A New NHS for a New Age | Let’s go Dutch

A New NHS for a New Age | Let’s go Dutch

The UK healthcare debate has reached a stalemate. While both major political parties promise minor reforms and record funding, the reality on the ground tells a different story. #

As of early 2026, the NHS waiting list in England stands at 7.25 million cases, with nearly 6.13 million unique patients waiting for elective care.

Despite record levels of investment, the NHS continues to struggle with productivity. Cancer performance remains a critical concern: the 62-day urgent referral-to-treatment target—set at 85%—has not been met in over a decade, currently hovering around 68-70%.

To save the principle of universal healthcare, we must look at a model that works: The Netherlands.

The Dutch Model: High Quality, Low Politics

The Netherlands consistently ranks as one of the best healthcare systems globally, currently holding the 4th spot worldwide for healthcare quality (2025/26). While it costs roughly the same as the NHS—around 10-11% of GDP—its outcomes and accessibility are significantly higher.

The primary difference? Separation of powers. In the Netherlands, the government sets the rules, quality standards, and priorities, but it does not manage the hospitals or the insurance companies. This makes healthcare nearly apolitical, preventing it from being used as a “political football” every election cycle.

How the Dutch System Works (2026 Update)

Since the 2006 Health Insurance Act, the Netherlands has operated a Universal Social Health Insurance system. It is mandatory, regulated, and managed by private, mostly not-for-profit insurers.

1. Mandatory Basic Insurance (ZVW)

Every resident over 18 must purchase a basic insurance package.

• The Cost: In 2026, the average basic premium is €159 per month.

• No Discrimination: Insurers cannot refuse anyone based on age, pre-existing conditions, or health status.

• Subsidies: The government provides a “healthcare allowance” for low-income individuals to ensure affordability.

• The Deductible (Eigen Risico): A standard excess of €385 per year applies to most hospital care (GPs and maternity care are exempt).

2. Long-Term Care (WLZ)

Long-term nursing and disability care are funded through a separate, mandatory contribution from taxable income (approximately 9% of salary, capped at a maximum threshold). This ensures that social care is fully integrated and funded alongside medical care—solving the “bed-blocking” crisis that plagues the UK.

3. Primary Care and GP Access

The Dutch huisarts (GP) is the gatekeeper, much like in the UK. However, the system is backed by 160 primary care walk-in centers open 24/7. GPs are required to provide at least 50 hours of out-of-hours care annually, ensuring that urgent needs are met without flooding A&E departments.

Key Performance Indicators: UK vs. Netherlands (2026)

Applying the “Dutch Blueprint” to the NHS

Converting the NHS into a Dutch-style system would be the most significant reform since 1948. It would require at least three Acts of Parliament and a 2-3 year transition period.

• Disbanding the Bureaucracy: Central bodies like NHS England and the 42 Integrated Care Boards (ICBs) would be replaced by competitive, regulated Social Insurance Organizations (SIOs).

• Ending the GP “Small Business” Model: All GPs could become salaried under the NHSS, with increased incentives for preventative medicine and weekend coverage.

• Integrating Social Care: By adopting a “Social Tax” (like the Dutch WLZ), social care would be funded nationally, ending the postcode lottery and the need for families to sell homes to pay for care.

• Productivity Incentives: A “per-case” payment system for hospitals would replace block contracts, encouraging surgical teams to reduce waiting lists faster.

The Final Verdict

If we do nothing, the UK is heading toward a two-tier, USA-style system. As NHS wait times remain high, the growth of private hospitals (like the Cleveland Clinic and HCA) is accelerating. Without radical change, high-quality care will soon be reserved only for those who can afford private insurance.

By “Going Dutch,” we can preserve the spirit of Bevan’s “cradle to grave” care while modernizing the delivery for the 21st century.

Summary

We have explored how a Dutch-style Social Insurance system could solve the NHS productivity and waiting list crises. It is time for a bold, apolitical path forward.

Do you think a mandatory insurance premium of £130-£150 a month (with government subsidies) would be acceptable to the British public if it guaranteed surgery within six weeks?