How to Save the NHS

Around the world, the number of adults in bad health has fallen from 10.4% to 8.6% as health care steadily improved. But in the UK, the number in bad health increased from 5.8% to 7.4%.

Moreover, recent evidence shows that life expectancy in the UK is falling fast – it is, indeed, falling faster than anywhere else in the world. And it will continue to fall.

How much more evidence is needed to prove that the NHS has failed miserably, is continuing to fail miserably and will continue to fail miserably?

But there is a viable and valid alternative: a health care system which could replace the NHS and provide everyone in the country with much better health care – without costing a penny more.

The solution below is taken from my entirely accurate small book: NHS: What’s wrong and how to put it right. (Sadly, I doubt if NHS administrative staff will like it much.)

‘The only way to do something about the health care crisis is to provide the public with enough information so that they demand that politicians act. It is only politicians (given support from the public) who can possibly ever replace an organisation which is basically corrupt and dangerous and which has failed its customers (the patients).

The key figures which need to be widely shared are these:

First, the amount of money which taxpayers spend on the NHS was, for 2021-22, £193 billion (this figure does not include benefit payments of various kinds).

Second, the number of people living in the UK is currently 67,886,004.

A moment with a calculator shows that taxpayers in the UK are paying the NHS £2,838 a head for looking after each man, woman and child in the country. That covers the third rate service offered by general practitioners and the second rate service offered by hospitals.

And this is where it becomes interesting because with just under £3,000 a head available to spend on health care, every individual and every family in the country could buy themselves excellent, comprehensive private health cover – cover that would entitle them to the services of a GP, available 24 hours a day and 365 days a year, and to treatment in a private hospital of their choice if needed.

How can this possibly be?


The NHS is the most bureaucratic, over-staffed organisation in the world. Remove the many thousands of unnecessary (and very expensive) administrators and the costs plummet.

Here’s how it would work.

First, the Government would allocate £2,838 in health vouchers (like luncheon vouchers if you will) to every individual in the country. A family of four would receive four times that sum, and so on. The full £2,838 would be available for every man, woman and child – regardless of sex or age.

Those doctors wanting to work as general practitioners (or, as I prefer it, family doctors) would simply set up in their own locality and offer their services to patients. All family doctors in an area would, of course, be in competition with one another to provide the best service. There would be no need for any central administration.

And so, for example, Dr Z might say to his potential patients that he would make himself available for consultations, home visits and telephone calls for 24 hours a day, 365 days a year. He would announce that he was working in partnership with two other local doctors and that if he was not available (because he was having the evening off, or taking a holiday) then one of his partners would be available in his absence. There would always be a doctor available for a consultation or a home visit and the patient would choose whether he or she wanted to be seen at home or in the surgery. (This would save Dr Z a good deal of money because he wouldn’t need a big clinic or a great many members of staff. He could turn a room in his home into a consulting room and hire his wife to answer the phone in his absence – just as used to happen in the early days of the NHS. These days, of course, she could hire her husband to do these things.)

‘How much will this cost me?’ will be the first question a potential patient might ask.

‘I would expect you to pay me by direct debit,’ Dr Z might reply. ‘And I’d like a monthly payment of £20 per person. That’s £240 a year. For that I will provide all the medical services you require from me and you will receive all basic medicines – such as antibiotics and painkillers – at no extra charge. If you need very unusual and expensive medicines that will be covered by a small insurance policy costing just £10 a year. If you need an operation or specialist advice then I will arrange for you to be seen by a consultant specialist at one of the local private hospitals. This will be paid for through your hospital insurance scheme.’

‘So I will have to pay you even when I am well?’ the prospective patient will ask.

‘Yes,’ Dr Z will reply. ‘That is the way that doctors always used to be paid in sophisticated cultures. And it’s the way the NHS used to operate. You paid your taxes whether you were ill or well.’

‘How many patients will you be looking after?’ will be an obvious question from the prospective patient.

‘I will have no more than 500 patients,’ Dr Z will reply. ‘My practice will close when I have 500 patients. That will give me an income of £120,000 a year which will be, after my modest expenses, around the same as I earn at the moment from the NHS. You will benefit because with just 500 patients to look after I will know you and your family and I will have far more time to spend with you. And I will benefit because although I will be available at all times I will have a much smaller list of patients to care for, I will be able to enjoy the work I was trained for and I will have virtually no boring and time consuming paperwork to complete. There will, of course, be no complicated appointments system to manage and I, or one of my two partners, will see every patient either immediately or within hours of their wanting to see me.’

‘But what if I need to go to hospital for an operation or treatment?’ the patient will ask.

‘Your hospital cover will be provided by BUPA or PPP or one of the other big health insurance companies,’ Dr Z will reply. ‘They will all be required by law to offer hospital cover at the same price whatever your personal medical history or age might be. After paying me £250 a year (including the £10 for rare drugs insurance cover) you will have £2,588 a year for hospital cover. You will find that you will be able to buy excellent cover with that amount of money available. A family of four will have £10,352 available. If you like I can arrange the cover for you to make sure that you have the best local hospitals and specialists available. The bill for hospital cover will be much lower than the sum available and so there will be vouchers available for use if you want to access alternative or complementary medical services.’

And it will be as simple as that.

Everyone will benefit. It’s a win-win situation for every patient and every doctor.

The only losers will be the administrators who currently suck up most of the money allocated to the NHS.

They will have to find useful jobs outside the health sector.

Taken from the book NHS: What’s wrong and how to put it right by Vernon Coleman