To think a privatised health service would be an improvement?

[WhiteStars]

At the moment we all have to be grateful for the overstretched and often inefficient service we receive. I had a 9am appointment today with a nurse practitioner. At that time in the morning she was already running 25 mins late on her appointments- how?!

She also couldn't use her computer system so I had to then wait for a doctor to come and issue the standard repeat prescription (I couldn't get this over the phone as needed a blood pressure check). The doctor then issued the wrong medication and only corrected it when I noticed she had done the wrong thing on the screen.

All very minor but not a great service at all really. We all know how over stretched the service is and everyone says it's at breaking point. Why is everyone so against paying for health insurance and getting a better service or going private?

It's not uncommon to hear of people waiting weeks to get an appointment and not being able to book in advance. The government would save an inordinate amount of money that could be ploughed into schools whilst subsidising some health services but with people paying an annual health insurance fee. We already pay for prescriptions in England. I would rather have a better private service than the NHS as it is now- on it's last legs and not really fit for purpose any more. AIBU?

I work in private healthcare and we have similar issues with appointments being late and computer issues

Although it generally is quicker to get an appointment or referral appointment, this is mainly because there is less people using the system as it is not affordable for most.

Also insurers are a nightmare and a lot don't pay up for what they've promised, especially in cases of long term illness

Perhaps the reason the us system is mentioned so much is because if we were to go private then the powers that be would push for that system over the European systems which correct me if I'm wrong are funded through high taxationplus private health insurance.

I guess it's also used in threads like this because it's the other extreme and people like discussing extreme worse case scenario type things.

Mm, well I was just writing a post pointing out that this shedding of risk happens across all areas of outsourcing, not just healthcare - and in industries where there are substantial, long-standing private providers and a large private sector market (eg construction, IT).

I have friends who bid for govt (and private) contracts. They deal with a lot of people who think that privatisation is a magic bullet and simply don't seem to understand that items like "how many staff will we need to fulfil this service" don't simply disappear from the accounting sheet because they've crossed the public/private border. 'Cos guess what - the private company ALSO needs to know how many staff to take on to fulfil the service. It's not magic.

And since the private company has no intention of making a loss on the contract, it very typically asks for fixed amounts of business, or charges much higher to cover the contingency of having people sitting around.

When companies don't follow either of the above two routes, they generally find themselves:
a) making a loss and dropping out
b) failing to adequately provide the service and screwing the users/customers
c) failing to adequately provide the service and being chucked out halfway through the contract with much expensive lawyering. As well as screwing the users.

The number of times a friend's company has lost work to a competitor who has underbid to win the contract, and then fails to fulfil. Even more fun, friend's company is sometimes then offered the contract - for less money, because incompetent co has had the lion's share of the budget...

There's a lot of headdesking...

Sorry, that was to Otherpeoplesteens - re-wrote my intended post to include a response to your specific comment.

My family has had truly atrocious treatment from the NHS. However if I lived in most countries with private care my children would either be dead or unable to be a functional citizen. We'd also be bankrupt. Hey ho.

Yabvvvvu
For all the reasons others have mentioned.

The number of times a friend's company has lost work to a competitor who has underbid to win the contract, and then fails to fulfil. Even more fun, friend's company is sometimes then offered the contract - for less money, because incompetent co has had the lion's share of the budget...

This in spades. The service I work for within the NHS is going out to tender next year. It's highly likely a private company will win the bid as has happened when similar services in different areas have gone. Problem is these services are now largely failing with dropping cqc standards and regularly come in over budget. The people working on our bid will attempt to over emphasise all this so that the contract remains within the NHS, however it Ultimately boils down to.money and if private companies claim they can do it cheaper then they will probably win the bid.

PausingFlatly - all very valid points. I am more than familiar with these issues!

However, what you're describing is competition for the market. Imagine that every four years Tesco, Asda, Morrisons and so on had to bid for the one contract to supply supermarket services to Britain (or a region or whatever.) That's the behaviour you'd naturally expect.

Where there is effective competition in the market, with providers competing day in, day out for customers to bring their money to them, the silver bullet generally works.

OK imagine this OP.

you go to bed one night feeling perfectly healthy. at 1am you have a seizure. by 8am you have a huge non fading rash, vomiting photophobia and a blinding headache and feel utterly exhausted . by 9.30am you are in a hospital bed on an anti biotics drip and there you stay for a week undergoing varuous painful tests before being diagnosed with a long term conditon which will need ongoing medication and a minimum of 4 hospital check ups and year.....

now imagine that on top of all that you are worrying about what's going to happen to your insurance premiums and what will happen when the insurers stop paying

and don't say never because my first paragraph describes exactly what happened to.me in June ... still want a privatised NHS?

We're in the US. John Oliver did a good show on it. One of his points is that there is no large buying group for supplies so the hospitals etc pay through the nose for meds and supplies, something you would bunk they could work out at least at state level. So you get ridiculous situations where for a med I need for a few months cost 6k a month with a 10% copay at 600 a month. Except I got dicked around by my insurance so my dr put the script in at a compounding pharmacy, total cost 105/mth. For the same meds.

We pay 500/mth for our family, thec company pays the other 20k a year insurance and we still have 5k copays per year, 100 per dr visit for the DC if it isn't the yearly checkup. Thankful we have prescription insurance as well which reduced one I had to get from 90 to 10. Then imagine you are told you are covered for something and a year after the death of a baby, as you are facing the first anniversary, you get a bill for 3.5k and there is not a damn thing you can do about it.

FormerlyFrikadela - what you've described is the stupidity of NHS commissioners who think they're doing the right thing by awarding a contract to anyone (NHS or independent sector) who says that they can do it for less than the cost of delivering what they've specified.

Can you tell I used to be an NHS competition economist and market-maker, who now holds complete and utter contempt for commissioners with an overinflated sense of their own ability?

Some years ago my sister in the US was paying about $800 a month for herself and school age daughter.
Just before we went for a visit she cut a finger very badly and needed A&E and specialist stitching.

I said, 'Well, at least your insurance covered it.'

She said, 'You're joking - I had to pay a $2000 excess!'

Despite its faults, I think we're lucky to have the NHS. I just wish people wouldn't abuse it - going to the GP for every minute thing, stockpiling free or highly subsidised meds they don't need - a friend of ours was seriously guilty of this and I bet he was far from the only one.

Not to mention abusive drunks causing trouble in A&E, or people needing A&E merely because they're so drunk. IMO there should be hefty fines for this. We are far too soft IMO.

I can understand why the OP feels as she does, even though her complaints are relatively minor.

The NHS can only offer standard services and admittedly now, many areas cannot offer comprehensive care for patients.

I feel shamed when I hear stories like - instead of spending money treating people, we are paying millions of pounds to private firms to BLOCK GP REFERRALS www.theguardian.com/society/2017/jan/04/nhs-paying-millions-private-firms-block-gp-referrals-hospital

I am not certain that private healthcare as the only option, is the way forwards, however the NHS really needs to get its house in order and prioritise patient care, over statistics and arse covering exercises.

It's infuriating in the extreme. I won't being to pretend I understand the business aspect behind NHS services but one thing I do know is that one of the first things that have happened in services like ours that went to private companies is a mass exodus of the staff once it becomes clear that the company that's taken over will only maintain the NHS terms and conditions for a short time. Doesn't seem such a good deal when they end up running on agency staff does it?

I always go private. £40 for an appointment and I get noone else in the waiting room, a bored GP who is delighted to see me and spends ages and gives me lots of empathy which seems to be included in the price. Its bliss.
It's a choice a lot of people don't have.

There are a lot of problems with the NHS. Their entire IT is astonishingly outdated - I was at a healthtech conference a while back where a doctor said he has used computers in hospitals here that predate mice, and said that the time spend wasted on inadequate IT admin work is the equivalent of up to 60,000 doctors a year - hours wasted on every shift wrestling with computer systems that most of us didn't even know still existed.

The other big area of wastage is contractors. Everybody should be directly employed and there should be no agencies creaming off profits in between healthcare workers and patients.

GP surgeries all over the country are CLOSING because we can't get enough GP's - a friend is a partner in a surgery in the SE and they advertised for a new GP recently and they had ONE APPLICANT. Obviously they would still have hired her if she'd had three heads and didn't speak a word of English. Recruitment is a huge problem area, but also the amount of wastage on admin in my friend's (big) surgery is astonishing and very frustrating for the doctors, and a poor use of their salaries.

I do think there is room for more private option treatment here though. In my city, there is only one private GP, and she's amazing, but also £££. I would like a system where I could see a private GP for about £50 if I wanted to "fast track" basic care like that. I'd be freeing up a space for someone who needed care but couldn't afford to go elsewhere.

I'm sick with flu at the moment, so just have to wait it out, but next time I need GP care, I'm going to give Push Doctor a whirl and see how they do.

I work in mental health in the UK, not perfect under the NHS I grant you. Not many patients I come across would be in a position to pay anything. What's private healthcare's solution for those with long term mental health conditions?

I always go private. £40 for an appointment and I get noone else in the waiting room, a bored GP who is delighted to see me and spends ages and gives me lots of empathy which seems to be included in the price. Its bliss.

It's a choice a lot of people don't have.

No, but many of us do have that choice. However, it's quite a difficult choice to actualise - there simply aren't enough GP's of either description, state or private.

I don't think it's wrong to spend money to skip the queue. If I go into Primark to buy a cheap top on a Saturday afternoon, there will be 30 people in the queue ahead of me. If I go into Whistles I am served straight away.

I think we should have more choices at the first line of defence (GP's, nurse practitioners etc), but we need MORE GP's, whichever way you look at it. Importing them is a pain, because their qualifications don't always align with our requirements, so we need to train more of them and make staying more appealing - they're qualifying here and bloody LEAVING (and who can blame them?)

www.theguardian.com/society/2015/aug/23/new-doctors-leave-nhs-for-better-life-abroad

with providers competing day in, day out for customers to bring their money to them, the silver bullet generally works.

But that doesn't happen in a market for healthcare.

For quite a list of reasons. In no particular order:

• You pointed out yourself that costs to enter the healthcare market are large - not like shoe shops which have comparatively low set-up costs for skills, widely-available premises, products.

• People simply can't shop for most healthcare the way the do for washing powder. I buy washing powder frequently; I develop an opinion of how well one works for me; if I choose to try out a different one next month, the risks to me if it doesn't work out are low; the product is consistent and predictable, and doesn't depend on variables like whether it's winter or I had a chest infection that day; I can tell immediately whether or not the powder has done a good job.

Even for simple, self-contained stuff (hernias, hip replacements), there are no such accessible criteria for me to make my so-called "choice". And some previous numpty writing a nice review because a pretty nurse smiled at them really doesn't fill those information deficiencies.

• High street competition is the definition of inefficiency. Shops duplicate services until one goes out of business.

• Healthcare is not optional. A gap in provision of shoe shops in Smallville till the market decides to provide, is no big deal. A gap in provision of healthcare in Smallville...

• Staff development, economies of scale... I could go on.

The company I used to work for are now in the UK helping the MoD streamline their processes for purchasing and contracts. There is no reason a similar company couldn't come in and take over his role in the NHS. Overhauling budget, getting rid of managament layers, ensuring front line staff are adequate and equipment is sufficient and training NhS managers remaining in how to run a streamlined, cost effective system that actually delivers healthcare. Performance of management company can be linked to KPIs to ensure they don't take the piss either.

Youokhun I imagine they'd be the ones where the state picks up the bill. However whereas now a lot of my patients are on medication that costs hundreds of pounds a month the but have relatively few side effects (think the newer antipsychotics, especially in depot form) they'd be forced onto the cheap older medication that many people suffer life changing side effects from.

state money follows choosy, discerning patients

Try being choosy and discerning when you're suicidally depressed and just been sectioned.

£40 for an appointment and I get noone else in the waiting room, a bored GP who is delighted to see me and spends ages and gives me lots of empathy which seems to be included in the price.

I've had empathy in buckets from my GPs. Once had two GPs and a nurse sit with me for an hour while I cried about my new diagnosis.

"Freeing up space" - yes, your private consultation fee magically creates new doctors from thin air.

whereas now a lot of my patients are on medication that costs hundreds of pounds a month the but have relatively few side effects (think the newer antipsychotics, especially in depot form) they'd be forced onto the cheap older medication that many people suffer life changing side effects from.

A digression, but "relatively few side effects"? You're kidding, right?

There are many other models besides the NHS and the US system.

Most european countries have private health insurance but it is much more controlled than the US system - it's compulsory, your employer contributes, the amount you pay depends on what you earn.

Then when you get treatment you have to pay and claim it back - or a proportion of it anyway. This means everyone has access, but overuse is discouraged.

The NHS is not fit for purpose in my view. Yes we have excellent surgeons and have some world class services but where it falls down is the co-ordination between services and the supportive care. You may have a really good surgical outcome but as the after care is so poor in many cases (lack of physio, filthy wards, over worked nurses leading to sub optimal care), the results are not good. UK has worse cancer survival than most of the rest of Europe - this is due to waiting times mainly.

Fair enough Theother. Although incidence of extra pyramidal side effects is higher in older antipsychotics.

I think my point was that in a private system I imagine less attention would be paid to finding the right meds with the most tolerable side effects in spite of cost.