The biggest problem with the NHS is that it is either a sacred cow or a cash cow, depending which side of the equation you come down on. For that reason, there is no discussion on how the NHS should evolve to face new circumstances.
The NHS was established as a cradle-to-grave, free at the point of use, health service to overcome the horrendous lack of affordable treatment for the majority of the population, the subsequent deaths due to treatable ailments and the obvious injustice of condemning people to a short and brutal life on a class basis. The problems that we now face are all largely due to the success of this model - and partly due to a creeping increase in the services offered. However, the creep in services, the costs of available treatments and the increasingly ageing population can be addressed - IF there is a will.
The other factor, as pointed out, is the appalling state of social care and the "rob Peter to pay Paul" cuts in provision. Social care is a national issue, like health, why it is treated as a local issue is beyond me. Equally, why we are able to build and run hospitals to look after the sick, but must relay on the private sector to build, run or supply social care facilities is beyond me. Putting a price on someone's welfare seems to me to be an invitation to the unscrupulous to provide as little as possible for as high a price as possible. Relying on a private sector based on profit to provide ongoing social care at a reasonable price obviously doesn't work - so we end up with insufficient supply and back-pressure on the hospitals.
Unfortunately, health and welfare have now been caught in a vice between expectation and affordability. The original concept of a health service to treat curable disease and to provide help has become a "right" where people demand access to services, regardless of cost. "Free at the point of use" has become "Free". Help has become dependency. But nobody sees a way to address these issues.
As we say at home "If I was you, I wouldn't start from here" ...... many sensible suggestions have been made about changes to the current service - and there are now many "competitor" services to compare against - but fear of creeping privatization and an inability to battle the entrenched objectors to change means little happens and very slowly - or, worse, things half-happen and we end up with the worst of both worlds..... think PFI, think dental care, think social provision.
As someone who has, luckily, been a nett contributor to the NHS for many years until recently, I do wonder whether some treatments offered actually fall within its original remit. As someone who has had major surgery and treatment by the NHS recently, I also wonder whether there are some aspects where I could have contributed or made decisions based on cost. In both cases I would like to see bills for treatment prepared and sent so that people are aware how much their own usage costs. At the same time, a billing system might actually give some confidence that NHS managers can actually do their jobs. However there are many other things which could be done, payment for GP services (as in most countries), insurance as an addition to NHS funding, not an alternative, etc., etc.. However, in the hands of politicians of all shades only sledgehammers are available - the whole of social care needs to be de-politicised.
Just because I'm paranoid, it doesn't mean they're not out to get me