NHS and private health care

[Stumpted88]

I am fortunate enough to have private health care at work, just signed up, it includes;

A phone line to speak to a gp 24 hours a day
A mental health crisis team
Self referral, post a phone call to the insurance agency, for physio, chiropractors, osteopaths (both unavailable on the nhs currently), feet doctors (I forget their actual names) and a bunch of minor ailment treatments that you would wait an age on the nhs

It costs my large company around £27 a month to insure me. I also am a higher rate tax payer, and pay around £500-600 a month in NI.

It occurred to me today that if employers of a certain size have an opt in to enrol all staff on private health care, akin to the pension scheme, (I also pay tax on the £27) this would alleviate a massive burden on the NHS?

Not sure if the private sector could cope logistically, but in an ideal world and they could, would a hybrid of socially funded and privately funded healthcare work?

Personally I think it would work positively in the short term, as waiting lists would be reduced dramatically over night, long term, I am not so sure?

It won’t work because the UK doesn’t have a fit for purpose private healthcare system. The same doctors do both and there aren’t enough of them to go round. Having private healthcare really makes little difference to most people in terms of what treatment is actually available. I speak from bitter experience.

No the private sector couldn't cope, logistically.
I'm assuming you're fit and healthy, therefore cheap to insure as low risk.
There's a good reason chiropractors and osteopathy aren't available on the NHS - there is no evidence that they are effective.

The way things work in private healthcare are that if you're a difficult patient, they either price you out so you go to the NHS or they say they don't have the resources.

The waiting lists aren't really caused by young, fit patients who can have their op and be home the same or next day. It's elderly or already unwell patients who need an ITU bed, or a 5-6 day hospital stay, or who come in for an op and then need a social care package for discharge. The conveyer belt stops moving when these people are on the list, through no fault of their own.

These are the same people who won't be looked after by the private sector, because they're not profitable.

I actually have a neck injury, progressive not an accident etc. I am in a lot of pain daily, so chiropractic relief and physio is extremely important to me to manage the pain without drugs (previously prescribed muscle relaxants/sleeping pills). I missed 4 days off work and have been late/non productive lots due to the pain.

I did put in my op, if it was logistically possible, appreciate it isn’t right now.

I wouldn’t begrudge paying the same NI, plus tax on private medical insurance to free up spaces for those in need. If employers where legally made to pay private medical

And supposing the private health care systems could cope. Then what's? two tier system, one for those with jobs that come with nice benefits packages and another for those that don't? And what would happen to those considered too big an insurance liability?

There are combined models that work but I can't see that happening here.

The 'burden' on the NHS isn't so much the patients as the way it's run.

The real issue in the NHS is a shortage of staff. Where would you get the staff if you expanded the private healthcare sector? Ah yes, from the NHS.

I do believe there should be tax incentives for companies and individuals to take private health insurance. Of course it's true the private hospitals cherry pick well patients for straightforward operations and it doesn't help the issues Whywhywhy mentions, but it would still help a bit. Also, if you look at the list of 17 operations that the NHS is cutting back on, and check out private costs, well it's worth saving a few £000 if you can to cover costs should you need one of those even if you don't take out insurance.

By the way that GP phone line was brill when we used it. (😭😭😭 DH changed jobs and we lost the insurance benefit).

When DD2 was about two we drove up to Scotland to the Pils. We would have the DC in pyjamas, 7 hour drive, arrive late, straight to bed. It wasn't until next night I had her in the bath and noticed a nasty sore on her buttock. I actually wondered if it was a pressure sore from being strapped in a car seat for so long. Anyway, phoned the GP line, he instantly diagnosed (as far as he could be sure without seeing it) Impetigo, told me to go to GP next day, expect certain antibiotics. Went to Pil's GP next morning, it was as he said, treatment he had recommended and it soon cleared up.

We used it a few other times too, much better than 111 because you speak to an actual GP straight away.

I a. True private health system your known issue with your shoulders would not be covered by your insurance.
My husbands will cover some things if you are symptom free for a year once you start.
The reason private health is so cheap in the UK is that the NHS props it up they don't have to provide any emergency treatment so they don't have to buy expensive equipment a lot of highly specialised surgery is done in NHS hospitals using NHS equipment which isn't cross charged, NHS nurses used to cover private ITU beds leaving less for NHS bed. Again the nurses are not cross charged but the surgeons and anaesthetists are. Only 1 ITU I worked in paid the nurses to work on their days off this not taking from the NHS all the other we had to do it as part of our NHS shift but even in that hospital it means the NHS lost a ITU bed.

So no but you can guarantee that some positions would dearly love to do what you suggested until the NHS it nearly private then they will increase you premiums.
Our private insurance for 4 for people 10 years ago was just a few dollars Shy of $1000 a month and our friends who worked for the same company and have children the same age as my 2 told me recently their has gone up to just over $2000 a month. My neighbour couldn't get insurance for herself or one of her sons and her other son she had been fighting for 3 years for them to pay for his squint treatment because they said it was cosmetic he had double vision with it.
she had had her colon removed due to Crohnes and her son had CP which was why they couldn't get insurance.

Sorry neck issue

Our local, brand new state of the art private hospital. Was having to get our nurses to do overtime to look after spinal patients. As their staff had no idea what they were doing with them. The staff in private hospitals may not have the same Experience as NHS. The surgeon has now stopped operating there.

A lot of NHS docs already work in private health care too so I can't see your idea helping much tbh.

We have a combined system. In the main it works really well.

I used to work in the public system but try and get everything possible done in the private system to take the pressure off public. However i’ve had instances where a condition of mine could only be treated in the public system. One of my kids has very complex health needs and is better suited to the public system whereas the rest of the family has only had conditions that could be adequately treated in the private system so it’s not an either/or, it’s condition dependant. The majority of our private hospitals don’t have A&E’s and if they do they are for minor things such as stitching, broken bones etc although some private hospitals have developed top notch A&E coronary care units so taking heart attacks are no issue but very hospital dependant.

The majority of specialists do a mix of public/private. Public has more interesting cases but is not well paid, private is more the run if the mill work but the money is good. As I said, it’s s system that works quite well.

Nice idea in principle but no, it doesn't work. I work in the NHS and have private healthcare myself so I see it's advantages. As a young, relatively fit person, private healthcare works for me, but only because I know how to use it. I can choose my appointment times, my exact consultant and book exactly when I need surgery/treatment so I have less time off work.

My grandma with her cancer and broken hip received better care in the NHS than privately. It's not designed for complex care and overnight especially there can be dangerously low levels of doctors available in the private hospitals. Frightening in obstetric hospitals actually.

As soon as there's an emergency, you'll most likely be transferred back to the NHS hospital because they have the facilities, intensive care units and the staff trained to treat anything and everything. Private healthcare picks the healthy people!

That’s just basically suggesting that we have a system somewhat akin to the American one, where you get ‘insurance’ through work but with the add in of the NHS for the sort of jobs the poorest and most disadvantaged do.

It would give any government (and I include Labour in this) the opportunity to run down the health service and say ‘Well, if you want good treatment, you need to get insurance.’ It would also cause difficulties to change it later on. If quite a lot of people were getting decent care, they wouldn’t feel they needed to vote in a government offering to improve the NHS. Less people using the NHS would allow it to be politically sidelined as it dropped down the list of priorities for many.

Plus if the private health sector expanded significantly, they would cream off the best staff and the NHS would be left with, er, the less desirable staff dregs, again, detrimental to the service NHS patients would receive. Many, many private doctors now work for the NHS too, so while the wait times might be longer on the NHS, the level of expertise offered is roughly the same. If doctors had enough private patients allowed the best doctors to go full time private, it would really harm standards in the NHS.

I’m not really in favour of it being pushed. Why couldn’t we just raise NI contributions from employers to pay into the NHS instead?

*My grandma with her cancer and broken hip received better care in the NHS than privately. It's not designed for complex care and overnight especially there can be dangerously low levels of doctors available in the private hospitals. Frightening in obstetric hospitals actually.

As soon as there's an emergency, you'll most likely be transferred back to the NHS hospital because they have the facilities, intensive care units and the staff trained to treat anything and everything. Private healthcare picks the healthy people!*

In a true dual care model you will find private hospitals get the funding they need to do most of what you have described. The issue is you don’t truly have a dual care model at present.

Some of our private hospitals are designed for low level stuff, some are designed for high level care, for example they do heart transplants, complex neurosurgery etc and have critical care teams and intensive care facilities to manage such patients.

It’s really no different to our public hospitals in a way. Large teaching hospitals in key metro areas are geared up for complex cases and critical care, whereas a hospital in the outer suburbs or rural areas will not be able to cater for any of this and you will need an immediate transfer. Some public hospitals are not able to cater for complex obstetrics cases and have no special care nurseries so patients need to transfer to another public hospital that does cater for this. Some private hospitals are set up for complex obstetric care and have high level special care nurseries, some are not. I gave birth in a private hospital set up for complex obstetric care. 2 anaesthetists on site 24/7 for obstetrics and ob presence on site so in an emergency you may get the ob there at the time if your own ob cannot make it in time. Some public hospitals don’t have this level of staffing for obstetric services, some have more than what I described. Again hospital dependant so in a true dual care model you can’t really say public is better than private or the other way, you can only compare the care at each individual hospital irrespective of the system it sits in.

Plus if the private health sector expanded significantly, they would cream off the best staff and the NHS would be left with, er, the less desirable staff dregs, again, detrimental to the service NHS patients would receive. Many, many private doctors now work for the NHS too, so while the wait times might be longer on the NHS, the level of expertise offered is roughly the same. If doctors had enough private patients allowed the best doctors to go full time private, it would really harm standards in the NHS.

That won’t happen.

I used to work in our public system for nearly 30 years. I have lots of friends and family that work in both systems. You don’t seem to understand how it would work.

The ‘best staff’ actually want to work in the public system. Having said that they work in tertiary teaching hospitals not general hospitals. So public hospitals will already have a two-tier system in regards to staff.

Those ‘best and brightest’ WANT to work in the public system because they want the challenge and excitement of complex and rare cases. You don’t tend to get this in the private system. So they split their time satisfying their need for skill in the public system and they do run of the mill drudge work in the private system for $$. The thing is these people don’t do run of the mill work in the public system anyway, that’s left to the (highly skilled) people they are teaching so the public system really loses nothing in this regard. As above though, keep in mind that at some private hospitals organ transplants and complex neurosurgery actually makes up some of this ‘drudge work’ . Also, re organ transplants it’s not a case of a private patient goes ahead of a public patient so no cause for outrage, it’s all run by a central register system and is based on need, priority and match.

Of course there are some specialists who don’t cross systems. Some ob’s will only do private work in top notch private hospitals, some may prefer public tertiary hospitals only, some may do both, some may work in areas where there are no private hospitals, their public is not set up for complex so do low level stuff their entire career. Completely mixed bag.

Same with other specialties. Quite a few people one of my kids see only do work in public tertiaries as they prefer interesting work over $$, others they see work both systems but see them in the public system as it’s essier to keep everything together in one place for the patient. It’s completely false that any ‘good’ specialist would just move to the private system as you describe.

Will add, absolutely agree with the sentiment that no-one in their right mind would want a USA health system.

The American system is not the only alternative. It is a very expensive, discriminatory, inefficient system.
I know several people who live in France, or have elderly parents there ( one is a gp in the Uk). They all say the French system is very good. It is based on a mix of personal insurance and state funding.
The NHS is struggling under a very expensive PFI system and wasteful, very expensive contracts.

Don’t disagree OP. IIRC I think you used to get some tax back if you had private health insurance, my dad had us all in BUPA in the ‘80s and I’m sure he got some kind of tax relief on it. I also have an issue with my shoulder after an accident; the NHS gave me 4 sessions of physio, the first of which she (physio) couldn’t do anything as my muscles were too tense and I was screaming when she touched me, gave me some exercises and told me to come back the following week. So I basically just got 3 free massages. I then ended up paying out hundreds for chiropractic treatment and physio so I could function normally (it hurt to hold a cup of tea). I would welcome what you’re suggesting. I think it would cut down on time off work as problems would be treated earlier and minor things wouldn’t escalate.

When DD2 was about two we drove up to Scotland to the Pils. We would have the DC in pyjamas, 7 hour drive, arrive late, straight to bed. It wasn't until next night I had her in the bath and noticed a nasty sore on her buttock. I actually wondered if it was a pressure sore from being strapped in a car seat for so long. shock Anyway, phoned the GP line, he instantly diagnosed (as far as he could be sure without seeing it) Impetigo, told me to go to GP next day, expect certain antibiotics. Went to Pil's GP next morning, it was as he said, treatment he had recommended and it soon cleared up.

So you used an NHS GP? I'm sorry but did you really need someone on a phone line to tell you to take your dd to the Dr?

One thing you seem to be forgetting OP (amongst many things) is that if you use a private GP you get a private prescription that you pay for (the actual paper itself) that you take to a chemist and pay the actual cost of your drugs and quite possibly a fee for the dispensing. Is your private insurance going to pay for that?

You also need to consider the increased costs if private hospitals had to have NHS standards, you know things like a Dr in the hospital overnight. You do know private hospitals don't have to do this don't you?

And the ones that do? Well if the hospital delivers babies then the Dr on duty will be a registrar obstetrician or an F2, just what you need if you have a heart attack in the night.

The German system works like that, it's a mix of state provided insurance and employer through your job. I haven't see how it works in a big hospital, but in my parents' small local hospital it works well. Everyone uses the same hospital whether private or state so it isn't a two tier system and the private money means everybody gets a nicer hospital. State insurance does get you less perks, for example you are in a shared ward of 6 not a twin room - but you can pay a small amount direct to the hospital to upgrade. It feels fairer than the UK where if you can't afford private insurance you can't get any of its benefits, and where private money goes into nicer facilities for a select few, and insurer's profit margins - but doesn't generally in any way improve NHS facilities for the rest of us.

I also find it Intersting there is an assumption that if you don't have the NHS then the o my option is the American one. Not true. Health care system in Australia works very well. Still has its problems, obviously. But once you earn X amount and are over 30 you need to have private cover (you pay for it) if you choose not to/ you pay a Medicare levy- extra tax as you could have health care and choose not to. There is a wide range of options from basic to superior cover- so it's not an issue. You activate your private insurance in public hospitals- it gets you nothing over the public patients, except a choice in surgeon. But it means the hospital is paid by insurance so alleviates the public purse. Road tax is paid to TAC- all car accident, whether your fault or not, then get covered by TAC insurance- taking another large burden off the public system. You pay for ambulance cover- a whole $80 a year. Unless you're in benefits and then pay nothing. Private hospitals have ICU's &ED,s and the staff are experienced. Can't deal with major trauma, but can deal with medical issues. The system works better than the NHS does. Not perfect- but care is definitely better and faster here.

You seem to forget that private insurance consigns anybody with a "pre-existing condition" to the dustbin and will not cover them. It's a shit system.

I'd prefer something like France or the various other countries with similar systems that work well and deliver a much higher standard of care and services than we get.

And just generally less acceptance of treating people worse than cattle, then expecting them to be grateful for it.

Nice idea but wouldn’t relieve NHS. The reasons for the challenges facing the NHS are multifactorial and complex and won’t be solved by the private sector offering a few people with relatively minor issues more physio, sadly. Now if you could stop Article 50 and reduce haemorrhage of EU staff that is happening right now.........

And despite the daily mail, the NHs remains one of the most efficient healthcare systems in the world.