Britain’s National Health Service model — which is funded entirely by taxation and free at point of delivery — is “not sustainable”, former health secretary Sajid Javid has said.
The Tory MP, who is stepping down at the next election, said radical change is required and the UK should look to emulate other European countries, such as Germany and France.
Their health systems are funded by a mix of general taxation and health insurance schemes.
In an interview with Sky News, Mr Javid said many people in Britain feel they have no choice but to pay for private insurance.
“I actually welcome having that kind of discussion, because we need to have this honest debate as a country,” he said.
“I don’t think the NHS will survive many more years in the way it says on paper it’s supposed to deliver, unless we start making fundamental reform.
“It’s not going to be ‘let’s give it an extra £5 billion ($6.08 billion) or £10 billion’. While that might help at the margin without looking at the model of delivery, I’m afraid it’s not going to make enough difference.
“People are queuing for their operations, for their diagnostics, for ambulances, they are queuing for GPs, and I don’t think anyone thinks that’s a sensible way to go forward.”
In Germany, the vast majority of people pay into a statutory health insurance scheme, with a contribution matched by their employer. Anyone who earns more than about £56,000 a year, civil servants, and the self-employed have private insurance.
However, they use the same doctors and hospitals as the rest of the public. The government pays for the care of the poorest.
France operates a statutory health insurance system, which is funded by mandatory employee and employer contributions. Almost everyone tops up their coverage with private insurance. The poorest in society have access to means-tested subsidies.
Nurses strike in the UK — in pictures
Mr Javid’s comments come as health leaders say the situation in the NHS will become “increasingly difficult” next week, when nurses walk out again before ambulance staff strike.
The nurse who cared for Boris Johnson when he became seriously ill with Covid-19 has said that nurses have "had enough".
Jenny McGee resigned in 2021, citing the government's pay offer and its "lack of respect" for the profession.
In a new interview she said nurses feel under "so much pressure ... every single shift".
Ms McGee, who cared for Mr Johnson in intensive care at St Thomas' Hospital in central London in 2020, said nurses "can't give the care that we so desperately want to give".
And she said nurses "just want to be paid a fair wage".
Some senior Conservatives have urged Rishi Sunak to get nurses a better pay deal, either by directly proposing one or by getting the NHS pay review body to recommend a new offer.
Those urging the government to open talks include the former health minister and current health and social care committee chairman Steve Brine, former cabinet minister Jake Berry and doctor and former health minister Dan Poulter.
“This year we have had an unprecedented set of circumstances that we have been presented with, that has resulted from runaway inflation from the war in Ukraine,” Dr Poulter told the BBC Newsnight programme on Thursday.
“The Scottish government recognised that, they have come forward with an improved offer. Whilst I don’t think the nursing unions are taking [the offer] — wanting close to 20 per cent is reasonable, it would be very easy and in the best interests of patients and the NHS to move forward.”
The leader of the Royal College of Nursing nurses' union, Pat Cullen, warned that action would escalate unless UK ministers back down on their refusal to negotiate on pay.
“As time moves on — unfortunately, if this government doesn't speak to us and doesn't get into a room — I'm afraid that this will escalate,” she told BBC's Question Time.
Saffron Cordery, the interim chief executive of NHS Providers, which represents trusts in England, said the nurses' strike on Thursday had an effect on patients.
She told BBC Radio 4's Today programme that about 40 per cent to 60 per cent of routine operations were “cancelled in places where the strikes were held”.
“So, it's fair to say that there's been a relatively significant impact and I think it was a very demanding day overall, on the front line in the NHS,” she said.
“It's going to get increasingly difficult for trust leaders to manage this process because we know that the winter is always a very tricky time in the NHS and we know it's a particularly demanding time.
“Coming alongside an ambulance strike on the following day, I think it's going to be a very challenging time next week.”
Nurses are due to strike next Tuesday.