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?

My point exactly. Very well said @Labraradabrador

My concern is that it will be like now, only 9% of the population pay for prescriptions, is that going to be the same for private?

And the reason it is so much quicker getting diagnostics done in a private system is that it becomes a profit driver for hospitals- when they are paid per use hospitals are incentivised to buy more machines and ensure staff are available to run them. Does it incentivise some waste in terms of over diagnosis? Absolutely! But on the other hand you don’t have cancer patients waiting months for critical scans, people don’t take as much time out of work because they can do everything they need in a single day, and the equipment is more likely to be cutting edge.

when proper counterbalances are in place, profit CAN be a force for better health outcomes.

But we have that with the NHS's "internal market" that we've had for the past 20 odd years. Where trusts "bid" for contracts, get paid per treatment/test, etc., and it's not worked, mostly because of lack of any real competition. In theory it should have "cured" the NHS, but because of lack of open market competition, it's just added more layers of bureaucracy and costs and we're left with arguments between trusts as to who is responsible for paying for treatments, one trust/provider not offering a service and sending patient back to a different trust/provider because they're not getting paid for, say, a specific test or prescription, etc. The fragmentation of the NHS is probably the biggest cause of it's current poor state and that was made worse by having different trusts competing for contracts but in a wholly artificial market controlled by civil servants. It's a bit like rail privatisation where you have so-called different train operating companies, but like the NHS, they're not free to operate as they wish and they remain hamstrung to the civil servants who control every aspect.

That's exactly my objection to when people suggest fines for missing appointments etc. It's only that same 9% who would end up paying. The exempt 91% wouldn't care as they'd continue to be exempt and would not suffer any consequence. As always, it's the workers who'd get screwed who are probably not the ones who are missing appointments!

Higher, progressive taxation, taxing of wealth, closing any tax loopholes etc.

"taxguru · Today 18:54

Pootle23 · Today 18:25

My concern is that it will be like now, only 9% of the population pay for prescriptions, is that going to be the same for private?
That's exactly my objection to when people suggest fines for missing appointments etc. It's only that same 9% who would end up paying. The exempt 91% wouldn't care as they'd continue to be exempt and would not suffer any consequence. As always, it's the workers who'd get screwed who are probably not the ones who are missing appointments!"

Well the exemptions would need to be got rid of! There's no sense in someone not being charged for missing appointments just because they're over 60. Or even because they're disabled (unless their disability means theyre unable to organise themselves to the point that they couldn't cancel an appointment) the only people who should be exempt are those who GENUINELY couldn't afford to pay, so very low incomes, those unable to organise their lives - maybe psychosis patients for example, and kids who have no income, the fine could be set at a low level, say £10 or £20 but they should absolutely be charged.

Right, so you want someone else to foot the bill.

You honestly think any government is going to touch that with a bargepole?

Probably not, but they should. Of all the toxic lies and crazy schemes of the inept, corrupt neo-Conservatives Brexit was possibly the worst. The harm will probably never be undone but it could be ameliorated for future generations. And that no government will touch the idea of rejoining with a bargepole is a sad testament to the stranglehold the toxic, right wing fat cats have over the media.

If that was aimed at me then no, not at all, I'm a taxpayer too! But I do think the very wealthy should be taxed more and the super rich corporations avoiding paying tax should not be permitted, why on earth should that be allowed? Amazon, anyone?

I find it intriguing how people here, including you, Labrador, are lauding the healthcare systems of European countries but are not so keen on their tax systems. I guess it's quite telling as you are an American. I'm from a European country BTW.

Yes I would absolutely support
moving to insurance schemes that are not for profit as they have in many parts of Europe

The healthcare is considerably better than ours and the outcomes are better

The NHS has long had its day and it’s time we stopped living in the past of how good it once was. It was great it hasn’t been for a long long time and we should expect a far better overall service

I would like to see a cross party committee to work on what is best for the publics healthcare and to work on the changes that have to be made together this would be best for the public but sadly I doubt this will happen and we shall continue to use loans to prop up the failing service (Labour) and more it the NHS being privatised (Conservative)

Run for profit...what could possibly go wrong?.
Water companies.
Energy companies.
Transport companies.
Anyone seen a running theme here.

I often wonder if some NHS services rely on missed appointments, to fit everyone in? More than once I've sat in GP waiting room for up to an hour after my appointment time, because they're behind schedule. I understand why. They only get 5-10 mins slots and lots of patients need longer, but I can't help thinking they need some missed appointments to get through all those who do show up.

Also I think a lot of people who don't show up without cancelling are in vulnerable circumstances, that affect their ability to show up. People going through a mental health crisis or DV or the homeless, or a confused elderly person.

I also wonder how many people simply can't get through to reschedule or cancel appointments? Phones unanswered, or receptionist not passing message on.

If there's a charge for missed appointments, would need to consider individual reasons why (and in my idealistic world, give them effective support for whatever issues they're dealing with). Also need to make sure it's easy for patients to get in contact in advance, to reschedule or cancel when they can't make it or no longer needs the appointment.

Lots of people pay tax, but a shocking minority are net contributors financially speaking. It is easy to pay in when you get more back. We have a productivity problem in the UK and jacking up the tax rate for high earners and corporations isn’t going to drive he revenue you seem to think it will, certainly not in the long run.

I actually quite like the US healthcare system, thank you very much. It is not perfect, but especially since AHA passed is actually a pretty good balance (in states that have accepted the Medicare extension anyways) of private and public interest. It also drives a lot of global innovation in pharmaceuticals and med tech, for which you are very welcome. I know it is considered an article of faith that everything American is bad, but a majority of Americans wouldn’t actually want to trade with the UK if given the choice, even those that advocate for a more socialised approach to healthcare.

How many missed appointments are down to bad admin?.
I got a letter on a Saturday ,I phoned on the Monday only to be told that I hadn't got in touch quick enough and they were sending out a second letter...they are closed Saturday and Sunday.🤔
.t

So we will have a situation where children of some of the parents on here on six figures will get free prescriptions while people on low incomes pay or are means tested.

I can see that being a vote winner 🙄

Yip let's turn the clock back to when people couldn't afford to get a doctor..fuck it let's go back to home remedies or a Spey wife.

Blimey. You've certainly made your position clear.

"So we will have a situation where children of some of the parents on here on six figures will get free prescriptions while people on low incomes pay or are means tested."

So fairly similar to the situation where retirees who own 6 properties and have 4 million in the bank get free prescriptions then, and a state pension, and cold weather payments and a bus pass. Except they have the ability to actually pay because they have their own money. Kids don't.

There is clearly a lot of sensible thinking power on this thread, including everyone whose views differ from mine. Why would we not use MN's collective voice, which is politically significant? What are we asking for? Accessible healthcare for our children and aged parents, and for ourselves so we can work to support our families, without having obstacles thrown in the way. I am equally certain that the vast majority of healthcare professionals would applaud this because they want something very similar. But it cannot end up being a we'll fund everything. Personally, I'd limit treatment for the over 80s to palliative only care, and probably (you're all going to hate me) be very sparing about treating very prem babies, just because they have so many health and SEN issues that will cost too much for too many years because while we can keep them alive, we still can't give them much quality of life. Of course their parents will move heaven and earth to keep them; we all would. Basically, we need to learn how to die again. None of us will live forever, and most would not want to. I do not want to end up having to talk to my grandchildren for the rest of my life, because no one else if left of my generation -- even when they are 40. They won't share my memories or remember mutual friends. But accepting that death is the inevitable end to life, and that taxes have to be paid in the meantime, three score years and ten (which is three years away for me) seems a reasonable objective. Anything more in good health is a bonus. (Putting my hard hat on!)

I wonder how many people advocating Private Insurance actually get help or fully funded as part of their salary benefits?

I don't know the full story and can't remember exactly what happened, but my SIL used to live in the US. One of her colleagues was made redundant. She found another job fairly quickly but before starting was diagnosed with a health issue. From what I understand from SIL lots of Americans rely on employers for their health insurance. Her ex colleague was told by the insurer at her new company she wouldn't be covered for her health condition because it was pre-existing. If she'd be diagnosed after starting the new job, she would've been covered. She ended up in a terrible financial mess. I've also heard from acquaintances in the US, of people going bankrupt and losing their homes to pay for treatment even if insured, because it's not included on the insurance for some reason. Maybe I'm not getting the full stories but it doesn't sound such a good system to me.

The system in some European countries is different, and if the UK was to change I think that might work but not the US one.

That's a very valid argument. I've had a letter come after an appointment.

Privatised health care scares me, especially if it is going to be like the US system.

I get your message @Againname , but what was diagnosed? Ingrowing toenails might get you excluded from podiatry claims, but it should not prevent a claim for maternity or cancer care.