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.

Discovereads
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.

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My GP friend describes her role as assessing in 5 to 7 minutes which patient potentially has a serious symptom that needs a proper investigation and which patient has a short term condition that will get better by itself in a couple of weeks with no need for medication/ intervention.

Oh and praying that she gets it right.

I think the NHS should do much less, but do it well. This will mean that the poor get worse health care than those who can afford to pay. I do care about that, I really do, but at the moment, people are not getting even basic care at all, which I think is worse. And I cannot see that people will pay more taxes. They will not vote for a party that owns up to that. I know that people wont admit to this, but when was labour last in power?
Then its a case of deciding what not to fund. IVF, breast reconstruction, wigs, dentistry for adults, ear syringing, basic chiropody, growth hormone deficiencies, etc etc. Not a decision I would ever want to make. The inarticulate/poor/elderly cannot even access GP appointments right now and we are failing more or less every guideline from ambulance waits to cancer pathways - just everything really. It is not a time I would want to get ill in the country.

Your SIL sounds like she has health anxiety, a mental illness for which she should receive treatment.

That’s not abuse unless you are saying that every patient knows as much as a medical doctor and so knows in advance if their condition is serious or will get better on its own?

That is true, but you are going against your own philosophy are you not? You think paying a fee reduces time wasters, so would not having to wait also reduce time wasters? If time wasters/abusers were the problem….I don’t think they are.

And again, this is rationing caused by lack of proper funding, which has then caused lack of sufficient NHS staff, hence wait lists and queues.

Privatisation isn’t going to solve the underfunding problem. Making people wait or pay are both unsatisfactory ways to ration care.

The problem with that is that its a sliding slope. The first to be axed for 'poor people' would be access to mental health services. It may just be me but basically everyone i know who doesn't have a full time job has some sort of mental health issue. We already have an acute mental health crisis; not funding it at all would make things worse and possibly it would mean that the people who don't get treatment are on benefits for life (which would cost more in the long run). I still have some hope that my mentally ill friend would be able to rebuild her life some day and even hold down a job (I know she is capable as she worked from age 22 to age 43); and thankfully she is getting nhs treatment for her mania/bipolar disorder/depression etc etc and not paying a penny for it.

I do support a social insurance system but this has always come with the caveat that unemployed people would have full access to all healthcare they need and the government would pay the premiums. Having a narrower scope for state funded healthcare would just mean poorer health for the general population.

Then its a case of deciding what not to fund. IVF, breast +reconstruction, wigs, dentistry for adults*

Most people struggle with dental costs.

But what does your tax system look like?

I don’t have access to the Treasury model, but NI is just a form of income tax, so why not simplify the system and just add it to income tax - and it should be payable on all forms of income, then for instance, wealthy pensioners would pay it on income over the tax free allowance. I know pensioners, who are better off, than they were when they were working.

I wouldn’t call the likes of Starbucks and the other multinationals “the average Joe”. They should pay corporation tax on all income arising in the UK (less legitimate allowable expenses), instead they use intellectual property to transfer profits to tax jurisdictions with lower tax rates.

This thread is about privatising the NHS, which is what I addressed; it is not asking how to cure all the ills of the British economy.

For the record, I don't believe IVF should be funded after the first cycle. I also don't think there should be anything other than palliative care for anyone aged over 80 with a serious condition. In all honesty, we need to get to grips with the reality that dementia is a catastrophic wave of caring needs for people who have looked after their health until they were engulfed by time. My DMIL at 94 is one: she hates the life she has now, and she has nothing left to look forward to. But she is in an excellent care home. I can't fault the care, it's just that she would prefer her daughter to have the £4,500 per month it's costing to keep her, to buy a home her daughter can retire into. Her daughter is 58, and a care worker.

DMIL has the luxury of a civil service spousal pension, and is a widow, plus she has her own state pension after a life of work. She has done everything right, by the book.. It really isn't a character fault to develop dementia at 87, and to live to 94, but it is very very expensive.

@Discovereads

"That is true, but you are going against your own philosophy are you not? You think paying a fee reduces time wasters, so would not having to wait also reduce time wasters? If time wasters/abusers were the problem….I don’t think they are.

And again, this is rationing caused by lack of proper funding, which has then caused lack of sufficient NHS staff, hence wait lists and queues.

Privatisation isn’t going to solve the underfunding problem. Making people wait or pay are both unsatisfactory ways to ration care."

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What I am saying is that when a product or service is free then people will always take more of it than they actually need whether that be free carrier bags before the 5p charge, or a handful of McDonalds napkins when you only need two or health services.

I don't think there are knowingly time wasters or abusers who go out to deliberately abuse the NHS. but I do think that there are people with very mild conditions that would not visit a doctor if there was a fee or would wait until it was more necessary.

Equally there are people who want to or feel a need to have a condition diagnosed and will repeatedly go to the doctors until they have this validated.

Whilst there is currently no constraint on demand for health services other than queuing and wait times then demand will always be high with those that are able to queue / wait. Increasing NHS funding to increase supply of health services and reduce wait times will simply be met by an increase in demand .

A small fee such as with supermarket carrier bags or even McDonalds napkins would make people reflect and consider more seriously whether they need a doctor's appointment/ hospital visit rather than "hey I'll just pop along to the doctor's anyway to get it checked seeing as it's free"

Privatisation will siphon more money out of the NHS and put it in the hands of mainly American investors.

Rishi and Boris' mates will pick over the profitable bits and the NHS will pick up the training and development of staff (that's going well) and the less profitable bits.

Meanwhile we're around 62,000 medical staff short, care workers are in short supply (and mainly private) and there's not enough staff to train and mentor any newbies.

GP practices are being privatised and consolidated, breast, MRI and CT scanners are rented out from private firms and plunked in supermarket, health centre and hospital car parks and care workers are paid pittances.

Privatisation isn't working for the patients.

I've even got private dental insurance and I can't get a dentist visit - there simply aren't enough dentists, let alone physiotherapists, specialist nurses, ANPs, SALTs, OPs and doctors and nurses.

@Discovereads She refuses all mental health investigation. Dr's have suggested it. She absolutely refutes she has any health anxiety.

Rationing services works, ruthlessly. If it isn't urgent or painful, it's probably not serious. Regardless, until you are prepared to do what's needed to qualify and to prove it, then your fears are unproved. It sounds brutal, I know, but if you or your family don't insist on investigation, then who is supposed to go there for you? HCPs are too busy.

Not read full thread.

This is why the government are choking it to death.

I am seeing this debate from both sides. My DMIL is 94 and living in a care home with dementia, but with the funds to pay 4,500 per month from the proceeds of selling her home, and my SIL is a 58-y-o carer who is depending on some inheritance to put a roof over her head in her old age. I honestly struggle to know what is right or just in this situation.

Your SIL's ability to afford her home is also subject to the laws of supply and demand. if there was a way for families to make a decision regarding their ailing parents which is also in line with the wishes of the parents and will allow the heirs to keep more of their inheritance, you can bet that a lot of families would choose this option and many of them would be richer than your DMIL. Ceteris paribus, your SIL's inheritance may not be sufficient to cover the shortfall in her income and she would be back to square one. DH and I saved 70k by living with family in London but it isn't such a huge advantage as many people our age were also doing the same/getting gifts from family. We ended up with an average flat in London which is ok, but if we had saved 10k less (which is not inconceivable), we would probably not have been able to get anything....Ultimately, your SIL's ability to afford to buy her own place is not only subject to mortgage and lending conditions (much harder at her age), but also relative to the other buyers on the market (most of whom would be younger and have higher income, which may even outweigh a smaller deposit). At least by paying the nursing home, you know your DMIL is getting excellent care. Using that money to buy your SIL a home, well we aren't even sure if that is enough!

Paying for social care is only possible through the sale of her home. Would be very different if she was still at home and having to pay for medical care.

Who are these people "popping" to the doctor?! Round here, it takes 45 min on hold to get a GP appointment and last time we went to minor injuries, the wait was 5 hours. I've been trying to get my DD seen by a paediatrician since Jan 2020.

I think the major problem with any kind of charging is that patients would start to expect higher quality in terms of what marketing people call "the product surround" e.g. phone calls answered promptly and politely, online booking available, possible to change appointments, appointments running on time, clean, tidy and moderately comfortable waiting room...the NHS is not going to be able to do this consistently!

Would privatising the NHS suddenly attract people into nursing though? People are living longer and thus there are inevitably more ailments to deal with. There are things that we can all do to take responsibility for in terms of our health too. Some things are sadly unavoidable but we can all do our bit to minimise the impact on the health service such as trying to stay physically fit and reducing impact on A&E services.

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

Its not the same consultation though is it? Privately a consultant can offer what they think you need or would be of most benefit. On the NHS they are increasingly restricted in what can be offered. The disparity is already significant and its a rationing of healthcare which goes under most radars because everyone assumes they are being offered the best possible, not the best that the CCG will pay for.

This is a really important point. Care that is free at the point of access is only free for the time rich. So the sharp elbowed who can navigate the system may fight their way in.

The self employed, the zero hours contract staff and those with no free help for family care don't go to doctors appointments let alone hospital appointments with the hours of waiting because they can't afford to pay out a day's income for the privilege (and of course on zero hours you risk losing future work).

These people are already "paying" hard money for medical care. We just pretend its free and maintain a veneer of smug complacency and sneer at the Americans.

There is no evidence that the European systems deter people with low incomes from accessing health care. Any HCP will tell you of appointments cancelled or missed because people can't afford time away from work or don't have help to access an appointment.They are producing better overall outcomes and these days, better outcomes for spending.

I don't think that introducing charges for certain aspects of the NHS is in of itself the end of all that we know but I think that the suspicion with the Tories is that it would just be a first step in offloading it onto private companies and then washing their hands of it. It was not their idea in the first place and whilst I do know that there are Tory voters who do support a national health service, the right wing libertarian element of the Tory party have a strong influence and definitely want it gone. They have no interest in public services.

YABU OP

It would be atrocious to have a model like in the US, where a simple blood test costs hundreds of dollars.

Also, private doesn't always mean better. In a private consultation in the UK, you can usually choose which consultant you want to see, which is good. But if you are having any procedure beyond the consultation, you will be faced with private clinics, where supporting staff is not always proficient or sufficiently trained (as they unsurprisingly cut costs and corners too).

Private clinics are a business and they are there to make money. This shouldn't come as a surprise to anyone.

The self employed, the zero hours contract staff and those with no free help for family care don't go to doctors appointments let alone hospital appointments with the hours of waiting because they can't afford to pay out a day's income for the privilege (and of course on zero hours you risk losing future work)

Thats down to employment regulation, not the NHS.

Who waits hours after their appointment time? is that common?

I can only speak to the 3 NHS trusts i ve been using (or rather my FiL) and appointment times are usually fairly reliable, i did once have a Fracture clinic appointment which was the worst but even then 45mins to 60mins max wait.

We did have a very long delay once because they decided my FiL needed a further scan and he was offered one 4 hours later or could return but the original scan time was accurate.