen unfortunately.

The reason the US system is so expensive is partly because the 'worried well' get treatment all the time, sometimes when they dont need it, because there is money to be made by doctors, and the pharma industry. The decrepit are too expensive to treat, so often dont get treatment at all.

Because nobody wants to hear that the NHS in its current form is unsustainable

I agree. I think the current model is just unsustainable and it sadly has had its day. It's far better to have a decently funded insurance based model from the start than piecemeal services that arent available and force people to fork out money when they need treatment which they would have got if they had insurance. It doesn't need to be anything like a US model, but all European countries have a partial insurance model and all of them are far more efficient than the NHS. The problem is no one wants to say it.

Obviously we have an ageing population which expects ever more sophisticated medical care. But that doesn't explain why NHS productivity has actually reduced recently despite more funding and extra personnel.

So what is going on? We can all see the NHS is collapsing but why has it got so much worse in the last couple of years? I know the Covid backlog is an issue but there is clearly some other stuff going on too.

Pledging it pre election would be political suicide because the other side would portray it as destroying the NHS. Remember the "Death Tax", which was a perfectly sensible policy brought down by negative spin?

And the problem is that it might take more than five years to implement and bed down so even if Starmer came in day one and said "right, we're doing X" the plan would still be vulnerable to attack and misrepresentation before the next election. I think realistically the way to go is a big cross party consultation during the next parliament to come up with a really detailed plan using the best elements of the German/Australian/Belgian etc systems, to put to the electorate in the 2029 election, and with the big European and UK insurers primed and ready to step in.

But realistically it's going to cost a lot. All the costs of the NHS plus the costs of a billing system and insurer profit margins at an absolute minimum. The question is how to spread those costs around.

I do think something's going to happen though. Wes Streeting is a man with a plan, itching to get stuck in.

I had treatment in the US privately. What surprised me was not seeing lots of decrepit old unable to manage themselves people (I'll be like that soon btw). I don't know what they did with them but everyone was a walking well (ish) and the colonoscopy suite was like a factory - only one nurse about getting everyone ready - well they got themselves ready (stripped and on to trolley, then medication to relax) and in and out one after the other. It was a clinic with that speciality - they rattled through them. No ambulances, wheelchairs, everyone looking after themselves with someone arriving to take them home by car.
Everyone has cars nowadays or uber or taxis are available. We should get ourselves to hospital unless heartattack or broken bones.

I think the NHS has got too big & expensive to control so there is no plan. Ultimately it probably needs to move to a partial insurance model but few politicians dare to publicly say that as it would cause an outcry.

I think the issue is people are scared of the reform being the version of healthcare offered in the states. And realistically if reform happens under the conservatives, it will be. The system in the states seems to bankrupt ordinary people. Everyone has pre existing conditions too so who would insure all these unhealthy people if we did the states model..

I always liked the german system which is insurance based but doesnt seem to have that no pre-existing conditions or bankruptcy element the states has - but i imagine it would be a hard sell for labour.

Agree with all of the above. We need to give up the myth of the NHS being "free".

Reform and repairing public services costs.money.

To get that money, taxes need to go up.

Ant party that suggests people pay more tax ias committing political suicide.

Everyone wants everything, everyone wants to pay nothing for it.

It’s obvious. We need to move to a partial insurance model. All these doctors that clear off to Australia are not joining a NHS. Nor will they anywhere else in the world! So that’s what we must do. Learn from others. Also become lot more efficient. We need to stop treating the NHS as untouchable and accept we are asking it to do too much. We are asking younger workers to pay higher and higher taxes to cope with an aging population whilst those young people have fewer and fewer options for buying homes etc.

We do need to think about who gets what. My mum has a nhs dentist. We sat next to a lady chatting on her phone about all her holidays. She could have gone private. She took up a much needed place a poor person needed. I know loads of elderly people with very generous pensions who insist on nhs dental care. They manage to buy expensive glasses! They manage expensive holidays but won’t pay 1p towards their health. This has to change.