Should the NHS charge for its services?

The challenges the NHS is facing in the UK are well known, and increasing backlogs for operations and treatment constantly raise concerns about patient safety. What are the causes? According to The Guardian, it is the impact of an accumulation of major cost cuts over the last few decades, which has created a steady deterioration of capacity and resources, further exacerbated by the Covid-19 pandemic.

In 2022, 350,000 patients entering A&E had to wait for more than 12 hours to be admitted to a hospital, compared to only 1,306 patients in 2015. All these patients were medical emergencies and required urgent treatment.

The Royal College of Emergency Medicine estimates that up to 500 people could be dying each week because of delays in emergency care.

The lack of beds and staff in hospitals has created an intolerable situation for patients and health workers.

Doctors and nurses are reported to be chronically overworked and are now demanding both better salaries and working conditions. The NHS has been entirely free to all since the 1940s and now, with an ageing population and the resultant pressures of capacity, the system is said to be “at breaking point”.

It is useful to compare the UK with other developed countries of similar size. Germany, for example, is believed to have one of the best health systems globally – and whilst not everything is working perfectly there either, the country spends just under 13% of its GDP on health compared to the UK's 12%. But health insurance is mandatory in Germany, with employees and employers paying monthly fees. Higher-earning and self-employed citizens can enrol for private health coverage. The government is not directly involved in providing care.

Germany is better staffed and has higher capacity than the UK, with around 14 nurses per 1,000 patients compared to 9 in the UK and almost 3 times as many hospital beds. Patients enjoy a greater degree of individual choice and benefit from shorter waiting times.

It may be inevitable that the UK has to move to a paid or partly paid model, and this would inevitably require significant structural changes, but may be the answer?