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 disagree. I am 63 and as far back as I remember one has had to pay for things the NHS should but doesn't provide. Examples:

My prolapsed bladder (mismanaged birth in 1994). Repaired 2000 - GP said there was no point referring on the NHS. They wouldn't do it. Maternity care in 1994 was dire. Whilst I had community midwives for 10 days following a botched birth, they were hopeless but had a lot if time to natter.

Infant grommets: 1996 and 1999. GP said not available on the NHS as speech well developed despite intractable ear infections (14 and 11!). Dealt with privately.

The DC's teeth - needed straightening but didn't meet the NHS bar.

Establishing my back was broken 2020 - GP refused to refer because I wasn't in enough pain! MRI privately established it. This was despite established osteoporosis.

NHS dentistry - never been available with the excellent dentists - or when a crown is required.

Physio for DC after breaks - not provided but made all the difference.

I think you must be living on a different planet.

I don't think that's really the point though. No one ( I hope) is suggesting that we should have some sort of Quietus for the elderly at a certain age.

But there is a lot of benefit to be had around thinking about what the real outcomes and goals of healthcare are as people age. It's not just about the money either, it's about what makes for good care. Personally, I think the money element isn't really the point at all, it's just a result of the more basic problem of trying to work against the natural, and inevitable decline of the body, which always in the end has to fail to deliver.

If we imagine that somehow we can fend off death inevitably, or medical interventions will really put us back to feeling a lot better, we will tend to take one approach to medical decisions. That's how we think with kids most of the time, almost until death is imminent - old age is too far away for natural death to be a consideration, and if disease is beaten there may be a really high chance or good quality of life, a long life full of human experiences, and a real improvement in condition. There is often good reason to go full on with medical interventions, even if some are invasive and involve suffering.

After a certain age, which is usually about 75, that changes. People may be very healthy that long, or longer. But once there is a real illness or decline, the prognosis is very different. Chances are the amount of time left won't be extended much - even if the intervention is successful, it's quite possible another illness will appear in short order. The interventions themselves are less likely to be successful, and recovery longer,than in a younger person. Often there is no real recovery, only a continuing slow decline, even when the intervention is counted as successful. The aftermath of the intervention, even if successful, may include more acute suffering than there was before. In some cases the recovery time might be longer than the average lifespan of a person at that age.

When that's the reality, an 80 year old suddenly faced with medical decisions might make very different decisions than a 20 year old.

The usual approach is to let people make these decisions themselves, which theoretically is sound, but because culturally we don't really deal with the realities of inevitable decline and death,we get people at 75 or 80 making the kinds of decisions that people at 20 might make. Often medical staff don't really help them understand the realities around the outcomes of the treatments they are proposing. We have over the last half century or so added about a decade on to people's lifespan, but it isn't necessarily a healthy decade - often it's beset by illness and poor quality of life.

Socialism for the corporations!!!

No jam for the average Joe though...

This is an absolutely ridiculous situation.

It's mind-boggling.

I think it must depend so much on the GP practice you’re with and maybe your local trust.

I always get referred to a specialist immediately (sometimes to my surprise – I might have just mentioned something towards the end of an appointment about something else, and expected to just have a quick chat / keep an eye on it). I’m late 30s.

In the past 5-ish years I’ve received referrals for:

• Unexplained pain / sensation in my abdomen (not extreme pain, just new). Within 2 months I’d had an ultrasound investigation at a hospital.
• Mole I was unsure about – sent directly to a dermatologist for a full body check
• Blocked-feeling ear (muffled) – referred immediately to ENT hospital, appointment within 3 months.
• Breast matter – I did a check and it felt like one side felt different to the other. Referral directly to breast consultant for examination
• Referral to physio for knee issue (weakness since taking up endurance running). Appointment with a physio within several months and sent home with a treatment plan.
• Referral to speak with surgeon about having a plate removed from an old break. Was left up to me if I wanted to get it removed or not (was not causing me problems but I’d been given to understand there was a possibility of it causing issues in future – they were happy to operate if I wanted).

There are more, these are just a few off the top of my head. I haven’t ever pushed for referral (I’d often assumed the GP would be able to take a look or I’d be told to keep an eye on it – in the case of the ear referral I cancelled it as it cleared up by itself).

Recently I went to A&E on a weekend evening and was seen within 1.5 hours and had had an ECG, blood tests and been discharged within 3.5.

I wouldn’t use the NHS for talking therapy (the approach is, I guess as you might expect, pathology/deficit-focused with long waiting lists nowadays – I was referred to a bereavement counsellor in the early 2000s and was seen quickly; I expect demand has grown since then).

My experience of diagnostics and treatment on the NHS has generally been great. Sorry to hear about your experience with your back issue and birth complications.

@MelifluousMint your experience of NHS is so far from mine, it's hard to believe we're experiencing the same system!!
Can I ask what region you're in? Maybe that's what makes the difference

Yeah I’m in the North West

I'm in London. I think maybe the reason is the enormous number of people trying to access the services here. There just isn't enough to go round maybe?
Some of my experiences from the last few years (and there have been more these are just off the top of my head!)

• given medication for "unusual bleeding and period paid" without being asked about possibility of pregnancy or given a test. It's a drug that shouldn't be taken when pregnant (I was pregnant)
• son (6) had severe ear pain. Was clearly an ear infection. He was vomiting from the pain. Was told NHS can't give antibiotics unless they can confirm it's an infection, but they can't confirm an infection as he has wax in the ear so they can't see the drum, but they don't remove wax. Had to take him to a private hearing aid place who removed the wax and said the infection was so bad it was at risk of bursting his eardrum. Gave us antibiotics but cost me £100
• best friend repeatedly sent away from GP with cream for a fungal infection on skin aged 25. "Fungal infection" didn't clear. At about the 5th presentation friend was referred to dermatologist. It was melanoma. Tragically this friend died age 31.
• MIL has blood cancer. Was not told by anyone about paxlovid when she had COVID recently. I had to tell her. She rang the GP who said "oh yes, you're eligible. Unfortunately you've left it too long. You need to take in the first 5 days"
• was lied to about usual birth of twins. Was told it was normal and usual to have them vaginally. It's not, it's just cheaper. Unsurprisingly everything went wrong and it was hugely traumatic. Luckily me and the children are healthy now.

God there are loads more but I need to get the kids ready for school.

@Itsrainingten yep, we were London. Now Surrey which is worse. Compare and contrast DS with a burst eardrum:

London - three GP trips with pus and yellow fluid running from the ear. "We don't do anything, he doesn't need ab's" it took weeks to get better and he was below par.

Austria - the protocol is immediate referral to an ENT specialist who thoroughly examined and cleaned the ear, prescribed anti-biotics and advised specialist referral when home. DS slept that night and was back on the slopes the next morning.

GP: a referralis not necessary and will take two years anyway. I had him referred privately. The ENT consultant advised DS had something called choleastasis (sp) which is an inner ear issue where every time there is an infection a little bone is laid down. Eventually it causes total loss of hearing and if left the surgery becomes complex. The little bit of bone was causing the membrane (over the drum) to grow on the wonk, hence the burst eardums.

At the stage it was caught for DS a little grommet pulled the membrane straight and allowed it to heal properly.

DH's paternal grandad/DS's paternal great grandad was stone deaf by the age of 25. It was put down to boxing but with hindsight probably not.

Sorry @MelifluousMint , I was tired and writing that post took me straight back to the acute trauma ward and DMIL's six weeks there. It was a profoundly shocking experience in a first world country. She fell out of bed onto a hard floor, and waited 27 hours for an ambulance, because she was in a care home. When she was discharged, after a six week stay and multiple infections, she died five hours later.

I think you have been very very fortunate in your experience of the NHS.

Bad.

Unless you're happy for poor people to suffer and die. Then it's good.

Happy to pay £50,000+ to have a baby. Then it's good.

Happy to let asthmatics and the elderly go without their meds. Then it's good.

@Itsrainingten

MIL has blood cancer. Was not told by anyone about paxlovid when she had COVID recently. I had to tell her. She rang the GP who said "oh yes, you're eligible. Unfortunately you've left it too long. You need to take in the first 5 days"

Similar to my OH who has bone marrow cancer. He was told by his haematologist to get Paxlovid if he caught covid. He did catch it, but no one knew how he'd get it! He phoned the GP surgery, but they said they didn't know and would get someone to phone him back. No one did so he phoned again next day, same, no one phoned back. Then he phoned the oncology dept, they didn't know either and said someone would call back, but no one did. On day 3, he phoned the "emergency" cancer nurse team, but that went to answerphone so he left a message, no one called back. By day 4, no one had phoned back, neither from the GP, oncology dept nor "emergency" cancer nurses, so he phoned back all 3! Day 5 and finally the oncology dept called back to give him a phone number of the covid ward who, they said, would issue the drug. He phoned them, and yes, they could issue the drug, but they couldn't do it that day, and with it being day 6 when they could issue it, it couldn't be taken, so they said they couldn't issue and and basically told him off for not contacting them sooner!! The whole system is too fragmented and the left hand doesn't know what the right hand is doing.

What a load of tripe. People in France, Germany, Australia, Canada, etc., don't have to pay £50k to have a baby!

The same with immunotherapy for allergies - these treatments make a substantial and life saving difference to patients, but are almost impossible to obtain on the NHS.

@Labraradabrador so wow us with the good things the Tory government has done apart from stoking up tension between different groups.
Thing is if you moved to the UK now you’d see that the NHS is really shit in comparison but oh no nothing to do with the government who fund it 😂 just the ‘system’. Are they ever responsible for anything ?
And to add, satisfaction levels re the NHS were the highest they’d ever been under Labour funnily enough.

But no one has whacked high earners for tax.

And why on earth would people keep their earnings below the higher tax bracket? You realise that only earnings over the threshold are taxed at the higher rate? So people would still be taking home more money.

And individuals do not leave countries in search of lower personal tax. If they did they would already have done so. People have families, children at school, they like living in London etc. Plus they’d have to be offered work in other countries, for which they might need a visa or new qualifications or another language. People are surprisingly immobile.

@TempestTost Your post at 0039 eloquently summarises my rather poorly expressed sentiments about ageing and its influences and effects on the decision making process. And the rule of thumb that 75 and/or the onset of serious illnesses is the moment to consider how much medical intervention is wanted and what can be accomplished.

I wrote (and deleted) a long explanation of how I reached the view that we should all be permitted to chose the moment and manner of our death, all about my DPiL's declining years. Their experiences, over a 25 year retirement, shaped my views. My clever, kind, funny DMiL would gladly have taken the fast route out, and as a qualified SRN, she felt she should have had the option. Except, dementia...

@NewFriendlyLadybird when I'm taking about people going over the £100k. When their tax free allowance gets reduced too.

• If you earn between £100,000 and £125,140, you could pay 60% tax due to a tapered personal allowance. This means every £100 you earn is reduced to £40.
• There are a few ways to avoid the 60% tax trap, but you must be proactive.

Why would anyone willingly take the step up from a £100k job to a £120k job that will have them paying effectively 60% tax?

There will be people Doctors and the like who Op to opt to work less hours at a higher rate to keep their earnings below the £100k.

@NewFriendlyLadybird I'd disagree that people don't make decisions based on tax, or relocate for financial reasons. Close relatives made redundant at 50 with a large payoff after 20 years with a large multinational company decided to go to the UAE rather than pay tax at 40% in the UK, or 45% in Germany or 55% in Belgium. Their decision was guided by tax, international school fees for two DC and cost of living considerations. Just because you don't know people who would, doesn't mean it doesn't happen!

Until people take far more responsibility for the state of their health you could throw an infinite amount of money at the NHS and it would not touch the surface. We should not be paying for someone else's lack of discipline.

I think that the NHS has been run into the ground so that privatisation seems like a great idea. Private companies will then cream off the profitable sectors. Of course it needs reform but we should fight tooth and nail to keep it, you don't know what you've got till it's gone.

Sorry, but I know loads of people working less than full time because the incremental wage just isn’t worth the loss of free time. I work freelance and basically stop taking projects once I hit the higher tax band + pension allowance. Why should I do more of the same work for less money? I don’t need it to cover bills, and on balance would rather spend more time with the kids, have time for hobbies, and generally dick about. Several friends in payroll jobs who only work 3 or 4 days a week for similar reasons. If there wasn’t such a cliff edge in the different tax bands I probably would work more than I am now.

The really rich are hyper mobile - they'll probably already send their kids to a boarding school, pay for private medical care, etc., so they're a lot more mobile.

Just look at Tyson Fury apparently "relocating" to Isle of Man - that's millions of tax lost to UK Government, just as other rich people relocated there previously. They've not all moved to IOM for steam trains and trams!!

Yep, same with GPs, dentists and hospital consultants reducing their hours to stay under £100k pa. so they don't lose free childcare, don't lose the personal allowance, etc.

One of my clients (an electrician) deliberately takes 2 months off work every year to avoid breaching the VAT threshold and to avoid breaching the £50k H/R threshold as he doesn't want to lose child benefit, nor pay higher rate tax, nor suffer VAT loss on ALL his income - if he breached the VAT threshold by just £1k per year, he'd lose out by thousands. Between the VAT threshold and the H/R band, it's artificially holding back his business.

Exactly the same scenario with other clients such as a B&B, small cafe, gift shop, etc - all taking extra weeks closed and reducing opening times/rooms to stay under the VAT threshold and H/R tax threshold.

People who aren't working in the tax industry simply don't realise how much of a disincentive and "brake" these tax cliff edges are on both employees and business growth.

My plumber quotes for work, and then sends you a complete list of parts needed to complete it, for the customer to buy themelves so that element of the job stays off his books. This is explicitly so that his turnover is labour only, to stay beneath the threshold at which he'd have to register for VAT.

When I did freelance work (I used to draft company annual reports and write the occasional speech), I only worked eight months per year. Partly for tax reasons and partly because there's a busy reporting season built around tax, calendar and business years. My projects were all finished by May and nothing re-started until September. In a few years, I did graduate recruitment projects over the summer to be ready for the university milk round and job fairs that had October deadlines. When I was full, and was asked to price additional work or jobs I didn't fancy, I priced it 50% or more above my normal rate, so that if I got it, at least I was handsomely over-compensated. Demand management. I once tried sub-contracting work to another excellent writer I knew well, but they knew nothing about economics, which cost me that client's business forever.