The New Cabinet

Or c) both the above

MargaretX sounds good. How much does it cost if you don't mind me asking?

Of course it can't survive as it is. Unless, of course, we spend as much money on it as other EU countries, which is what Brexit has promised. Oh, I forgot, they lied.
Sitting here typing this with a cast and a sling on my arm, both courtesy of the NHS.

I am reading about Europe pre-WW1 at the moment. Bismarck introduced the first welfare state in Europe duri g the 1880a. This included unemployment insurance and old age pensions - so I think Germany has led the way in welfare state issues.

Jane10I can't say how much it costs but it is paid by the worker and the employer. Under a certain income, paying is compulsory, better earners can pay if they want to and most do. But it is greater percentage of your salary/wages than National Insurance and is only for health. Its not cheap but children are free.

Doctors are normal students and do 4 years in hospital after leaving uni. then they usually specialise and become consultants. these consultants set up their own practices so you don't usually go to a hospital unless for operations or Cancer treatment.
e.g.With a very bad sore throat or severe earrache you go straight away to an Ear,Nose and Throat doctor.
The consulatant exmaines you and tells you immediately what he has seen on his screen. No waiting for results to come in unless a biopsiy has been taken..
All the finances are in the hands of several Krankenkasse, but the government makes the laws governing them and what
they provide and what is necessary health care.

I think you'll find that one big difference between Germany (and other countries) and the UK regarding healthcare finance is that pensioners continue to pay health insurance. Politicians know that and it will be interesting to see if they're brave enough to go down that route.

So DJ what is the way forward for the NHS?

Doesn't the German system work out more expensive than the NHS though?
All models of health care that involve a combination of private and public are problematic. The system in Australia seems to be chaotic with a limited NHS for poorer people and many ordinary middle class people playing very high insurance.

I've just looked it up. Employees pay 7.3% of their salary and the employers pay another 7.3%. On top of that, there's 2.2% for long-term care. Pensioners pay the same rate out of their pensions and the pensions insurance company pays the same amount. It's a lot more expensive.

How's the quality? It isn't just about money. I think many would pay more in the UK, particularly if it was a dedicated insurance.

Germany has a shortage of doctors.

www.wsj.com/articles/germany-seeks-foreign-cure-for-its-doctor-shortage-1437434991

Germans also pay 3% for unemployment insurance and another (approximately) 9% for pensions contributions. Therefore, they pay much more than we do in the UK for benefits provided by NI, but get more back.

The French pay 5.25% of income, capital and winnings, but this doesn't cover the whole cost, so most people also have private health insurance to cover the gap.

If we want more, we're going to have to pay for it one way or other.

Rather than seeing it as 'a lot more expensive', what happens dd if we think of it as greater investment in countries such as Germany? I think this would tell us we get incredible value for money and provide a good argument for increased funding by, for instance ring fencing NI and continuing it through life including on pensioner income.

You're preaching to the converted, gracesgran. I've thought for a long time that there should be separate ring-fenced funds for healthcare. Germans receive the same level of healthcare, no matter how much they've paid.

I fear that in the UK we're heading for a healthcare system where very basic services are provided by the NHS, while those who can afford it will take out private insurance, but only to pay for themselves.

I thought I might be DD. I share your fears about the difference of provision but the government needs to take care as we have seen what happens when people feel they are not getting a fare deal.

Anya, the future is to go back, get rid of the purchaser/provider split. All the money spent on the health service to be used in the health service. Get rid of the privatisation that has happened, and stop pretending that the health service is ring-fenced whilst asking it to save £22 billion.
The money is in the system to make the health sevice better. However, when you have almost all the top ministers standing to gain from privatisation, it isn't going to happen, is it?

nhap.org/the-biggest-attack-on-the-nhs/

Stop this as well. It isn't going to be an NHS at all soon.

But can we sustain it from taxes alone in the long term? It is doubtless getting more expensive as new treatments are developed and cost more. And the population is not a particularly healthy one, so demand is going to increase.

What I am utterly against is ending up with a two tier system. We so need a conversation in this country. But stealth is the name of the game by those who can see vast profits. They have no intention of accepting anything other than a free market.

The PAC says that the NHS has not costed staffing into any of its financial forecasts for the 7 day NHS. Rather remiss of them.

www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news-parliament-2015/nhs-staff-numbers-report-published-15-16

What's the tax gap?
How many billions are tax payers being cheated out of each year?
Even private health companies take their profits offshore.
Of course we can afford it, if everybody is made to pay their taxes properly.

www.taxresearch.org.uk/Blog/2016/03/29/why-hmrc-have-got-the-tax-gap-wrong/

When they closed our surgery down we were told the NHS was bankrupt, although I'm sure the personal service we provided saved money long term. But the NHS is clogged up with people who see Dr's for the slightest thing [and they're usually the ones who return time and time again]. Obesity is a ticking time bomb and A&E departments have to deal with alcohol fuelled problems. We need to train up more nurses [without them having to pay for the pleasure, I might add] as agency staff must be costing the NHS a fortune, although a lot of agency staff [or so I've heard] do so because it fits in better with family commitments as the NHS is not flexible enough to help in that way. When the S.O.'s mother was in and out of hospital a lot in her last years she was often clogging up the system by not being allowed home due to inefficiency with the social services [even though she had privately paid carers coming in twice a day]. I don't know what I'd do if I had to pay health insurance now, as my pension is miniscule .

Anya I don't understand why you have concern about the sustainability of funding from taxes. We have a pool of money which is currently in peoples pockets and we have to transfer it from there to pay for medical treatment and care for the population. We either do this via private insurance or pooled insurance; to me that is just a choice.

I do understand your concerns about it "... doubtless getting more expensive as new treatments are developed and cost more. And the population is not a particularly healthy one, so demand is going to increase." However, to me this seems not to do with funding but with organisation. I have no personal objection to the idea of re-organising the NHS to suit the present day but I would like a declared re-organisation plan. Do any of us really know exactly why the government want Junior Doctors to work the 7 day week they are trying to achieve? Where does this fit in to an update of the organisation of the NHS. I feel the politicians in power are treating us like mushrooms yet again.

In Germany pensioners pay a lot less than when they were working. As to shortage of Doctors there isn't one its just that they don't want to work in country areas. There has been talk of making them work in the country for 5 years but no government wants to start it as it is not popular. It is expected that with increased retirement there will be short fall.

I live in a middle class market town and we have loads of doctors. They have nice houses, good schools, middle class patients, Golf and Tennis, The GPs, dentists and Consultants in the area share the 48 hours emergency service with a rota at weekends, so the A&E is used but not over used.
On the other hand a gastroenterologist is not the best person for sprained ankle but he keeps his hand in.

I'm sure if I lived in Berlin I would not be so optimistic about the Health Service here......

Bye the way Germans and their pensioners still pay 1.8% of their income for the reunification of Germany. Then they pay 2% for the care of the elderly who are then divided into 5 classes and depending on how frail or dement you are, you get more money.This money is paid in cash.

So you see the Health System is just part of a way of life for Germans which says you get what you pay for and no nonsense about things being free.
There is no such thing as a free lunch.

Totally agree Tegan

Gracesgran what I mean is, with rising costs and demand, taxes would surely have to increase. I'm quite happy to pay extra, if it was guaranteed to be ring-fenced to go to the NHS, as would I suspect many others.

But yes, rather than this piecemeal approach I'd be delighted to see the government, ANY government, set out its 50 year plan for the NHS, spelling it out clearly and honestly.