NHS should be a co-pay system.

It means that the volume of income generating work is equivalent to or greater than the PFI payments. 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.

Your last paragraph is entirely correct.

it’s paid for itself in increased workload since it opened

I don't understand what this sentence means.

The only way to judge the value of that PFI contract would be to work out how much it would have cost to provide the same thing without a PFI deal.

The early PFI deals were poorly negotiated and ended up with basic maintenance tasks costing an arm and a leg. Negotiators got wiser with the later ones and I would really like to see the figures for the last few.

@dwordle your arguments only make sense if we swap ‘better’ with ‘cheaper at point of use’.

for me a ‘better’ means access to innovative medicines, timely treatment, basic dignity in care - and ultimately better outcomes. All of which are have rapidly deteriorated in the uk relative to other countries with different funding models.

No, I don’t agree. DH has been a higher rate tax payer for years and barely used the NHS but now he’s sick he needs lots of appointments and is likely to lose his job because of said sickness. Hes already paid his dues… to now have to pay again to see the doctor about pain that’s preventing him working would cause us to really struggle. Much better to get him in, treated and better so he can go back to being a work horse paying his tax!

i find your argumentation nonsensical. Having a partially private system (which is the vast majority of the developed world) is not the same as ‘no healthcare’. I also never claimed that healthcare in the us is ‘free’ with jobs - rather the opposite in that even with great insurance you always pay something and therefore recognise that healthcare has value.

good healthcare costs money, and excellent care cost a great deal more. I want everyone to have good care, but I also think people should be able to pay more for excellent care if they can.

And fwiw, France is generally recognised to have far superior cancer care than the uk.

Agree. Needs completely reformed. It doesn’t have to be the US system

What a bizarre reply, so you would rather have no healthcare than a system that provides universal free healthcare that is ranked in the top 5 in the world.

America has millions of people who can't afford it, and you say it comes free with employment....this only applies to certain jobs. Something like 10 percent of Americans have absolutely no healthcare provision, another 20 percent have inadequate provision.

France doesn't have a better healthcare system than the UK and they pay huge amounts in tax to fund it. They don't have the same cancer care provision...no where near.

Having lived all over the world, the best places have been Australia and Saudi....but again you have to pay into a compulsory scheme and it's not cheap.

You have no idea what you are talking about when comparing to other countries. Yes, PUMA only covers 70%, but most people have additional insurance to cover the 30% if needed. In the US insurance is very expensive, especially for the self employed who foot the whole bill, but for most people employers cover the majority of insurance and taxes are lower.

individuals in both of these countries are exposed to some extent to the cost of the healthcare they consume, but that isn’t a downside- in many cases that is by design as it provides some mechanism for the consumer to understand the implications of their choices. Free at point of care is not the holy grail, but rather the fatal flaw in the system for the nhs - there is a reason no other country has copied it.

and I will reiterate that there is a vast gulf in the quality of care you receive in France or the us vs the uk. We don’t have access to many innovative medicines, diagnostics are often outdated and/or insufficient to meet needs, referral times and waitlists are far outside accepted standards, and no one can count on an ambulance getting to them with any urgency or a hospital bed being available if it does.

in the us the worst case is crippling medical debt, which is awful, but to my mind better than dying a preventable death with insufficient care.

Fine, 20% and the rest comes from general taxation. The point is, we already pay for it - it’s just not an itemised bill.

There have been no new PFI contracts since 2018 - Tory governments were equally fond of them - and they have a duration of 25/30 years. My local hospital has one with just another five years to go and it’s paid for itself in increased workload since it opened.

Looking at top 20 countries for healthcare, no surprise to fin we are nowhere on the list. % rating healthcare

Taiwan (78.72)
South Korea (77.7)
Australia (74.11)
Canada (71.32)
Sweden (70.73)
Ireland (67.99)
Netherlands (65.38)
Germany (64.66)
Norway (64.63)
Israel (61.73)
Belgium (60.16)
Switzerland (59.6)
Japan (59.52)
Singapore (57.96)
United States (56.71)
Austria (54.86)
United Arab Emirates (52.3)
Czech Republic (52.25)
Finland (52.1)
Portugal (51.99)

I am a frequent visitor to Canada and they have great healthcare compared to us- Yes thy do contribute towards it but they really get a lot for their contribution.

Canadian residents pay for Medicare through their taxes, but the medical services are free at the point of use. On average an individual might pay around $5,000 per year which is about £2,800 or so.

I am not advocating we all pay that in UK but perhaps we could have something similar where the amount you contribute, depends on say your income. I know people will say that is the end of NHS, however, let's be honest it is no longer fit for purpose in its current state and something needs to be done to change things.

The lack of communication between different NHS depts, different trusts, between GP and hospital etc is an absolute disgrace and needs to be tackled. It really shouldn't be the responsibility of ill patients to have to act as go-between between the different depts, even moreso when they are so hard to contact, don't answer phone messages, don't pass on messages when you do manage to speak to someone etc.

Disagree. The wealthy will go private. Why should soneone who works hard at a low wage pay whilst someone on welfare gets it free. Either NHS is free OR charged at the point of access. No payment no treatment.

I just think spending by our government needs change. They take in a collosal amount in taxes. There are areas where it seems spending is ridiculous. A lot of waste on the projects they do. Id rather they were more sensible and prioritised our money better.

Id be happy to pay a small contribution per gp appointment if it was shown to be a real change maker. However, i think anyone on any benefit should not be required to pay.

From where?

Agreed, a friend had similar problems, has memory issues so doesn’t always remember specific details, has to rely on family to prompt. My friend would be penalised for something she can’t help.

Her daughter can’t use a phone so relies on her mum to take phone calls that can’t be changed to email. Friend has had several phone calls where she has spent 3-4 hours on trying to get through to cancel appointments for daughter and then daughter was listed as missed appointments.

Daughter has many health conditions which means she has so many different departments for nhs, none of them communicate between them so daughter has to act as go between because they failed to cooperate on an issue.

@Icecreamandcoffee

I would also support everyone having to pay an appointment fee or deposit to see the GP. I would love to know how many private dentist appointments are missed (especially where dentists take a deposit against the appointment). I imagine many of those who have paid their appointment deposit at the private dentist are highly motivated to attend their appointment or make sure they re-arrange or cancel in a timely manner so as to not loose their deposit. I can also see people making use of the local pharmacy more, so many pharmacies can now prescribe certain medication and offer advice for many conditions and there are certain conditions where the NHS say the pharmacy is the recommended route for treatment but because the GP appointment is "free" they use them.

I'd want to see statistics first. I.e. what proportion of missed appointments were in different age groups, proportion between workers and disabled and retired and unemployed, type of appointment missed, etc etc. Until we have ALL the facts, bare numbers of missed appointments mean nothing. No point charging for appointments if most of the missed ones are from people who'd be exempt anyway (due to unemployment, age or disability). I'd not support any charges that would only be levied on workers as that's just yet another tax on workers.

I'd also want some proper analysis of reasons, i.e. what proportion are because people never received the appointment letter, or who couldn't get an answer when trying to phone to change/cancel it, or other NHS admin cock-ups.

It's easy for the NHS to use their usual excuse of "patient blaming" for all it's ills, but a lot of the time, it's down to NHS systems, staff incompetence, poor admin and poor management etc.

Charging shouldn't be brought in just to raise revenue, as the cost WILL fall unfairly on innocent workers.

Population has also increased over that time frame from around 60 million to around 70 million. Then you have to factor in inflation, pay rises, and of course the ruinous cost of Labour's love of PFI for their fancy new hospitals with atriums which our grandkids will still be paying for long after we're dead and probably long after the buildings need massive refurbishment/improvement at even more cost. Not saying there hasn't been a massive rise in spending on the NHS, but it's got lots of factors, plus of course the monumental waste and inefficiency.

Which is mostly spent on benefits such as state pension. Very little of it is ring fenced for the NHS.

Surely an extra 200 billion would make up for this. 50 billion in 2000, 250 billion now

I agree. Misuse is rife and is breaking the system.

I would start by getting rid of all free prescriptions for adults and instead push the pre- payment certificates angle. So anyone who needs lots of medication can still have cheaper access with pre payment certificates.

I would also support everyone having to pay an appointment fee or deposit to see the GP. I would love to know how many private dentist appointments are missed (especially where dentists take a deposit against the appointment). I imagine many of those who have paid their appointment deposit at the private dentist are highly motivated to attend their appointment or make sure they re-arrange or cancel in a timely manner so as to not loose their deposit. I can also see people making use of the local pharmacy more, so many pharmacies can now prescribe certain medication and offer advice for many conditions and there are certain conditions where the NHS say the pharmacy is the recommended route for treatment but because the GP appointment is "free" they use them.

It isn't that long ago that people paid "insurances" for drs. My own Nan (pre NHS) used to pay 2p a week to the local dr, which then entitled the whole family to appointments and treatment.

I would also like to see some tightening up of A+E with banded treatment. Actual emergency, accident or urgent treatment needed requiring A+E - free treatment. Going to A+E because you can't get a drs appointment for your cold/ headache/ backache or for something to do ect should come with a charge. This would of course require GP's to refer properly to hospital care pathways. So for example you go to GP for headaches but GP actually thinks investigation is needed they refer on (can be done by phone or email) to the correct hospital department - free treatment.

It's a mad system at the moment - higher rate of tax payers are in the same NHS waiting list as the millions that could work but don't! Couldn't make it up.

let medical staff run the hospitals,

They tried that at my local hospital, the chief executive was a gynaecologist. During his reign the place haemorrhaged staff and money and waiting lists went through the ceiling. Following his sacking it took a couple of years to rebuild and repair the damage.

Copay systems don't mean having to pay a proportion of the cost, that's an insurance system. A copay is just a nominal sum per appointment/hospital night. For instance I pay 30 euros per GP appointment and that covers everything that occurs in the appointment (blood tests, ecg, x ray, whatever), specialist clinic is 70 odd euros a visit, staying in a hospital costs 70 euros per night (which tbf is a steep increase from the 35 euros it was just a few years ago) and that includes everything that happens including surgery no matter how expensive it is. Long term hospital stay fees are determined according to income level. Now it can be a lot if you have to spend a couple of weeks in hospital or get ill a lot but they will always do a payment plan with no interest if you can't pay as soon as you get the bill.