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.

But why should they be employed by the NHS?

Because otherwise you’re allowing a private provider to write themselves a blank cheque for taxpayers’ money. It couldn’t be more open to abuse. It’s nothing to do with politicisation. Yes, there needs to be a review of delivery, it’s badly needed and that review has to include checks and balances on the finance otherwise it will go the same way as the utilities have. Look at the water companies.

NHS dentists have done it for decades. They decide the work needed and claim from the NHS. As do opticians for eye tests and nhs glasses. Ad do spec savers for hearing aids. Same with pharmacies. All mostly private firms claiming nhs funds. NHS do spit checks to check the claims are valid. Years ago I had to go to a different dental surgery where some kind of auditor checked my teeth to make sure my own dentist was doing the right course of treatment before it was authorised.

But you’re not writing a blank cheque. That pure hyperbole. The check is the funding mechanism. It works perfectly well elsewhere in Europe and delivers better patient outcomes. To ignore that is to put ideology and politics ahead of public health and patients.

You are, either deliberately or though lack of understanding, conflating a pure private system like the US with a hybrid public funded / private and not for profit delivery model to try and support a position that isn’t really defensible, because it’s ideology driven.

How is the funding the check? It seems to me the insistence on changing the funding model is what’s ideologically driven. The delivery model is broken and now you seem intent on breaking the funding model too.

The services you mention involve very little NHS expenditure @taxguru. NHS dentists are like unicorns, opticians only provide NHS funded eye tests to a small part of the population and glasses to an even smaller one. Most elderly people buy their hearing tests and aids privately. Pharmacies fill prescriptions written by NHS doctors. None of that involves writing private providers a blank cheque.

If you insist on NHS medics making the diagnosis before the private sector can deliver the care - you will hit the same bottlenecks. There are not enough of them.
Increasing the workforce will take time and funds.

Let's see what the Darzi review comes up with

I have always believed that the nhs should not be left to the whims of politicians. It should be other/ out side of political control. Run by medical professionals who have to be clear and transparent in their actions. Funding should be set by act of parliament which cannot be altered other than increase (the only parliamentary input). Oversight would be via non political, non profit body.
The health of the nation is not the plaything of political parties or big business.

Pharmacists are doing more and more, certainly not just handing out gp prescriptions. They’re doing more and more of issuing drugs etc themselves plus giving jabs etc.

£3billion spent on nhs dentistry - that’s not tiny!

GPs issuing prescriptions are mostly self employed, ieprivate, and some have their own pharmacies owned by the gp partners!

£3billion spent on nhs dentistry - that’s not tiny!

It may not be tiny it’s still a budget “cut to the bone” which is why NHS dentists are as common as rocking horse shit.

www.bda.org/media-centre/nhs-dentistry-sees-biggest-fall-in-budget-in-decades/

I think you need to decide whether you think the delivery or the funding model is broken…up until recently your position has been that the delivery model is fine, but the NHS needs more funding and that’s what’s broken. But based on what you have written in this post, you now think the delivery model is broken, and the funding model is fine (but presumably needs more funding).

I thought it was fairly obvious how the social insurance funding model used by European countries to deliver better outcomes for patients is the check. The state runs the social insurance, deducts money from tax payers and controls the funding. The social insurance scheme pays the providers. The healthcare providers are on the whole either not for profit or private businesses. They are successful by delivering quality healthcare. But they don’t have a blank check to charge whatever they like, because, there are many suppliers and the social insurance scheme has the buying power. In addition the framework of what services is provided / paid for / charged is overseen by an independent organisation.

The other advantage is that is does begin to decouple healthcare from politicians, who are woefully under equipped to have any say in it. One organisation (a little like NICE) sets out what the system needs to support. The social insurance scheme sets premiums / contributions on a whole country basis so everyone pays something, and the combined contributions create the social insurance fund. Meanwhile, delivery is provided by motivated individuals and organisations, who have a vested interest in providing good service, facilities and outcomes because they better they are the more patients they are likely to attract. The existing private health cover can exist alongside, though some may decide that they no longer need it.

I know that’s not how the NHS works…but it is how world class healthcare is delivered. Why are we not entitled to world class healthcare, just because ‘NHS’…?

up until recently your position has been that the delivery model is fine, but the NHS needs more funding and that’s what’s broken

Completely untrue, you’re confusing me with someone else. The delivery model has been broken for a very long time and it needs radical review and reform. Obviously that will need investment. The funding model is fine, everyone pays something now through taxation. Even those people below the income tax threshold pay tax in the form of VAT, fuel tax, etc. Reforming delivery is a gargantuan task by itself, we can’t afford the distraction of upending the funding model.

Australian here. So thankful for our healthcare model. Can get to a Dr generally either same day or next with either a face to face appointment or phone call -your choice. None of this wait all day for a phone call rubbish or sitting in a phone queue all morning to not get anywhere. No restrictions on where you go depending on where you live, it’s your choice to go to any Dr if they have availability which a lot do. We pay to see a Dr but it’s subsidised by the Government . Low income earners and Pensioners are generally free. We can attend a public hospital for emergencies for free (contribution to public health is via our taxes). You can also pay for private health if you wish to expedite non emergency hospital type surgery. I would be an anxious mess living in the UK not having reliable access to medical care.

We cant afford Not to upend the funding model! Otherwise we’ll sleepwalk to the USA system.

We won’t sleepwalk into anything if the we stay true to the basic tenets on which the NHS is formed. Start fucking with the funding model and there will be no service left at all in the wake of years of chaos.

Ah well in that case I apologise. You have been a staunch defender of everything NHS, knocking everyone’s criticism of it so I assumed you were happy with the delivery model. My mistake. But, the funding model doesn’t work because there’s no link between NI and the funding for the NHS. It’s entirely notional, and subject to political meddling, as seen by the recent cuts in it by Rishi, and the abandoned social care increase that preceded it. What NI raises has in no way any ring fenced funding for healthcare. It all comes out of the general tax pot. A proper social insurance scheme is ring fenced funding that can’t be meddled with constantly by politicians.

I come back to the same point. Other countries do it differently, and they do it better. Patient outcomes are improved. Political interference is less. Why are we not entitled to a better system? Is it because the bristish just don’t like change? Or is it old school British arrogance, against all evidence, that the NHS is a better way than most of the rest of the world. I reckon if it was, at some point over the last 70 years more countries would have copied it. And they haven’t.

To avoid further mistakes, can you please explain why you think the funding model works?

But, the funding model doesn’t work because there’s no link between NI and the funding for the NHS

There doesn’t need to be. Public services are paid for through a variety of taxation sources. Pensions aren’t paid for by NI, despite the link with qualifying contributions. Quite honestly there would be little point in having politicians if they had no jurisdiction over public spending - do you think politicians in all the countries you use as exemplars have no say in health administration?

Well, I fundamentally disagree. Of course there needs to be a link. A properly funded healthcare services needs to be sure that it has ringfenced funds sufficient to provide the needs of the population. And choosing pensions, another area we fall behind much of Europe, to make the point is laughable. Do you really think it’s sustainable for a healthcare system to operate without long term certainty of funding?

If you bothered to understand how other countries do things perhaps you could see beyond the blue and white NHS borders. The role of politicians in healthcare is to ensure that there’s a system that works, and the needs of the population are met. It’s also to set broader policy. It’s not to arbitrarily set budgets based on short term political whims. People who actually know what they’re doing can then work out how much money is needed to fund it, and then politicians can influence where the burden of that cost lies, through the use of varying social insurance contribution scales. The horse trading takes place at that stage as to politically where they want the burden to lie. Because it’s ringfenced they can’t use sleight of hand to use the funds to prop up their own pet projects. The health are system then has medium and long term certainty over funding. The population has certainty, confidence and a choice of where to go for healthcare. And they get better outcomes. Honestly, it’s not that difficult to understand. I’ll ask again, why are we not entitled to a better system?

And choosing pensions, another area we fall behind much of Europe, to make the point is laughable.

I didn’t “choose” pensions, they’re literally the only public expenditure with a clear link to NI. No I don’t think it’s sustainable for a healthcare system to operate without long term certainty of funding but your suggested funding model would be no means more certain than the current one.

There will never be ringfenced funds for anything. Decades ago Brown massively increased tobacco duty, promising to ring fence it for the NHS, if that ever happened I bet it doesn’t now.

We should have a better healthcare system and we need to recognise that it requires reform of delivery and the funds to make that happen. The difference between your view and mine is that you want to meddle to fix something that isn’t broken. I want to focus on what is broken.

I recently paid for private surgery, around £2500 including general anaesthetic (day case). I could have it done on the NHS, but the waiting list was over 3 years as although my condition was painful, intimate and embarrasing, it was not life-threatening and so there is a long wait.

So, I saved up - and sacrificed holidays and treats for over a year. I appreciate not everyone can do this, and I'm certainly not rich - average income, not the eye-watering amount some people on MN earn! But I made savings here and there because I could not put up with it any longer.

All done and dusted in less than four weeks!

Week 1, phoned up the private hospital, who e-mailed me a quote next day and a phone number to choose and book the consultant. Week 2, saw the consultant, arranged the surgery for 'the week after next'. Week 3, pre-op clinic appointment. Week 4, surgery day after a bank holiday, done by 3pm.

The irony is that ALL of the staff who looked after me also worked for the NHS. The admin was superb. The accomodation was first class. I was spoken to politely by everyone. I did not have to wait for my prescription, and I had a follow-up appointment two weeks later at a time of my choosing.

No involvement with a GP, who weren't interested anyway ... I'd do it again in a heartbeat if I needed to.

Wonder why if you pay £2500 for something you get happy staff and good service, but if you try and provide the same service for less, it isn't as good....

Agree with every word.

@FixTheBone I pay far far more than £2,500pa for the NHS. There have been years when our tax bill has been £250,000. In addition I pay £3k for AXA. Via AXA I get efficient, helpful service via the NHS I do not. We aren't all paying 20% or receiving benefits you know.

Marking this thread ready for the next time someone moans at me for bringing up someones irrelevant posting history and it wasnt even accurate here Seems some can get away with it and some cant!

If you are thinking of me @JenniferBooth , I would like to make peace with you. We've clashed politically on threads but you always hold your ground with good arguments, and given the situation you described elsewhere, I am better able to understand and respect why you hold those opinions. My experience is different. But .... pax?

Ok fair enough.