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.

@AlaskaThunderfuckHiiiiiiiii there are not enough houses - housing costs are too high - too much money is tied up in property - that money could be freed up to invest in newer technologies.

@EcoEcoIA empty properties and second homes should be utilised first

Not privatised, but they should start charging.

The bulge in boomers impacted society right from when they came of age, from policy around education and jobs, to housing, regulation, and healthcare. This issue stems from Gen X expecting the same as what the boomers has, and to some points they got it, however partway through that generation the drawbridge started to be pulled up as it wasn’t sustainable. Policy’s still focus on boomers and older gen x with the future bring constantly mortgaged form millennials and gen z to pay back. It’s only not sustainable as we operate on a buy now pay later system of tax.

Absolutely agree

So rationing through ability to pay.

it's a nuanced and difficult issue; but privatisation can sometimes make things better. My understanding is that telecoms before privatisation had very poor service- with long delays for phone installation.

www.ft.com/content/48a6cb1c-0a38-11ea-bb52-34c8d9dc6d84

Sometimes competition does drive improvements in customer satisfaction and effectiveness/ productivity. Sometimes its not as effective (I don't think water privatisation has been effective, there is no choice in who supplies your water, in the same was as you can choose between BT/ Virgin/ Sky for a phoneline or broadband)

Health is different to Broadband, but what we have now isn't working; and hasn't for a long time. The NHS receives more funding than ever before; and countless restructures; and everything seems to get worse. Most people I know have enormous (rightly) respect for NHS clinical staff, but also have at least one horror story of themselves or a loved one receiving poor or sub-optimal care.

As previous posters have suggested; an aging population that lives longer post retirement (which is fab) but which has increasing complex, multiple (and expensive) health needs adds to the challenges. Upcoming health problems with lifestyle factors such as type 2 diabetes is also an issue.

It feels challenging to have conversations about how we best care for our older population. Social care is even more broken than the NHS. There is a significant challenge with how we resource and pay for dignified appropriate health and social care for people. It is an emotive issue. Older people (rightly) feel that they have paid into an insurance based system that will provide what they need when they need it. That's sadly not the case though. There is no giant investment fund to pay for the care that people need now. It's being paid for from general taxes. We need to find better ways of doing things for the future. Otherwise; people paying into the system now in their 20's, 30's and 40's have no hope of being able to access healthcare that will even meet their most basic expectations

But more people requires more spending on infrastructure, services, etc., and ultimately they, too, will require healthcare and pensions in old age. It's just continuing a pyramid/ponzi scheme. If we had, say, another million immigrants this year, then in a few decades time, we'd have probably three quarters of a million people in retirement, being paid state pensions, requiring expensive NHS or care services, etc, so you'd need even more immigrants to provide their care and pay for it! It's never ending.

@AlaskaThunderfuckHiiiiiiiii Once mass house building starts and people are sure that we really mean business then house prices will fall - the empty properties and second homes will be sold in a rapidly devaluing housing market.

@Kazzyhoward No. We can control immigration to create a uniform age distribution. There will be an initial increase in population then it can level off.

It’s a bottomless pit that needs to be overhauled and then we can have a system that is accountable to the public, clinicians paid well and people cared for in
a timely way in clean orderly hospitals with rating systems and transparency.
The Australian model would work well here.

it's a nuanced and difficult issue; but privatisation can sometimes make things better.

Certainly our experiences with audiology for hearing aids was infinitely better done privately via Specsavers than by the NHS via the local hospital audiology dept which took several months and multiple appointments whereas your're in and out in one appointment with Specsavers and get exactly the same hearing aids, without charge!

Likewise when my father needed cataract surgery, the NHS were a nightmare with cancelled appointments, every step taking months, general misadministration (turning up and the eye surgeon not knowing which eye to do first because notes were missing, so spending ages trying to phone other departments to find the notes etc). When my Mother had hers done, it was with a private firm doing it on the NHS, just a couple of weeks between optician referral and first consultation, then a couple of weeks before surgery, no cancellations, no delays, no lost records, etc.

Privatisation isn't all about posh rooms, better coffee, etc. It's just generally a lot more efficient and less stressful as things get done and there's less of the "can't be arsed" and "you're getting it free so put up with the crap" kind of attitude from some NHS staff!

Mass house building will never happen

The question I always ask when people say "we" can't afford it, especially with an ageing population, is who exactly is going to be paying for it?

The costs aren't going to go away - if anything, with a privatised service, they'll go up as they would need to include a profit margin.

So if the costs are still there, it just means that we, the general public, will have to pay for it out of savings, if we have them, or go bankrupt or not be treated if we don't (iirc, the biggest cause of bankruptcy in the US is health care costs )

And as for old people......

That only works if numbers of "oldies" would otherwise fall without immigration. All the statistics/forecasts I've seen for the UK suggest no significant fall in the old age population!

@Kazzyhoward and when they come to pension age state pension will be means tested, and at the same level as universal credit.

@Kazzyhoward How do we fund it though? I believe in the 60s there were 5 workers to 1 pensioner whereas its projected to be 2:1 at some point.
Also you need young people for innovation & progression.

If we open the doors to immigration, are the immigrants going to be happy to pay higher taxes/nic as that's also necessary to pay for the ageing demographic. Wages is only one side of the coin. To attract the right calibre of immigrant (i.e. qualified and experience in the professions/trades needed) we need their complete package (i.e. pay, less tax/nic, less housing/utilities costs) to be attractive. No use offering wage rises to incentivise them to come and then having tax/nic at higher rates then their home countries!

A system that allowed top ups and charging for premium appointments or services would be a good place to start. If we say said it's £20 to see the GP before 10am or after 5pm those who work would pay it to save a days annual leave and the elderly could have the middle of the day appointments. Bringing in cash for the NHS but not costing any extra for the poor.

For anything other than time critical surgery you could have two waiting lists with one costing X to join and one being free but slower.

I'm currently paying a private physio that makes a profit as the NHS wait time was to long and the appointments were assigned not booked. I would happily pay that money to the NHS if they offered the same service so the profit could be reinvested.

Interestingly our dentist has just started offering a premium plan to NHS patients

Yes I do agree we will struggle to attract them as they will have the power as lots of countries will want/need them

@Kazzyhoward we can reach a steady state where annually
deaths = births + immigrantion.

If the government was serious about attracting skilled and experienced migrants it would stop propping up the high house prices. House prices and high rents make Britain less attractive. Paying a bit more tax for healthcare is a drop in the ocean next to current housing costs.

pretty I think you expect everyone to be poor, old and broken - we have millions of pensioners that are millionaires and yet use the NHS three times a week, expensive joint replacements etc etc. We have many tens of millions that CAN afford to pay.

minus emmigration

Lots of these already go private. Although anyone using the NHS three times a week will be so ill they probably can not afford to go private. They will already be paying high social care costs which quickly drains your money away.

Well, for a start a 2:1 ratio simply wouldn't work as the tax would be so high the worker wouldn't be able to afford to live! So increasing tax/nic on the workers won't pay for it!

So, the pensioners have to fund themselves more, i.e. pay more tax, as they've largely escaped all the recent NIC increases (both Labour and Tories have raised NIC which pensioners don't pay). Means tested basic state pension, so those with other pensions or savings or second/casual jobs don't get state pension. Maybe end the tax free lump sums from occupational pensions upon retirement. Deduct NIC from pensions. Reduce tax reliefs and increase rates of tax on capital gains.

Basically look at how pensioners fund themselves and their lifestyle and start to tax those sources of incomes/gains rather than the usual "go to" easy option of ever increasing taxes etc on workers.