NHS should be a co-pay system.

[PeonyPatch]

Who agrees? Other countries who use this model include France, Germany and the Netherlands and they are some of the highest ranked healthcare systems in the world. The NHS is no longer fit for purpose, and it hasn’t been for a long time. I am proud that we have a free at point of access system here but it’s no longer sustainable and has been mismanaged and inadequately funded for a very long time. The only way I think it could improve is by gradually making it co-pay - perhaps capping it like Germany does.

My question wasn't just directed at Erin1975. Can anyone provide an answer?

I can't see that anyone has mentioned anywhere the other thing that's sending NHS spending soaring. That's the expansion of what it covers: complex procedures that used to be impossible (uterus transplant being a very recent one) , new drugs for common illnesses like rheumatoid arthritis that cost hundreds of pounds per dose, expensive drugs expected to be given to cancer victims to extend life by a few months, home dialysis machines instead of sharing a hospital one, etc etc etc None of these things are wrong but cumulatively they cost an absolute fortune compared with when the NHS was established.

Which isn't sustainable - it WILL all fall down at some point - it's inevitable.

@Imdunfer That's what NICE is for - although they have recently been bullied by the US into accepting more expensive drugs as within cost level.

NICE should be stringent in conducting cost benefit analysis.

If there is limited benefit and a large cost then the answer is no. If you really want this then you'll have to fund it yourself.

I would cut a large amount of procedures that are currently on the NHS, especially for those over 80.

I know - ageist, but throwing endless resources at the old is killing the young.

I talking about big user bases like the autoimmune disease community who used to get old drugs that cost pennies but when those don't work well are now on biologics that cost hundreds of pounds a week and are delivered in a refrigerated van service. The moderately high cost times the very high number of users come to an eye watering fee.

A an older person i want, and I know lots more want, the choice to die quietly without pain if we decide we don't want our non-terminal ailments treated. But it's going to be a very, very long time before we can have that in this country.

I do get your point, but I'd be bloody furious to be an otherwise healthy 80 year old who's paid taxes non stop since I was 18 to be refused a hip replacement needed to stay mobile on age alone!

Definitely this, there shouldn’t be anyone who doesn’t contribute at all, there’s many many people on benefits only income who have much more disposable income than someone who works full time

I think you have a fundamental misunderstanding of the definition of ‘aging population’

Tell me what bit ive misunderstood and how? I assume an aging population is when the average age in a country is increasing.

The change isn't a couple of years it's from something around 75 years in 1990 to an expected 83 in 2026.

Another 8 years. And that change has mostly been achieved by medical advances stopping people from dying, so it's a double whammy of another 8 years of ill health and NHS cost.

It's a real issue.

But we pay national insurance…

Absolutely. We’d soon see a quick change in how the country looks after itself. Or it could become a pay and refund service. But money has to change hands.

It's not the worst by any stretch because it offers care that is largely unavailable in most countries. It does this at some of the lowest funding per capita in the western world.

How it's funded is a matter of how you want to access care. At the moment you pay very little in but can access anything from emergency care to state of the art cancer care for nothing. So no matter what your financial situation you can always get treated. CO Pay would require you to pay up front and either the provider or the patient then has to claim something back. You could take insurance for the liability but again relies on you having the money to do it.

I will give you an example of (PUMA) in France. You could find up to 30% of the costs. So if you need heart surgery you could find yourself with 50,000 euro bill which is why many people are simply better off not working and get it for nothing. The same in Ireland.

In America where it's funded solely by insurance people die all the time because they have no insurance. The cost of insurance is over 600 dollars per month per person at the moment....so please tell me you could afford that? The adverts you see about 20 pounds a month would leave you wholly under insured.

It a well funded funeral service, it largely depends whether you want a return to slums and working class people dieing at 40 from treatable conditions

Copay systems don't mean having to pay a proportion of the cost, that's an insurance system. A copay is just a nominal sum per appointment/hospital night. For instance I pay 30 euros per GP appointment and that covers everything that occurs in the appointment (blood tests, ecg, x ray, whatever), specialist clinic is 70 odd euros a visit, staying in a hospital costs 70 euros per night (which tbf is a steep increase from the 35 euros it was just a few years ago) and that includes everything that happens including surgery no matter how expensive it is. Long term hospital stay fees are determined according to income level. Now it can be a lot if you have to spend a couple of weeks in hospital or get ill a lot but they will always do a payment plan with no interest if you can't pay as soon as you get the bill.

let medical staff run the hospitals,

They tried that at my local hospital, the chief executive was a gynaecologist. During his reign the place haemorrhaged staff and money and waiting lists went through the ceiling. Following his sacking it took a couple of years to rebuild and repair the damage.

It's a mad system at the moment - higher rate of tax payers are in the same NHS waiting list as the millions that could work but don't! Couldn't make it up.

I agree. Misuse is rife and is breaking the system.

I would start by getting rid of all free prescriptions for adults and instead push the pre- payment certificates angle. So anyone who needs lots of medication can still have cheaper access with pre payment certificates.

I would also support everyone having to pay an appointment fee or deposit to see the GP. I would love to know how many private dentist appointments are missed (especially where dentists take a deposit against the appointment). I imagine many of those who have paid their appointment deposit at the private dentist are highly motivated to attend their appointment or make sure they re-arrange or cancel in a timely manner so as to not loose their deposit. I can also see people making use of the local pharmacy more, so many pharmacies can now prescribe certain medication and offer advice for many conditions and there are certain conditions where the NHS say the pharmacy is the recommended route for treatment but because the GP appointment is "free" they use them.

It isn't that long ago that people paid "insurances" for drs. My own Nan (pre NHS) used to pay 2p a week to the local dr, which then entitled the whole family to appointments and treatment.

I would also like to see some tightening up of A+E with banded treatment. Actual emergency, accident or urgent treatment needed requiring A+E - free treatment. Going to A+E because you can't get a drs appointment for your cold/ headache/ backache or for something to do ect should come with a charge. This would of course require GP's to refer properly to hospital care pathways. So for example you go to GP for headaches but GP actually thinks investigation is needed they refer on (can be done by phone or email) to the correct hospital department - free treatment.

Surely an extra 200 billion would make up for this. 50 billion in 2000, 250 billion now

Which is mostly spent on benefits such as state pension. Very little of it is ring fenced for the NHS.

Population has also increased over that time frame from around 60 million to around 70 million. Then you have to factor in inflation, pay rises, and of course the ruinous cost of Labour's love of PFI for their fancy new hospitals with atriums which our grandkids will still be paying for long after we're dead and probably long after the buildings need massive refurbishment/improvement at even more cost. Not saying there hasn't been a massive rise in spending on the NHS, but it's got lots of factors, plus of course the monumental waste and inefficiency.

@Icecreamandcoffee

I would also support everyone having to pay an appointment fee or deposit to see the GP. I would love to know how many private dentist appointments are missed (especially where dentists take a deposit against the appointment). I imagine many of those who have paid their appointment deposit at the private dentist are highly motivated to attend their appointment or make sure they re-arrange or cancel in a timely manner so as to not loose their deposit. I can also see people making use of the local pharmacy more, so many pharmacies can now prescribe certain medication and offer advice for many conditions and there are certain conditions where the NHS say the pharmacy is the recommended route for treatment but because the GP appointment is "free" they use them.

I'd want to see statistics first. I.e. what proportion of missed appointments were in different age groups, proportion between workers and disabled and retired and unemployed, type of appointment missed, etc etc. Until we have ALL the facts, bare numbers of missed appointments mean nothing. No point charging for appointments if most of the missed ones are from people who'd be exempt anyway (due to unemployment, age or disability). I'd not support any charges that would only be levied on workers as that's just yet another tax on workers.

I'd also want some proper analysis of reasons, i.e. what proportion are because people never received the appointment letter, or who couldn't get an answer when trying to phone to change/cancel it, or other NHS admin cock-ups.

It's easy for the NHS to use their usual excuse of "patient blaming" for all it's ills, but a lot of the time, it's down to NHS systems, staff incompetence, poor admin and poor management etc.

Charging shouldn't be brought in just to raise revenue, as the cost WILL fall unfairly on innocent workers.

Agreed, a friend had similar problems, has memory issues so doesn’t always remember specific details, has to rely on family to prompt. My friend would be penalised for something she can’t help.

Her daughter can’t use a phone so relies on her mum to take phone calls that can’t be changed to email. Friend has had several phone calls where she has spent 3-4 hours on trying to get through to cancel appointments for daughter and then daughter was listed as missed appointments.

Daughter has many health conditions which means she has so many different departments for nhs, none of them communicate between them so daughter has to act as go between because they failed to cooperate on an issue.

From where?

I just think spending by our government needs change. They take in a collosal amount in taxes. There are areas where it seems spending is ridiculous. A lot of waste on the projects they do. Id rather they were more sensible and prioritised our money better.

Id be happy to pay a small contribution per gp appointment if it was shown to be a real change maker. However, i think anyone on any benefit should not be required to pay.

Disagree. The wealthy will go private. Why should soneone who works hard at a low wage pay whilst someone on welfare gets it free. Either NHS is free OR charged at the point of access. No payment no treatment.