To think the NHS will eventually have to be privatised ?

[Felixsmama]

When the NHS was founded 1 in 2 people died before the age of 65. It's now 1 in 8, the last 10 years of people's lives can be spent with multiple co-morbid conditions which are expensive to treat and keep under control. The NHS wasn't designed for what it's not having to do, we have an aging population. Shouldn't we start to have conversations about what going forward our health service should look like? There's multiple models not just the US one.

Unfortunately pride doesn’t make ill people better. A practical, functioning healthcare system does. NHS ain’t it.

We need to spend the OECD average.
The US gets terrible results because the system is based purely on who can afford to pay. So the rich get brilliant treatment, people in the middle okay treatment, and people in the bottom shocking treatment, or a lack of it.
The US has a shockingly high rate of maternal and baby deaths because lots of people get no, or very little anti-natal and post-natal care. They get the birth and that is it. So conditions like pre-eclampsia go undiagnosed until it is too late.

Britain has a very low level of spending on health care but expects a first-class service. It does not stack up.

@sst1234 maybe you should check your facts rather than shrieking hysterically like a Tory troll.

You say The UK spends well above the OECD average on healthcare.

You are wrong. According to the ONS:

In 2017, the UK spent £2,989 per person on healthcare, which was around the median for members of the Organisation for Economic Co-operation and Development: OECD (£2,913 per person).

However, of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).

Source

So if we want the NHS to deliver healthcare of the quality enjoyed in France or Germany, we need to spend more per person, raise more tax.

The problem with your pension plan is that at the age of 20 people don’t know if they are going to be sufficiently wealthy to not need a state pension, so they have to start paying and building up a pension pot. So what happens to that pension pot if by the age of 40 it is clear they are wealthy enough to fund their own retirement? People will not agree to pay into pension funds for years if there is no return. Similarly with health, you might think you are wealthy enough to fund your own care , and of course with health you can take out good health insurance, but if at some point in the future you are faced with enormous health issues, needing a drug that costs many thousands that your health insurer won’t cover, would you then be allowed to opt back into to the NHS.

I think the principle of everyone contributing to the NHS is sound, and is what a new system should be based on, but it needs to be complimented by an additional but optional insurance scheme, that covers not the practical medical side of health care but things like faster access, private rooms etc, with the NHS having not only funds from general taxation but also the profits from the insurance scheme ( and insurance schemes are profitable!) to put into better provision , training, pay and access for everyone.

@viques that would destroy the NHS.
You can already book private rooms and pay for them. When people get treatment should be based on medical needs, not a paid-for fast-track pass. It is not a theme park.

If you’re going to quote OECD, you may want to actually quote OECD. Not sure why you were so
triggered by a fact, but here is a more up to date source.

www.oecd.org/els/health-systems/health-expenditure.htm

OECD average spend, even as recently as 2020, is 9.7%. Compared with UK spending 12% of its GDP on its healthcare.

Leave you to read.

I’m a nurse and have also worked in the senior layer of NHS management which is outside healthcare settings.

Frontline NHS is mainly very good. NHS senior management needs sorting the fuck out. There are a lot of people making huge amounts of money delivering very, very little and massive duplication. Seriously, I’ve been appalled at what I’ve seen.

Unfortunately they hide behind the general public’s ‘I love the NHS’ blue hearts bollocks that stops any objective criticism of the NHS or serious attempts at reform.

The NHS is already destroying itself! To say that treatment should be based on clinical need is ignoring the fact that for many people getting good healthcare is currently a postcode lottery. The current system of private healthcare already means that paying gets you faster access , we all know that. What is needed is a way of encouraging ordinary people to invest more in the NHS because no government is going to increase public contributions to the level that would fund the system properly. So we need a system that produces an income to be re invested in the system, and that will need incentives.

@viques increased taxes do that.
Waht you are suggesting is a system where well-off people who can pay more get a good NHS, and those who are poorer get a shit NHS.

No, we need a system where people who are willing ( and yes obviously able to do so financially) invest more in the NHS through additional insurance. That extra income improves the provision for everyone, because it goes back into the system and eventually improves it for everyone. So no, not everyone will be able to pay extra through insurance. But many can or would pay if they felt they were going to get something back from it. It would in all honesty for most people probably look pretty much like the system we have now since actual medical or clinical treatment will be the same for all patients, maybe the insurance would offer nicer rooms, more choice about timing ( even quicker appointments), choice of hospital/consultant etc and that would be enough incentive for many.

The NHS is underfunded, no government will dare increase general taxation to fund it sufficiently ( which would also incidentally be more difficult for poorer groups in society to deal with), the country will never contemplate moving to a wholly privatised system of healthcare, so somehow another funding stream has to be found.

You’ve compared OECD without covid extra % of GDP to the U.K. with Covid extra % of GDP. That’s not a valid comparison.

I don't think it's fair to say that the US system is based 'purely on who can afford to pay'. They spend billions of taxpayer's dollars on Medicare, Medicaid, veterans' healthcare and (since Obamacare) on underwriting insurance.

It's fair to say their system is extremely expensive, fragmented, politicised, too dependent on employment and age status and doesn't have universal coverage.

Definitely not something for us to emulate, although there's a lot of innovation at the top end, but what good is that if few can benefit?

Perhaps we should encourage people to take up as many vices as possible:

You do know that Medicare, Medicaid and VA is not free right? There is still a monthly cost for it. It’s much lower than private health insurance, but it’s still hundreds of $ a month. Which is another reason why millions of Americans have no healthcare access at all.

Yes, I know in outline how the US system works.

The NHS isn't free either (think of all the things that aren't covered and the time costs of accessing what is) and the UK's out of pocket healthcare spending has ballooned in recent years (people are paying directly or even crowdfunding). There was a recent FT article arguing that our system IS being privatised by making healthcare a private responsibility through inertia.

HA2 needs to happen and the endless relays and inquired and spending reviews have just added costs upon cost.

the west coast mainline is full, goods which could go via rail go via truck, services in and around the Birmingham area have little scope for improvement because the rail system is jammed.

Freeing up capacity by moving services down HS2 is vital, it’s not just about getting to London quicker but anything on the west coast cannot by improved until that happens so it will also help get better services along the chilten corridor through Banbury as well.

we need to make out rail systems better and have more capacity to encourage people in cities to give up cars or reduce it, and to reduce the trucks in the road. These will have massive environmental and health benefits.

London has a great public transport network and places like Birmingham need to have the same level of investment. However that starts by giving the capacity for the transport for West Midlands department to actually make improvements .

Also bring ham is a GDP outlier across the whole of Europe and is significantly under productive for its size I’ll try and find the study on it that basically Birmingham has a level of productivity to a city half its size due to a reliance on bus networks and congestion. For the UKs second largest city it needs investment and HS2 is part of that.

Public infrastructure projects are also great for providing work, and creating a supporting industry around them all good things.

Spending doesn’t need to be health or public infrastructure when there are tax loopholes you could drive a tank through

They’re talking about charging over 60’s for prescriptions and people paying £8-9 per day when in hospital… I think that will become the new norm… a ‘donation’ towards GP appointments, etc

There's many over 60s who have a significantly higher income than many working people though.

I assume by "RIchard Branston" you mean Virgin Health? Those practices were not "privatised" - GP practices were already private businesses and those private business owners sold them to chains.

From its inception the NHS has never been fully nationally owned - it was bastardised at the outset due to lobbying by the doctors' unions who wanted to keep their private practices and businesses running alongside.

Many parts of health care have never been nationally owned but contracted out.

The NHS itself is a chaotic and bureacratic mess of tens of thousands of little fiefdoms who can't even agree on basics like data handling protocols.

Healthcare may be free at the point of access but getting that access requires tenacity, sharp elbows and care is heavily rationed with the criteria rarely available or understood by the patient. Huge areas of care have simply been removed from cover, disparity between sex groups, ethnic groups and social groups is getting worse and not better.

I've worked and used healthcare in three European countries, have a child in a fourth, a sibling in a fifth. All had state regulated insurance models, all slightly different, all including support for low incomes, all have better health outcomes than the UK. The choice is not NHS and a bottomless pit of funding vs death on the streets in the US.

Shouldn't we be having a conversation about the fact that the nhs was set up in an era when people generally didn't live beyond 75, when babies who now survive with life-long health conditions died rather than growing up needing life long health care, when people with cancer expected to die quickly, when people who had strokes and heart attacks died, when pneumonia and UTIs caused the death of older people ? I'm not saying these were good days - just that our expectations have changed massively.

www.thetimes.co.uk/article/nhs-sacred-cow-must-be-put-out-of-its-misery-l9pnxnmbf

Sorry that I can't paste the article and that it's behind the paywall, but here's an article from today's Times that uses the Civitas report and stats published a few days ago.

Universal coverage within a multi-payer system, as described in the article linked above about global healthcare systems, is the way the UK should be considering healthcare funding.

Or the Israeli system -- which has four national MHO chains competing for patient registrations. It doesn't cost more, because there is a per capita average annual patient budget paid by government, so there are incentives for healthcare organisations to keep people in good health while also operating and purchasing efficiently.

The NHS itself is a chaotic and bureacratic mess of tens of thousands of little fiefdoms who can't even agree on basics like data handling protocols.
Healthcare may be free at the point of access but getting that access requires tenacity, sharp elbows and care is heavily rationed with the criteria rarely available or understood by the patient. Huge areas of care have simply been removed from cover, disparity between sex groups, ethnic groups and social groups is getting worse and not better.
I've worked and used healthcare in three European countries, have a child in a fourth, a sibling in a fifth. All had state regulated insurance models, all slightly different, all including support for low incomes, all have better health outcomes than the UK. The choice is not NHS and a bottomless pit of funding vs death on the streets in the US.

This, in a nutshell!

No, but I do think that eventually we’ll have to start paying a small amount for visits to GP, A&E, and that better off pensioners will no longer get endless free prescriptions. Small charges are normal in certain other European countries, inc. Sweden - popularly supposed to be a socialist Utopia. They also pay something for the ‘board’ element of hospital stays. There is an annual cap on prescription charges though.

I can’t see any U.K. govt. having the guts to introduce it though - they’ll all be too shit scared of being wiped out at the next election.

OECD average spend, even as recently as 2020, is 9.7%. Compared with UK spending 12% of its GDP on its healthcare

How long has the UK been spending 12% of GDP on Healthcare? (which in itself, isn't the same as spending on the NHS) Healthcare total spend inc pensions, health prevention programs, drug re hab etc.

NHS spend in the first 8 years of the Tory Govt, was slashed in real terms.

Care to mention which G7 country makes its AHPs spend approx 45k to train?

A small amount of payment for visits will cause some people to get more ill before visiting and will cost the NHS more in their treatment. In particular, I think you would have fewer people detected with early-stage cancer and more people with more advanced cancer. Trying to get some people to go to the Dr with issues such as blood in poo or prostrate issues or vaginal pain is already difficult. People already put off this kind of GP visit. So I am not convinced it would save money. Exactly the same issue with mental health and LOTS of GP visits are for mental health. Someone suicidal or very depressed can struggle to make themselves go to the GP, a payment will lead to more delays.
And more and more people are really struggling. What you consider a small amount will be unaffordable to many. People will end up at the foodbank so they can afford to see a GP.
There seems an unwillingness to understand how people act and unintended consequences.
And any GP payment will mean more people going to A and E. Even some people not desperately poor will alter their behaviour to save quite small amounts of money. There is lots of research to show that with new charges, even people who can afford it, alter their behaviour to avoid payment. It is why speeding fines have been so effective. And it is why parking charges in a city centre displace parking further and further out until it becomes too far to walk, or people shop elsewhere with no parking charges. With major things people will seek treatment. But most of what people go to GPs about are worrying lumps, niggling pain, rashes, anxiety and depression - all things where you can put off a GPs visit. A friend died in her fifties because she kept putting off going to the GP with signs of cancer. It was curable earlier on.