People would be happy to pay more tax if it went directly to the NHS

[Blackcats7]

I think people would be happy to pay more tax if it was guaranteed to go to the NHS.

I agree with this. In a way, the fact that managers in the NHS are able to see waste so clearly is a good thing. The issue in the NHS is that those managers are not empowered to fix the problems they see. The weaknesses of other systems often involve waste that's better hidden, or hides in plain site disguised as a virtue: the profits of healthcare and insurance companies, for example.

To be entirely transparent here, I do think the NHS especially its establishment needs a big kick in the backside. And this is a total anecdata hypothesis, which is very close to my life.

Yesterday, I had to call 111 to ask what to do for my DH68 with a 20-year cardiac history. I made DH more comfortable (trial and error) and at 23:00 we got a call back, so I said he was no worse and dozing. "We'll pass the information on to his GP so the case can be followed up." (DH slept well and we're headed home this morning). Phone call from GP at 11:45am asking what happened? Are you okay, do you need seeing this afternoon? Suddenly, the e-pieces are clicking and linking and working; the GP had got the 23:00 notification from 111 and called to check if an appointment was necessary. It wasn't, the call took a minute and a half.

He's waiting for a routine (but very technically difficult) procedure which should, if successful, transform him from a worried but well-ish 68 year old businessman back to a much healthier man with the capacity to run a company and meet a payroll.

As he is 68 and technically retired, with a pension, the NHS can't quite decide whether he should be allowed to run out of power like an old clockwork toy or whether HMRC would want them to keep him ticking over to keep funding the system. It's not a big business that he runs, about £1m pa in sales, so the tax take is VAT on turnover (he charges that), corporation tax first at c 20%, and he takes his income as a dividend from profits. Every so often there is a year when you don't make a profit. The cost of the operation privately is about £40k, and it's tricky; it might not work. In fact, it succeeds about 30%.

I am not asking for sympathy here, or a handhold. But the question is: If you were a doctor, or an NHS manager, on what basis would you make the call?

You don't have to save DH at any cost... I sometimes want to push him under a bus!

What should happen is that he gets the op @Papyrophile. Money, let alone his future tax paying potential, won’t enter the equation when the clinical staff (not managers) make the decision. My dad got a half hip replacement following a fall aged 99.

He's already had it tried, twice. It won't keep him alive; it only improves the quality of his life. But it means he can (and probably will, because he's an obstinate so-and-so) work longer, and do a valuable role that he is good at, that is simultaneously quite valuable to the UK's defensive position, militarily.

Nope. I would be happy to pay less tax and opt out the system entirely and pay for private care as and when needed. The system is broken. Should just move to Australian system and cut the free health service.

It's easy to say @Toffeecat2019 , but the cost of this particular procedure is £40,000 privately. There are not very many people in the UK who would be willing to pay £40k knowing that the failure rate is so high.

HS2 has currently cost £24.7 billion, not £60 billion, which was close to the estimated overall cost of the project.

Why does the conversation always jump to the USA system? The French, German and Spanish systems are much better and more affordable. IMO it would be well worth looking at whether we could move to a similar model.

I agree. We really need to move to a more European system. The trouble is that we're sleep waling towards the USA system because no one will accept the NHS is knackered and whilst it remains a sacred cow the changes needed will never happen and it will just get worse, meaning more and more people will go private , i.e. more like the two tier US system than a sustainable European style system.

Why does the conversation always jump to the USA system? The French, German and Spanish systems are much better and more affordable. IMO it would be well worth looking at whether we could move to a similar model.

Honestly, because I don't think the NHS lovers can accept that our European neighbours have better systems. It's therefore easier to talk about unaffordable US health care deductibles as they think it proves their point about the NHS being untouchable.

For what it's worth, friends and family living in Switzerland and Portugal think their healthcare set up is better too.

From what I gather about the German system, it encourages healthy competition between local providers. No-one wants to use the crappy hospitals so they have to improve or face a drop in revenue. I can think of several in this category near me.

A friend lives in Switzerland. The DC see a paediatrician once a year as routine part of health cover (cost of living v high there but so are salaries).

The effort I had to go to in the UK to get a paediatrician to see DD...once...and despite them saying we should have a follow up in 6 months it's now a year and we're still waiting.

We should definitely be looking to the European systems but do we have the capacity to treat the conditions that would then be found early, by a proactive system? I'm guessing not.

I also think that an awful lot of UK health expenditure is currently unrecorded as people take things into their own hands, ordering medications online, paying for private healthcare as and when. If I looked at my actual healthcare spend over the last 15 years compared to what the NHS has spent on me/my family it would be way higher.

Chinese acquaintance told me they have all dentistry done on visits home. Too difficult and expensive here.

The state are getting away with some pretty extreme cheapskating here...

Why does the conversation always jump to the USA system? The French, German and Spanish systems are much better and more affordable. IMO it would be well worth looking at whether we could move to a similar model.

• Because that is the model being promoted by the people donating money to the politicians and is the model that the UK is in great danger of moving towards?

• Because that is what some people - those who can afford it (or at least who believe that they will be able to afford it when illness or an accident strikes) - seem to prefer. They won't pay more tax so that everyone benefits, but will happily pay a premium so that they recieve priority treatment?

• Because anything "European" seems to be an anathema to a large number of influential and verbose people in the UK?

FWIW I live in an EU country. I pay no more in tax (proportionally) than I was paying in the UK - i.e. I pay income tax, a ringfenced health tax (a bit like national insurance) and a mandatory State pension contribution (again, similar to national insurance), all as percentages of my gross income.

I have a British work colleague who has just joined us on a temporary contract (but he's employed by the local company and therefore covered for local healthcare). He recently asked about how to he should go about seeing a doctor, as he has a long-standing but minor issue that has started to give him some discomfort again. He's been waiting over a year for a referral in the UK and still has no appointment. I told him that he could just walk in a see a GP, show his local healthcard and if necessary, the GP would refer him to the hospital consultant. He looked at me in disbelief, but went along to the GP anyway and was seen there and then. He was given a referral letter and the phone number of the Consultant, which he contacted and was given an appointment the following week. 10 days from seeing the GP to seeing the Consultant. As it happens he doesn't need an operation, but had he done so, this would have probably taken place within 2-3 weeks.

This is what good healthcare looks like in a modern, prosperous country. It is like this because politicians, and the electorate, have decided that this is the level of service that the country aspires to and the relevent levels of investment - in training, staff retention, equipment, buildings etc - have been allocated.

Hunt and the Conservatives - and many posters on here - claim that the country cannot afford this. Bullshit! These politicians have decided that healthcare is not the priority that it is in other countries, and their donors and the media have convinced the electorate that this is indeed the case - and that private healthcare is the way forward. It is for those who can afford it. It is a goldmine for the private providers under an "American" model who are promoting it. But it is turning into a disaster for the vast majority, and for the country as a whole.

To a degree, I think that anyone accustomed to the NHS modus operandi assumes they will languish in a queue for several months before anything progresses. The notion that the patient can inititate is completely missing in the NHS. On the cost issues: most early visits are for conditions that can be treated quickly, or quicker and far cheaper than if left untreated.

But there IS (like it or not, and IMO quite rightly) a reluctance to do too much for people over retirement age. I know BlossomToes will pop up to say her dad got a hip replacement at 99. Modern medicine is vastly capable and costs a bomb, so focus it on people of working age. Written by a fit 68yo women who came through breast cancer.

Any and every healthcare system has to pick priorities. My view is that the focus should favour youth, and that we should help older people improve their own health with advice and support and proven medication.

My dad got a part hip replacement because he suffered a neck of femur fracture @Papyrophile. They had absolutely no choice.

Having said that I completely disagree with you. Universal good quality healthcare should be available at any age. If we’re going to pick priorities it should be based on clinical need, not age.

We may not ever agree on that one, @BlossomToes. My DMIL also had a neck of femur fracture at 93, and there was no discussion of a hip replacement. They did a partial repair by cementing the femur, but the clinicians (geriatric orthopedic trauma unit consultant) explained that most over 75s die within 12 months of a major trauma. That said, my NDN's mother (who was even older than DMIL) is making great progress. I think the clinical assessment may be based on the chances of success. DMIL was very frail, with dementia and long term illnesses, and no drive to live.

Not treating or limiting treatment for the over 65s etc isn't my experience at all.

But is that treatment timely and done to limit destress? no.

Why is that? the NHS hasn't capacity to do preventative stuff, so everything becomes fire fighting, emergency care and clinical staff doing admin work.

On european healthcare systems, they pay in far more and have done for decades, hence far more nurses, beds, doc's, equipment.

The UKs overall tax burden is way below what the French pay.

The UK has chosen tax cuts, £30 billion since last October, the UK also had North Sea oil, we squandered that too.

When you compare healthcare expenditure with life expectancy, one of the most impressive countries in the world (if not THE most impressive), is Cuba. It has a nationalised healthcare system similar to the NHS and as it’s run on a shoestring, it badly needs more investment. But it puts a lot of emphasis on preventative medicine and achieves a surprising amount with very little.

It would be interesting to know how Cuban medica feel about it.

No because they are wasteful. Spend too much money on Management and not enough on frontline staff.

Compared with other healthcare systems the NHS is chronically undermanaged.

When my DD worked for the NHS, she spent around 30% of her time doing duties that management and administration staff should have done but they didn't because they were also understaffed, so clinical staff had to do these.

Examples would be: finding care home places & community care packages for patients, dealing with complex family concerns, ordering equipment, organising work TOIL & holiday rotas, doing performance reviews, IT issues.

People who come out with crap like "NHS wastes too much on management" have zero knowledge and their opinions are based on ignorance.

@Cattenberg

The Cuban healthcare system makes a lot of money from exporting its doctors to other countries (the Cuban state gets paid the actual salary and then pays the doctor the Cuban salary) as well as selling healthcare services to other Latin American countries.

That’s nice. Let’s me know when you have written your cheque. Is this some kind of student politics course work?

There's a survey about this from Oct 2023. 48% of people would be prepared to spend more. But of those people who would be prepared to spend more, it's a ridiculously small amount. I read that those people whose income in 60k and over would be prepared to spend an extra £100 per year. That's not really going to cut it tbh.

People say they want to spend more, but they don't really. I think we should have a dialogue where we say things like, well, you can pay x and then expect to wait 10 hours in a and e , or pay partially for this or that service. Or we should agree a basic price to see the GP...but we shouldn't expect to receive a private level of health care; in terms of short waiting times etc on the NHS.