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?

See I fear that it has crossed a line somewhere. I have no doubt my GP probably would really like to see me, the reception emailed to tell me I needed to see him but she couldn't book me in as I have to call to make an appointment. Call is on an answerphone. App tells you to call. So, is this helpful and making my health better? No. It is making me cross and worried and I have no way to fix it other than risk going in to be shouted at by the receptionist that I have to call to make an appointment.

What am I supposed to do?

There is no one there to provide these services. Hence the point in my post. Hospitals are dangerously understaffed. Every shift is dangerous to staff and patients. 100% people suffer because of the health service (or lack of it).

There are no staff. Minimal doctors and nurses working every single shift. They are leaving in their droves or going off sick. You can’t provide a good service when you doing the job of 3 nurses. It’s impossible.

My GP is permanently staffed by locum doctors. My hospital relies on the good will of burnt out doctors and nurses. How long until this system completely implodes?

The people who would not benefit from a privatised NHS are the middle classes. The rich will be able to afford quality care. The poor will get care via a social system. The middle will have to pay. Could you afford to pay around £1000 a month from your family income to top up? You’ll have to if you have assets eg a house or a wage above the benefits cut off. God help you if your child develops a long term health condition (even if it’s covered in childhood it won’t be in adulthood). You won’t be able to get insurance if you have a condition.

The combined income tax, health insurance, personal insurance and local tax in France is higher than the taxes we pay here, but the quality and availability of care is worth it. We need to deal with the level of waste and incompetent management in the NHS at the same time as modernising the system. Also the IT/communications system.

The UK can afford to fund the NHS properly, it just chooses not to.

I live in the US and have family in the UK and whilst I would not want the UK to go down the US insurance route (but then why would it, there are plenty of other options available), surely something needs to change? Other than the government doubling their funding, what else is there to do but partially privatise?

By the way, I pay no more for my contribution to my health insurance than I would towards NI in the UK, though I appreciate that does cover other stuff too.

APPG's run continuously in the area as if NHS, Social Care, Longevity, all these issues have all party groups working on them and coming up with plans. The problem is that health and welfare are such touchy subjects, every time anything slightly different to the status quo, are proposed, they are dropped like a hot potato, as everyone screams privatisation, or is not willing to change, or won't contribute more.

Digitisation and video appointments were a hugely decisive issue only 5 years ago. BMJ and GP groups screamed blue bloody murder over the proposed changes. They were completely against on-line consultations or prescriptions. Along comes Covid, and we are now where the proposals were at, 5/10 years ago. Without COVID, we may never have got there.

I’m not denying the current system isn’t broken but the answer is to fix it not throw the baby out with the bath water.

Sadly @Supernova23 , you'll get a whole lot of shit for your honesty here.
But YANBU, fully concur.
None of my nhs friends believe it can continue in its present form.
I wish you would stay, but understand why you would leave

I think it's the difference between a sock with a toe hole (when Tories came in) and a sock with only the gusset remaining. Fixing it will likely be a false economy and I don't like the sunk costs fallacy. I think a complete change needs to happen but I think it will be years before we see proper change even when it is decided on, because staffing doesn't repair and replace over weeks or months.

We need to spend more per head as the NHS does actually deliver a lot for the money it gets. Privatisation will end up costing everybody more.
We need to spend more on training and retaining our home grown clinical staff and stop trying to keep their wages low. They are low in relationship to the developed world and it doesn’t make sense as we end up losing them and then having to ship them in from poorer countries to replace.
We also need to stop using it as a political tool and stop the endless cycles of changes. For instance centralisation then decentralization 15 years later then back to centralisation another 15 years after that.
We need a social care tax that everyone pays instead of it being a lottery for people that may end up with dementia and spend all their money on social care.
But yes I do want to keep the NHS. I do work for it as well.

I don’t know, if you deliberately shit into your own hand so you can throw it at a nurse for not getting your methadone quickly enough, then racially abuse her (patient on my ward last month) I don’t think you are a lovely person who is just under a bit of stress. We aren’t talking about people being a bit short on the phone here.

@PurpleBugz

I would rather pay double national insurance than privatise the NHS.

Before that stage, we need to impose NIC on ALL forms of income, not just wages, so it needs to be charged on pensions, BTL rental income, dividends, interest, foreign income, capital gains, etc.

For far too long the burden has been on the shoulders of workers and people with higher incomes have enjoyed a lower tax burden when that income is NIC free.

Income tax and NIC on wages is already high enough, especially when you add in student loan repayments, compulsory workplace pension deductions, loss of child benefit on incomes over £50k etc.

We need to spread the burden.

Once we've done that stage, we can then start to look at increasing rates etc if necessary.

Interesting to see the widespread acceptance that something has to change - that wouldn't have happened not so very long ago

Agree with so many that a co-pay European model of some kind may well work, but it's a worry about exempting pensioners, those not working, etc - as a PP said, wouldn't this be just one more incentive not to work, and why should we exempt those pensioners who can afford to pay?

I’ve always supported the nhs, but I’m paying for a lot of it privately, now, anyway,.

Private GP, private ear testing, private dentist, private scans etc

Its going from bad to farce.🤷‍♀️

You can tax those things, but NI on them makes no sense. 😗

The biggest problem is that those expensive complex needs individuals are uninsurable and unprofitable.

They will still need public money poured into their care - and it will cost more to the public to do this because of the privatisation process that means a profit is due to the shareholders.

The simple stuff - private GPs/testing/easy surgery - is already privatised. Of course when it goes wrong those individuals get bounced back to the NHS for the public to pay for private company's mistakes/ongoing care.

We need to restrict care - we cannot do everything for everyone for as long as people want it. It doesn't work. We have to work on need and the most acute needs plus preventative work - which needs a 'Health in all policy' approach to work.

I want the NHS to continue, but I know it has to change. The demand on it's services is unworkable - and some of that demand is created by media based fear mongering over it's imminent demise which is making some individuals fight desperately for what they want, but do not necessarily need.

The thing is, it just isn't thousands in most European countries. Its more like €300 -€400 for an entire family, and that includes 'nice to have' extras like private dentist and physio. Salaries are quite a bit higher too, and often any out of pocket expenses are tax deductible.

And it's not possible to charge excessive amounts for pre-existing conditions, and no one is uninsurable.

Things like childhood Vaccinations and check ups are covered directly by the state so not part of the insurance system.

Yes. I am sure you're right. I was not blaming individuals - sorry if it came across that way.
I know doctors who have left because they couldn't stand the bad care they were being forced to give - that or work 3 hours past their finishing time every night.

There is a shortage in a lot of skilled occupations currently, even those with ok working conditions so I don't think it's purely that.

Probably we need to train more people - bringing back bursaries for nurses would probably help.

Privatising wouldn't reduce the demand though so wouldn't help with the staffing situation.

There's a lot of talk about fear mongering but the hyperbole is to be found on both sides, as though a crumbling NHS or pay through the nose American system were the only options. But there are so many countries that manage to operate between the two.

I , like others, believe that there needs to be a radical shake up of NHS provision.

Since the introduction of the NHS, diagnostics and treatment has improved immeasurably and at an eye-watering cost. We also live much longer than then.

Ever increasing injections of tax payers' money won't make much of a difference. There are far too many bureaucrats within the NHS with some nonsensical roles which has been the case for decades.
In my case I had cataract surgery. A simple procedure.
Three vast wadges of paperwork were given/sent to me. Much of it duplicated.

At the pre op I had to verbally go through the paperwork with a HCA who wrote exactly what I'd filled in on my own forms onto her forms. When I pointed out that I'd filled in the same forms she said it was a formality and that she had to go through it all verbally with me.
So why did I have to fill the forms in?

On the morning of the surgery the clerk only wanted the top sheet of only one of the wadges with my essential details.
I still had to see the surgeon to go through and sign forms I'd already signed , the same with the anaesthetist.

Multiply this throughout the NHS ...!!!

That being said, NHS procurement contracts needs a thorough investigation as there's some really dodgy dealings there.

I'm also of the opinion that affluent retirees should, at the very least, be induced into paying some form of contributions . This will need to be means tested but I know how, as a society, we all feel about means testing.

The thing is, though, there's an elephant in the room which does need addressing and that is the huge number of benefits that are being claimed and the ever dwindling pool of taxpayers money that can be called upon to fund them and the NHS , Education etc...
THAT needs addressing and we can start by taxing the very wealthy, many of whom syphon off billions in tax revenue from the economy , many of whom are pretending to govern us and have our interests in their so called hearts.

GP surgeries have always been private businesses

I am not sure if the Irish example has already been given but it is based on a public/private system. So basically two tier healthcare. The public system, like the NHS, has massive access issues with wait times excessive. That is with nearly 50% of the population having private health insurance. Health insurance prices are nothing like the US, depending on your plan you're looking at anything from €1500 to €5000 a year for your family depending on your package. Most private employers now do have health insurance as part of your employment. With private insurance. Private health insurance means your wait times are reduced and can get seen in private hospitals or clinics. Our gps are means tested so if you are eligible for a medical card you pay nothing. You get free gp care for kids up to 12, anyone else has to pay, for my GP it's about €60 for a GP visit. We also have private A&E clinics if you want to avoid the queues at A&E for minor injuries and illnesses.
With A&E in public hospitals you have to pay if you just turn up (,unless you have a medical card) but it's free if you have a gp referral letter. I guess to make sure people go to gp rather then straight to A&E.
My husband is English his parents have no health insurance and have recently paid thousands privately to get treatment because waiting list was so long. I am grateful my parents have private health insurance.
We always envied the NHS here but I think it's becoming clear that a completely free health service is no longer working with aging populations and people living longer. I don't think it needs to be fully privatised but maybe a tiered payment system based on affordability

NI is just another form of tax, I think the poster is saying the same total rate of tax (inclusive of NI) should apply to income from other sources not just PAYE.

Have a look at how many MPs have a financial interest in private healthcare companies. I think the plan Noam Chomsky refers to is going rather well. The media have certainly succeeded in persuading many people that privatisation is the only way. But who really benefits?

For those taking privatisation, please look around see where it has actually worked well. It will lead to profiteering, people will not be able to afford it eventually. Look at dentistry, better career than being a doctor. Less stress more money.

Having said that, NHS was built when people were arguably fitter, ate healthier and when there fewer people. I think our modern lifestyles have created a health timebomb. I will also say that in my circle, few people use the NHS as it's very difficult to get appointments and hard to keep up with treatment or getting results. I have to be seriously concerned about something for me to ring my Gp cause the thought of ringing and actually trying to get an appointment is hugely stressful especially if you are full time work.

I think the answer is to deal with deficiencies, test more frequently to prevent, privatise some aspects of it (for example getting tests) and in some cases provide funds to carers to look after sick or elderly at home. Would also be good to fund more training.