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?

That isn’t the only two options. Another option is for he nhs to collect fees at point of service - charge a nominal feel for gp or hospital visits, charge extra for ‘premium’ time slots of appointments or for the ability to book ahead at a time convenient for you, better integrate private services within the nhs and offer hem more broadly, reduce the scope of what the nhs covers financially and ask patients (or their insurance) to pay for more. An insurance market is probably part of that, either in the sense it works today (you opt in to having insurance) or it could be a mandatory requirement as is he case in some other countries.

If it weren't for Europe's absurd rules on data protection, electronic medical records could have been in place and close to universal for 10 years plus. The technology existed 20 years ago. I visited the company's head offices, in North Carolina, as part of the research for a client's annual report. Everyone has an NHS number from birth or official entry to the country. So every test, scan and consult is simply logged to a patient's NHS number. While I'm sure it ain't as simple as I just suggested, it's hardly beyond the bounds of feasibility.

Tracker1234, there is one simple answer, people need to start taking care of their own health instead of having lousy lifestyle choices and then expecting the NHS to cure their obesity and substance misuse co morbidities.Th NHS was set up for ill people with poor social circumstances and resulting disease and could not afford healthcare, not those with the self induced problems of the modern world . God help them if NHS is privatised, there will be a lot of young deaths.

Exactly. I just can't fathom why the NHS can't offer "add ons" for a price.

Take hearing aids - under the NHS you get a basic one, no choice. Your alternative is to pay a couple of grand to a private hearing clinic who will be making a grand profit on that. Why can't the NHS offer a "better" alternative for a price, maybe £1500, so they get to keep the £500 profit and the patient saves £500?

Same with beds, why can't patients be offered a private room for £x rather than have room allocation random, with some NHS patients getting a private room and others being on a ward (I'm talking cases where no clinical "need" for a private room which is obviously a different story).

Why not free the NHS of the shackles of political dogma and allow it to "compete" with private providers to give a better service to paying patients and let it keep the profits for reinvestment etc. People with money are going private anyway, so the NHS is losing out.

Just compare it with NHS dentistry and opticians. Those who qualify for free/subsidised treatment/glasses have the option to "trade up" for a different coloured filling or a bridge instead of an extraction, or better frames for their kid's glasses, etc. Why can't that kind of thing be extended to other NHS services??

The real reason is that too many people are obsessed with political dogma and "equality" - they just hate the fact that some people can afford better, whether it's education, health, or whatever, so at the altar of "equality", they're pushing everyone into the same crap service, the race to the bottom, based solely on jealousy!

Logan’s Run then? Actually I can see that being a vision for some.

Do you really get better quality chemo or any other drugs?

I'm not convinced better quality is really a thing beyond the superficial nicer crutches.

It is no secret that many newly approved (and therefore pricey) drugs, especially when it comes to cancer are only available privately.

Disagree that opposition to this sort of system must be based on jealousy

Personally I find the idea of going to an NHS hospital and getting a better ‘service’ (nicer bed, more privacy, etc.) than someone else because I paid more just gross.

Allowing payment for non-essential product upgrades / add ons such as the hearing aid example – on the face of it, not so obviously bad

We accept a different level of service and quality determined by price in pretty much everything else (food, housing, clothing, transport), I am not sure I understand why healthcare should be any different.

Because we don't want a society with two tier health and two tier access to life, for some, who can't afford operations.

Also, small prices will be like prescription prices-a Trojan horse to open the door.

@Needanewname42 I'd put taxes up, if it were up to me. I'm not in a political party, so I can't help influence that. Especially, I'd put taxes up for the demonstrably well off, many of whom have had a very easy ride compared to others.

But we have a two tier health system now? There has been an explosion in private healthcare in our non-London area, with multiple private gps opening within past 3 years - about half of the families in dd class no longer even bother with their nhs gp anymore as have given it up as hopeless. There are gaps at the moment which mean we are still reliant on the nhs more than I would like, but in London those gaps are closing fast, and I expect other population centres will follow in time. When the middle class no longer relies on the nhs, expect commitment to funding even at current levels to erode

really the nhs has a choice of being an ever degrading bottom tier (destination of last resort) or find a way to work with, and on some levels compete with the private sector.

In which case you have no need to campaign for change. Anyway, we clearly disagree, ethically and otherwise.

But it needs to be a more indirect tax, or corporation tax, slapping more income tax on people isn't really fair.
Your getting to the stage where people are looking thinking why work full-time and pay £x amount of tax, where they can reduce hours and not have a a massively noticeable difference in their take home pay

I know someone who went for a £10k reduction in salary for a role closer to home. Less stress, less tax, less fuel, better quality of life, and not much difference in the figures at the end of the month.

Corporation tax has already just increased from 19% to 25%, so no scope there.

I'd say VAT would be a good one, both an increase in the rate and an expansion of the scope.

Also, leave NIC rates the same but extend it to ALL income sources, including pensions and stop it being "per employment" as currently you can have someone with two part time jobs not paying it, but someone with one job earning the same has to pay it!

So many ways of increasing the tax take, but it needs to be spread over a wider group of people, not just workers!

Probably bad because then we'll have to pay for poor care

Because healthcare is about prevention and alleviation of suffering and about valuing and protecting life. It’s based on need and survival – not an expression of who you are, a lifestyle choice, an indulgence or a status symbol.

One person in need of treatment is the same as the next person in need of treatment. People are offered treatment according to clinical criteria and that alone. It’s a central principle of the NHS and a good one.

@taxguru would it not be simpler to scrap NI and add that to general Income Tax.
It's seems like an extra layer of admin for the sake of it.

How about raising the higher rate of income tax and introducing another higher tier for super high earners?

Definitely agree with levying NIC on all income sources— that would be a great one.

Lower earners pay disproportionately more in VAT anyway, and that’s a tax on purchases so I don’t think that would be appropriate to use for the NHS.

Just like food and housing there is an underlying need that needs to be met, and should be met for all people. There’s also a great deal that is discretionary - some people place greater monetary value on time, or convenience, some want choice in where they receive treatment or by which doctor, there are extras like physio or occupational therapy that some might want more of. There are loads of treatments that NICE has deemed poor value for money at the state level, but for which individuals might really value and be willing to pay.

You can't keep whacking high earners for tax. People will either refuse to take the step up into the super high earning roles or they'll work part-time.

Zero point in taking a step up, more stress, more hours, for not much more money in the people.

They'll also be people who decide to leave the country in pursuit of lower tax.

@Labraradabrador again all revolves around ability to pay. Let’s guess you are a higher earner ? Much like wealthy folk flash their cars as status symbols, they’ll be able to bang on about their superior care. The NHS just isn’t able to offer spare single rooms for people with cash to flash. Most of the rooms are used to accommodate patients with infectious diseases like MRSA and VRE. Unless of course there’s loads of investment. Actually what happened to those 40 new hospitals we were promised ?

@Needanewname42 but there are loads of loopholes for higher earners to avoid paying the full amount of tax. Don’t they pay less tax relatively to someone on an average or low wage ?

"The NHS is chronically short of money because a callous, tight-fisted Tory government won’t pay it what it needs. In fact, it is so short of money that, as we found out this morning, it can only afford to pay a mere £400 each to obese men in order to persuade them to lose weight (although in a trial they only succeeded in losing enough money to bag an average of £128 each of the possible prize money). The NHS considers this good value because it spends an average of £979 to £1375 per year caring for severely overweight people, compared with £638 a year looking after someone of ordinary size."

Well go ahead and do that then, privately. The option is open to you.

(It’s quite easy to find a physiotherapist or OH practitioner directly. If you want the NHS to make a profit from selling these services, presumably you’ll be expecting to pay the same or more?)

With regards to choice about where you receive treatment, there is some patient choice with regard to referrals. However it is absolutely not a case of slipping your GP some extra money…

And this is also quite different to getting a cushier bed or nicer treatment in an NHS hospital because you have the means to pay (i.e. the paying for a private room suggestion).

The central principle of the NHS is that treatment is based on clinical need alone and not an individual’s ability to pay.

And likewise that the same treatment is available to all irrespective of gender, race, disability, maternity status, marital status, caring responsibilities, and so on. Each of which at a population level have a statistically significant impact on disposable income and wealth.