To think the time has come to abolish the NHS healthcare model

[OptimismvsRealism]

Free at the point of use also means denial of care to a lot of people. What torture to know that new medications are arriving regularly (eg lecanemab) but it's only for the very wealthy.

The UK is different from how it was in 1948. We should be brave enough to move on from then.

How much more would you be prepared to pay than you are currently paying?

I will also say there are a lot of options to be seen by a doctor/Nurse practitioner. That isn’t a traditional setting.

A lot of our pharmacies have ‘minute clinics’ staffed by a nurse practitioner. Great for quick things that pop up at unexpected times. I used one with suspected conjunctivitis on a Sunday morning. Walked in signed in and had a script filled in the pharmacy. I think I paid $10 for the visit + a $10 prescription copay. All in I think it took an hour, including travel time. My insurance company has a 24/7 online service available (without copay I think). Great for those things you need taken care of but don’t want to screw around with an in person visit.

My husband works for the city and they have a walk in clinic for city employees + family. They save a ton of money in their health insurance premiums by offer this clinic staffed by nurses employed by the city anyway for community health. So free visits + free common prescriptions (asthma inhalers, antibiotics, birth control). A lot of employees use this for their kids school and sports check ups and repeat medications. Now his city is a little unique in this but a lot of cities run wellness clinics especially this time of year for back to school.

I always thought that was a really smart idea. My DH used them recently for a dodgy toenail… they tested for the usual things and determined it was likely an injury. They hooked him up with a podiatrist and week later he’s minus 1 toenail

All of these things relieve the pressure on doctors offices so you can get in when you need to physically be seen.

Goodness, you're a real charmer aren't you.

Be thankful that your genetics don't put you at a risk of cancer (like mine did). If it wasn't for the NHS, I would be dead as there is no way I could have afforded to not only pay for my cancer treatment, but also the genetic testing that revealed not one but two genetic mutations that resulted in me getting cancer before I was 50. And believe me, I looked after myself, and made all the so-called correct lifestyle choices - didn't smoke, drink, eat in excess, exercised regularly, good weight, low body fat etc. etc. yet I still got cancer.

The NHS needs fixing. Yes, that is undeniable. Get rid of all the layers of middle management for starters. But ditching it completely for an entirely different model isn't the answer. For me, the NHS has been nothing short of miraculous. I owe it my life and am incredibly grateful to have it, flaws and all.

Edited for typo

I live in a European country, and can see a doctor quickly - i.e. simply by walking in to the surgery and on average waiting for 10-15 minutes. There are very short waiting lists for hospital treatment or for appointments with Consultants or for MRI scans etc - usually just two to three weeks from seeing the GP. I recently had a minor operation just 5 weeks from seeing the GP, with the entire process involving first seeing the GP, then a Consultant, then a follow-up phone consultation and finally the operation.

There are almost twice the number of doctors per capita here as in the UK - because the government and the population realised years ago that keeping people healthy and investing in health care (and social care) pays off in the end, so there has been far greater investment per capita than in the UK, raised through income taxes, "national health insurance" that is ringfenced for healthcare and from taxes on employers. Overall my taxes and deductions are similar to what I'd pay on the same salary in the UK.

A country like Germany invests the same per capita in healthcare in 3 years that the UK invests in 4 years - so every 3 years, the UK by comparison is missing an entire year's worth of investment. This has been happening for the last 20 years or more, but accellerated in the last 14 years as the politicians in power made a conscious decision to underfund the NHS. Remember, when politicians (of whatever party) say that the country cannot afford it, what they really mean is that they have decided that they will not make the required investment.

The fire brigade is no use to you either. Until your house burns down.

DadJoke,or simply go private.

BIossomtoes trouble is now most of the service users aren't, obesity being one of the main causes of many avoidable diseases.

Those countries are richer than the UK. Germany's GDP was over 4 trillion in 2023 versus over 2 trillion for the UK in the same time period. I have no doubt our government could make different choices with the money we do have - but just to say Germany is a significantly richer country

Are you implying that everyone paying for all their healthcare for all is better than providing free healthcare for all but with a few limitations on some treatments that aren’t judged to be cost effective?

It’s actually been working pretty well since it was established. Established so that those with less money would still have access to medical help. Whilst there is always room for improvement, and it’s been severely challenged by covid and austerity, most of the time it provides decent healthcare that is free at the point of access and doesn’t provide different levels of care depending on wealth. Several people around me are alive today, only because of the NHS. Without it they would be dead. I’ve had excellent care and so have many people I know.

I work for the NHS and we provide a great service. I’ve seen the NHS go through changes over a period of 30 years and there are ups and downs in terms of how well we can provide services but generally speaking it is filled with highly skilled and knowledgeable people, working exceptionally hard to provide better and better care.

Even if you are privileged enough to be able to afford private health care, you still will need emergency services.

The problem isn’t the model, the problem is complex and not fixable just by throwing more money at it or ditching it all together, but by tackling the causes of ill health and building health and well-being. That is a multi level and complex endeavour.

One example: A huge amount of money is spent on avoidable diseases but to turn the tide on that would require much stricter controls on industry. Something the last government wouldn’t have done. May be this one will.

Most of Europe has universal healthcare without an NHS. Australia has a tax incentive on private health insurance to reduce the burden on the state / BGS equivalent. There are a lot of different models to investigate and use as inspiration. None of them routinely leave people waiting 9 months for a 15 minute telephone appointment.

The NHS isn't working. Our cancer survival rates are amongst the worst in Europe. That affects every family. People are dying in the UK when they wouldn't be dying in European countries. That's appalling.

Many services are at breaking point and people are suffering. The system needs to change to provide 21st century care. I've worked in the NHS for decades and now live in mainland Europe. The differences in healthcare are stark.

The NHS never routinely leaves people waiting nine months for a 15 minute telephone appointment either. In fact I’ve never heard of it happening. It needs root and branch review and investment, not a different funding model.

Well that's not going to happen...

Well let’s see how this unfold now that high tax payers are leaving the country. I see your point.
We pay double for everything and the private school VAT was the cherry on top. Beggars believe people feel so entitled here. They even complain when people do not like to pay so much tax here WTF. Like if they are the ones getting shafted.
The European model is much better but even in America the insurance for the majority work out much better than the taxes paid here. Over 65’s have free healthcare access over there too. Plus people keep much more of their salaries.

I tend to agree that some of reform is needed, but we also need to talk about the elephant in the room…

I see more and more fat and obese people around, I am specifically horrified by the number of young children I see with large bellies and clearly heading for an obese adulthood. Something needs to be done about that, no healthcare can cope with the consequences of that.

It's not even the reduction in proteins, it's that there is no clinically significant difference in clinical outcomes that matter.

I completely agree and I prescribe expensive drugs regularly - my specialty is one of the top 2 for drug costs, as we use lots of biologics.

Yes Nigel. Of course Nigel.

The American model is the last one to take inspiration from. Disgraceful. Whenever/wherever private insurance companies are involved, it turns into a disaster incredibly quickly.

I would agree to some contribution at the point of use, proportional to income, but going straight back to the NHS rather than to some private bloodsucker.

I know someone who had emergency surgery in new york in the 60s and because he was from the UK they would not operate until they had his cheque in hand. He managed all finances so his wife could not get the cheque sorted. He literally signed it as he was getting gowned up.

The NHS needs streamlining like most government apparatus. It does not need razing to the ground. We certainly don't want an utterly inhumane American system where the cost of health care is inflated to increase profit margins and health care is denied to those unable to pay.

America is a third world country lacking basic social care, minimal employee protections and a lack of women's reproductive rights. We don't want to become more like them, we've imported quite enough of their culture already.

Yes the NHS could be better, but the idea of abandoning a long entrenched institution because you don't like NICE guidelines about one drug is reductive.

I much prefer the French model. The current system here isn’t sustainable with an ageing population eg free prescriptions for over 60s but nobody wants to pay.

How much more would you be prepared to pay than you are currently paying?

Higher rate tax payers in the UK pay similar levels of taxes to other European countries. The difference is the average earners here aren’t taxed as much…

I came to say this.
I think it's heartbreaking that families affected by dementia will watch the news and feel they are being denied Lecanemab as they feel it will cure dementia.
All Dementia medication has v limited effectiveness, if the NHS wants to review dementia treatment it needs to stop pumping it's money into these ineffectual medical treatments and start encouraging the much cheaper and clinically proven, cognitive stimulation therapies.

But you know, medical model and all that 🙄 people love to take a pill.

My dd has just beaten an illness she has been battling for 5 years. She has multiple diagnosis. I know from reading parents from other countries on forums her care would not have been covered by insurance for so long if at all. The stress and anguish I see them go through is terrifying.Her health needs are in her EHCP and I doubt very much a private provider would hold much sway. We have had hospital stay upon hospital stay, needed A&E countless times, needed support from our GP, work from several services within the NHS liaising and she will need ongoing support.

I had an health scare recently and the tests and subsequent care has been amazing.

Until you need the NHS in a major way which can happen to anyway you don’t realise how lucky we are. The fear of funding on top of terrifying health struggles must be unbearable. Knowing you can trust the hands you’re in too, that they’re not just trying to make money out of you is huge. Yeah it’s struggling at the moment( thanks Tories and crap managers) and we have had/ have difficult waits at times but it’s bloody amazing.

@R3dSho3s thanks for saying it much better than me.