Inevitable slide away from NHS?

[Ataraxy]

It seems to me that NHS/healthcare starter posts these days are inciting debate towards the USA healthcare system? Eg

1. We should charge certain groups of people for their healthcare.
2. We should have insurance to pay for our healthcare.
3. We take our children to the doctors too often and should use over-the-counter instead.
4. IVF shouldn't be available on NHS.

Added to the recent programmes on paying for the NHS, the 'secret' TTIP agreement between the EU and USA which will allow USA organizations to take over NHS services, and Manchester having its own NHS budget. AIBU to think we being prepared for the inevitable collapse of the NHS in favour of private healthcare?

I'm not accusing OPs of being of the four footed variety. It's just that I'm picking up a worrying trend.

BTW my new name isn't connected with this post, it's coincidental. I've been on MN a lot of years, but I was just outed by a friend of mine.

People pick up on news stories about the NHS and conclude it is not working.

It is being deliberately run down by the government so that people will support privatisation.

We already fund the NHS through insurance - National Insurance- which endures everyone has access to the same healthcare.

Friends in the US who are pretty wealthy and have good insurance tell me it still costs them £60 for a simple tube of cream. It is an unfair and inefficient system but obviously a lot of companies make a lot of money out of it.

I can't see how a private nhs would be sustainable to be honest. I don't see how it would change anything either really. I can only see it getting worse if it was to be privatised, just my two pence though as an nhs worker

I don't agree that posters are inciting debate towards a US based system at all. When other systems are discussed, European systems are frequently mentioned.

As for our healthcare system, there is a very valid place for private healthcare and insurance alongside the NHS, and I can't see what's worrying about discussing more than one single way of delivering healthcare.

I agree with you that it seems like a softening up campaign - a couple of interesting links:

nhap.org/whats-wrong-privatising-nhs/

nhap.org/nha-party-vindicated-nhs-warnings

From what I've read from European posters on these threads though their insurance doesn't cover everything either and are still having other costs.

The nhs definately needs a shake up no denying that but I think it's the management levels that need to be looked at. While at work the other day an ambulance arrived to take two patients to an outpatient appointment at the infirmary, another patient also had an appointment there and the ambulance crew agreed to take him also seeing as they were all going to same place, then just as that was sorted another ambulance pulled up to take the other patient! What an absolute waste of resources and an example of very poor management.

I just don't think that privatising it is the answer

It's an interesting one. I've lived in the US and experienced the healthcare system there, which I think is seriously lacking, no matter how much you pay. I also think the healthcare system there is creating a subconsciously neurotic, workaholic nation who are petrified of not having insurance and if they do find themselves without, wait until they are simply falling apart to seek health. (A friend of mine was an ER specialist in a county hospital and said nearly all of the non-accident cases he saw were people who couldn't afford insurance coming in with diseases in very advanced stages because they hadn't had the money to seek help earlier.)

For many years, my family and I have had full level private health insurance in the UK. In the last two years we have had to (unfortunately) use it a fair bit. And it has made me the biggest ever fan of the NHS. We actually eschewed certain treatments in the private sector and went with the NHS because it's better and the aftercare is exemplary.

All you get with private health insurance is no waiting list and a room. That's it. Private hospitals are (at least in London) largely staffed by agency nurses who more often than not come and go without any consistency. I'm of the minds these days that it's a big bloody scam. The doctors are the same as the NHS - in fact, I would go so far as to say that the best consultants have a heavy NHS workload. For so many reasons I don't have the time to go into (and it would bore you) it would be a tragedy of the highest order if the NHS slides into privatisation. Because it is state regulated, because the safeguarding (Mid Staffs notwithstanding ) is of a high standard, we have an incredible system that is and should be the envy of the world. Yes there are management issues, yes our finest brains are thinking twice before becoming doctors, but it is run much better than the private sector IMHO.

I will say that I was in A&E recently and of all the people who came in, I reckon about 50% were using it as a drop-in centre. I can see the logic in getting people to pay a nominal fee to use it if only as a deterrent but I'm not sure it would raise all that much money.

It's simple really. And it will take more than the laughable 2 billion 'extra' than is being promised by political parties. We need to flood it with money, we need to pay consultants and experts more money so that they don't feel the need to top up with private fees and we need to waive tuition fees for medical and nursing degrees.

Honestly, the last few years has been an epiphany for me. Having seen it from both sides of the fence, nothing holds a candle to the NHS. I would be happy to pay extra - ie. what I spend on private healthcare - to safeguard it for generations to come.

Blimey. Didn't mean to go off on one, but I have. Sorry, OP. YANBU

Bertie - I couldn't have put that better myself, I'd be happy to pay more NI to help the nhs into the future.

It's a shame alot of minor injury units etc were closed, they really were just asking for trouble, the community cottage hospital I work in used to have one but not anymore. 12 hour shifts were another huge mistake imo, patient care is really affected and staff morale is low. I also feel it should be easier to become a nurse the degree course is so hard and I know very few people manage to pass, the majority of it is legal stuff hardly any patient care so we have nurses basically being trained to fill in paperwork and sit on computers, in fact we had a student not long ago that when asked to help a patient with personal hygiene turned around said 'I'm not here to do that, I'm here to sit on the computer'! Also the degree course doesn't cover venepuncture (separate e-learning) or setting up IV, theory covered but not allowed to practice until qualified so really what is the point if not equipped with some of the basics?

I was watching a program about Sandy hook (tragic shooting of small children in primary school in the USA), one of the interviewees who works in social services was saying how appalling the support is for people with mental health issues. If your insurance runs out, you are miraculously better immediately and are sent home.
It is a terrible system lets hope and pray we don't go the same way.

I can't afford to go private, what if they made us pay for contraceptives too? I just had my implant replaced, I wonder how much that actually costs? And DS1 has cystic fibrosis and type 1 diabetes, he already has to pay for all his CF medication, how much would it cost if he had to pay for his insulin and hospital stays too? Poor people need a free NHS.

We need to flood it with money, we need to pay consultants and experts more money so that they don't feel the need to top up with private fees and we need to waive tuition fees for medical and nursing degrees.

I am with you on the last point BUT the NHS was flooded with money during the last Labour government with no discernible impact on productivity, but a significant increase in staff pay. My DH is a NHS consultant and he is a brilliant doctor. However, he is also home by 6pm every evening (leaving plenty of time for PP) despite seeing more than twice the "recommended" number of patients for his specialism. His salary is well into six figures and he expects to retire on at least GBP 60k a year. He also has a large private practice which he uses as a "holiday fund"....

It's great (for us), but sustaniable in the long term for a publically funded system? I seriously doubt it.

I think the OP IBU. I am in favour of privatisation along the lines of a European model, NOT the US model. The simple reason is that I believe proper competition between private companies will increase standards and that patients should have a choice of doctors and hospitals. I have been horribly treated in NHS hospitals - our local one smells like a sewer - and I would like to be able to vote with my feel and go somewhere else.

Oldfarticus. I think you need to remember that you are basing your opinion on a Consultanf, theajoriyy of NHS workers and are not as financially rewarded!!

Sorry
The majority

Agreed waiting, but how many consultants and other staff are there - something like 10% of the population? -all paid from public funds? There is also the cost of the pension scheme to consider - which has been reformed, but is still astonishingly generous, as are the other benefits (maternitiy/paternity leave, annual leave, sick pay, etc). It's wrong to look at pay alone without considering the cost of all the other benefits.

Don't get me wrong, I think doctors should be paid extremely well (and not just for selfish reasons!) However, I doubt that simply "flooding the NHS with cash" will magically improve things. The management will still be terrible and there will still be eye-watering waste.

My local sewer-hospital, for example...hosed with cash by Brown during his term as PM. In 2006, it used a million quid to build a swanky entrance to the "Trust Headquarters" next to the main hospital building. Despite the fact that it still had mixed wards where 12 beds shared one stinking shower. And just to make sure it pissed everyone off equally, it built the swanky entrance over the staff car park.

Even under one of the European models the tax money paid into health needs to be significantly more than is given to the NHS then the insurance costs are on top of that. If you look at the WHO figures it is clear to see that the NHS is underfunded rather than not fit for purpose.

Maybe senior consultants are paid too much, I wouldn't know but nurses and HCAs certainly aren't.

Labour didn't flood the NHS with money, they gave it the right amount, it is possible it didn't get directed the right way all the time but it was much better than it is now and public satisfaction was at a record high just before the last general election.

Oldfarticus, my DH is a consultant too. He has been at it for nearly a decade. His working hours and pay (well paid but only 5 figures) are very different to your husbands. Firstly his rota is a strange pattern making private practise very tricky. He typically has lists that start at 8 am so he needs to be at work for 7.30 to ensure he sees his patients first. His afternoon lists/clinics end at 5.30 so by the time they have overrun he usually finishes at 6-6.30. Sometimes earlier when patients don't turn up, maybe later. He comes home and spends at least an hour an evening on emails. Oh, he also doesn't have a lunch break timetabled it to his rota - the manager decided they were cutting corner with their sessions so the morning session ends at 1, the afternoon session starts at 1.
I do agree that we need changes in the NHS. However I'm not sure what the answer is. I've experienced the Australian system with free emergency treatment. Having to pay for stuff does affect your decisions. I remember going to the GP within the first few weeks and having to pay to see the GP then paying for contraception. Dd fell and bumped her head. In the uk, I would have asked the GP to check her out but In Oz, I just kept an eye on her myself. There was a moment where I thought about calling an ambulance but you have to pay for ambulance call outs and we were warned to make sure the ambulance doesn't take you to a private hospital. However, should we be paying for non-essential treatments such as IVF, cosmetic treatments etc... I don't know. Ideally the NHS would have enough money to pay for everything but it doesn't.

This link
shows how the UK ranks among other western countries in terms of quality and patient outcomes per capita spend. It comes out first on almost every measure! This is not the story we are being told by the government and in much of the media. Why is that?

Maybe because the reality of people's experiences doesn't back up that link? In so many cases, it just doesn't, and when it's you or your loved one that is being failed, it doesn't matter that the care might be good on the other side of the hospital.

Until we have a system that gives every single person that needs it good quality care within a reasonable timeframe, there will always be a reason to look for ways of improving the NHS.

Absolutely it needs improving and will continue to, every single health system in the world lets people down but the chronically underfunded NHS does so more than some others. What it doesn't need though is making worse then letting the profiteers in to grab a bit to privatise and line their own pockets with tax/NI money without patients actually getting any better care.

If we funded the NHS properly we wouldn't be having this conversation. We need an 8% increase in budget per year just to maintain the current service. What we're getting is cuts year on year to health budgets and social care and welfare and unsurprisingly we're finding that we can't cope.

Why wouldn't it be a change towards French or Italian or German model of care?

Can we actually afford to have a high quality NHS? I'm not sure we can.

Staff need to be paid more than they currently are, and there needs to be more of them. That's a huge expense before we even start on improving patient care. Then if we're going to provide appointments and treatment within reasonable waiting times, which I don't believe we are anywhere even close to at the moment, we need to build more hospitals an surgeries to enable people to be seen. There are new medications and treatments being made available all the time, and that's going to need to be paid for if patients are going to benefit. Social care is a fundamental part of a health service and that is woefully underfunded at the moment and to get that up to a decent standard for everyone is going to cost a huge amount.

I just can't see how the NHS is ever going to improve if we need to put in 8% more money every year just to maintain the (often dire) service we have at the moment. Where's the money going to come from?

I agree that nurses and HCAs are actually underpaid in this day and age I certainly don't feel I get paid enough for the work/hours I do (even though I do it mainly because I love the job, I still have a family to feed). I live in Scotland(work for English nhs) my local infirmary never seems to have half the problems I hear about with the English nhs, longest I waited in a&e recently (DD had an awful chest infection and doctors was closed and her nose kept bleeding loads and wouldn't stop) was an hour and that was a Saturday night over Christmas. My doctors surgery offers walk in clinics in the morning and evening so no appointments needed (although not all are like that round here some you get given an appointment for 3 days time!) I don't know if it is because the scottish government are spending the money in the right places or better management structure but it seems to be working.

Ptolemy's needle - I agree. We are all going to have to pay lots more for healthcare in future, one way or another. By some measures, we are the second most indebted country in the world. It's all very well saying that the NHS needs more money, but there is no magic money tree, and that money will need to be borrowed and repaid by the next generation.

I think that one of the problems at the moment is that there is no clarity over what the NHS can and will provide. For example, cateract operations may be restricted to one eye, IVF may be notionally "available" but with qualifications so strict that few comply. In my case, a procedure was available, but if I wanted anaesthesia, I had to go private (at a cost of GBP 3K). I would prefer a clear contract with competition between providers, with emergency care paid for from taxation along with the insurance premia of those who cannot afford to pay.

I understand what some posters are saying about wanting choice, and certain sectors - communications for example - really benefited from de-regulation and market competition. (Remember how back in the day everybody had the same BT phone which took forever to be connected?!)

However, healthcare is an area that is too precious and too important to be trusted to the hands of people who want to run it like a business. I appreciate it is a bureaucratic behemoth, but when something is run for profit the agenda changes entirely and it puts people's lives in danger.

Really in the UK the private system is all smoke and mirrors. You are paying for the following: nice room, excellent food and the 'appearance' of smaller nurse-patient ratios. The truth is that a night on a private ward can be very very hairy with a skeleton agency staff and sometimes NO doctor anywhere near the ward.

Also, if you have something really very serious, you want to be in a big specialist NHS teaching hospital.

Going the whole privatisation hog a la the US will only further entrench the stark divide between rich and poor that is already opening up in the UK.

It doesn't mean we shouldn't be making every effort to improve he NHS but privatisation is not the answer IMO.

I don't think we can generalise about either private or NHS care, but when my family chose to use private care over the NHS because the NHS service was so bad, we certainly weren't paying just for a nice room and better food.

We saw exactly the same consultant that we'd seen on the NHS, the difference was that when we saw him privately he had the time to discuss options with us and answer questions rather than just telling us what would be happening in a few months time, and it made all the difference to the feeling of control we had over the situation. We were given options that weren't available on the NHS. We saw the same person every time so had continuity of care and a doctor that knew us personally, rather than seeing a different doctor each time after waiting 3 hours plus in a clinic getting more and more anxious.

In short, the private experience was far superior to the NHS one, and it was worth every penny.