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?

I am all in favour of the European partial privatisation model - we cannot go on like this. If I didn’t have private health insurance for our family I simply wouldn’t feel comfortable anymore. It has become an essential expense for many people

Teen DD has been unfortunate enough to end up in an NHS hospital a few times over the past year or two and each time she has felt incredibly unsafe, frankly the treatment that she received (or to be frank didn’t receive) was disgraceful. The lack of staff is causing a dangerous lack of care and attention

I’ve lived in countries that are in a partial privatised country. I paid health insurance through taxation each month because I had the no frills state insurance.
So when I had a baby, the only cost I had was about 30 euros for antenatal blood tests. I stayed in hospital for 3 days and had excellent attentive care from the midwives who would look after the baby so I could have a soak and checked on me without having to call for help.

If you have lived in the USA you wouldn't be asking that question. It means normal working people on normal salaries can't get healthcare unless their employer offers it

People like you immediately jumping to the conclusion that any privatisation = the USA model are part of the problem.

If its the figures I've seen it completely ignores the "hidden cost" to the economy of patients having to lose work or incur other costs due to their time being deemed zero value. It also doesn't cover the costs kicked out to social care or the value (lost to the economy) of families frequently expected to provide personal and feeding care in hospital to vulnerable patients or people unable to work whilst waiting for care/treatment.

I don't live in the USA - I live in Europe where state backed insurance type models are the norm. Its the UK which is the outlier.

I think everyone would prefer an NHS that was fantastic and free at the point of use but it is no longer possible so we have to either go for an insurance model or accept the care will be very basic.

“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,”

Half the issue is symptoms and conditions aren’t treated soon enough because the nhs can only do a firefighting service currently.

If minor issues were treated sooner then a lot of major issues would be prevented.

I think I like the sound of the system in some European countries too. I don't know enough about it to say it's definitely better but I've heard good things about it.

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.

A lot of the problems (with medically complex issues) are because of failing and underfunded public services. Poverty, housing issues, loneliness, and lack of timely and effective support. (The fact that lots of people have had to move away from family and friends for work or housing is related to this).

Poverty and stress affect health. Mental and physical. Then the NHS gets stuck with the consequences. It's not possible to look at the problems of an overloaded NHS in isolation from the other problems.

If we invested in good public services including the NHS (long waiting lists mean health conditions deteriorate and are more complex by the time someone's seen), it would save money in the end.

Social services, supportive benefits system including recognition of the contributions carers make to society, better child maintenance enforcement, social housing, education, training, and work opportunities. Then people would be less sick and need less NHS care.

With life expectancy, I'm mentioned this on a couple of different threads and nobody's confirmed yet but I understand it's no longer increasing?

So lovely to hear of your positive (and affordable!) experience. Health insurance definitely does not have to be based on the frightening USA model.

And, here's what can happen (all too often) when you have a baby in the NHS system now:-

https://www.theguardian.com/lifeandstyle/article/2024/may/13/uk-inquiry-calls-for-maternity-care-overhaul-after-harrowing-testimonies

https://www.dailymail.co.uk/health/article-13411259/Mothers-left-blood-covered-sheets-told-stop-stressing-dead-babies-dismissed-anxious-harrowing-reality-giving-birth-NHS-hospitals-revealed-damning-report-shows-huge-postcode-lottery-care.html

I'd definitely choose a private healthcare insurance model over that.

We have too many who haven’t paid in.
All the health tourists and immigrants don’t pay in, and yet nothing is done?
i have mid stage Parkinson’s at nearly 62, yes I need more care and drugs, I can’t change that. Research yes, treatment almost zero, I couldn’t prevent that.
Restructuring the nhs and more efficiency could save money, remember it’s for all.

I used to be anti charges for appointments I now think people should be charged for GP appointments.
Tenner, for everyone, excluding followup appointments.
Discourage people calling up for nothing, and cold they can treat at home.

Good. Will bring discipline and accountability.
It will also reduce misuse by members of the public.
We should be studying other European countries, maybe Australia, and adapting the best of their systems

I would like to see some sort of privatisation. But one where I contributed via tax to help people who can't afford insurance. But equally a tax break for me to come out of a government paid system ....not sure that would work though!

Immigrants pay in more than anyone. All the immigrants I know have paid in three times:

1st time:
NHS surcharge which is paid when you apply for your visa - Most foreign nationals applying for temporary permission to live in the UK are required to pay an immigration health surcharge (IHS) in addition to the visa application fee. From 6 February 2024, the standard rate will be £1,035 per year of the visa, paid in advance.
2nd time:
NI charges on their income (in common with most citizens)
3rd time:
Paying for private medical care because the overloaded GP surgeries will not / cannot take new patients, so the only way to see a doctor is to pay for it privately.

Most western countries face ageing populations, increasingly obese patients etc.

These are not challenges unique to the U.K.

The US faces these challenges and has a mostly privatised healthcare system.

The U.K. faces these challenges and has a mixed system with a lot of the provision being provided by private companies (eg cataract surgery, GPs etc) but mostly free at the point of use.

Europe faces these challenges and mostly has a system of rebates that mean if you are local and have a job it's all covered.

It's not obvious why changing the system helps deal with these challenges.

More elderly people is mostly a social care problem (ie care in their own homes) and it's only when unpaid carers burn out that they largely end up in hospital, The care homes which look after elderly people who need a higher level of care are completely private with state funding for those who can't pay.

They spend time in hospital because there's so much arguing over funding by SS and because there are so few places available for them to move on to.

Interesting thread

I don't believe the nhs as it is is fit for purpose

After a cancer scare where my nhs care was absolutely diabolical I now have private healthcare anyway

I appreciate this isn't an option for everyone

At our GP’s it’s a 3-4 week wait for a triage phone call to see if you need a drs appointment, which is most likely another 3 weeks wait. It’s no wonder people are misusing A and E.
We can’t go on like it is thats for sure. I think some sort of health insurance and leave the NHS for A and E emergencies, car accidents, heart attacks etc the rest of it through a private system.

Privatisation isn't going to magic up the staff we need.

With better pay and better conditions staff retention + recruitment levels would be vastly improved

Privatisation doesn’t necessarily mean more efficient or cheaper. People complain about the bureaucracy in the NHS but the percentage spent on admin in the USA is significantly higher as are the costs for drugs and operations etc. People are billed ridiculously sums for simple drugs like aspirin in hospitals.

Also healthcare is different to most other services. If I have cancer I need treatment quickly. I don’t want to shop around for the treatment and I can’t wait or hold off buying treatment so I’m more beholden than with other services.

They'd probably suggest not using the US model. There are lots of other effective models (I am more familiar with Europe but they could be worldwide).

@ThomasinaLivesHere - I agree that the USA model isn't the way forward. But there are many other systems that include elements of privatisation that work well. It isn't the US model or nothing - we need to find a model that works for us in the UK. Most posters are in agreement that what isn't working currently is the NHS the way it is.

In general I'm a cautious free marketeer. But it doesn't work for things that are natural monopolies such as the water companies.

In reality many parts of the NHS are already serviced/supplied by private companies (every single thing it buys), and all its employees are 'private' contractors selling their labour to the NHS for profit. If you don't agree with that last point, try suggesting that they shouldn't be paid a market rate of pay and see how far you get. As OP says, many are tempted to move overseas, so they already operate in a 'market' selling their skills to whichever employer/country is the most attractive.

Many of the things cited by OP wouldn't be solved by privatisation. They're cultural and structural. So proper reform would be the answer.

I'm impressed by the Israeli system that has several competing health services - you choose which one you want to join - and they all operate on a not-for-profit basis. I don't think wholesate privatisation would suit the UK.

I used to work in theatres as an auxiliary before I was a qualified nurse. We had people not turn up for major elective surgeries. This would cost tens of thousands in equipment that needs to be ordered in, staffing costs, drug costs etc. Happened more regularly than you’d think, too.