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.

Namechange25793, at last someone with some sense!!!

This is largely because they don't have the computer system to do appointments by email, and most new spending on the NHS has to go on the politically popular new nurses and doctors, and not on the infrastructure and equipment that enables them to work effectively and efficiently.

On tax there was some opinion polling about this recently. The average amount of extra tax that people are willing to pay is £10.

So that's an extra £690 million.

Good luck fixing the NHS with that.

It wouldn’t though. We pay higher taxes in Scotland and I cannot see any improvements in NHS Scotland or public services!

I am not suggesting that healthcare should not be free (well it isn't free we all pay into it at some point) I mean how it is funded. There is no reason why we can not follow healthcare services in Europe it cant be done over night but it can be done

What many will champion about the NHS is that it is free at the point of use we do not have to think about insurance, we do not have options (unless you have the money to go private) we do not have to pay a small amount to see a GP start adding this into the discussions about healthcare and the government will face a back lash and fear of losing the next election this is why I feel it needs to be cross party working on this

The NHS is broken, its been failing the public for years, its fails staff we certainly can have a better health care system which of course needs a lot more money but this is not the only issue

Changing the funding model doesn't change anything in the NHS, insurance companies, whether mutuals or state owned, just add layers of administration... claiming back for appointments etc more directors/senior managers in each of these organisations.

The bottom line is that we in the UK pay less per capita for healthcare but want Euro levels of service.

@HRTQueen Which euro healthcare model would you follow? they are all different.

@HRTQueen "I am not suggesting that healthcare should not be free (well it isn't free we all pay into it at some point) I mean how it is funded. There is no reason why we can not follow healthcare services in Europe it cant be done over night but it can be done"

Funding in European systems is basically the same as in the UK. Where I live (in Europe) healthcare insurance contributions are deducted from wages and salaries on a percentage scale, and employers also pay a percentage. This is almost exactly the same as the UK National Insurance deductions scheme. An average person here pays around the same as they would in the UK on the same salary. This money is ring-fenced for healthcare, and the government tops up as well.

The UK issues seem more to be about the size of the funding pot and how it is spent (i.e. how healthcare is delivered).

It is a fact that the UK invests far less per head on healthcare than most other comparable countries. This directly impacts on the amount of investment in hospitals, staff, facilities etc. This impacts on efficiency - NHS systems and processes are years behind what I have seen in Europe. It means staff spend time coping with the problems that this inefficiency causes rather than on patient care. It means waiting - for GP appointments, for ambulances, for hospital appointments and treatment. It means that what should be a Health service has become a Sickness service - i.e. the NHS spends so much time dealng with those who are already sick that there are no resources left to begin to look at preventing people getting sick in the first place, or in identifying issues before they become serious.

The second issue - how healthcare is delivered - is very different in many European countries, as described in the posts above. Short version - there are fixed rates for an operation or treatment, agreed between the Health Funds and the Health Providers (be they private, charities, state-owned, training hospitals or whatever); a concept that the UK public and politicians seem to find difficult to understand, being understandably frightened of the American model.

Nope.

I'd like to see the money they've got spent sensibly first.

Far more needs to be spent for the benefit of the patient than currently is.

Exactly. Changing the funding model would be expensive tinkering at the edges and would improve nothing. Just like Landsley’s mad reorganisation - cost £13 billion and made things worse.

Compared with countries such as Germany, the UK health service is underfunded by around 30% a year - every year. The impact is clear to see - 8 million people on the NHS England hospital waiting list, long waits for vital services such as GPs and A&E. None of this would be deemed acceptable elsewhere - politicians like Hunt would have been kicked out years ago for allowing the service to deteriorate to the level that he did.

Yes - the NHS could be more efficient and effective (but that too would require investment in staff, systems, facilities and equipment), but there is no way that the NHS is going to clear the backlog and build a sustainable service comparable with others in Europe and elsewhere without a significant increase in investment.

So what would you cut to give extra to patient services?

"Less managers" is an oft cited demand but then who does the equipment ordering etc, the staff training, HR, pay roll, mtce....?

or another "needs better IT" well, that costs money, huge amounts and on-going and in the short term, doesn't treat a single extra patient

All organisations need good and expert management, the NHS is, if anything under managed, leading to inefficiency and med staff doing administration tasks, like ringing around trying to organise a care home place, a care package.... access equipment?

I have family/friends in Germany and France and Netherlands and have experienced healthcare in Germany (was excellent but for something minor so can’t judge it on this)

Money is deducted from wages they have better options to manage their healthcare, easier access to different areas of healthcare rather than based on referrals from GP’s it certainly costs them more but then wages are higher and yes aware our government funding is far lower. They also pay a small amount for services we do not (unless unable to afford to not sure if this is the case in France ) this will be the stumbling point as so many uphold the NHS as it’s apparently free.

Of course it will cost to make changes but it’s not working it hasn’t worked as it should have for years not just under the Tories. it won’t change while we have consecutive governments changing the goal posts Labour may go better but they will not be in power forever

I think there is probably too many splinters of teams in the NHS this creates more management and this is what often people are referring to when complaints about the NHS being over managed

I'd be more than happy.

@BIossomtoes

"Exactly. Changing the funding model would be expensive tinkering at the edges and would improve nothing."

Changing the funding model
does have the potential to make a significant difference:

1. Normally the supply and demand of a product or service are regulated through price. However when the price is set low (say in the case of clothing or food by Government regulations in Communist countries) then demand is regulated by queuing. In the case of the NHS it is actually free at the point of service so the rationing of supply is managed by how much time you have and are able to wait. Clearly access to a health service based purely on the ability to pay would adversely penalise the poor but equally access to a health service based purely on how much time you have, adversely penalises the time poor.

A system where individuals incurred a cost at point of use and that was at a level the poor could afford would significantly reduce unnecessary demand (as for example with the 10p charge on carrier bags that reduced demand by 80%). The means by which individuals would incurred that charge could be at the point of use or through their individual health insurance policies.

2. given the higher productivity in the private sector compared to the public sector the introduction of more private health care provision backed by individual insurance policies would both increase choice and improve productivity.

The reason productivity is higher in the private sector is because it cherry picks easy cases, doesn’t provide an emergency service and doesn’t treat chronic disease. Doubtless the NHS would be more productive if it operated under similar conditions. Changing the funding model would change none of the things that affect its productivity.

https://www.gov.uk/government/news/government-issues-rallying-cry-to-the-nation-to-help-fix-nhs
Apologies if this has already been shared as I have not read the whole thread.
The NHS is broken beyond repair there have been too many reforms with layers of management plus scrutiny and governance added at every turn.
I joined the NHS in 2007 and have seen the management structure in my own Trust increase exponentially since then.

The NHS is not under funded it is mismanaged with too much spend on staff costs and by that I mean senior managers instead of patient care.
I’ve no doubt there will be another tranche of senior managers recruited to oversee Wes Streeting overhaul of the NHS.

There’s general consensus that if anything the NHS is under managed

https://www.miphealth.org.uk/home/news-campaigns/NewsArticles/IPPR-research-shows-cost-of-undermanagement-in-nhs.aspx

Nice try but the chart I referenced was differences in productivity between the private sector and the public sector in general and not just the healthcare sector.

Now you could try to argue that workers in the healthcare sector are for some special reason different where there are no differences in productivity?

The workers aren’t different. The work is.

Anyone who has worked in a commercial role in the NHS can tell you it's completely inefficient. It doesn't need money, it needs proper cross party reform.

Yes, this

Totally agree @KenAdams & @clothearedpotatohead

@1dayatatime You make two rather poor non sequitur arguments and the incompetent Jeremy Hunt is the last person who should be cited.

1. Are you seriously saying that it is possible to compare the demand for healthcare, which for individuals is often unknown, sudden and potentially life-threatening with the demand for 10p carrier bags?

Healthcare is not a service that is subject to the usual laws of supply and demand - when they get up in the morning, an individual cannot know in advance if they are going to need to see a GP, ambulance or go to hospital that day, and nor can they choose from multiple providers. Hunt rationed healthcare by availablilty in order to direct those patients who could pay into the arms of the private providers - with what he thought was the double win for the Conservatives that this is the same demographic whose taxes he has cut and who usually vote Conservative. In effect, healthcare in the UK has been ratoned both by availability and by price - which makes a mockery of the idea of Universal Healthcare and results in one person in eight in England waiting for a NHS appointment. Rationing by "how much time you have" is an appalling concept. If people need treatment, they need it sooner rather than later so that they can get on with their lives or return to work and start earning, and of course there are people who don't "have time" - people whose conditions will worsen before they see the Consultant or reach the operating table (and who thus need a more serious intervention), and people who quite simply run out of time and die before ever reaching the top of the waiting list.

2. "...the chart I referenced was differences in productivity between the private sector and the public sector in general and not just the healthcare sector. " In which case it is irrelevant to a discussion about healthcare provision. The comparison should be whether private hospitals and clinics are more or less productive than public healthcare facilities offering the same treatments.

Furthermore, efficiency in the general private sector and in the public sector cannot be meaningfully compared because they perform different types of work. The private sector can choose which services to offer, and where and when, and can choose to sacrifice customer service, aftercare and other additional features in the name of profit. If changes need to be made, these can be made quickly and without involving anyone else. If people do not like the service being offered, they can usually go elsewhere.

The public sector operates differently - it has to provide the full service as mandated by Parliament and has to answer to (and report to) numerous bodies (local and regional Boards and Councils, various interest groups and stakeholders, Ministers and their ministries etc.). The sheer amount of time spent at all management levels in completing forms and compiling reports that never get read is mind-boggling.

In addition, the public sector has budget constraints that the private sector does not have, and managers and directors have to work with what they're given. A private sector director can put forward a business case for more investment (for staff, equipment, product development etc.) and in any well-managed company, this will be considered and if seen as a good investment, the resources will be made available. Companies can go out and borrow funds if they can make a good case to shareholders and lenders. In the public sector this process does not exist - and in any case, in the NHS nobody has the time to do this as they are constantly fighting fires and moving from one crisis to the next. Managers and directors are given a fixed budget and fixed resourses "from above" - often from Ministers like Hunt who have scant knowledge of what the service does and who also have a political agenda - and told to get on with it. Any change that does occur is almost always directed from above and takes years to implement, all whlie trying to run a service. It is like trying to change the tyres on a car while doing 70 mph on the motorway. So these managers face the choice of being bollocked for not doing enough of Task A, or not doing enough of Task B, in the knowledge that with the constraints they have been given, it is impossible to do both A and B. NHS managers and directors are forced into making the decisions about how to ration the service available - and the Ministers are happy to let them be the scapegoats for the government's own incompetence or politically driven decisions.

I would pay more into an NHS pot that guaranteed me treatment when I needed it. But pay more tax generally? No.

You can do that, it’s called private health insurance.