What are your thoughts on privatising the NHS? Good or bad?

[Supernova23]

I would also love some input from those who have lived in countries that have private healthcare systems. Is it better or worse in your country?

For context, I love the prinicple of the NHS. I’m an NHS nurse. I also like a massive chunk of NHS nurses and doctors, think of looking for a way out on a daily basis. The lure of going abroad tempts me daily.

But as we know, we live on a tiny over populated island. People are living longer and getting sicker. People also abuse the system on a daily basis. I’ve been kicked, hit, spat at, called every name under the sun. I’ve been threatened numerous times. Me and my colleagues have been threatened by a maniac with a machete.

We are haemorrhaging staff on a daily basis. People either leave or go off long term sick. I can’t blame them.

Patients are becoming more medically complex with multiple co morbidities. In the nicest possible way, advances in medicine has meant that people who would have kicked the bucket long ago, are now people kept alive due to modern medicine. People are also getting much, much larger; this makes them more complex to manage in every sense. Even with basic bog standard care. We frequently have patients so large it takes at least 4 people reposition them. You try finding 4 spare hands on the wards; it’s a nightmare.

In my hospital alone, every single ward has multiple complex long stay patients that have been on the wards for 6+ months. In some cases it’s a year or more. The cost of these stays often runs into the hundreds of thousands, perhaps even millions, and is obviously reducing the number of patients we can admit.

I could ramble on. The system has been at breaking point for years. Would privatising the NHS improve it? Or is that cloud cuckoo land?

Privatising means more patients go bankrupt. Fewer holidays and fun stuff because people paying for health care. Fewer gen z able to buy a house because grandparents spent their inheritance on private healthcare. Already people are pulling their own teeth out. People won't get treated so more sick.
An efficient NHS leads to better health. Privatising health care means also pay shareholders and company priorities are making money not best health

Yes but that’s because your ‘very busy private hospital’ exists alongside the NHS, which picks up the patients who can’t or won’t pay and all the drudge care and procedures that your employers don’t want to treat. You’re not fighting against bed-blocking older people or people coming to A and E because of dental problems etc. Privatise the whole NHS and those problems will get worse and be spread about.

Well said.
Thank you

I can't stand that statistic about per capita spending in dollars. A dollar is not equal in every country.

If you normalise dollars to GBP then you end up at about $7.5k per capita.
Then consider that staff in the US are paid much more than in the UK (av. UK Nurse £37k / av. US Nurse $89k).
Add to that the fact that the care is better and a hell of a lot quicker, and you start to see where the money goes

Clearly the UK needs to spend more. However, in reaching the 8% or 9% estimate, UK calculations do not account for the wasted time of the patient and concomitant expenses borne by the patient due to inefficiency. Let me give you two recent examples:

Mother: sent an operation date at a London Hospital - it was cancelled at 36 hiurs notice - they live 80 miles away. Her's and steps train tickets were £57 and they had to book an hotel for the night before and for step on the day of the op. One night could not be cancelled at £99. Add to that about three hours of my time making and cancelling bookings and sorting out some associated appointments for her (hourly rate £50). That's £300 wasted notwithstanding the fact that my professional work has to be made up and the inconvenience for an hotel, left without a booking. All of that has a knock on economic effect.

Me: outpatient appointment for a chronic condition. The hospital changed this three times and sent a snotty letter after I had to rearrange the third appointment. My professional diary had to be managed too. The appointment was three months late due to the hospital messing about. The eventual.appointment was at 11.15. That means I have to be at the hospital by 10.15 to queue to park and I have to pay to do that because the queuing is after a ticket. Park at 10.45, arrive 20 minutes early. A notice to say clinic running 60 minutes late. There is no WiFi and I am not allowed to go to the coffee shop to keep on top of email. 60 minutes turns into 90 and I'm eventually seen at 1pm. I needed a scan which the consultant knew I'd need but hadn't made an appointment for it. I was fitted in at 2.30pm. Why couldn't a scan have been booked before my appointment?

So for 25 minutes of contact time including the scan, I spent about 90 minutes rearranging my diary because of changed appointments, booked a day of annual leave for the appointment to ease my stress (£value about £350), and spent five hours of my time to access 25 minutes of NHS time. It comes at a personal.cost in addition to tax, notwithstanding £12.50 to park in a poorly maintained car park.

Total cost of accessing the "free but not free services above was an additional and not accounted for £750.

The inefficiency and lack of respect for patient time is no longer sustainable. My rheumatology consultant is one of the best in the UK and does not do private work. Whilst they are great, I am seriously considering finding a private alternative.

There is simply no respect for the patient or their time.

You are 100% right, the number of excuses made and the complete unwillingness to take any responsibility for themselves and their health are legion.

You can't look at health care and individual responsibility without taking into account environmental health, public services, poverty and lack of affordable, decent housing.
If you have no kitchen, no fridge, no cooking facilities, how can you prepare healthy meals? You end up buying cheap fast food. This causes illness and obesity.
If you live in a cold, damp, mouldy flat ( like a huge number of council properties), how can you stay healthy?
How do you access services, keep appointments if you can't afford bus fares or if you live somewhere with little or no public transport?
There is so much that needs fixing.

My consultant did my referral for my annual treatment months ago. I organised the pre- treatment blood tests last week as instructed.
The treatment unit didn't book me in, so no appts till end of July. Now I have to repeat the blood tests again a week before.
So unnecessary, but typical NHS.

Two articles from the papers today have caught my interest, which speak to topics that are endlessly discussed on MN threads. Apologies that both are behind paywalls, but the BBC/R4 has mentioned the subjects so you may find more detail on their website.

One, reported in the Times, is about broadening prescribing parameters for the semaglutide/Ozempic/Wegovy weight loss drugs as more research is carried out on large numbers of individuals. It appears to help with a wide range of cardiac issues and alcoholism as well as weight loss. Miracle drug that should be more widely used? Or a license for Big Pharma to print money? Denmark's economic growth in the last two years is almost entirely the result of the explosion in semaglutide use.

Second story, from the FT, is about longevity statistics (from a new book The Longevity Imperative by Andrew Scott of the London Business School) which covers the doubling of UK life expectancy since the Industrial Revolution. It has been caused by a collapse in infant mortality: in 1841, 35% of UK male births died before their 20th birthday and 77% failed to reach their 70th. In 1910, death before reaching the first birthday was over 120 per 1,000 births. In 1965, the most common age of death was still during the first 12 months of life; now it's 87. By 2020, these figures were 0.7% and 21%.

Cleaner sanitary conditions, vaccinations and antibiotics started the trend but since the 1960s and 1970s the remarkable advances in neo-natal care will be a contributing factor, and also probably goes some way to answering the question about why special needs have increased so sharply in the last few decades.
Edited to correct SPAG.

Oh yes, that will be why so many Europeans are bankrupted by health bills. Oh no - the other thing - they are generally getting not just more timely care but better care and care for a great many conditions not covered by the NHS.

Honestly as a lifelong voter and continuing supporter for state backed health care the elevation of the NHS to a national religion its its biggest handicap.
Its shockingly dysfunctional, a terrible employer, generates enormous supplementary cost to the economy and yet people insist its the "best in the world" or that "just more money" is needed. The model simply doesn't work for modern health needs. It was resistant to change even when money was pouring in - money which could have modernised services was wasted in huge degree. Both the staff and patients deserve much better.

So the stories of US citizens being bankrupt because of their medical bills or doing a Dr Pimple popper are pie in the sky then? Which particular state models are you thinking of?

In what way does animal insurance differ from human insurance? It's the same mechanism driven by economics.

Would everyone please stop citing the US system. The rest of Europe has an insurance based system. It works very well.

That is usually because the shop won't sell you more than one small pack of paracetamol at a time.

It always the US system that is cited in order to ratchet up the scaremongering, the fact that countries in Europe do not have the NHS model but have far, far better healthcare systems is always ignored.

As a pp said nowhere else in the world has copied the NHS model, nowhere. Yet it is clung to by some as the absolute pinnacle of healthcare which it absolutely is not.

35 years ago I would have died. I had severe graves disease affecting my hear. I had been to the GP three times and three times was fobbed off. When my lower legs swelled like balloons I made a private GP appointment with my company's occupational health doctor. I was diagnosed within 24 hours.

The problems are not new and that experience tells me everything I need to know.

Don't start me on the topic of 56 day prescribing and wasted time that ensues from that.

I think we need to reevaluate working conditions in the NHS. 12 hour plus ( can become 14 ) shifts are dreadful. Add on commute etc. Years ago there use to be 3 shifts in a day. Hours slightly different in different regions. This made child care arrangement easier. Many mums with young children opted for night shifts so DC were looked after especially if the DC were poorly.
Too many NHS Consultants do private work when they could be seeing NHS patients quicker. Consultants should do a full working week in the NHS. They could be mentoring newly qualified Doctors and Residents better and sharing the load.

Staff should be treated with respect by the Trust. patients and the general public.
People in general seem to be more impatient and aggressive. We see this in the attitude to NHS staff and in retail.
Many sem to think that appointments etc should be at their convenience rather than on priority need. Appointments often run late as there are emergencies or a patient presents with more complex needs that first envisaged or they have to be told of devastating results. All of which has to be dealt with in a professional and empathetic manner. This can't be helped. No needs to be rude to the staff. Patients need to be aware this can happen and make contingency plans.
Missed appointments cost a lot of money. Sometimes there are unforseen problems that may mean you can't make an appointment. However, it should be easier for people to cancel an appointment or ask to rearrange an appointment.
People need to have more basic medical knowledge and first aid skills. Not everything needs to be seen by a doctor.
I really hope we keep our NHS and treat its workers better.

In principle I’m totally against it.

However an ex colleague who had really bad cataracts, was sent very promptly via the NHS to a specialist private clinic (no way could he have paid) where they were dealt with very quickly and efficiently, just a month apart.

Presumably cataracts are routinely outsourced now, but in any case, since his eyesight was by then so bad (fearing he was going blind he’d daftly neglected to do anything for so long) it was certainly better than possibly having to wait for ever on the NHS.

I'm not really sure what your point is? The UK isn't Australia? Do you think that's the only other model?

I get my NHS hearing aids from Specsavers - a private company contracted to provide NHS services.

My mother had her cataracts done by Spa Medical - a private company contracted to provide NHS services.

When my son was young, he got NHS glasses from a local private independent optician - a private company contracted to provide NHS services.

All these companies provided excellent service - far superior to the NHS "put up and shut up" attitude. Not posh tea/coffee/biscuits or reclining leather chair style of luxury, but at least they got the basics right, such as you being able to phone up and easily speak to someone to make/change appointments, the appointments running roughly to time, none of this turning up to find the appointment has been cancelled and then not bothering to even try to tell you beforehand, and easy to contact afterwards for advice, follow up appointments, etc. Basic customer service skills - something the NHS can't be bothered to provide with their "it's free so put up with crap" attitude!

It's useful to remember that when th NHS was started, there was a more limited idea of what counted as necessary health care. To some extent this was because what medicine could do was more limited.

But also, the whole concept of what health means has been expanded along side of the idea of total cradle to grave care, and I also think that people are in some ways much more entitled, much more inclined to believe they should just be able to pop a pill and live as they like and society owes them care - but they don't owe it to society to care for themselves.

I live now in Canada, which incidentally has a very similar model to the NHS, and also almost identical problems. Something I saw near me during the pandemic, and coming out of it because healthcare has been much less available - knowing they might not get into a doctor, or might need to wait a long ER wait, people seem more inclined to think twice about doing careless or risky things. I am not suggesting this as a good approach, but it's an observation that people's choices may be influenced by the sense there is a quick fix they don't have to pay for.

Exactly my point. Before Specsavers got the NHS contract for our city, I suffered the local hospital's audiology department. It was nearly a year between originally seeing my GP and finally getting the hearing aids. First, they lost the GP referral letter, which I only discovered after chasing them for the first few months and constantly being told "there's a backlog" because the person answering the phone couldn't be bothered to check on their system that I was even on the system - just a lazy default answer of "there's a backlog, you'll have to wait". I had to insist they check their system and that's when they finally saw I wasn't on it. Then after having to have another GP appointment so he could do another referral, I phoned to check I was at least on their system. Then I phoned every few weeks to chase an appointment. Finally got an appointment 3 months later, which was an appointment with an audiologist who just basically looked in my ears (which GP had already done), and said they'd arrange a hearing test, which again, took several weeks, in a different town, which was then cancelled but they didn't tell me so I turned up only to be turned away, and waited another few weeks for another test date. Then once it was done, back to audiology in the first hospital to speak to another audiologist who told me I needed hearing aids (no shit Sherlock) and they'd make an appointment with someone else to issue them, so another few weeks of a wait. I think it was eventually 8 or 9 different appointments in different places with different people until I finally got the hearing aids fitted and adjusted a couple of times, spanning a year.

When I now go to Specsavers, they do all that in one appointment, usually within a week or two of me contacting them, an appointment at a time of my choice, including weekends, with easy ability to make a follow up appointment afterwards if I think I need them adjusting. The difference is amazing. What's even better is that usually there's no need for adjustments because they get it right the first time, something the NHS audiologists never managed to do - with the NHS they gave them to me without "tweaking" at all and then I had to go back a few times as they made minor tweaks - Specsavers just did it from the outset and tailored the settings to my hearing test meaning usually no need to go back.

I think the NHS are their own worst enemy, especially the shambolic admin around appointments etc.

Oh come on @Gingerbee this is just more excuses for bad practice:

Many sem to think that appointments etc should be at their convenience rather than on priority need. Appointments often run late as there are emergencies or a patient presents with more complex needs that first envisaged or they have to be told of devastating results. All of which has to be dealt with in a professional and empathetic manner. This can't be helped. No needs to be rude to the staff. Patients need to be aware this can happen and make contingency plans.

Missed appointments cost a lot of money. Sometimes there are unforseen problems that may mean you can't make an appointment. However, it should be easier for people to cancel an appointment or ask to rearrange an appointment.

I have already detailed how my relative could not cancel an appointment for her husband which was just pure idiocy.

Yes put it all on the patient to make contingency plans rather than have the service manage their time more efficiently. How about the service make contingency plans for the above? How about some respect for the patients? How about not expecting them to wait hours and hours for an appointment they have turned up on time for?

I hear everything you say but where I live, it's invariably NHS staff who are spectacularly rude to patients for little or no apparent reason.

I hope you would agree that courtesy works two ways. Also if an appointment is provided for say 10.30, don't you think it would be helpful for Trusts to explain on the letter that there may be delays and people need to allow for this.

For the most part the NHS and those in it appear to have forgotten that many people got to work and have to make arrangements in relation to their work if they are to be unavailable for extended and lengthy periods.

When I pay twice and engage medical services privately, my time is better respected. And yet, I also pay for the NHS (in spades actually) and my time is not respected and too often staff are not courteous or polite.

Canada is very close, except it is run by each province. That is down to geographical size though.

I think it's an interesting thing that the problems with the Canadian health system are almost identical. Right down to not being able to train and retain enough doctors. But also wait times, spotty care, and all the rest, it's pretty dire.

In my province the wait list to get a family doctor is over 150,000 people. Chances are you will never get the call. They keep trying to bridge the gap with walk-in clinics for urgent needs and online appointments, but of course that does not work. I work in a place that provides a room and computer for people doing these online meets, they wait for hours for a random doctor who probably will tell them to go to the clinic or ER.

Too many NHS Consultants do private work when they could be seeing NHS patients quicker. Consultants should do a full working week in the NHS

Just to come back to this - consultants need to offer the NHS 11PAs (44 billable hours - significantly more actual hours) before they can do private work.

The trust may or may not take them up on that (the funding for this extra work has to come from somewhere), but they do have to offer it. So if somebody is working less than full time and doing private work, it is because the trust has agreed to it.

I personally don’t do private work, I’m in a specialty where it is not common, so no axe to grind. But this trope of consultants sloping off early to get to the Nuffield and leaving their juniors to struggle unsupervised is not accurate, IME. Maybe in the 1980s, but not in the last 20 years.