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.

And will GPs be expected not to see patients if they can't or won't pay? Who would be a receptionist collecting payment and turning away patients with no money? I can see it now. Verbal abuse thrown at receptionists and GPs who refuse to see a patient and people crying and pleading they can not afford it and for the GP to see them.
You do not get this in other countries because they are used to paying. We do not have that culture. And vets already experience these problems in the UK.
You seem to think everyone will rock up and politely pay and have no problem in doing so. That will not be the case.
And this is what people mean when they say policies are made by MPs out of touch with the public and how things actually work on the ground. Again and again I have seen policies introduced and then reversed, when the issues the public say will happen, do happen.
How did policymakers and MPs get so out of touch with the public?

To be clear, my criticism is of the organisation and how it is mismanaged - not of the over stretched, dedicated, hard working HCPs who are working for it. I have nothing but praise for them.

You shouldn’t feel you have to point that out though, to me it goes without saying. It amazes me how many grown adults don’t think this way though. Any kind of criticism of the holy cow that is the NHS is met with thundering accusations of ingratitude.
Its a very British trait I think to feel the need to be grateful for something substandard because it’s cheap or ‘free’.

Every time i have had to deal with the nhs i have to wait on the phone at least 30mins, be available for a ring back and or mad dash tk the surgery. It takes a half a day just to get something sorted. i would dearly love a private gp.

The NHS provides free care. So if it was privatised and you were made to pay for your treatment do you think it will be better? No not necessarily. You will get the exact same standards but then will be footing a bill at the end of it.
Thousands of nurses are leaving. Many that I have come across, have left just after qualifying to go on to do aesthetics then working for an agency at double the rate part time and for less stress.
They are currently struggling to recruit GP’s. One surgery near me currently has ONE GP! They cannot recruit a GP. They have had to rely on locum GP’s who have run a surgery for one day, got a better rate of pay, no stress of budget and government target constraints and then get to go home at the end of it.
There are already some trusts and many services within the NHS that are run by independent private firms and the ‘NHS nurse or allied health professionals’ that looks after you is actually employed by a private firm.
The mental health services are one example as when they went out to tender, it was a private firm that one the bud.

So no, I don’t think privatising it would be a solution. May be more hospital beds and better treatment of and support of staff could be a good start. Why would hospitals and a&e’s close when the population is increasing? This unfortunately has happened over the last few years and privatising it won’t change that.

The paper produced on this was being rubbished as an evil Tory plot that mustn't even be discussed, when it was actually produced by a team with decades of experience of operations in the NHS.

Its really common for state backed healthcare models to have some charging for the board element of hospital stays. There is no evidence either that this approach deters people from accessing health care as the models include support for low incomes.

The problem is everyone says they want more money spent on "the" NHS but come election time voters choose lower taxes.

Under Blair a huge amount of extra money was fed into the NHS and there were improvements in some of the key waiting lists but also there was a great deal of waste in additional layers or bureaucracy created - not all the value was realised in better outcomes for patients and not all health authorities delivered value or patient centred care for that money (anyone remember people waiting for hip replacements being given the choice of traveling to Belgium or dropping back down the waiting list?)

Reducing corporation tax over the past couple of decades has INCREASED tax revenue due to international firms basing themselves in the UK, and UK firms not moving abroad.

Likewise with Ireland who've benefitted massively by their low corporation tax rates which have brought in lots of employment as international firms have based themselves there.

You have to look beyond headline figures and look into behavioural aspects. Don't forget that tax revenues increased when the highest personal income tax rate fell from 50% to 45%.

@bakebeans

So if it was privatised and you were made to pay for your treatment do you think it will be better? No not necessarily. You will get the exact same standards but then will be footing a bill at the end of it.

It has been shown numerous times that competition (proper competition that is) improves customer service and outcomes.

Nothing in the NHS will improve when there's the prevailing attitude of "you're getting it free so you have to put up with crap service".

Give people a proper choice of GP surgeries and the ones offering better service (i.e. actually answering the phone or having appointment available) will get the custom and the crap ones will fall by the wayside.

When people have to pay for something (even trivial amounts), they're going to shop around for the best service. So standards will improve.

@antelopevalley

We need to spend the OECD average.

So you want to reduce spending then?

We already spend over the OECD average. Our spending is similar to Ireland, Spain and Italy!

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

How is that really different from paying more tax - except what you are proposing are taxes on the sick, rather than taxing those who can afford it in a progressive tax system? Merging NI with income tax; aligning CGT with income tax; stopping company takeovers by ladening them with debt and stop the interest payments being allowable for tax; and stop payments for intellectual property being allowable for tax (companies in the UK such as Starbucks pay their overseas parent company, located in a tax haven for the right to use the company name, thereby reducing their tax bill in the UK)….

It’s all very well talking about how people in their 60s, with higher incomes can afford to pay for prescriptions, etc, but this type of measure affects most, those just above the borderline for getting it for free, but are still struggling? See articles on holiday hunger in families, who don’t qualify for free school meals?

Really the point of the NHS is to keep the workforce healthy; and having people unable to work because they can’t get treatment, is a waste of money!

It looks to be heading that way:

www.telegraph.co.uk/news/2022/07/23/uks-runaway-health-spending-costs-10k-per-household-produces/

So if people can't pay, they can't go to hospital?

My DP is self-employed, when he was in hospital we were really skint as we had no income coming in from him, plus daily parking charges from visits. Another £63 on top would have been shit. And we are always just over the limit for any help as we both work full-time.

And if people will not pay, do they go to prison? For not paying a hospital debt? Seriously what happens in terms of enforcement? Because if they do this people will end up being taken to court for non-payment.

@Kazzyhoward
im not sure where you have been doing your research but having experienced both sides as a patient in both NHs and private healthcare, it’s not always better. A family member had a surgical procedure done privately but the after care was not looked into. No follow up, no phone calls. Was informed to keep an eye on the wound. It ended up falling on a&e, Intravenous antibiotics, NHS district nurses for wound care and the GP following up to sort things out as the ‘private hospital’ wasn’t equipped.

Another example, was a patient admitted to a&e feeling unwell. It turned out their private psychiatrist had prescribed them on large amounts of diazepam.

Many consultants do private and NHS care. You still get the same consultation. Privately you may get care sooner, and there are treatments which are not available on the NHS but that doesn’t mean it will change.

The one thing I will agree to however is private treatment in the dental world is far apart from the NHS and given I have to pay for NHS dental treatment with limited options, If I knew years ago that private dental treatment years ago would have have prevented the current issues I am experiencing today, I would have changed.

First step is to get the Tories out. They want to privatise the NHS. They have run it into the ground for the last 12 years and Covid has gutted it. We can have an NHS that works.

Competition works when there is genuine choice. Health is more akin to a train than a shop - You don't have a choice of the service in your areas, although there may be multiple providers across the UK - if you need emergency treatment, you go to the nearest A&E.

Maybe if the system is fixed similar to NICE with drugs, so that there is a set rate the NHS will bill, and its then private insurance who don't have a stake in the hospital or a service locked like in the USA then its possible an end user could get a good premium for insurance, but that wont improve the hospital itself.

What you would likely see is certain hospitals which have funding would become more popular, creating waiting list there, and other hospitals in the area would not be as profitable, they would then have to cut services, driving more people to the other hospital creating vicious spiral. Other hospital could then up prices knowing they have greater market share, meaning we end up in a system which has unequal outcomes.

I am not against private business being involved in the NHS but they should be for driving down costs of support services and not in healthcare provision (unless we go with private hospitals but funded by the state for all patients so the end user doesn't see the difference) but if we do this then privatisation and capitalism has shown where the costs are fixed they will then drive down standards to increase profits, so we will ultimately end up paying more of our tax fees, to a lower quality service, only for it to end up in a tycoons remuneration pot

I did mention GP surgeries re competition rather than A&E!

Likewise competition works in other "privatised" areas such as opticians, dentists, etc., where history has shown patients can freely move between service providers to get the best service (obviously more problematic in recent years re dentists no longer doing NHS work!).

A&E is a different matter completely as are serious illness treatments/operations, etc such as heart attacks, cancers etc.

But certainly, there could be competition between providers for scans, x-rays, broken bones, elective surgeries, audiology, physiotherapy, minor injury units, podiatry etc.

As you point out people are living longer but also the population in the UK has increased. In 1948 the UK population was 49 million and now it is 67 million.

Sadly people do not restrict their demands on a service or goods when it is free, for example the use of carrier bags has decreased by 95% since a 5p (now 20p) charge was introduced in 2015. And as we saw in communist countries where prices cannot change in response to demand (with the NHS there is no or little charge) then demand is managed by queuing instead. Previously access to health care was restricted by having enough money to pay for it but now it is restricted by having enough time to queue for it.

The solution in my mind is indeed a hybrid system rather than a completely free at point of use system where a small fee or insurance premium incentives people to only use it when they need it (like carrier bags).

But the NHS is such a sacred cow that no politician or political party is ever going to get elected if they mention reform of the NHS let alone mentioning the "privatisation " word.

So in the meantime the queues will just get longer, access more difficult and politicians get elected by promising more money or introducing "targets" or middle management to "fix things" but failing to deliver on both.

@1dayatatime

But the NHS is such a sacred cow that no politician or political party is ever going to get elected if they mention reform of the NHS let alone mentioning the "privatisation " word.

Unfortunately, it's the politicians themselves who have caused it by their obsession with the NHS at election time and in Common's exchanges, so they've basically backed themselves into a corner where sensible cross-party discussion is simply impossible.

The party leaders need to put their differences aside for the good of the voters and agree on some kind of "de-politicising" of the NHS and setting up cross party committee to properly and openly discuss our future health and care needs.

It won't happen of course as leading politicians on both sides prefer the infantile exchanges, slogans and gimmicks.

@1dayatatime

You can’t compare healthcare to carrier bags. People don’t demand more healthcare than what they need. Your analysis only applies to wants not needs. It’s not like you can ring up your GP and say, I’m not sick but gosh I’d really like some antibiotics and while you’re at it throw in some pain killers and send me for a MRI as I’d like a picture of my brain. Or that more broken legs or appendicitis cases happen “because it’s free” to treat them. The correlation between paying for healthcare and demand being lower is because people in need end up going without healthcare and then dying prematurely or ending up in A&E when a mild condition gets life threatening. That’s what your system would cause. Not people demanding less, but people in need going without.

In addition, adding a fee either at point of service or in insurance premiums directly discriminates against the disabled and those with chronic health conditions. The people most likely to be in poverty will be forced to pay more healthcare costs than the abled and healthy people who are least likely to be in poverty.

On the contrary, a small fee will put people off expecting prescriptions from the GP for things they could buy over the counter, or encourage them to try other things first instead of a GP (or A&E) visit being the default for every little thing.

As for the disabled etc., I'd expect there to be exemptions as there are in other areas. Eg diabetics don't pay for eye tests, cancer sufferers don't pay for prescriptions, etc

Haven't read the whole thread, so it may have already been said. The NHS has been steadily privatised in bite sized and larger chunks since at least the 1980s. Basically everything that can be contracted out has been already, and where not possible internal markets have been set up to encourage competition. It would be interesting to know whether all this has resulted in real savings or merely opportunities for contractors. Perhaps it's not even possible to disentangle the web that has resulted. With no public appetite to understand (so many people seem to think that the NHS has not changed since its inception when it has been subject to constant and substantial change for decades), there's no political gain in seeking the facts anyway because that's not what people vote for. The focus is always on a few cheap sound bites x new hospitals or y more staff, which don't stack up anyway. We keep devolving treatments to cheaper, narrowly trained roles, which may seem fine for the majority, however for eg they tend to order all tests and that not only costs more but patients are also subject to unnecessary tests which a doctor would see are not needed. With the studied refusal to train more doctors (not just medical schools, but foundation places), perhaps being treated by a doctor will become a rare event in a decade or so. Forthcoming contracting out opportunities there?

Private healthcare in the UK is increasingly the playground of a few large beasts and that will not produce outcomes as good as I've seen in more independent models. It's almost impossible to deliver world-beating innovative treatment without public development. Although most of our very best also work privately (NHS pension limits, anyone?), this is just a relatively minor treatment spin-off that could/would not be developed privately. We'd certainly insist on the NHS ourselves (even at the moment) if we were on the table.

@1dayatatime, sadly, I agree with every word you have written above.

I think there should be far-reaching change, but based around hybrid care and payment models.

It is ridiculous that people like me get free prescriptions just for being over 60. I don't need many and I can afford to pay, or my DH got a pre-payment certificate for about £100 for a whole year. Once I filled a private prescription and it was cheaper than the dispensing fee.

@maryso

Haven't read the whole thread, so it may have already been said. The NHS has been steadily privatised in bite sized and larger chunks since at least the 1980s.

It's been partly private ever since it's inception. GP's have never been part of the NHS, they've always been self employed/small private businesses, as have dentists, opticians, pharmacies, etc. All have been paid by the NHS for services/goods they provide.

The "private" aspect is, indeed, expanding, generally for the better, in terms of things like Specsavers issuing NHS hearing aids, private firms providing mobile x-ray and scanner units and staff for them, private firms doing cataract operations, etc.

No it won’t, numerous studies on the behaviour of people have been done where you do have to pay a fee to access healthcare and every conclusion has been demand is lowered because people in need go without. There is no lowering of demand due to discouraging mythical “abusers” who demand healthcare they do not need. The higher the out of pocket fees/costs, the more that go without healthcare they need:

”Almost half of adults — 46% — report struggling to afford out-of-pocket healthcare costs, according to a Kaiser Family Foundation survey conducted in September and October. These shares are substantially higher than the shares who report difficulty affording other household expenses such as rent or mortgage, gasoline, monthly utilities, or food and groceries,” the KFF authors wrote. In addition, some Americans are forgoing physician office visits (24%), mental health services (17%) and hospital services (13%) due to costs. Deferral of hospital services was higher for respondents from households with income under $40,000 (18%), as well as for Black (20%) and Hispanic (21%) respondents. Regarding medications, 29% of respondents said that within the past year, they had not taken medicine as prescribed because of cost.”
www.hfma.org/topics/accounting-and-financial-reporting/article/2-new-studies-illustrate-the-burden-of-healthcare-costs-in-the-p.html