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.

If anything we need to go backwards.

So many services are now outsourced the NHS is paying for patients to be treated privately.

Virtually all cataract surgery is done in the private sector.

We used to have NHS cleaners who were proud to do the job, that got contracted out to people who didn't care and then we get an increase in MRSA.

Private hospitals are all very well for elective treatment/surgery, but AFAIK they don’t do emergencies.

It's going towards private healthcare anyway for many conditions and will continue to need more and more.

The problem is when private doesn't equal good care, but shoddy care just done quicker.

According to a Swedish friend, virtually everyone in Sweden pays a small amount for visits to GP and A&E, ditto for prescriptions (with an annual cap for those who need a lot) and something towards the ‘board’ element of hospital stays.

And Sweden is popularly supposed to be a socialist Utopia, with relatively high taxes.

TBH I can’t ever see any U.K. govt. - of whatever colour - proposing any such charges - they’d be too terrified of annihilation at the next election. ‘Free at the point of use’ has become such a sacred cow.

IMO some people do take the piss, though - I’ve seen too much of people gaily stockpiling free prescriptions they don’t need, which only end up being thrown away. I once counted over 60 items in an elderly friend’s bathroom - all ultimately thrown away more than once. He could have well afforded to pay a small amount for each that he needed, and TBH since he was tight with money, even a £3 charge would have stopped him stockpiling so many. And I wouldn’t mind betting he’s not alone. I read somewhere that even the cheapest prescription item costs around £7 in admin costs.

To improve the NHS, I believe the first step is to improve the flow. We need to start with social care, rather than health care.

We also need to start focusing on prevention and taking personal responsibility for our health.

We pay about £7, in patient care is limited to a maximim of £7 per day in charges, you also don’t pay more than about £89 per year due to a charges cap.

Medication/prescription charges vary depending on the cost of the item, the yearly cap is about £160. Similar for dental care, but the cap is much lower for adults until they reach 25. Obviously no charges for children.

The mechanism to work it all out costs more than the fees actually raise.

Obesity costs NHS a lot of money and we still don't take any real actions to fix it https://healthmedia.blog.gov.uk/2023/06/07/government-plans-to-tackle-obesity-in-england/

@newmummycwharf1 "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."

According to the World Bank, Germany's GDP in 2023 was $4.45 trillion, and the UK's GDP was $3.34 trillion (not "just over 2 trillion") - but there are millions more people living in Germany (84.5 million) than in the UK (68.6 million)

Germany's GDP per capita is only 6% higher than that of the UK, yet Germany invests over 30% more per capita in healthcare than the UK does.

In the UK, the total economic cost of sickness absence, lost productivity through worklessness, informal care giving, and health-related productivity losses, are estimated to be over £100bn annually. This is the government's own figure. When the government says that it cannot afford to invest in the NHS, the response should be that it cannot afford not to invest in healthcare.

True.

At another level obesity is also risk stratified with poverty.

Poverty costs the NHS an enormous amount of money to treat.

https://www.kingsfund.org.uk/insight-and-analysis/press-releases/poverty-health-nhs-services

At times, it feels like we're displacing money away from people who need it to pay people to treat them for the consequences of not having that money and everything that flows from that (e.g., housing, food, education, opportunities).

And that's now happening as the rule rather than the exception, and the waiting lists are even worse.

In 2013 i didba hip replacement 9 days after the GP referral was made, now it's 9 months until anyone even gets seen in clinic and a further year, minimum, before any surgery happens.

The NHS has been utterly wrecked in the last 10 years moving it from one of the best performing systems, especially per £ spent, to one of the worst, frankly, given how slowly things changenin the NHS, its astonishing how the Tories have managed this, it almost seems deliberate.

@GETTINGLIKEMYMOTHER

I’ve seen too much of people gaily stockpiling free prescriptions they don’t need, which only end up being thrown away.

Not always their fault.

My OH has cancer and gets a monthly sack full of different prescription drugs. Some he never takes (such as anti sickness and anti diarrhoea). Some he takes less frequently than prescribed, i.e. omeprazole every other day instead of every day. Fair enough, these aren't expensive. But the killer is his cancer drugs. One he is prescribed 3 per month, the other 21 days. Both are hugely expensive. He has agreed with his oncologist to only take the first every 2 weeks, so only 2 per month and the other to take every other day so only 14 instead of 28.

You'd think it would be easy to get the prescriptions changed for the lower amounts. Nope. Oncologist won't change the "package" as she says it's more trouble than it's worth because any changes have to go to some kind of "committee" and that if she reduces the amounts, she may have trouble getting this "committee" to increase them again. It sounds absolutely bonkers. She's said a few times that "it's ok", as her department are given the funds for the full prescription so it doesn't affect her departmental budget if fewer are actually used!

OH must have thousands (or even tens of thousands) of pounds of drugs in his cupboard. One of the tablets costs over a thousand pounds per tablet and he has several of them.

I've had similar with my drugs (T2 diabetes and high blood pressure). I used to order via the pharmacy and would hand them the "tick box" repeat form, with only the items I needed ticked. Many times, I'd pick them up to find everything had been prescribed. Pharmacy would say the GP had done it, and blame them. When I contacted the GP, they'd claim the form came through fully ticked. No way of knowing who to believe. I also ended up with a stockpile of drugs I never ordered. But again, neither the GP surgery nor pharmacy were remotely bothered when I told them.

It's as if they don't care about waste.

High tax payers won’t all leave the country. That’s a tired old threat that the wealthiest trot out to keep the least wealthy in their place.

Yeah, the high-tax payers won't leave the country but a lot of people don't understand that the solution isn't just to 'tax the rich more' because doing so won't really make a dent.

It's the middle classes and working classes who will be primarily effected. Like the pensioners losing the winter fuel allowance already are.

@taxguru, I fully appreciate what you say. However a good many of the items stockpiled by our friend were things he could easily have bought in Boots, e.g. a bath preparation (more than once he tried to pass a few to me) and a good many packs of paracetamol, which you can buy anywhere for relative peanuts now. (In the U.K. you can anyway, in France you have to go to a pharmacy, which is bound to be closed when you need something now…)

In that case, the solution must be for GPs to stop prescribing things that can be bought cheaply and easily elsewhere. It's human nature for people to take the piss and get things for free, so we need to stop facilitating that kind of behaviour. We probably need to do it by "stealth", i.e. little and often rather than a massive change which would cause a backlash. Perhaps start charging a nominal fee per item with no exemptions, i.e. 50p or £1 per item prescribed, regardless of exemption/prepayment, etc., to start to change the mindset.

Ideally though things like paracetemol could still be prescribed in some way so someone could buy more than two boxes at a time.

Yes, and TBH I was pleasantly surprised when my GP told me I could buy the necessary stronger painkillers at the Boots pharmacy counter when I’d just been diagnosed with shingles - though thankfully not too bad a case.

Yes, obviously when something is otherwise restricted but a patient needs it in bulk, then some provision has to be made. Pretty easy to make "bulk" purchases only available at pharmacies backed up with some kind of approval from a GP such as an authorisation card/letter. But as per my idea, a small charge per item would help people think about whether they actually need it or not which has to be a step in the right direction.

(You're welcome, @Dymaxion :) )

Exactly, that's how it works in my European country. Free choice of doctors/care providers is a principle enshrined in the system. When my gynae performed a smear on me without my consent in my second pregnancy and possibly caused a placenta previa bleed, I didn't go back and went to another one (should have reported her too, but oh well). I've had a succession of minor surgeries recently that have failed - prob not due to the care, but I still chose to have the last repair done in hospital rather than at the surgical practice I had used previously. I don't need to justify that to anyone, and there's no upfront cost to me (beyond what I pay monthly to my insurer, obv). I also didn't have to wait. With the last surgery, op date was a week (!) after the initial appt (which I'd waited maybe 5 weeks for). And this wasn't a particularly urgent thing - needed doing, but I wouldn't have died from waiting another few weeks.

@OptimismvsRealism
Hello Tory leadership hopeful.

DH and I both earn over £100k per annum. Because we are over 60 we get free prescriptions. When we retire dven though our pension income will be significantly higher than the national average we'll still get free prescriptions.

In many ways it's payback for some of the poor care we and the DC have received and the fact that pretty basic things have only been available privately: bladder prolapse surgery post botched birth, grommets, optimal osteoporosis care.

We need a system like that in France or Germany. Money has to change hands to get the concept of service back into the system.

I think your argument is much too simplistic but when taken what you say at face value
What system do you suggest instead then?

A model like the USA where many people can't afford basic health care or medicines? People die because of it and emergency workers take details of a patients insurance before agreeing to treat them

I think the NHS model is the best and there is no where better in an emergency. The problem with the NHS isn't the model it's that it hasn't been funded properly for years. Even in countries like France that rely on an insurance type scheme the Government fund it a higher rate than we fund the NHS. And even then when my daughter lived in France she was told she would have to pay a deposit of several thousand Euros before the hospital agreed to book her in for her necessary C-section because they thought she had the wrong insurance.
I would be quite prepared to pay more tax to fund the NHS better.

Those systems are not perfect having lived in France and the UK I would choose the NHS system every time

The difference per capita is more than that. Try 10/16% in 2022 and 2023.

The NHS certainly contributes to the reduction in productivity. There are over 7 million people - 7 MILLION! on waitlists.

The answer is not more money - the government has invested. The NHS is underfunded but if you look at the data, the difference in funding over the years is much less than you would think. Health foundation report (attached)

More money is needed but how that money is raised and how it is spent is really key. If people paid directly for aspects of their own care - use and waste would reduce and personal responsibility for health would improve. As Bevan said - we have to continue to re-evaluate.

Killing the conversation does no one any good. Every option should be on the table and seriously options appraised.

In that case, the solution must be for GPs to stop prescribing things that can be bought cheaply and easily elsewhere. It's human nature for people to take the piss and get things for free, so we need to stop facilitating that kind of behaviour.

I was asked if I could get my own paracetamol when leaving hospital as it was far more expensive for them vs me buying it myself. Why doesn’t NHS procurement have the same buying power as a retailer? I was pissed off tbh, not because it wasn’t free but because 24 hrs after a CS the last thing I wanted to do was stop at a pharmacy!