It has taken a little over 10 years and Tory cuts to push the NHS from the top to second from the bottom of risk nation health care.

As others have said one of the things we have in France is top-up insurance. Serious illnesses are funded 100% and other treatments at 70% with the top-up insurance picking up the rest.

Yes, someone mentioned that yesterday. But when I looked up comparison figures for state spending on health that 70% that the French government contributes is more than the UK government contributes to offer the service completely free.

Even if the UK govt. contributed as much per capita as the French government we could see 'some' improvement.

Mamie

growstuff

What kind of reform?

It would certainly require more money.

As others have said one of the things we have in France is top-up insurance. Serious illnesses are funded 100% and other treatments at 70% with the top-up insurance picking up the rest. Earlier in the thread someone was talking of an 18€ charge for A and E. In fact this is a charge to the top-up and would be invisible to the user who would use their Carte Vitale for administrative purposes in the hospital. This card is essential to prove that you have the right to treatment.
If you have a low income you are funded at 100%.
The top-up insurance is one method of enhancing the state funding which is done through the equivalent of National Insurance.
We pay it willingly for the quality of service that we receive.

Normal and reasonable in many countries. Not here, apparently.

Remember the complaints when NI went up? People don’t want to pay what it takes to fund their treatment. And yes, I know that NI payments just go into the pot. People don’t put their money where their mouth is, do they?

The claim that so-called 'health tourism' costs the NHS £3 billion is total nonsense to put it mildly. Even the Tory government bent on blaming deliberate foreigners could only get the figure up to £300 million at most. That's £2.7 billion less than the nonsense put about by those who should know better. The Tories would do better to recover defective PPE costs and find ways of cutting down NHS PFI debt than wasting taxpayers' money chasing foreigners.

MaizieD

^As others have said one of the things we have in France is top-up insurance. Serious illnesses are funded 100% and other treatments at 70% with the top-up insurance picking up the rest.^

Yes, someone mentioned that yesterday. But when I looked up comparison figures for state spending on health that 70% that the French government contributes is more than the UK government contributes to offer the service completely free.

Even if the UK govt. contributed as much per capita as the French government we could see 'some' improvement.

Wow. Thanks for that analysis Maizie.

The 70% is also funded by contributions though Maizie. Cotisations (contributions) are high for employers and employees and are for health, pensions, unemployment, accidents etc. There are also taxes CSG / CRDS paid along with income tax.

Mamie

The 70% is also funded by contributions though Maizie. Cotisations (contributions) are high for employers and employees and are for health, pensions, unemployment, accidents etc. There are also taxes CSG / CRDS paid along with income tax.

Errr.

It's not as the though UK citizens don't pay any tax, Mamie. It's just not hypothecated as yours appears to be.

(though this point puts in in something of an odd position because I know full well that taxation in the UK doesn't fund spending...)

Yes well aware about UK tax Maizie I still pay it!
The contributions here are like National Insurance in the UK, but a big percentage of income. This is why small businesses have found it hard to flourish in France. Macron has got rid of some of the obstacles to expansion but it is still hard going. I think the way it works here is more because essentially it is a socialist country; people expect to make high contributions and in return expect to be looked after by the state. The gap between rich and poor is much narrower than the UK.

I suspect part of your high tax problem is because France uses the euro. It can't make independent decisions about how much money to release into the economy. It has to be done via the ECB.
Whereas Sterling is a sovereign currency so the UK govt. can issue as much as it likes.
When we rejoin the EU we must never, never actually adopt the euro. We can 'work towards' joining it, like Sweden has for decades..

Don't think it has anything to do with the Euro Maizie, you are
barking up the wrong tree there.
I've been self employed in France for 35 years and the 'cotisations' have been much higher than Britain even when
it was in French Francs. Made me gasp for air in the beginning
especially as you were pursued relentlessly for payment.
I didn't really understand the system then but can now see how
much better off it has made made Social Serviçes and health.
But it still makes me gasp for air when I get the cotisation demand! I've always said I would be personally richer in Britain than here, but thats not the answer really.

So American owned Boots are going to close down 300 shops. I thought pharmacies and pharmacists were going to be used to take pressure off GP surgeries?

MayBee70

So American owned Boots are going to close down 300 shops. I thought pharmacies and pharmacists were going to be used to take pressure off GP surgeries?

Obviously the Tories did not do their homework. Pharmacies are a crucial part of service to the public and it may be necessary to take them into public ownership if they are to provide a universal service accessible to all especially in rural areas with poor public transport.

Grantanow

MayBee70

So American owned Boots are going to close down 300 shops. I thought pharmacies and pharmacists were going to be used to take pressure off GP surgeries?

Obviously the Tories did not do their homework. Pharmacies are a crucial part of service to the public and it may be necessary to take them into public ownership if they are to provide a universal service accessible to all especially in rural areas with poor public transport.

Lloyds recently announced the closure of all 237 pharmacies in Sainsburys branches too. They obviously can’t make them profitable. I can’t imagine pharmacies going down a public ownership route, they are private contractors rather than utilities. It’s more likely that there will be further distances between them and they are strategically sited so each one reaches enough volume of work for the NHS to become profitable.

I don't know much about the training of pharmacists. Do they have transferable skills for medical positions?

My other thought is, are they too finding ut difficult to get staff?

DaisyAnneReturns

I don't know much about the training of pharmacists. Do they have transferable skills for medical positions?

My other thought is, are they too finding ut difficult to get staff?

Pharmacists are highly trained, and do have transferable skills, which is why they are in great demand. Many GP practices now employ their own pharmacists, and those roles are very attractive to community pharmacists, which has a knock on effect on recruitment. I think there are lots of factors, a big one is the decline in customers buying health and beauty products from chemists, as supermarkets carry good ranges and people buy online instead - which affects profit margins for Boots, Lloyds etc.

Thanks Casdon, that really helps.

I'm still trying to work out how chemist's can afford to make up the bubble packs and deliver them. It's certainly a complex business and seems to hang between, or perhaps be sqashed by, both the private and public sectors.

Dispensing doctors practices do well financially out of it*so I assume pharmacies do, too. *At least that’s what DH tells me and he used to work for Boots.

Our gp’s pharmacy went through a period of finding it impossible to recruit about a year ago. They were seriously short staffed but things seem to have improved now.

'I can’t imagine pharmacies going down a public ownership route, they are private contractors rather than utilities.'

It's not a matter of what private contractors want. If pharmacies run by the private sector cannot provide an adequate public dispensing service then the government should step in.

The fact is that the profit motive does not always lead to a properly distributed service.

I have found that they provide an adequate service but there are drug supply issues not helped by Brexit. I don’t understand this thinking that the government has to be involved in everything.

Grantanow

'I can’t imagine pharmacies going down a public ownership route, they are private contractors rather than utilities.'

It's not a matter of what private contractors want. If pharmacies run by the private sector cannot provide an adequate public dispensing service then the government should step in.

The fact is that the profit motive does not always lead to a properly distributed service.

That’s not where we are Grantanow. Not all community pharmacies will close because the business for them is still there, and some of them closing will mean more core dispensing and other NHS work for those that remain which will ensure they remain profitable - but the public will have to travel further to reach them. I’m not saying I agree that’s the way it should be, but it’s the reality.

I doubt that essential public services can be left to the profit motive of the private sector. Just look at the water monopolies and the disaster now pending for customers and the taxpayer in the Thames and other regions. Private sector mentality has led to raw sewage in rivers, public opprobrium for ignoring harassment and false prosecutions of subpostmasters. It's indefensible.

There was raw sewage in rivers and the sea before privatisation as successive governments had failed to invest. That includes sainted Labour.

Germanshepherdsmum

There was raw sewage in rivers and the sea before privatisation as successive governments had failed to invest. That includes sainted Labour.

Indeed.

It never seems to be noted - the sea and rivers have been dumping grounds forever, or so we read.

Grantanow

I doubt that essential public services can be left to the profit motive of the private sector. Just look at the water monopolies and the disaster now pending for customers and the taxpayer in the Thames and other regions. Private sector mentality has led to raw sewage in rivers, public opprobrium for ignoring harassment and false prosecutions of subpostmasters. It's indefensible.

I completely agree, but this isn’t the same scenario. Community pharmacies are paid by the NHS on a fee per service provided basis, they are viable as contractor run private businesses so long as they are the route for prescriptions and have a critical mass of users. The government is supporting the expansion of the remit of community pharmacists, which is also on a fee per service basis.
I’m not a Tory supporter just in case you thought I was beating a political drum, but do I know from experience how the NHS contractor system works. I’m far more concerned about dentists than I am about pharmacists under this government.