My major issue with it is that there is no attempt to try and drive down costs over the long-run, it’s all just knee-jerk, sugar rush cuts with no consideration of the consequences. Zero lessons learned from austerity

That and social insurance. That gets me every time

Of course the NHS can run more effectively; it did so just 6 years ago

But achieving those improvements requires investment in capital (buildings, IT, diagnostic equipment, beds), correct staff mix, investment in preventative activity, sorting social care etc. None of that mentioned

The most frustrating thing with the endless reports from these think tanks is the absolute refusal to engage with any of the reasons that NHS productivity has declined or what could be done about it

Instead, it's all hand wavey salami slicing and endlessly debunked ideas

In fact, social insurance models are often associated with higher admin costs

And the cost of shifting our model would be enormous, the "mother and father" of all NHS reforms

All for almost no real efficiency gain

Read our paper here: www.instituteforgovernment.org.uk/publication/...

In addition to the £11bn, they claim that moving to a social insurance model would deliver "substantial savings". They don't even bother having a source for this

The evidence is clear: there is no benefit from a social insurance model vs funding from general taxation

www.oecd.org/content/dam/...

There's supposedly £1bn further savings from reducing agency staff. The NHS spent ~£2bn on agency staff in 2024/25

The govt has an ambition to reduce it by another £1bn over 5 years as part of SR departmental efficiency plans. A further £1bn seems extremely unlikely

www.gov.uk/government/n...

Once you exclude the old and the young, the "savings" drop dramatically. We estimated that a £10 charge would raise £350m-£400m, so £700m-£800m for a £20 charge

But it would also deter people from seeking care, potentially adding costs later when they need more intensive treatment

£5bn comes from charging £20 for a GP appointment

But the most intensive users of GPs are elderly people and children

We currently do not charge them for prescriptions so seems politically difficult to charge them for appointments