Why would Reform voters accept that they will scrap the NHS?

[NEGUY82]

Even when you present them with pretty undeniable proof they wants to do it they just say "lefty propaganda, he said he won't" - well of course he says he won't it would cost him the election.

This is utter nonsense. Most of the NHS has already been outsourced because it has been underfunded for decades. The decisions are driven by the budget which is decided by incompetent politicians whose only objective is to stay in office by garnering votes saying what their constituents want to hear (regardless of whether it is a lie, true, possible, impossible) and secondly to ensure their own financial interests are advanced (no turkey is going to vote for Christmas ergo no MP is going to vote for a law that adversely affects their personal or family wealth).

No outsourcing decisions are made by the NHS based on keeping core competencies in house and out source for other needs. The NHS civil service leadership has very little say, it’s pretty much the PM, Cabinet and Health Secretary.

This feels like more of a political point than a factual claim.

The mainstream figure for amount of contracted services is 7-25%, depending on the definition used.

Virtually none of those decisions are made at ministerial level, let alone by the cabinet, though of course govt/parliament sets the overall framework.

No it’s a factual claim. The ministerial level decides which kinds of services are outsourced and which are not. Lower level NHS officials write the statements of requirements and manage the procurement process and contract execution. Yes, the decision as to which contractor gets the contract is at a lower level but it is often politically influenced. A trust can’t decide to go off piste and contract out or bring in house whatever they feel like. In addition, the funds are in specific accounts earmarked for specific activities. There are strict rules that prohibit using funds earmarked for say mental health for elective surgeries, and rules about funds that must be used in house versus contracts. You can’t for example use funds for NHS employee wages to contract in a consultant. There is a lot less flexibility than you can imagine.

The reason NHS contracts are outsourced is because the abysmal 2012 Lansley bill made it a requirement that services are put out to tender. Quite often the tendering process is so time consuming and costly that the NHS teams who would bid can’t afford to do so. It’s beyond me why Streeting didn’t repeal this on day one.

https://www.kingsfund.org.uk/insight-and-analysis/reports/nhs-compare-health-care-systems-other-countries

Have not read the full thread so maybe someone has already posted this but it's always worth coming back to. Basically the research shows that the type of funding model is not the problem for the NHS. It's the amount of money that goes in. That's the bottom line.

A tonne of money is wasted in the NHS, I don't think needs more money just wiser spending.

I can buy a pack of paracetemol for 54p, it somehow costs the NHS £12, what?? That has to be a dodgy deal going up someone's Nose.

The whole thing isn't central, you can go for bloods at one Hospital - go to a different Hospital a couple of days later and they can't see the results - happened to me a few times, it's insane - the money that must waste.

Sort out things like those and it'll free up a tonne of money.

Oh yes, wiser spending. Says every government since around 1980. It’s all obfuscation and bullshit.

I don’t think it’s the model per se that’s the issue. As in, properly funded a single-payer model can work.

I think that our model in combination with our demographics and political system is unworkable, becuase the funding gap will widen and widen until the system breaks.

We can’t significantly change either our demographics or our political system.

So we need healthcare reforms that will bring in new revenue streams, like a dual-track model with more and more insurance-based provision for those who choose it.

I thought that’s what we’ve already got. Despite being a huge cheerleader for the NHS I wasn’t prepared to go progressively blind on the very long waiting list for cataract surgery so I paid. I’m very happy to stay with the NHS for all my other health needs.

What is it about our demographics and political system that you think makes the NHS model unworkable? The NHS was rated number one in the world back in 2010 - someone else mentioned this up thread I think - do you think our demographics and political system have changed significantly since then?

We know exactly what happened in 2010, I doubt it's a coincidence.

It's never been that good though. There have always been long waiting lists, even in the Blair years. The only good thing about it was that you didn't often get a bill.
The model needs to be changed, as infinite demand cannot be met by working taxpayer funds alone. There is no competition for patients, they have no choice of provider really and healthy competition drives efficiency.

Our demographics have changed a lot, through aging. Healthcare costs increase massively with old age so this matters a lot, and we have fewer earners per old person too.

Our political system is just as bad at doing long-term reform but now has far less headroom to borrow. Our debt interest has more than doubled, and debt has almost doubled as a share of GDP.

These trends all get worse too.

I made this table, also with OBR projections for 2040.

That’s great for you. What about the people who can’t pay. Do they just go blind?

I expect so. It wouldn’t have made any difference to them, would it?

And you’re a huge cheerleader for the NHS in its current state? Where poor people go blind on waiting lists?

Did I say “in its current state”? No, you added that. The waiting lists for cataract surgery are much shorter now, I paid for my surgery in 2019 when they were two years long where I live, according to a friend they’re now six months but still too long.

Yes, it's around 5-6 months where I live.

This is the biggest factor in demonstrating that the system is beyond repair in its current form. It's 'spoiling the ship for a happorth of tar'. Imagine what extra benefits a blind person will need to claim after the dysfunctional NHS has let them go unnecessarily blind.
You can have the best BUPA cover but in an accident, you have no option but to go to your local NHS A&E. You can't be sure that you won't be waiting for hours on a trolley, that you will be treated well, that you won't suffer an adverse event. In short it is a lottery and you hope for the best.
Then you realise that because of the infinite demand, the NHS constantly refines its treatment protocols...letting people go blind is likely an unintended consequence of this.
I mean things like no longer doing ear wax removal, telling people they have to have multiple infections before removing wisdom teeth, doing hysteroscopy on women without anaesthetic.
It all involves making the patient/taxpayer suffer for longer before they are entitled to access 'free at point of use' care.
I would rather have a system which wanted to minimise my pain and suffering.

It isn’t a sign that the system is beyond repair. It’s a sign that the NHS can’t manage on its current budget and needs considerable investment. Have a look at how much other Western countries spend on their healthcare.

Is that all coming from general taxation in those countries?

You said we currently have a system which was similar to what @GeneralPeter was envisaging. What was your actual point?

No, it’s total spending which is often a combination of public spending and private insurance.

But I don’t think the NHS cares where its investment comes from. Money is money!

I'm sure the NHS doesn't care where the cash comes from. But that's not the point. We can't afford to fund the NHS in ever more ludicrous amounts from general taxation. Unless you agree with wealth redistribution via higher tax burdens.

So the money has to come via other models which is what the thread was discussing and some posters criticising.

I would also like to see a proper discussion on productivity in the NHS which has stayed static or decreased despite increased funding.