Thank you! Late, but here

@healthfoundation.bsky.social @charlestallack.bsky.social @mancunianmedic.bsky.social @martinmckee.bsky.social @helensalisbury.bsky.social

You'd want to design some exemptions and various rules... But—luckily—government already has a fairer and more efficient way of raising revenue for the NHS… tax!

We should focus on the real problems facing the NHS, not made up ones

www.bmj.com/content/380/...

And on more user charges (eg £X to see your GP), evidence tells us they can reduce demand for health care, but that includes the care people need to stay healthy

The poorest and sickest patients suffer as a result

pmc.ncbi.nlm.nih.gov/articles/PMC...

My colleagues summarised this and other evidence here:

www.health.org.uk/sites/defaul...

People want government to improve the NHS, not reform its funding model. This would waste years of time and money and would not address the NHS’s problems

Evidence on health system characteristics and performance points us to this conclusion too

www.oecd.org/en/publicati...

When presented with detail on how other models work—including social insurance, like in some European countries, or some version of our current model with additional user charges—they overwhelmingly favour sticking with our current tax-funded system

www.health.org.uk/reports-and-...

And despite low public satisfaction with NHS services, the public have strong support for the NHS’s model—free at the point of use, comprehensive, and primarily tax funded

www.kingsfund.org.uk/insight-and-...

The way the NHS is funded—largely through general taxation—is an efficient and equitable way of raising revenue, with comparatively low admin costs

In either case, there’s no clear evidence that one model performs better than the other

(and recent work suggests that, if you were starting from scratch, you would not choose SHI)

core.ac.uk/download/pdf...

onlinelibrary.wiley.com/doi/10.1002/...

Both systems basically rely on the same thing: risk pooling across the population, funded by compulsory payments (whether you call these a tax or not)

www.ft.com/content/602f...

How countries fund health care is shaped by history, culture, politics, values, more

The distinction between Beveridge (tax funded) and Bismarck (social insurance) systems has blurred over time, as countries with social insurance increasingly rely on extra government £

www.who.int/europe/publi...

@mancunianmedic.bsky.social @healthfoundation.bsky.social @hpiandycowper.bsky.social

Rejigging NHS structures while the health service is in crisis is a distraction that NHS staff and patients could do without. See more @healthfoundation.bsky.social

Government could achieve the same objectives with far less disruption—for instance, by bringing some functions into the department over time, leaving others at arms length from ministers, and avoiding distracting legislative changes needed to scrap NHS England entirely

But scrapping NHS England altogether will be a massive distraction. Evidence tells us that NHS reorganisations cause disruption and rarely deliver the benefits politicians expect. They also waste time and effort that could be spent on work to improve services

There is some logic in bringing NHS England and the department closer together—for instance, to reduce fragmentation and improve clarity for the health service