NHS should be a co-pay system.

Completely agree, for all it's flaws it's still the best system for funding healthcare. I think some NHS trusts could do more to organise their services rather than try and fool the target system but a lot of this is down to money and the shortages in staff.

Nonsense. I've been spending a lot of time in various hospital departments in a big city hospital and the vast majority of patients were older white British people. Most migrants are younger, healthier, and don't need the NHS. In fact the only migrants I really saw were the ones treating me. The A&E heart consultant was a very lovely Syrian woman who came as a refugee and was eventually allowed to start practicing here. Try and engage your brain before posting such crap.

This, unfortunately.

Just today I have received two letters in separate envelopes regarding a condition for which I’ve been referred to a consultant.Multiply that a few thousand times up and down the country with today’s postage costs and you can see how wasteful the NHS is.

Canada attempted a co pay system some years back. It had to be scrapped because the administrative costs of running it were greater than the money it brought in. And no I don’t agree with the OP. It would never be run like any European system. It would be run along American insurance lines.

Look what happened to the student loan book. First run by the uk govt. with promises of capping interest rates etc. Students took out the loans on the basis of those conditions. Then the (Tory) govt decided it didn’t want the Student Loans on govt books so sold it to a private firm who would only buy it on the basis that interest rates could be set by the private company. The UK govt broke their social contract with the students and agreed. Rates are now double or triple baseline interest rates.

People are naive if they don’t think this exact same scenario wouldn’t happen to co-pay. Wait and see what happens if Reform get in. American health care companies are salivating at the thought of the UK market. Money to be made.

Who is that directed at?

Guessing like us you don't have a severely disabled child !

Glad to hear that your DH has responded so well. These are the examples that people should be hearing more about. Not to give them false hope, to but to demonstrate how making certain lifestyle choices can impact outcomes. It's never to late to make those choices.

@NorthXNorthWest

You are not special, we all carry health risks, some you can’t control, like genetics or random chance. You might still end up with something like dementia or cancer. But there is a lot you can influence through how you live and manage your health, which can affect when illness shows up, how severe it becomes, and how much strain it puts on the NHS. That’s not about blame, it’s just reality or scarce resources, and why personal responsibility has to be part of the conversation.

Another point is that being fit and healthy improves your chances of harsh treatments being tolerable and effective. Take one of the many cancers that doesn't have "lifestyle" causes. Being fit and healthy may well improve your tolerance of the chemotherapy and other drugs, may mean that you can tolerate a stronger dose to hit the cancer quicker and stronger, or even a "healthy" gut system may make some of the drugs more effective due to absorption etc.

My DH has a cancer with no known causes - his haematologist has often told him it is pure "luck" as to who gets it and who doesn't. She's been regularly amazed at how well his body responds to the treatment. His first course of chemotherapy should have been "at least" six rounds and he was started on the highest level of drugs to "hit it hard". The blood "markers" for his cancer halved after just the first round, then halved again after the second round and were negligible/trivial after the third round, so they didn't do rounds 4 to 6. Haematolologist said she'd never seen anything like it. And that was after they'd halved the chemo dose for the second and third rounds. DH was "super" fit, had always eaten healthily, never smoked nor drugs, very moderate alcohol (occasional, not even weekly), not overweight, plenty of exercise (walking, cycling, swimming, skiing, golf, squash etc). He was told that the first chemo session would "probably" last 18 months before the next major treatment cycle was needed (it's incurable, but treatable), but the very lose "maintenance" dose he's been on, has now lasted 7 years and is still keeping it under control, which again, the haematologist has never heard of before!

I do think people need to take their fitness and health more seriously. It really isn't just that so many diseases/illnesses are caused by poor lifestyle choices, it's that a healthier body can respond better to treatments for all the other diseases that don't have known causes.

A heavy smoker who develops lung cancer and keeps smoking is likely to cost the NHS considerably less because they’ll die much sooner.

Not all of them do. But all of them whether they live a short or a long time are costing time, resources and money. All of which are in short supply.

Alcoholism is an illness. George Best received a liver transplant and was warned to stop drinking. He didn't and died a year later. His treatment, cost time, money and valuable resources, which included a liver. A liver that could have gone to someone who did not or no longer consumer alcohol. Survival rates at 20 years, post transplant, are around 50%. Add to this that around 1 in 10 people die while waiting for a transplant or become too ill for a transplant. There are financial and non financials cost for personal choice.

Either way there’s little I can do about it. It’s in the lap of the gods. Or, of course, I might get diagnosed with cancer tomorrow, who knows?

You are not special, we all carry health risks, some you can’t control, like genetics or random chance. You might still end up with something like dementia or cancer. But there is a lot you can influence through how you live and manage your health, which can affect when illness shows up, how severe it becomes, and how much strain it puts on the NHS. That’s not about blame, it’s just reality or scarce resources, and why personal responsibility has to be part of the conversation.

Many smokers don't pay the tobacco duty because they buy knock off duty free from their mates down the pub or under the counter from dodgy convenience stores or go themselves across the channel to stock up on booze and fags if they live in the South East.

Completely irrelevant. The figures I’ve quoted are the revenue the Treasury actually receives from taxable tobacco sales, the fact that it could be more if there was no black market is neither here nor there.

Many smokers don't pay the tobacco duty because they buy knock off duty free from their mates down the pub or under the counter from dodgy convenience stores or go themselves across the channel to stock up on booze and fags if they live in the South East.

Lots of older people don't cost the NHS much at all - not everyone ends up with expensive treatments required in their old age - lots just live a pretty healthy retirement and drop dead after costing the NHS very little indeed.

Did I say ALL? Are you representative of everyone in the UK?

Many, not all, NHS patients could improve outcomes and reduce avoidable strain on the system by managing their health more proactively.

Is what I said

@ThingsAreNotWhatTheyWere I don't like being made to feel like a burden to the NHS by strangers when I'm already well aware of the fact.

Then I suggest you address that to people who are saying that, not me.

On the other hand, a heavy smoker who develops asthma or even lung cancer but keeps smoking is likely to cost the NHS far more than someone who doesn't smoke or is who supported to stop.

A heavy smoker who develops lung cancer and keeps smoking is likely to cost the NHS considerably less because they’ll die much sooner. Of course there’s also the small matter that the Treasury gains £12 billion annually from tobacco tax and VAT on smoking products yet the cost to the NHS of smoking related diseases is £1.8 billion.

It’s quite absurd to assert that health isn’t a lottery because it is. I may inherit my dad’s genes and be sharp as a needle to my dying breath at 99 like him. Or I may inherit my mum’s from a family riddled with dementia and end my life away with the fairies. Either way there’s little I can do about it. It’s in the lap of the gods. Or, of course, I might get diagnosed with cancer tomorrow, who knows?

I'm not trying to point score, I'm actually trying to point out how offensive it is to someone who's needed lifetime care under multiple hospitals that if only I did X, Y, Z all my problems would magically disappear. I've never smoked or taken drugs, pnly drink in moderation, was pretty active until my stroke, but still try to do as much as I can, and I do eat healthily. And as someone with Coeliac disease I can tell you that the vast, majority of sufferers will stop eating stuff that makes them ill!

ETA I certainly do nuance, but I don't like being made to feel like a burden to the NHS by strangers when I'm already well aware of the fact.

@BIossomtoes
@ThingsAreNotWhatTheyWere

Peer reviewed research exists on pessimism, luck and motivation. There is also a lot of research on learned helplessness.

As for What utter bollocks. Life threatening diseases are a lottery.

Not every life threatening illness is a lottery. Some are. Some aren’t. Trying to point score by pretending they are all the same is bollocks as is say the major fact is luck.

There are plenty of life-threatening conditions where people can make changes that improve both their quality of life and the cost of their care. A person with coeliac disease didn’t choose it, but managing their diet makes a huge difference to their quality of life and their cost to the NHS. On the other hand, a heavy smoker who develops asthma or even lung cancer but keeps smoking is likely to cost the NHS far more than someone who doesn't smoke or is who supported to stop. Money, time and resources that could have been used elsewhere. That's something to be mad about, not someone who works hard but earns more than you.

People who find solutions don't have a binary way of thinking nor do they try to derail conversation with extremes. They recognise that there will always be things outside people’s control and that there is also often a lot within it. Many, not all, NHS patients could improve outcomes and reduce avoidable strain on the system by managing their health more proactively.

If we are looking at fairness when it comes to funding the NHS then we have to have the uncomfortable conversations about users of the NHS pulling their weight where they can, as well as waste and inefficiency in the system.

No problem. It bears saying twice!

Sorry @BIossomtoes, I didn't mean to quote you, although I was indeed posting in a very similar vein to you!

You can of course eat well and keep as fit and active as possible to try and mitigate risks, but the rest is down to luck.

Not if you have the misfortune (bad luck) to be born with health conditions that predispose you to certain health issues. And I'm not sure you can do much to control whether you develop autoimmune conditions - and once you develop one, they are more likely to come in clusters...

What utter bollocks. Life threatening diseases are a lottery.

Luck is an excuse used by the lazy and those who are not prepared to do what they can.

That's not what you said, this is what you said that my answer referred to.

" In my local trust the volume and range of provision wouldn’t be possible without the PFI provision so your assessment falls at the first fence."

It was all done on borrowed money and could have been done on National Debt if it had not been done on PFI

@paolo2145 on this basis, if it costs an average of £2800 to provide a Canadian standard of healthcare, in the uk you would need to be earning over £41,600 to fund this. To contribute £2,800 to UK health services via National Insurance (NI) in 2025/26, you would need to earn approximately £41,600 per year. This calculation is based on the 8% main rate of NI applied to earnings between £242.01 and £967 per week, for those employed.
MoneyHelper
+1

• Calculation Breakdown: With an annual income of £41,600, your weekly earnings are roughly £800.
• NI Calculation: No NI is paid on the first £242.01/week.
• Taxable Amount: On the remaining
• £558 per week, you pay 8% (
• £44.60 per week).
• Annual Total:
• weeks =
• (Note: To reach exactly £2,800, the earnings would need to be higher, closer to £48,000–£50,000, assuming 8% rate consistently applies).

Average uk earners are contributing much less:

Average UK earners contribute hundreds of pounds annually to the NHS through general taxation and National Insurance, with one estimate suggesting around £792 per year. The NHS is primarily funded by taxes (including income tax, VAT, and NICs), with average annual costs per person reaching over £4,000 in recent years.
Key details on NHS funding and contributions:

• Funding Sources: The NHS is funded by general taxation, National Insurance Contributions (NICs), and other taxes like alcohol and tobacco duty.
• Contribution Estimate: An estimate suggests an average UK taxpayer contributes £792 per year in general taxation towards the NHS.
• Expenditure per Head: In 2024/25, health expenditure per head varied by nation, ranging from £3,462 in England to £3,758 in Wales.
• Cost per Person: The average person costs the NHS approximately £4,188 a year.
• National Insurance: Employee NICs are charged at 8% on earnings between £242 and £967 per week, with a 13.8% employer rate.
• IFS | Institute for Fiscal Studies
• +3