The Brexit project featured huge adverts on the big red bus that leaving the EU would bring us £350 million per week for the NHS. Nine years later, the NHS is much worse off, any freed up revenues seemingly vanishing into thin air. Nigel Farage’s brain child, Brexit, made medications, and supplies in general, more expensive and harder to source and many talented European NHS staff have left our shores.
Now Nigel Farage has finally opened up about Reform’s plans for our NHS, a system based on the current model in France.
UK residents pay for the NHS mainly through general taxation and National Insurance. Eligibility for NHS care is based on residence, not on payment of contributions. Under IR35 rules, freelancers are taxed as employees, though the hiring organisation is responsible for the employer’s NI.
In France, many healthcare costs are paid by the French social security system, the Assurance Maladie, leaving the rest to be paid by the patients via their own funds or by a patient’s private top-up insurance. Social security payments alone are not enough.
For many people in paid employment, the employer makes the top-up contribution to a collective private health insurance, which may be cheaper than individual private cover. Self-employed people have to choose their own insurance.
Average costs of top-up insurance were €979 in 2024, but this varies greatly depending on age, gender, region and medical needs. Men typically pay less than women for their top-up insurance up to the age of 45, from which age they pay more.
Similarly, under 25s are likely to pay only a third of what over 65s pay. The standard fee for a GP consultation is now €30.
People with modest incomes (for example, around €10,200 a year for a single adult, with higher limits for larger households) may be eligible for the state’s low-cost or free alternative to top-up insurance, the complémentaire santé solidaire (CSS).
Hospital stays
Forfait hospitalier is a daily €20 charge towards accommodation, meals and laundry, which is not reimbursed by the state. Most optional top-up healthcare insurance policies cover it.
The state reimburses 80% of the costs for services of the hospital’s medical staff, medicine and equipment.
Service charges vary depending on the hospital and region. These can come to as much as €3,000 a day in intensive care. (There is a bill of €600 per day for those who don’t have supplementary medical insurance).
Who qualifies for free hospital treatment?
In France, certain groups qualify for free hospital treatment. These include pregnant women during the last four months of pregnancy, at birth and for 12 days afterwards; infants under 30 days old; people on low incomes covered by the complémentaire santé solidaire; and those entitled to the aide médicale d’État (AME). Treatment is also free for people hospitalised after an accident at work or an occupational illness, patients receiving hospital care at home, disabled children under 20 in specialist care, those with military pensions and victims of terrorism.
Experts in healthcare cast doubt on the use of the French model for Britain. It may be very counterproductive. Our system currently underperforms countries in Europe, but not all have an insurance based model. Some use tax based systems like ours.
Changing the funding model of the NHS would be a lot of work in terms of administration and operations. These changes in themselves would be very expensive. So much for the Reform’s aim to emulate the US Department of Government Efficiency (DOGE)!
The overall level of investment in health is more important than the way the system is delivered. The UK has historically spent less per person on health than many high-income European countries across the funding model gamut, including France, Germany, the Netherlands, Belgium, Austria, Denmark, Ireland, Norway, Sweden and Switzerland.
Insurance-based systems still have to deal with problems. Access to care has been a growing problem in France where patients are waiting two months on average to see some specialists in 2023, compared to just over a month in 2019.
Broken contractual agreements
If Reform changes the NHS system, they break a contract with the British people. Their 2024 manifesto promised to keep the NHS free at the point of use. Abolishing this model means they would break not only their own manifesto pledge but disrupt a contract the UK state currently has with us, the people.
Another manifesto point was very telling. Reform called for tax relief of 20% on all private healthcare and insurance, effectively a state handout to those wealthy enough to pay it. Reform also pledged to use more independent (ie private) healthcare capacity, paid for by the NHS. The NHS would therefore be charged more money for a service than if it ran the service itself. Healthcare is thus a source of revenue and corporate profits for private firms.
Donald Trump wanted healthcare to be on the table for the UK-US trade deal. Starmer refused to budge on this. It’s quite feasible Farage would allow a UK-US trade deal in healthcare.
Farage is co-founder of a campaign, Action on World Health, which aims to ‘take back control’ of and water down health policies from the WHO, which are designed to ensure countries can collaborate efficiently in the event of a pandemic or other public health crisis. This group, which claims adult citizens should be allowed to indulge in less harmful uses of vaping, has links to the tobacco industry. Farage initially failed to enter his involvement on the MP register of interests until reminded to do so. Co-founder, David Roach, said Action on World Health did not have a public list of donors to respect confidentiality.
Comment
The deficit in the economy that is Brexit and all the problems it has caused were foisted onto the Labour government. Cuts to services in general are dealt in order to service the national debt. Brexit made these worse. Leaving the Dublin convention removed the UK’s ability to return some asylum seekers to EU countries, which increased the pressure on the UK’s asylum system.
Reform is already on a path to abolish parts of the welfare state and plans to force more disabled people out to work.
Shouting loudly about problems they themselves caused won’t fix these, neither will a pile of policies to gain clickbait. Britain needs a pragmatic solution to fix our revenue problems and a prime minister with his or her priorities in the right place.
Duty to the country and ECHR is required, not deal making with foreign powers like Donald Trump to maximize their influence and profits on our shores. One of the most frequent uses of ECHR regulations are in medical cases. It’s time for the public to wake up and take back control of their opinions, to see through the clickbait headlines and pause for a moment to think about what these new Reform policies would mean.
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