Just privatise the NHS

[user1237865]

Totally prepared to be told IABU but I've just got to the point where I think the NHS is so far gone it should be privatised.

Totally outing so I've Name changed. In NI we have 2 private hospitals but they don't do emergency's, they don't do ante natal care. Really they only provide you with an appointment with a consultant who will then decide in treatment which in most cases will happen on the NHS. If it's something like cataracts they'll do it but the private hospitals here don't do anything major. Perhaps the rest of the UK is the same. I'm not sure.

Today DSis was sent to A&E by the GP. DM and her have now been waiting 7 hours to be seen. While waiting another man collapsed and died in front of them. I think this is beyond ridiculous how can they let this happen?! If people were seen in a decent time frame this would be less likely.

FIL has terminal cancer again nowhere to treat him when he gets recurring sepsis so most times he sits on a chair (around ever 2 months) for 36 hours getting an IV in A&E before he's finally gets moved to a ward.

I paid for private ante natal care each time I was pregnant. It did give me appointments every 3 weeks and scans with a consultant but when it came to giving birth it was a time when the consultant was working a shift for the NHS thus using their resources and beds. Yes the care was probably therefore cheaper than had I been paying for my stay in hospital too but it isn't an option here.

The whole things a complete joke. Those willing to pay/ have insurance are still stuck blocking the NHS which in my opinion should be there for those that can't afford their own treatment or can't get insurance through their job.

Surely if a lot of it was private, pay would be better, meaning more people choosing it as a career (and not leaving) meaning people actually get proper care! Though so much of what I think could be wrong as I don't understand it all fully.

I’m sure. I don’t think I’ll be going back. I’d like to, but return to practice is such a performance, to start at the bottom
again in a stressful, overrun department for band five pay? It’s hard to see an upside.

Presumably you have hard evidence of your claim there?

Rhetoric, by the way, is not evidence of any kind, so if you could link to some hard evidence that'd be great!

I’ve worked in the Canadian healthcare system, and had experience of using the Swiss, German and Maltese systems. They all have their faults, I wouldn’t greatly mind if we switched from the current system to those systems.

But it wouldn’t be cheaper. You can’t increase bed numbers, staff numbers, keep the same range of coverage, and have it not be more expensive.

The systems mentioned above cost more than the UK system, and cover less. eg in Canada, drugs aren’t covered - DH spent $80 on a week’s course of amoxicillin. In Switzerland you pay for outpatient drugs (not a prescription charge, the actual cost), crutches/walking aids, a copay for inpatient stays, etc).

So we could switch to one of those systems, with all the upheaval involved (how are we selling off all of the nationally-owned NHS hospitals to private providers? Are they putting in bids? Can you imagine how disruptive that’s going to be?), and get the same service for more money (because the private provider needs to make a profit too).

Or you could just put more money in to the NHS. Which seems more straightforward to me.

And why do you think the Tories are so keen on doing this? Look at PPE - they’d just sell the hospitals off cheaply to their mates, the companies held by Tory peers, or whichever companies are willing to make a “donation” to Boris’s next holiday. It would be like Track and Trace all over again - to me, the Tories have spent the last two years demonstrating why we should never trust them to do this.

I agree with Changechangychange. Switching to an insurance-based system would be hugely administratively complex in the handover and you'd need a whole pricing and billing infrastructure that would cost real money, plus profit margins. You're shelling out enormous amounts of money before you even start trying to improve provision. It all has to be paid for.

It does have to be paid for. But I think it's the only realistic option so we'd be better grasping the nettle sooner rather than later.

I think NHS should remain but not in its current form. I don't feel it should offer everything--podiatry, physio, non-urgent dermatology, certain elective surgeries, for instance. Cancer care/A&E/urgent care/chronic or long-term health conditions management definitely should remain as well as community nursing.

I do feel a healthcare system such as France/Germany would be good here.
People should pay somewhat towards their healthcare and this should be means-tested.

When the NHS was founded, healthcare was very different. We now have increased longevity, ever-increasing chronic/acute/long-term health conditions caused by pollution/lifestyle/expansion of medical knowledge and diagnoses and a much larger population. The NHS in it's current form is not sustainable.

Pouring money into it is not the sole answer.

Good point. Society took drastic measures and the costs have been huge

But this would need a corollary in that any HCP receiving funded training should be handcuffed to the NHS for the equivalent of a military short service commission for eight to 10 FTE years post-qualification.

NHS students would drop like fliesmedical/nurse training can be brutal on the wards-retention would be crap if newly-qualifieds would be forced to do 8-10 years FTE afterwards. Added to which, burn out would be massive.

(didn't mean to cross out)

Privatisation wouldn't help anything as the core issue is lack of staff and facilities. If it were solely a management issue we could talk about whether the structure of the NHS is sufficiently efficient or responsive. It's quite likely there are some management issues which cause staff to quit, but when you look at the numbers, there's simply not enough health care professionals to provide the needed standard of care. Going private helps an individual in the short term, but when a doctor goes private, they typically see fewer patients, making things worse for the system as a whole. The USA, which has a comparable number of doctors per capita, has vastly expanded mid-level providers (nurse practitioners and physician assistants) to help fill that gap, but the UK has not.

The USA, which has a comparable number of doctors per capita, has vastly expanded mid-level providers (nurse practitioners and physician assistants) to help fill that gap, but the UK has not.

The UK is starting to. ANPs and paramedic practitioners in the larger surgeries now and in A&E/urgent care. Physician's Associates are coming in...

Yes, there's changes on that front, but the UK is behind so it will take time to catch up. The trick is really that there's things midlevels can't do, and the USA has problems with that too. If it weren't for international graduates, many residency programmes would never fill their family medicine places.

@Eeksteek that is a shame that you wouldn't return. Obviously I don't know your circumstances, or which band you were at previously, but absolutely... I wouldn't fancy joining as a B5 nowadays. It is just so different. You are just a major part of patient flow and never get to rehab effectively. Although, I am very grateful that my job is purely rehab. I struggle on the wards nowadays!

'If the NHS was funded properly, restructured a bit in some areas, we trained more doctors and nurses and paid them a better wage things would be very different'

I'm sorry but this is all very simplistic. We need a mix of private and public healthcare - 'a bit' of restructuring is a major massive job with a fair amount of culture shift, both internally as well as for the public. It's summer - wait for the annual winter crisis, with social care crisis and cost of living increase in the mix. It's a public service and employer, not a holy grail. There are fewer students applying for nursing degrees (wonder why?) and we managed to get rid of a lot of doctors with Brexit. People vote with their feet and go working elsewhere.

@LetstalkaboutBruno 6-12 months unpaid placement, formal study and starting right at the bottom again (part time pretty unlikely) and being compared and contrasted with new grads and their time and energy, while lone parenting. It’s really quite demoralising to consider.

Or I could do a three month coding boot camp and work from home for band 6 starting pay and double it in a year or two to band 8 levels. Objectively, it’s hard to justify, and although I miss the patients and the work, I don’t miss the stressed environment, poor management, limited progression, and low pay for skilled and challenging work. If I have to start again, I might as start completely over in something else with better prospects and less time, effort and stress.

Obviously there would have to be flexibility built-in to a PQE service model. You can't stop people getting pregnant for example but just leaving to go to Australia or Canada for more money/nicer lifestyle, could be curbed by requiring repayment of the unserved element of student debt.

Just like, if any company wanted to invest in acquiring an NHS facility, the payment would have to include repayment of all existing debt, including any PFI contracts outstanding, and assuming and guaranteeing existing pension commitments, to remove the TUPEing out option. That would deter the asset strippers and bottom fishers. Plus, obviously, there would need to be safeguards to prevent redevelopment of the most valuable sites. And minimum future investment standards. Those are just a few of the pitfalls I wouldn't trust civil servants to negotiate.

X-post with @Eeksteek . Completely understand why you would hesitate to return!

Changes are needed - but any party is to scared to say it for fear of the other parties saying your trying g to privatise & the unions don’t help.

I don’t want a privatisation- due to my medical past issues it would cost probably to much for me- that scares me.

trying to fix it when it’s quite broken - money is wasted at so many levels. And the wonderful nurses and staff and patients are the most impacted

It will need a strong person party prepared to do it - the 1950s NHS isn’t working.

@Eeksteek I have a lot of colleagues who have left and have considered returning. Many remaining colleagues tell them to not bother, it's not worth it at the moment (likely, ever). That's knowing that they would probably just step back in to where they left off.

Knowing that you would have to go through all of that to get going again? No thanks. Admire anyone who has that patience, but I certainly don't see many who would/do!

I have considered re-training many times, but I just don't know what I want to do (I like the idea of Medicine/ACCP) but that would need some serious consideration. I have considered non-healthcare altogether too.

So are you saying that people with money should get treatment before people who do not have money??

@LetstalkaboutBruno its a complete no-brainer. Much as I loved my job, I ultimately did it for the pay, not the feels. I’m not prepared to take that amount of time and energy away from myself and my child for that low a level of compensation and stress and opportunity, when I can earn the same in half the time elsewhere with more benefits and less hassle. I didn’t mind working my way up once, but I’m not doing it all over again. I expect to have to make up for taking time out, but not to that extent. Especially as a sole earner and parent. I’ve got to be more efficient to earn and parent for two. Maybe I would feel differently if I were in a two parent family (but honestly, I doubt it. I think even if I were still working in the NHS I’d be looking to get out)

@Eeksteek I commend you, it's admirable. I wish I had the balls to leave and go elsewhere! I know I won't be in the NHS forever. Maybe when a child comes along that will be my moment to go...

I work with multiple part time B7's who are struggling financially due to their drop in hours. That is not attractive, at all!

It wasn’t that brave. I had an inheritance to fall back on, and moved away from the south east for lower cost housing and family back up. Another no brainer, really. If I could step back in part time at B6 after a few months RTP study, I’d do it like a shot. But if I’m going to work for basic pay, I’ll do a job with basic stress. I suppose it might be possible in future, if the vacancies are there, they’ll support RTP. I don’t think there are objective standards, it’s all done through supervision, so it’ll be variable, and if they’re desperate it might be whether negotiating.

@Eeksteek I don't know where you are at the moment, but you would almost be able to put money on a Trust taking you as a PT B6 as everywhere is so incredibly short staffed. Having said that, I know how strange Heads of Dept's are about PT working, so actually... I could be wrong and it'll be a nightmare! A few ladies I know who did the return to work stuff did Locum posts. They chose the shifts, so was always part time!

Of course, that is all for when (if) the time comes.

Basic level stress sounds good to me!

So wanted to visit my walk in GP, but no, I have to self refer. I call the number and no answer the first four calls. On the fifth call some one answers and takes down details so a nurse can call me back. If I get through the call with the nurse I may then be allowed to visit the centre. What a waste of everyone's time.