This is low, even for Reform

Whether the NHS is directly funded by the state or by insurance it is constrained by the state's monetary system. i.e how much money it issues into the economy. It either has to issue enough to directly fund the NHS or enough to enable citizens to pay their insurance contributions. And insurance funds' ability to generate enough income from investments to cover the NHS costs is also limited by the amount of state issued money to produce enough money to make its 'investments' pay.

Yes, quite.

It sounds complex, but is entirely logical.

Good analysis at 11.07 Graphite

I've been working through this with AI and the question we've arrived at is remarkable similar to Sarah Reed's.

What does he think an insurance system would accomplish that the government couldn't accomplish simply by allocating more sterling to the NHS — and what exactly would determine the amount of healthcare resources available?

Whether the NHS is directly funded by the state or by insurance it is constrained by the state's monetary system. i.e how much money it issues into the economy. It either has to issue enough to directly fund the NHS or enough to enable citizens to pay their insurance contributions. And insurance funds' ability to generate enough income from investments to cover the NHS costs is also limited by the amount of state issued money to produce enough money to make its 'investments' pay.

Our frontline nurses and doctors are just amazing people, their job sounds so difficult, and the managers should be sorting oit these issues themselves!

I'm pretty sure managers do sort out these issues - the efficiency of their departments is tracked.

However, if budgets have been cut, and the supply of equipment and essential items per unit/ward reduced - he or she will have no control over the consequences.

But they are an easy and popular scapegoat.

What manifesto? The 2024 General Election manifesto, or what Reform insisted on calling a "contract" because it was “an agreement with the people” was withdrawn just weeks after the election and described by themselves as unworkable.

So much for an agreement. In two years, nothing has replaced it. Dr David Bull, who has since quit his job has party chair, claimed to have written a healthcare policy but it has never materialised.

“Our pledges to you” issued as part of the 2026 Reform Conference mentions nothing about NHS care beyond training places.

www.reformparty.uk/policies/the-first-100-days-our-pledges-to-you

Sarah Reed, Senior Fellow Nuffield Trust:

There isn’t compelling evidence that any specific funding model leads to better clinical outcomes, whether insurance or tax based. Multiple studies have looked at this question, concluding that there are no positive health gains linked with moving to a social health insurance system , and that no one type of funding model is systematically better when it comes to delivering value for money.

This is why we see variation in outcomes among countries with similar approaches. Countries with social health insurance like France, the Netherlands and Germany all perform better than the UK on key indicators, including rates of death from avoidable causes, life expectancy at birth, and infant and maternal mortality rates. But so do countries with tax-based systems like the NHS, such as Denmark, Sweden, New Zealand and Norway. There are many questions our relative performance should raise …

but a big bang reform to change the funding model would be a politically, administratively and operationally expensive way to entirely miss the point.

It's also important to note that social health insurance systems and tax-based ones aren’t nearly as different as they’re often made out to be. Social health insurance essentially functions as payroll tax in many countries, and many countries with social health insurance subsidise these revenues with other taxes, as employer and employee-based contributions have fallen short of required levels.

Citing one glossy experience at a private hospital is meaningless. The private system doesn’t have to provide contingency for 70 million people, any of whom could fall ill at any time. Many of these are old, poor, are not employed so are not in any payroll tax system and don't have the means to pay for insurance.

Roughly £65 billion of NHS funding each year comes from national insurance contributions. It’s why Rachel Reeves increased employer’s NIC - to put another £25 billion a year into the NHS.

The private system will rarely touch anything of an emergency nature. Insurance won’t cover existing conditions. Private hospitals don’t want to deal with ongoing conditions. It’s a quick in-out system which nowadays relies on paid contracts with the NHS to perform day surgeries to keep it going financially. It is never going to be anything more than a supplementary system for conditions which are quick to treat and for wealthy people to queue jump.

Btw, never compare our private hospital care, which runs alongside our NHS and is very specialised. For example it has no A&E function.

Never compare this with models from other countries. Initially Farage favoured the USA model of healthcare, thank god he dropped this. Then he did mention several other European healthcare models.

The reason that there is so much speculation is because Reform haven’t nailed down exactly what their plans are, this is such an important area, especially as we are an aging population.

There are 23,000+ live advertised vacancies for nurses today. The RCN estimates the “need” is closer to 55,000.

In addition within midwifery it’s an estimated shortage of 2,500, whilst ironically 1 in 3 newly qualified midwives cannot find permanent jobs due to hospital budgetary constraints.

Around 500-600 GP surgeries are needed.

Dentists are also needed.

This is just England.

This doesn’t include all the other specialisms within our NHS, physios, radiographers, healthcare assistants and so on.

Cutting the budgets further certainly isn’t the answer.

You could use the above examples within our education system too, shortage of teachers, many leaving the profession due to burnout, and the ridiculous expectations placed on teachers. Huge student debts compared with pretty mediocre salaries, particularly in primary schools. Supplies being bought on a weekly basis out of teachers own pockets.

Cuts in education budgets have resulted in Heads struggling to recruit and keep good quality staff.

It’s not more cuts we need.

I would love to see the breakdown of the so called “waste” Reform speak of and to see exactly where they propose to cut.

All they can “cut” in most public services now is staff!

In terms of our NHS, it needs overhauling, it requires more staff at all levels.

However, today in 2026, our NHS saved the lives of both my DiL and our grandson. Three hospitals have been involved in his care, he has one to one nursing and will be in hospital until at least end of November.

During my 67 years, our NHS has saved both my parents lives twice, delivered me of four children, saved my life at least once, treated my husband, in 2020, mid lockdown for heart failure saving his life.

My entire family have made use of our GP services several times.

It’s not perfect, but we’ve had more than value for money and as between us both DH and I have 10 different meds each day plus the associated annual and sometimes, 6 monthly check ups/ blood test etc which go with such medications.

It’s far from perfect, but without it many of my family members might not be here now.

Meandrogrog

Cost, moral and life, far more important to me than financial. Although, of course finances/economics is extremely import in politics.

Dickens

^I so agree with you, particularly about healthcare. Its vitally important. It does rather feed back into my point that we are all paying into a system which is not delivering back to us the services we need.^

To my mind this does not simply mean ever higher taxes but for the taxes we do pay to be wisely spent but this seems to not be achievable whichever party is in power!

... bear with me a minute (or five) Meandrogrog

Not too long ago, I spent almost 3 months in hospital. And, I saw a few 'things'.

You know those ring-binders containing your notes kept at the end of the bed. Well, mine - and those for other patients, kept malfunctioning and the notes fell out all over the floor; consultants, doctors, nurses, all scrabbled around, constantly, picking them up and replacing them - only for them to fall out again the next time the binder was opened.

They were, as they say, "cheap and nasty" (that's what my consultant said) - but, they.were.cheap - is the point. Because the NHS budgets had been charged to make those (seemingly never ending) cuts. The malfunctioning binders had to be replaced, and they were - with more cheap ones... what used to be known as throwing good money after bad.

It would have made economic sense to purchase the more expensive - but more reliably-functioning binders. And, ultimately, cheaper.

My point is - 'cuts' don't always cut it.

And in order to comply with more cuts - essential supplies were also reduced in numbers and quality. Often, supplies simply ran out. A very elderly lady in my ward had to rely on inco pads. There were none left when she needed one - this resulted in 2 nurses leaving the ward, going in different directions throughout the hospital, to see if they could blag some from another ward. As other wards were also suffering the same lack of supplies, this resulted in one nurse being gone for nearly 45 minutes, returning triumphantly with 2 further pads which were all that could be spared from whichever ward they'd been filched from. Our ward was nearly always 'down' one nurse, the usual short staff problem - and this lack of supplies was a regular occurrence.

Do you see what I'm driving at? When politicians make demands for 'efficiency' savings and talk about further 'cuts' to NHS budgets, this could be - more often than not - the end result. I know this is just one aspect of it, but it stuck in my mind because I saw these 'things' happening so frequently - and I also noted the exasperation of the staff.

Farage - and others on the Right, it's not just him - want to eliminate 'waste', but as I said previously, just how much 'waste is left to be eliminated? The NHS is under-staffed, we know that, and budgets have been cut to the bone almost. The very last thing it needs - or any department come to that... is more cuts.

There is absolutely no getting away from the fact that if we want services that function - any service - they have got to be properly funded.

But, you will give Reform a chance (assuming the company wins an election) and Farage will set about disbanding the NHS for the 'French' insurance model. And the money that could be spent on front-line services will go into the myriad organisations that will be necessary for billing, admin etc. Those that can afford it will 'go private' or have already. And those that can't will suffer a much reduced service... and don't think that this will only be those individuals on low-wages - the 'middle' class who now 'manage' OK will, as always, be in that same position that always afflicts them - they will be "too rich" - but not rich enough...

...OK, I meant 10 minutes then

Our frontline nurses and doctors are just amazing people, their job sounds so difficult, and the managers should be sorting oit these issues themselves!

I had to pay privately for an operation last hear after being lost in the NHS system. Its just not working, probably due to the demand.

The private experience was amazing, high tech and the hospital itself was clean, spacious, well run, no waiting for anything. The reception area was like that of a hotel, the staff were not stressed. I was able to have the operation quickly and the aftercare was first rate, with clinical staff in my private en-suite room more or less constantly. It really was a different world.

I do not know a great deal about the French system, but from the little I have heard it seems there is no waiting.

Reform’s manifesto states there will be no change in our free at the point of use NHS but Labour are apparently trying to suggest he wants to bring in a French based system. The problem is that it starts to be believed if stated often enough.

Though I have to admit that both I and AI have forgotten a vital component of the economy. Much of this enterprise is being held up by a mountain of private debt, consumers buying on credit (for enterprises need customers to buy their products), which could well collapse…

According to google AI

Yes entrepreneurs create substantial wealth for a country by turning raw ideas, labour and capital into productive new goods, services and economic value

They do not add anything to the stock of money in the country., which would be my definition of ‘creating wealth’. All that they are doing is diverting money which already exists from one enterprise to another. The successful entrepreneur may become wealthy and create jobs, but unless there is a flow of new money into the economy it will happen at the expense of failure somewhere else as both enterprises will be competing for the same pool of money.

So we still haven’t identified the source of the additional money.

This is by job creation, resource optimization, innovation, tax expansion and market expansion.

This is gobbledegook magical regurgitation of ‘free market’ economists’ mantras.

I so agree with you, particularly about healthcare. Its vitally important. It does rather feed back into my point that we are all paying into a system which is not delivering back to us the services we need.

To my mind this does not simply mean ever higher taxes but for the taxes we do pay to be wisely spent but this seems to not be achievable whichever party is in power!

... bear with me a minute (or five) Meandrogrog

Not too long ago, I spent almost 3 months in hospital. And, I saw a few 'things'.

You know those ring-binders containing your notes kept at the end of the bed. Well, mine - and those for other patients, kept malfunctioning and the notes fell out all over the floor; consultants, doctors, nurses, all scrabbled around, constantly, picking them up and replacing them - only for them to fall out again the next time the binder was opened.

They were, as they say, "cheap and nasty" (that's what my consultant said) - but, they.were.cheap - is the point. Because the NHS budgets had been charged to make those (seemingly never ending) cuts. The malfunctioning binders had to be replaced, and they were - with more cheap ones... what used to be known as throwing good money after bad.

It would have made economic sense to purchase the more expensive - but more reliably-functioning binders. And, ultimately, cheaper.

My point is - 'cuts' don't always cut it.

And in order to comply with more cuts - essential supplies were also reduced in numbers and quality. Often, supplies simply ran out. A very elderly lady in my ward had to rely on inco pads. There were none left when she needed one - this resulted in 2 nurses leaving the ward, going in different directions throughout the hospital, to see if they could blag some from another ward. As other wards were also suffering the same lack of supplies, this resulted in one nurse being gone for nearly 45 minutes, returning triumphantly with 2 further pads which were all that could be spared from whichever ward they'd been filched from. Our ward was nearly always 'down' one nurse, the usual short staff problem - and this lack of supplies was a regular occurrence.

Do you see what I'm driving at? When politicians make demands for 'efficiency' savings and talk about further 'cuts' to NHS budgets, this could be - more often than not - the end result. I know this is just one aspect of it, but it stuck in my mind because I saw these 'things' happening so frequently - and I also noted the exasperation of the staff.

Farage - and others on the Right, it's not just him - want to eliminate 'waste', but as I said previously, just how much 'waste is left to be eliminated? The NHS is under-staffed, we know that, and budgets have been cut to the bone almost. The very last thing it needs - or any department come to that... is more cuts.

There is absolutely no getting away from the fact that if we want services that function - any service - they have got to be properly funded.

But, you will give Reform a chance (assuming the company wins an election) and Farage will set about disbanding the NHS for the 'French' insurance model. And the money that could be spent on front-line services will go into the myriad organisations that will be necessary for billing, admin etc. Those that can afford it will 'go private' or have already. And those that can't will suffer a much reduced service... and don't think that this will only be those individuals on low-wages - the 'middle' class who now 'manage' OK will, as always, be in that same position that always afflicts them - they will be "too rich" - but not rich enough...

...OK, I meant 10 minutes then

Reform doesn’t have a healthcare policy. It doesn’t even have a designated spokesperson on healthcare.

If Burnham called a snap election and by some miracle Reform got to 326 - which they won’t but say they did - how would that work?

Braverman, Jenrick, Kruger, Rosindell and Pochin are all predicted to lose their seats. That would leave Farage, Tice, Anderson and 323 new MPs with absolutely no experience.

Who would you make Secretary of State for Health and Social Care?

Who would chose for each Cabinet position?

How would fill 150 Ministerial posts?

members.parliament.uk/government/cabinet

www.instituteforgovernment.org.uk/explainer/government-ministers

The notion that Reform could form a functioning government is laughable. Just look at the calibre of the people who have become Reform councillors and the rate of attrition.

Cossy

Meandrogrog

* To my mind this does not simply mean ever higher taxes but for the taxes we do pay to be wisely spent but this seems to not be achievable whichever party is in power!

This is exactly why I want to give Reform the chance to prove they can deliver.*

At what cost?

Well that is the question Cossy! What is the cost now or with the previous Tory administration?

Meandrogrog

* To my mind this does not simply mean ever higher taxes but for the taxes we do pay to be wisely spent but this seems to not be achievable whichever party is in power!

This is exactly why I want to give Reform the chance to prove they can deliver.*

At what cost?

Dickens

^What I am very interested in is what alternative can there be to either capitalism or communism? When I have asked this question in the past reply was there none.^

Not strictly true Meandrogrog - I gave you the example of a mixed-economy. We even had one once, back when God was a boy. It had its problems, but they were not caused by the concept of the economic model itself, more by structural flaws that were UK-specific at the time, which were low-productivity and outdated industrial infrastructure.

But it should and could work, with highly-productive - maybe tech-driven - innovation... and a skilled workforce. Oh, and collaboration between Unions and business instead of the adversarial friction that we have today.

But a skilled and 'happy' workforce needs to be rewarded for its efforts, and it also needs to be able to rely on decent healthcare, for example. If someone has to attempt the now standard 8am rush to either 'eConsult' a doctor or beg a receptionist for an appointment when he/she should be focusing on getting to work and doing their job - or wait weeks (maybe even months) for a consultant appointment for a painful or worrying condition... this is just not only not good for the individual, it doesn't help businesses to run smoothly and efficiently either. And this is where we're at since 2008. So austerity-driven Capitalism just isn't working. I can't see Farage's massive state-shrinking doing much to rectify the problem, either.

Anyway - there is an alternative, so you did get a reply!

I so agree with you, particularly about healthcare. Its vitally important. It does rather feed back into my point that we are all paying into a system which is not delivering back to us the services we need.

To my mind this does not simply mean ever higher taxes but for the taxes we do pay to be wisely spent but this seems to not be achievable whichever party is in power!

This is exactly why I want to give Reform the chance to prove they can deliver.

MaizieD

Meandrogrog

MaizieD

You know they generate wealth from other people by offering services, goods etc. its how society has always worked from bartering goods to exchanging goods for money.

The barter theory, notably promulgated by Adam Smith and repeated for generations has been proven to be wrong. It isn't at all how society has always worked. Anthropology and archaeology have dispelled that myth.

Okay, 'exchanging goods for money'. What is money and where does it come from?

Money is a medium of exchange. It makes trading goods and services easy without bartering.
It measures and compares the value of things.
It saves purchasing power for future use.
Modern money has no intrinsic value, people trust it because governments declare it legal tender.

Money comes from central banks, commercial banks, debt creation and loan repayment.

What is your point Maisie?

My point is that entrepreneurs don't create wealth. Commercial banks can create money through loans but it doesn't stay in the economy for ever because it has to be repaid with interest. The interest removes additional money from the economy.

So that leaves central banks. Who has the say over central bank money creation?

According to google AI

Yes entrepreneurs create substantial wealth for a country by turning raw ideas, labour and capital into productive new goods, services and economic value.

This is by job creation, resource optimization, innovation, tax expansion and market expansion.

Meandrogrog

MaizieD

You know they generate wealth from other people by offering services, goods etc. its how society has always worked from bartering goods to exchanging goods for money.

The barter theory, notably promulgated by Adam Smith and repeated for generations has been proven to be wrong. It isn't at all how society has always worked. Anthropology and archaeology have dispelled that myth.

Okay, 'exchanging goods for money'. What is money and where does it come from?

Money is a medium of exchange. It makes trading goods and services easy without bartering.
It measures and compares the value of things.
It saves purchasing power for future use.
Modern money has no intrinsic value, people trust it because governments declare it legal tender.

Money comes from central banks, commercial banks, debt creation and loan repayment.

What is your point Maisie?

My point is that entrepreneurs don't create wealth. Commercial banks can create money through loans but it doesn't stay in the economy for ever because it has to be repaid with interest. The interest removes additional money from the economy.

So that leaves central banks. Who has the say over central bank money creation?

In my humble opinion, austerity did nothing but cause many people to be poorer and huge gaps in services.

I absolutely agree what we need capitalism, should not a system which appears to favour the rich, nor at the expense of any group of people.

The reason we have a huge benefit bill is partly because the government is topping up low income earners, subsiding their rent, due to extraordinarily high private rents, in my own area a very modest three bedroom house commands a rent of around £1,800 a month, a huge chunk out of most people’s taxed income.

Given that many who claim top ups via universal credit are working for large corporations, such as supermarkets, or at low levels in public organisations such as councils or hospitals, perhaps living wages are needed far more than minimum wage.

It is entirely possible to have healthy profitable companies and Mr/Mrs Average living a decent life.

It’s possible to have good public services and good healthcare.

All the majority of people actually want is a roof over their heads, decent food, the ability to keep themselves well, fit and healthy and to do the same for their families.

Most people are prepared to do a good days work, for a fair days pay.

Fraud and error within welfare in the UK really isn’t that high.

My question, one I’ve asked a lot, though maybe not here, is this;

Does anyone really need to be a billionaire?

I have zero issue with someone, any one, working hard, doing well, choosing how and when they spend their hard earned and well deserved cash.

However, for example two huge donations of £76,000,000 to squander on buying your way into power, is, in my view, pretty immoral.

As has been mentioned, almost all Reform councillors could do with a bit of support and extra training.

The people living in Pier Ward and Jaywick could certainly do with better accommodation.

The entire rhetoric of Reform totally sickens me, it’s nothing to do with their plans for our economy, it’s to do with their utter lack of humanity, lack of honestly and their exploitation of their own supporters.

What I am very interested in is what alternative can there be to either capitalism or communism? When I have asked this question in the past reply was there none.

Not strictly true Meandrogrog - I gave you the example of a mixed-economy. We even had one once, back when God was a boy. It had its problems, but they were not caused by the concept of the economic model itself, more by structural flaws that were UK-specific at the time, which were low-productivity and outdated industrial infrastructure.

But it should and could work, with highly-productive - maybe tech-driven - innovation... and a skilled workforce. Oh, and collaboration between Unions and business instead of the adversarial friction that we have today.

But a skilled and 'happy' workforce needs to be rewarded for its efforts, and it also needs to be able to rely on decent healthcare, for example. If someone has to attempt the now standard 8am rush to either 'eConsult' a doctor or beg a receptionist for an appointment when he/she should be focusing on getting to work and doing their job - or wait weeks (maybe even months) for a consultant appointment for a painful or worrying condition... this is just not only not good for the individual, it doesn't help businesses to run smoothly and efficiently either. And this is where we're at since 2008. So austerity-driven Capitalism just isn't working. I can't see Farage's massive state-shrinking doing much to rectify the problem, either.

Anyway - there is an alternative, so you did get a reply!

Above worries me, as I don’t believe any serving councillor should be encouraging people to protest, it’s not their role or remit!

So this is how that “very useful” app Reform are encouraging us to buy, is being used.

This man is a Reform councillor, who encouraged people to mount a protest against AS landing

MaizieD

^You know they generate wealth from other people by offering services, goods etc. its how society has always worked from bartering goods to exchanging goods for money.^

The barter theory, notably promulgated by Adam Smith and repeated for generations has been proven to be wrong. It isn't at all how society has always worked. Anthropology and archaeology have dispelled that myth.

Okay, 'exchanging goods for money'. What is money and where does it come from?

Money is a medium of exchange. It makes trading goods and services easy without bartering.
It measures and compares the value of things.
It saves purchasing power for future use.
Modern money has no intrinsic value, people trust it because governments declare it legal tender.

Money comes from central banks, commercial banks, debt creation and loan repayment.

What is your point Maisie?

You know they generate wealth from other people by offering services, goods etc. its how society has always worked from bartering goods to exchanging goods for money.

The barter theory, notably promulgated by Adam Smith and repeated for generations has been proven to be wrong. It isn't at all how society has always worked. Anthropology and archaeology have dispelled that myth.

Okay, 'exchanging goods for money'. What is money and where does it come from?

MaizieD

^Businesses generate wealth, its what The Apprentice and Dragons Den is all about.^

What, out of thin air? Or do they have printing presses in their garages?

You know they generate wealth from other people by offering services, goods etc. its how society has always worked from bartering goods to exchanging goods for money.

I am really interested in knowing your views on how the economy should be run if you feel it should be different from capitalism? Wealth has never been equal and I do wonder that those who think it should be distributed more equally are more idealistic than realistic, this is not pointed at you btw.

Businesses generate wealth, its what The Apprentice and Dragons Den is all about.

What, out of thin air? Or do they have printing presses in their garages?