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?

It would be horrific. If you privatise an essential service that has limited or no competition then you simply create a monopolistic cash cow for the operators and they will gouge the consumers mercilessly whilst giving as low a quality of service as they possibly can. That's exactly what happened with our utilities and railways. The NHS desperately needs fixing but privatisation is not the solution.

One of my DC lives and works in France. Everyone pays for insurance according to their income. If you can't earn, your health care is free. The system is excellent, far, far better than the NHS. In particular maternity care is very good. No problems getting GP appointments and investigations. Hospitals very efficient and care is prompt and good. Co pay is reasonable and based on income. It is nothing like the US system.

Certainly not my experience of private healthcare - for us it has been fantastic, timely, high quality care and when billed through insurance companies comes out far cheaper than you would expect.

What do you suggest the alternative is? As it stands the NHS is long past fixable

Better working conditions would help though.

I can’t imagine most people jumping with excitement to be paid 28k a year to be shat on (quite literally), abused regularly both verbally and physically, threatened with machetes etc.

Recently, I had a woman square up to me, scream in my face and shout abuse at me that she was not leaving until I sent her away with diazepam and morphine.

I do wonder if these charming individuals had to pay for their treatment if we would see quite so many of them present to front line services.

Making leisure centres free for under 18s and those on low incomes might encourage more exercise. That's just a few things
A few things that were tried and failed massively. The best exercising one can do is outside in the fresh air and free. It takes much more than that sort of incentive to make young people become healthier.

As for saying that health systems are better on the continent...it was, 20 years ago. Sadly, it has deteriorated there at an even more alarming rate than the UK. They are facing the exact same issues and worse.

As long as it remains free at the point of delivery and the service received is of a high standard, I don’t care how it’s delivered.

Why will it land on women? We have two very elderly members in my family; both are primarily cared for by men.

It’s interesting that everyone is so against an American insurance type system - we live near an American airbase, and I’ve heard many of them say how awful they find the NHS. I think they find the waiting about to see Gp, then specialist, then scan/investigation etc very slow when they’re used to just being able to ring and book a scan themselves. They’re Army families so not wealthy, they all seem happy enough with the American system.

The funding, number of beds and number of staff is also much higher!

I worked in Canada for several years (as a doctor). They have a single payer insurance model - so private hospitals who bill the local province (if you aren’t resident, you have to pay). Free for residents, it’s paid for out of taxation.

Works well, but it costs more per capita than the NHS, there is a LOT that isn’t covered. Medications aren’t covered, so DH paid $120 for five days of amoxicillin (cost to the NHS: £2). You can take out private top up insurance but it’s pricey. Children’s dental isn’t covered, so it cost me $180 every six months to get a checkup for my preschooler.

Most importantly, no linking with social care whatsoever. If you are admitted with a fall and it’s deemed you need a package of care or some rehab, that’s up to you and your family to sort. So obviously no bed blocking, they just turf you out to sort yourself out. There are flyers on lamp posts al over Toronto advertising for in-home care work (both looking for carers, and looking for work).

Acute hospitals don’t even provide a zimmer frame, your family need to nip out and buy one if you want one.

Obviously if we went down that route with the NHS, there’d be plenty of money in the existing budget. Not sure it would be politically palatable though.

That's exactly because it's competing with a universal free service. Don't kid yourself it would remain that way if there was no free alternative!

The US armed forces and veterans have famously excellent occupational health insurance provision though - a lot of people go into the armed forces specifically to access this (and the education credits) for their families.

A shop worker or finance clerk will have far more expensive and limited cover.

The NHS model was set up at a time when the average person lived for 10 years post-retirement. Now that figure is 20 years.

We either accept that the whole thing needs a much greater level of funding or switch to a mixed system where the majority of working people have health insurance with co-pay, and the NHS provides a basic catch-all service.

Hence the vast majority of posters (me included) are advocating for the European model

We already have issue with people not wanting to work because they are better off on benefits.

If you make healthcare free for people on benefits but not people working, it becomes another reason not to bother working or looking for a better paying job.

YABU
The NHS is already partially privatised- all GP surgeries are privatised and how great are they? So many people can’t get in to see their GP or are fobbed off that they end up in A&E.

Privatisation would continue to make the NHS worse.

Funnily enough I think Ozempic should be able to anyone who wants it over a certain BMI. Weight is so strongly linked with health outcomes; why not make it easy for people to get their weight down.

Type 2 diabetes is expected to cost the NHS around 12% of its budget in the near future so there’s got to be a cost/benefit analysis to be done.

People are mixing up "privatised" with needing to pay for it at point of service.

A lot is already privatised in the sense that Tory cronies get awarded contracts. It just results in money getting creamed off, shareholders getting richer, as for every other essential privatised service.

Needing to pay for it at point of use would undoubtedly help simply because more money would go into it.

We can't expect a good health service on the amount that currently gets spent per head.

I believe a properly funded not for profit system would be best. Probably paid for by compulsory insurance for working people (similar to NI but ringfenced for health care, not a private insurance company) with copayments. This would still probably mean about two thirds of the population not paying if it was free for children, pensioners, those on universal credit, etc.

@Supernova23 - a shout out and a massive thank you to you. Although I really do think the NHS needs a radical overhaul, and I am quite critical of it's falilings, I am very grateful to people like you who put yourselves oyt there day after day, saving lives, and dealing with all that abuse. You deserve better.

It's an interesting point that people would be more likely to value (and therefore treat with the modicum of respect) something that they are paying directly for.

It's so hard now to know because it has been so irreparably broken by the Tories. I don't even know what throwing money at it would do now, so many people have left, trust in doctors and NHS is at an all time low. I personally can't even get a GP appointment (answerphone message on their number all day, app tells you to call for an appt so circular - will have to drive in to see if I can get a face to face appointment made but have been told they send you home if you do this).

I've paid for private twice since Tories have been in. I had a terrible birth experience at a hospital that was found unsafe after Cameron never bought in the 15k midwives he kept saying he would. I've had good experiences at private healthcare but they don't do Emergency medicine, so even if you pay for it you still have to wait in a queue in an ambulance to get into the hospital like everyone else. I don't know what the solution is but it isn't going to happen over night and I do not like the idea of the 2 tier system which is already happening in a country that seems to be rolling backwards on all sorts of equality, safety and basic needs under the Tories.

Well something needs to change. We should look at what France and Germany are doing maybe the social insurance model. Can’t go on like this. We have private healthcare anyway.

? Most health tourists are British expats who did pay in for their working life and are now health tourists because they are not technically able to use the NHS for free now they no longer reside in the UK

? All immigrants pay into the NHS. On top of NIC, they pay a high NHS surcharge every year they are here until they get residency (ILR)

I've lived in multiple countries with state back mandatory insurance. It does not have to be a USA style system. In these countries insurance costs are often based on your income with the poorest not paying at all for their insurance (or for their treatment). Care does not need to cost the earth. Many middle income people pay about €120 a month.

No one in Western Europe expects to give birth/experience post partum in crowded wards with struggling staff. Private, en suite rooms with sofa beds for partners are standard. Follow up care in the home is as required.

When my child needed a short hospital stay we had a large private, en suite room with a bed for the parent and the ward had full time staff employed only to entertain the children and distract them from their treatments. Food and drinks are readily available and included for the patient and their accompanying adult. I never saw a single bill for this stay, all handled directly by the hospital and my insurance company.

Another example is routine MRI scans. I know the waiting list is incredibly long in the UK. Here, the MRI scanner is used by the hospital during normal working hours for their urgent work. Outside of this, in the evenings and weekends, it is used by a semi-private clinic (in reality, often the hospital staff getting some overtime). In this time they do all the routine scans of dodgy knees and back pains etc. I don't know anyone who has waited more than 2 weeks for a scan, even for the mildest of complaints.

It does not have to be a US model. There are countries with functioning healthcare systems where the public are able to access timely medical treatment without bankrupting themselves. I don't know if the UK would be able to run such a model, but I have seen that other functioning models are available!

I think we will end up paying something in the future hopefully not like USA but perhaps something like European countries have. It can't go on like it is. I don't think the issue is just money though it's a lot more complex like staff are leaving for better salaries abroad etc and people living longer and due to immigration over the last 10 years there are more people to treat and less staff to do this.

This is what the tory government have created from starving investment in the NHS for years despite pooring billions elsewhere.

Just have a look at america to see what youre in for in a privatised world - best case £30 -£40 a month, those with exclusions from health conditions having ridiculous premiums some of which would include mental health, people would stop declaring things, stop treating to avoid putting premiums up and some not afford to insure leaving them to suffer.

We already see this in the veterinary world in the UK - An insufficient insurance leads to shock payments eg. from an overnight stay from an incident eating something they shouldnt, now maxed out their claims, a second trip to the vets left a co worker £5k in debt... Now atleast they had the money / ability to take on the debt, but atleast putting a dog down would be an option..

Also, to add, salaries are higher so €120 is a very affordable amount for a middle income earner.