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.

Scotland found more people went to get eye tests when the charge was removed. The charge for an eye test is only about £20 and for most is once a year, but it was still enough to put people off getting their eyes tested.

Sorry, but you can’t apply this model to healthcare.
What happens when you pay for a GP visit is that standards will improve not because of competition, but because of the people choosing to go without. So, suddenly it’s easy to get an appointment. And staff are not over-strectched.

Outcomes will only improve for those who can afford to pay, but overall outcomes on a population level will drop. This is very clear in the US where 31 million with no access to healthcare results in 45,000 excess deaths per year due to no healthcare, which in turn is the root cause of the lower life expectancy for an American vs a British person.

More people would go to the hairdresser if it were free too! It's all very well saying that more people would do x or y, but given that there are constraints on how much tax people are willing (or able) to pay, then there has to be a brake on demand/consumption. If it's free, then the rationing is via the waiitg list/patient time.

I'm talking about a "small" free. The study you quote is America where nothing will be "small" in terms of fees! Completely different market.

As I said, the larger the fee the greater the impact. A small fee only has a smaller impact, but the nature of the impact is the same. Fees discourage people in need from accessing healthcare. Full stop. A small fee just means you’ll be barring the most vulnerable from healthcare. As the pp said regarding Scotland and £20 for eye tests….scrapping the fee meant more people getting eyes tested. There is no such thing as an unnecessary eye test. So that proves my point. People are neglecting their eye sight because even a £20 eye test fee puts them off accessing necessary eye tests.

Abusers of healthcare- people demanding healthcare they do not need are vanishingly rare and it’s a well peddled myth often used to justify privatisation.

And even if these “abusers” do exist, why do you think all these abusers are low income and would be put off with a small fee? You are envisioning the fee to be akin to a fine. Petty fines for seeing a GP you don’t need to see isn’t going to put off the well heeled “abuser” at all. So I question your logic in thinking fees discourage abuse.

Yeah, but you don’t need a haircut to live. A haircut is a want.
Yes there’s a limit to how much personal income tax can be levied, but that is only one tax amongst many.

Totally agree with the reply to this.
We have competition between GP surgeries. The good ones are over-subscribed. Before I moved I had a brilliant GP surgery in England. But the only local one taking on patients was that one run by the big American health firm. Loads of people complained about them and said how crap they were. They did not need to improve, they have a captive market and no ethos about serving local people. They are totally shit. That is what all GP surgeries would be like.

We do not have enough GPs or Drs or hospital beds to provide the service people should be getting. Charging for it does not change that fact.

This is why you have NICE criteria for who gest treatment. You can't have an MRI just because you fancy one for reassurance. Or an admittance to hospital for a bit of a rest.
GPs though should be easy to use because they are the first point of contact for anyone with a health issue.

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

No, I would prefer the systems say in France or Germany, but I can’t see any government going in that direction; so the NHS free at the point of use, is the next best thing - funded properly at the same level as those countries, through a progressive tax system. I think piecemeal charging for hospital stays or prescriptions for the over 60s is idiotic, as the administration will cost; and as I said are taxes on the sick, who tend to be poorer. As a pp said, charging for hospital stays is a double whammy on the self employed, who have no income; but have pay the overheads on their business and home already. These are just crude forms of taxation, which take no account of ability to pay!

Any civilised society looks after its children, the elderly and disabled; but the workers, who support them financially, need to be able to keep working; not off sick, for want of treatment, because they are in a queue of millions!

Exactly, it just doesn’t happen that scores of “abusers” are sucking up NHS treatments and resources they do not need. NICE guidelines ensure it is all based on bona fide need.

As a pp said, charging for hospital stays is a double whammy on the self employed, who have no income; but have pay the overheads on their business and home already. These are just crude forms of taxation, which take no account of ability to pay!

Great point, this applies to disabled as well. For example, I get PIP. PIP stops if you are in hospital. But you still have rent/utilities to pay while in hospital, but the government thinks you don’t need PIP while in hospital.

Privatising probably won't help much. 1 problem is lack of staff which more money won't help. I don't think better pay would encourage more drs/nurses and definitely not enough.
Another problem is ageing population which is only going to get worse and they are probably the least likely to afford to pay. I would like to see people having to pay for their own social care even if that means selling their house ,if they have one, before the state steps in. That would free up something.

But what does your tax system look like?

Brown/Blair increased NIC by 1% twice to "save the NHS". Rishi has just increased NIC by another 1.25%. So that's 3.25% and still nowhere near enough.

On another thread, teachers are complaining their pay rise isn't funded so there'll be cuts. So how much extra tax would be needed to fund education - another couple of percent?

How about police - everyone wants more constables on the beat. How much does that cost. Another couple of percent?

And so it goes on. A percent or two to "fund" all the different departments and you're soon looking at another 10% or so overall. Do you really think the average Joe Public can afford that or will be willing to pay it?

You can't keep carving away out of the same economy. It'd crash the economy as less money in peoples' pockets means less spending, meaning business closures, meaning unemployment, meaning higher benefits bill, meaning even more tax from the fewer people working!

The real answer is to grow the economy, and that means inward investment, i.e. attracting international firms to locate in Britain, encouraging UK tourism, increased technological development, building new infrastructure, incentivising new factories, etc.

A smaller tax percentage of a bigger economy means more tax revenue. A larger tax percentage of a smaller economy means less tax revenue!

@Kazzyhoward - love this quote of yours - "The real answer is to grow the economy, and that means inward investment, i.e. attracting international firms to locate in Britain, encouraging UK tourism, increased technological development, building new infrastructure, incentivising new factories, etc."

BUT, with Brexit we have made it much harder to attract international firms (the visa process for their staff is expensive and complicated), same for encouraging UK tourism. So we've rather shot ourselves in the foot :(

Yep Brexit has shrunk the economy by 5%
www.itv.com/news/2022-06-09/brexit-cost-the-uk-billions-in-lost-trade-and-tax-revenues-research-finds

If joe public can't stomach the necessary taxes , they won't be able to stomach the cost of private /pay as you go either

Politicians need to be honest over costs

And that includes showing what % of nhs spending is front line vs management and what can/ can't be treated for a given tax level

And that includes showing what % of nhs spending is front line vs management

That would make interesting reading!

Politicians will never be "honest" though. That's the problem with our current political system. Only interested in the next few years and keeping an eye on the next GE. That's why they don't think "long term".

Also, Blair wasn't "honest" when he increased NIC by 1% to "save the NHS" - it didn't and couldn't. He really meant an extra percent as a sticking plaster until another percent was needed, rinse and repeat!

There is a tipping point when people think "sod it" when taxes rise too high.

What about all the other demands of public services, all of which are likewise underfunded? Are you happy to pay 30% basic income tax, or 30% VAT? That's the reality of "properly funding" all the public services! Yes, it's politically attractive to "kick" the rich, but that won't bring in the level of funds required simply due to the numbers game (i.e. hugely more "poor" people than "rich") and as we know, the "rich" are mobile and can easily bugger off abroad to pay tax somewhere else with lower rates!

Not really, as in "big" numbers terms, the management cost would be minimal.

It'd need to be broken down into the wages bill split between front line v management which would be more useful.

Total spending includes billions spent on things like chemotherapy drugs costing a thousand pounds per tablet, or MRI scanners costing hundreds of thousands, or a new hospital wing costing millions. That forms the bulk of the budget and no one disputes that kind of spending.

But management wages as a proportion of total budget would be less than 1% so basically trivial. Whereas if it were a percentage of the total wages bill, it would probably be quite frightening!

As usual, it's not the raw numbers, it's how they are presented. The old adage, of lies, damn lies and statistics!

I would pay more tax
I would expect tax rates to be easier on the lower incomes
I would expect that no one on a standard salary should need to claim benefits

It could be done IF we had a more equal society - as it is we have the super rich avoiding contributing and too many very poor people who can't ( and don't legally) contribute much taxes

Also, Blair wasn't "honest" when he increased NIC by 1% to "save the NHS" - it didn't and couldn't. He really meant an extra percent as a sticking plaster until another percent was needed, rinse and repeat

Thats not really fair and also goes against your point of trying to take politics out of the NHS debate!
Blair raised taxes but the economy also grew under Blair quite substantially, around 3.7% p.a until 2008 & a GFC was hardly his fault.

So he did what your suggesting but because it was under Labour, it gets criticised :(

Austerity, whether you think it was necessary or not, saw little GDP growth and NHS spending slashed.

What we see now in the NHS is a direct result of Austerity and Brexit, too many EU workers esp in care left the UK.

I do not think the NHS will "have to" be privatised but I think the Tories have a hidden agenda to do so, despite what they say.

And yes I'd pay more tax. Every time I hear Liz Truss bang on about tax I think of all the things she is planning to drop as a result of the tax she won't be collecting.

It does happen unfortunately. My neurotic SIL (on benefits) has managed to get the following:

• her child an ECG when he merely had indigestion, nothing found


• both children on inhalers despite no asthma, they never carry them


• dozens upon dozens of medications prescribed for her own use and never taken a single one, they just stay in the cupboard unopened


• repeated demands for blood tests, scans, consultants, 2nd opinions, MRI, ECG, Cat, god knows what else - will not accept a single diagnosis given by any specialist. Just demands more tests.

So what happens in cases like this?

@Discovereads

"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: "

+++

The current system of managing demand through queuing means that demand is lowered by people who are time poor and cannot wait 9 hours at A&E or two weeks for a GP appointment. The check at the local GP for a potential cancer check is ignored by the patient who doesn't have time, the broken toe or finger is simply strapped up with micropore by the injured teenager that doesn't want to wait 9 hours etc etc.

We have simply swapped rationing of healthcare by ability to pay to rationing of health care by ability to wait.