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.

No more money for the NHS. It doesn't need it. Social Care on the other hand.....

If you kept old folk healthier, and out of hospital, you have sorted most issues within the NHS.

Yes, a ringfenced tax for the nhs.

A 2 tier approach needed,

Short term - huge investment to get rid of waiting lists. Current waits mean patients are sicker, have more mental health problems because their physical issues have not been addressed and when they finally do reach the top of the list the treatment is often costlier and with poorer outcomes.

Long term -

1.reform on a national basis, look for pockets of excellence with new approaches and drive rolling these out. There are so many annual awards out there that showcase good practice but they are rarely implemented beyond the local area.

1. Early intervention and self care / responsibility for individual health but this for many people needs to be encouraged with regular well check ups and good access to advice and support.
2. Better HR processes - to be able to get rid of staff who are seriously under performing/defrauding the nhs. Sick pay for staff should not come out of service budgets but should be managed separately to allow recruitment and use of temporary staff to ensure service delivery continues and prevent the knock on effect to other team members of low staffing levels.

Yes because all of this needs money now and we are at the tipping point of nearly no return.

So like health insurance you mean 🤷‍♀️

"Health insurance" doesn't need to be private health insurance.

There are other models, notably the "Social Health Insurance Model" found across much of Europe, which is a system under which everyone pays into a ringfenced health Fund through taxation (so not very different from what the UK has in terms of National Insurance) and the funds are managed by an independent, non-Government and not-for-profit organisation.

The unemployed, students, pensioners and others who are not in employment are covered by the scheme as well, so it is not dependent on the individual being in employment.

There is a second aspect of this, which is that the actual provision of care (hospital care and operations, Consultants, ambulances etc) is delivered by a variety of providers rather than by a State-run Health Service like the NHS. Some of these providers are public institutions (e.g. University/training hospitals, State hospitals), some are non-profit institutions such as charities like the Red Cross or long-established religious charities, and some are private companies. The key factor is that an operation costs the same regardless of where it takes place - the Health Fund will pay a fixed amount for the operation and reimburse the provider accordingly.

Manyandyoucanwalkover, absolutely but also change needs to come from the service users in terms of taking responsibility for their own health and not making poor lifestyle choices that result in avoidable self inflicted disease and co morbidities.

I agree. I still get letters from my consultant for appointments and blood results. It’s a complete waste of money. An email takes seconds where as this is paper, ink, envelopes, stamps. Even when I call to say I can’t make an appointment they write out again with the appointment change. It is utterly ridiculous.

Nope. NHS is a shit show. Would rather see it burn down and pay for private.

Just use private healthcare then and free up some space in the NHS for those people with no alternative.

I pay a lot in tax and NI so nope, why would I?

You just said that was what you wanted, while also destroying it for people with no choice. 🤷‍♀️

I said I'd like to see it burn but while I'm paying so much into it I'll use it as much as I want. I'll also continue using it once I cash out my stocks and crypto, quit my job in the UK and no longer am paying into it bc I have paid my fair share, way more than most.

But the comment was that people would be happy to pay more tax if if went directly into the NHS and that is just simply not true. The only people who think that way are the ones who just take from the system without ever paying their fair share.

It is true. I think that way and I’ve paid in way more than I’ve taken out.

https://www.bmj.com/content/384/bmj.q754#:~:text=It%20found%20that%2048%25%20agreed,spend%20more%20on%20the%20NHS.

They spend rather more as a percentage of GDP on health care in the Scandinavian countries and in Germany. Not sure about France.

Edit: sorry, didn’t see this thread was months old.

We are very seriously considering paying for our healthcare needs via insurance and top ups as part of relocation costs. I don't really want to pay for the NHS, only to find that DH and I are off the radar for healthcare. I would rather pay for an appointment slot to discuss my concerns. I don't consult a doctor without sound reason, so I do expect to be taken seriously.

You will be lucky. NHS can get v sticky about treating people domiciled abroad. I have seen it first hand - an awful lot of fuss to get seen.

I pay about £50 a month for primary healthcare insurance where I live. (Primary healthcare here is pay on arrival.)

So I am happy to pay between £600 and £700 a year for NHS or for insurance, but I don’t think the NHS would sort itself out if we all paid £600-£700 each more. We need an insurance model with private insurers and ring fenced contributions. And we need to limit what the NHS provides quite shamelessly. Possibly separate off mental health because it’s very expensive and actually social prescribing would imo help more with some aspects of that crisis than medicalisation.

@KTheGrey "We need an insurance model with private insurers and ring fenced contributions"

Absolutely not. Private insurers exist solely to make a profit, and as is already the case, they will exclude any "customers" who they cannot turn a profit from - older people, people with pre-existing conditions etc. - and exclude treatments that they deem to be too expensive to deliver or will cap the amount that they will cover.

The European "Bismark" insurance model is a different insurance model. The funds are ring-fenced but the insurance providers are non-profit, arms-length entities (usually called Krankenkasse [ = Health Funds]) that are funded through compulsory wage deductions (just like UK National Insurance) but are not subject to political interference.

Note too that these Health Funds are only involved in administering the money - collecting contributions and paying healthcare providers - rather than actually providing the healthcare. Healthcare is "purchased" by the patient and funded by the Fund according to an agreed scale of payments. Where I live in Europe, to take an example, surgery such as a hip replacement "costs" the Fund the same whether I choose a public hospital, a private hospital, a training/University hospital or a hospital run by a non-profit organisation such as a charity. The cost to me is the same - i.e. it's free at the point of delivery - but I can choose to pay extra (or pay into an additional commercial insurance fund) if I want a single room, private ambulance transport or any other non-medical add-ons.

@Havanananana

Absolutely not. Private insurers exist solely to make a profit, and as is already the case, they will exclude any "customers" who they cannot turn a profit from - older people, people with pre-existing conditions etc. - and exclude treatments that they deem to be too expensive to deliver or will cap the amount that they will cover.

Have you actually studied alternative insurance based models in other European countries, or the health systems of Australia, New Zealand or Canada??

Insurance firms and private health firms don't need to be profit making companies. Even some in the UK are constituted as charities or mutuals, as are some in other countries, and some "insurance" firms in other countries are state owned.

As so many people keep trying to point out, the only alternative ISN'T the American system, but if people in the UK continue to fight against any changes and reform of the NHS, then the American system is exactly what we'll end up with by default, simply by sleep walking into it!

Improving the NHS won’t be achieved by changing the funding model. It definitely needs reform but the way it’s funded is the least of its problems.

@taxguru

As my post suggests, I have experience of European healthcare - I've lived in several EU countries.

The UK has private providers of healthcare insurance that are non-profit (in the sense that they make a profit but re-invest this in the organisation and don't have shareholders). BUPA would be one, but BUPA only has one hospital and 50 health clinics - i.e it has cherry picked the services it will provide. These "non-profit" insurers also cherry-pick their customers, refusing to cover for a number of pre-existing conditions or setting premiums so high that they are unaffordable if a condition is diagnosed. BUPA's hospitals were sold to Spire several years ago. Spire is a FTSE 250 company, so is definately run to make a profit.

Nuffield Health as a healthcare provider is registered as a charity and notionally a non-profit organisation, but only provides treatment against payment - either the patient pays directly or their private insurance covers the cost. In the European scheme, a provider such as Nuffield would participate in the universal healthcare system by also providing treatment at a fixed, agreed cost to Krankenkasse patients, as in the hip replacement example in my post. This cost would be the same as the Krankenkasse would pay any other provider for the same treatment, be that a public hospital or a private (either profit or non-profit) provider. Many people in the UK seem not to understand how this system works, or how it differs from the American system.

I'm in complete agreement with your main point - that if people are unwilling to consider other forms of healthcare delivery (aka NHS reform) then the UK will sleepwalk into the American model - which is what many "low tax / small government" politicians would like to see, and what some very wealthy and powerful American companies have been lobbying for for many years. They see the UK health service as one of the last golden opportunities to milk a cash cow.

I agree that we need to move on form the NHS model and how it is funded or it will just slowly be privatised along the lines of how healthcare is delivered in the US

Labour need to be honest and need to be able to deal with the backlash that will happen I would like for their to be a cross party department dealing with NHS reform so it stops being a political football

either way the NHS free at the point of service use is no longer sustainable, it is a service that has been in decline for years and we need to move on

Although posters above are saying "I agree with you" to each other about selected bits, there is actually a fundamental disagreement between

@HRTQueen 's
"the NHS free at the point of service use is no longer sustainable, it is a service that has been in decline for years and we need to move on"

and @Havanananana 's
"The cost to me is the same - i.e. it's free at the point of delivery".

Having fundamentally conflicting objectives completely negates any apparent agreement on the method to achieve each person's objective.

This is starting to give me flashbacks to Brexit, where people with radically different preferred destinations were all eventually landed in a single destination – and one which was rather different from many of the destinations promoted during campaigning; voters having been given only the ability to vote AGAINST the status quo, rather than FOR their different desired destinations.

@HRTQueen Universal healthcare, free at the point of service, is sustainable. Many countries manage to do it, and none of the countries with which the UK should be comparing itself have anything like the waiting times (for GPs, ambulances, A&E) and waiting lists that the NHS has.

The UK should have access to universal healthcare as a right - this was the founding principle behind all of the Western healthcare schemes regardless of how they have been designed - and good healthcare should not be the sole preserve of those who can afford it. The NHS could be more efficient and more effective, and could embrace more modern technology and better ways of working - but when people complain of pouring money into a black hole, they should realise that the UK invests far less per capita in healthcare than most modern countries, has far fewer doctors, nurses and beds per capita than many other countries so on one level, it really is a question of resources (i.e. money) needed to bring these up to the standards found elsewhere. Something that cannot happen overnight, but will more than likely take a decade or more to achieve.

👏🏻👏🏻👏🏻👏🏻👏🏻

What Boris said about the money saved from paying the EU will go to the NHS was one bullshit lie