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.

You first. I don't respond to deflection.

In your vision for UK healthcare,

How and who would decide what "essential care" is?
Would that be the same as "getting what's available"?
How and who would decide whether people can "pay a bit" or "absolutely can't"?

With pay restorations and recent changes to pension tax treatment - the exodus of medics from the UK may slow down.

In the meantime, the government solution at least under the Tories was to introduce 'PAs' - who are people who have done a 2 year masters crash course to provide care in GP surgeries and hospitals - in lieu of doctors. The workforce plan is to expand to have 1000s of PAs - that is the solution to delivering NHS care. Privately, you can still see a consultant

Based on the international league table of cancer outcomes

The department of health would decide

Fucking obviously

People do pay “a bit”. It’s called taxation.

Guess what counts as basic - being able to see a GP

Britain sits at the bottom of a major league table for cancer survival in high-income countries, researchers have warned. While survival rates are improving for patients across the UK, the country still performs worst for key cancers including bowel, lung and pancreatic.

As a someone on very low household income, I'd be all for a minimal nominal fee for the gp or A&E to filter out the timewasters if went straight back into a rxtra triage at the door. Say the price of a prescription for A&E and maybe half that for the gp. But only for households on a decent wage, scraped if you have certain chronic conditions.

I worked in medical research. We was aiming for confidence of over 97% so scrapped anything below that. It's a complex balance I'm sure

@Overpayment Are you saying you think chronically sick and disabled people should pay more for healthcare?

I am really hoping I’ve misunderstood.

You do realise that NHS funding is basically a form of guaranteed insurance don't you. Some win, some lose, but any variation will be much of a muchness.

Health is a lottery which isn't always about lifestyle. Which, by the sounds of things, given your ailments, you must realise.

Be angry about your situation but don't blame everyone else. It's not as black and white as you make out.

It's not guaranteed insurance. I don't know anyone who can easily even speak to an NHS doctor on the phone. It is hopeless. No wonder people resent paying tax.

That's who.

@OptimismvsRealism In your vision for the UK healthcare system,

How and who would decide what "essential care" is?
Would that be the same as "getting what's available"?
How and who would decide whether people can "pay a bit" or "absolutely can't"?

Aide memoire:
GreatReader · Today 19:59
In your vision for UK healthcare,

How and who would decide what "essential care" is?
Would that be the same as "getting what's available"?
How and who would decide whether people can "pay a bit" or "absolutely can't"?
OptimismvsRealism · Today 19:53
I think that the entire funding system should be changed so that people pay a bit, unless they absolutely can't and if they absolutely can't they get what's available (which is probably better than what's currently available for anyone). I don't know if transgender care is essential any more than I know if prostatitis is liveable with.
GreatReader · Today 19:51
My question was about funding for transgender support, medications and support.

What are your views on that?

** "what are your views on NHS funding for transgender support, medications and surgery?"
OptimismvsRealism · Today 19:49
Funnily enough while looking at a really agonising crack in my perineum I started thinking about how sore it must be to mess with this area for that purpose. Personally I'd counsel against it.
GreatReader · Today 19:35
** what are your views on NHS funding for transgender support, medications and surgery?

Whilst another model may have potential to work better I have no faith that it would be implemented that way. If they scrap the NHS you can guarantee that there will be absolutely no reduction in tax we pay, but now we all just end up having to pay monthly private insurance premium + paying a deductable at each point of use. This additional money it costs us will just goto private insurance companies, none to the hospitals or staff - so the service stays the same/maybe feels just slightly better (for the majority) since poor people will stop using it.

I don't expect to pay less. I expect to be able to access healthcare.

I've never had an issue getting a doctor when I need one.

I can easily speak to my GP, I can equally easily get a face to face appointment if I need - rather than want - one. I don’t resent paying tax either.

Maybe we have a better telephone manner than the op

It seems to me that the “better” models people are talking about would require the majority of people to pay much more than they do now, through a combination of insurance, tax and possibly treatment charges.

Why are people open to this but against simply paying more in taxation?

Some other posters suggested introducing competition would improve things so we wouldn’t need as much funding, Are there formerly public services that are doing better under privatisation or part privatisation? I am not seeing it with dentistry, water, the royal mail etc. What can people point to that supports this?

There are over 7 million people on the NHS waiting lists currently. 7 MILLION!

I don't think whatever the rejigged model, tax should decrease. The tax we pay + social insurance should mean we can deliver a better more robust service. That would also need reforms in how the care is delivered, what is considered core service and what the social insurance covers.

I'm in an EU country. I pay between 6000 and 7000/year for my statutory (i.e. not private) health and social care insurance, as a % of my (modest to middling) pre-tax income. I'm self-employed; if I were employed, my employer would cover half of this. It's a huge expense - looked at like that, it does cost me 'thousands', and - as most years I probably don't cost as much as I pay - I'm partially subsidising others. I get relatively speedy access to the healthcare I need (certainly no waiting months to years for necessary ops or investigations), can see my GP whenever I need to, and would also get sick pay for 1.5 years at 70% of previous income. If I earned less I would get all that and pay proportionally less.

@TheLittleOldWomanWhoShrinks that sounds fabulous, the bit where you can get sick pay for 1.5 yrs at 70% of previous income. If you were employed, which I imagine the majority of people in your country are, the employer pays 50% of your healthcare ? I am sure the employers of the UK would be more than happy to do that, a healthy workforce is more productive ? What are state pensions like ? how about redundancy pay outs ? And more importantly which EU country is this ?

Don't forget that insurance companies also make deals with certain clinics so if you need to access a particular service it will be the insurance company who decides where you go. You won't be able just to go to your nearest hospital to have your procedure done.

The problems in funding the health service are due to more and more treatments coming to market ( which all cost money), better medical interventions ( including for very premature babies) meaning more people living with complex ( and expensive) conditions, all combined with an increasingly Unhealthy population ( obese and inactive) who get conditions due to being unhealthy.

These pressures exist however healthcare is funded.

Lateness is a huge issue. If someone turns up late I have a choice between

• saying to them sorry you have to rebook, getting a mouthful of abuse from them, and making wait lists go up further
• seeing them, and getting abuse from the patients after them that we ran late, and working late myself and potentially getting a fine from my children's after school club for a late collection

I appreciate life happens, but I give them my direct work mobile and ask them to message me if running late so can try to rejig things. Some will, and are very apologetic, some come in with an air of entitlement, don't apologise for being late, but are the first to moan if kept waiting.

It's not one or the other. Both different extremes. Many countries have hybrid systems that work well