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?

How would you feel as a nurse turning someone away because they didn't have insurance?
I don't agree with privatisation at all. Access to health care should be equal for everyone.
The government need to tackle social issues that lead to poor mental health and obesity and have early intervention in place for mental health to prevent escalation and people needing to be sectioned. CAMHS has been a shit show for years so not surprising that there are now so many people needing hospital care and so many people out of work due to disability.
More incentives for people to train as health care professionals would also help with the staffing crisis and support retention as more staff would mean less stress.

I think if you went to an insurance based system, people without insurance wouldn't even get near nurses.

It would be give us your insurance details before you even got past reception.

That's irrelevant. MPs have no insight of, or input to, the awarding of contracts. That would be the civil service.

One of the covid scandals was CockHand's mate from the pub...

They won’t believe you.

The current financing model (100% taxation) is frankly unsustainable. Forget the politics, real terms NHS funding has increased 36% since 2010, and the system is on its knees. There is no way the electorate would agree to the sort of tax rises a fully functioning NHS would require to keep offering increasingly expensive treatments to an ageing and increasingly obese population.

Most western countries (forget the U.S. for a minute) have an integrated public and private system with multiple providers, both Government funded and private hospitals etc, and crucially have patient charges , either direct co-pays or through insurance. In France, where I lived for a while, the payroll social charges (aka tax) accounted for about 80% of the healthcare funding, The other 20% was raised through supplemental private insurance and / or co-pays. The idea that patients shouldn’t pay a penny at the point of use is very hard to justify now (nb with safeguards and caps in place to protect the poor and long term sick) .

Still does happen!!

It’s not the awarding of contracts (though the existence of the “VIP lane” should tell you that it isn’t a fair or independent process).

It’s about the consistent defunding and degrading of the NHS, to push people towards the companies lobbying/bribing them, and the introduction of legislation to enable these companies to take over NHs contracts in the first place.

This is the Noam Chomsky who still insists Labour won the last UK election and that Ukraine are responsible for the war with Russia? There was a time when I would avidly read his work on linguistics - that was a very, very long time ago.

The NHS has always been substantially provided by private businesses, not least because both doctors and providers wanted it that way.

My DC who still lives in the EU cites their state backed insurance model as an incentive to stay there. Monthly costs are less than they would pay in UK NI (for a couple) and treatment has been excellent and in some cases has covered conditions which the NHS doesn't even consider. Scare stories about the US are irrelevant to the European models.

Not privatisation but they need to run it more like a private business. Bring in top managers from the private sector to cut away all the waste. Its not money that's the problem, its top heavy bureaucracy. Too much emphasis on rainbows and pronouns and not enough on actual care. It's right that medicine has advanced and that people are living much longer, often with little quality of life. Nobody seems to be allowed to pass away peacefully anymore. The obesity crisis is spinning out of control, we need to move back towards people taking responsibility for their own health, not expecting medics to wave a magic wand a cure all ills. There must be moves to retain full time staff and make working for the NHS more attractive, better pay for nurses, junior doctors etc. Every general election, the parties all pledge to overhaul and improve the NHS, but none of them are brave enough to actually push through real changes and get rid of all.the dead wood "Jobs for life" lot.
My DIL and my neice work for the NHS and frequently tell stories of the horrendous waste and bureaucracy

Bad. As is the privatisation by stealth that we're currently experiencing.

I would pay higher taxes to avoid it continuing.

To address your key points:

Yes everyone is covered by insurers in the state backed models - they can't participate in the system if they don't and prices are capped.

No system covers everything but all the state backed insurance models cover primary, screening and vaccinations (often provided directly by the state as universally needed) and frequently cover the kind of "annual medical" service which allows early interventions (and also therefore lower costs of treatment). Here, annual medicals don't exist in that form, even for older people where the entitlement to a health review is satisfy by the patient filling in a form which asks less than the average travel insurance application. Incidently IME European state backed model insurance even at the lower levels is more comprehensive than is genuinely available from NHS rationing/post code lotteries.

I've no idea how your aunt gets NHS treatment if she has been out of the UK for 5 years. My DC, their fellow expats and my former UK colleagues (with UK mail addresses to use) all have to take out a kin of bond - a premium for NHS care whilst here - or travel insurance.
They certainly can't swan back for treatment and there are processes for checking that entitlement and reclaiming costs. Most of the stories I've come across about "immigrants stealing our NHS" turn out to be bollocks.

It’s such a complex problem, the issue is the NHS is broken and broken badly. Just throwing money at it won’t work, the leadership has shown for years an amazing ability to mismanage money on a baffling scale (I’ve not worked for but have worked with the NHS). I’d be for privatising parts of it, definitely significant amounts of back office and support structures, ie non medical staff. That part is just a money pit. People need educating too, part of the of the weight on the system is that people run to it and abuse it simply because it’s free, that puts incredible pressure on it. Don’t go to your GP with a cold for example, get a grip.Plus, look after yourself a bit better and there’s less pressure, my FIL is overweight, inactive and drinks more than he’s meant to, he’s always got an appointment for something or other. As OP says it’s also become a victim of medical science, improved care creates problems for the system in many ways because the advances in science have grown it beyond the original intent.

I'm one of those who wouldn't be able to pay for private care. I already struggle with dental costs, glasses costs and prescription costs. Unfortunately the min income level for help hasn't raised with min wage increases so I have to pay now when I didn't have to before even though my circumstances are the same.

I'd hate to be put in a situation of medical treatment vs paying rent.

Privatisation is not the answer.

It has not worked for the railways, water, energy, or any other previously nationalised service. The semi-privatisation of dentistry has been a disaster with home dentistry on the rise.

The NHS could do with reorganisation, new finance structures, and new ways of training, attracting and keeping staff. But privatisation will not deliver these.

Nail on the head. Just like suggestions that patients pay for GP appointments or fined for not attending, but then applying the usual exemptions for the unemployed, elderly, etc., so basically just another tax or kick in the teeth for the workers!

Workers are sick of basically everyone and I can’t blame them. They get fuck all in return for their dutiful tax paying while being whinged at by those they’re paying for that they’re privileged. It’s a mugs game tbh

Why? NIC is now just a tax.

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).

This is the legacy of 14 years of Tory mismanagement of the country. The people in my outpatients clinics are often ground down, stressed, exhausted and unable to prioritise their health and well-being during chemo or radiotherapy because they have no support, no money to allow them to take time out or buy good food. Often they have late presentations because they were unable to get help sooner. I started to work out the proportion of patients I've had come through the doors in the last few years who, if they had been able to be referred when they first started having symptoms wouldn't now be having palliative care rather than treatment, but I had to stop to preserve my own mental health and that of my team.
Like everyone else in the nhs we are on our knees and it makes me angry when people come out with "oh let's just dismantle it and go for an insurance model". Our NHS invests a lot of money in health inequalities and trying to narrow the gap, but it is often limited in what it can do because the problems are structural, social and entrenched.

I don't want to lose our NHS and I welcome the private providers we work with as they add to our provision, not take it away.

We don't need another reform or restructure. My partner is a senior manager in the NHS and he has gone through 6 restructures in the last decade, including being at risk of redundancy twice. All of the restructuring was done at the whim of a politician and not for the good of the patient - definitely not for the staff. However, the attitude I see far too often towards people like my wonderful, caring and clever partner is that, as a manager, he is to blame for everything....while the govt gets away Scot free yet again. It's even more depressing when I see that attitude from my clinical colleagues. However, privatisation would work out well for him and his colleagues as he'd finally get the salary he deserves and the well staffed team he needs to carry out the work he does so well.

It is also depressing to read posts where my fellow clinicians judge people as nit deserving of healthcare because they are too fat, smokers or haven't looked after their health in another way. Totally ignoring the point made above that people are living such horrendous lives sometimes that they don't have the headspace to make the healthy choices. Why should they suffer for political ideology?

One final thoight. We are all just an illness or an accident away from being labelled a burden on the NHS. We will all become burdens as we age. The principles,of the NHS - providing healthcare which is free at the point of contact to everyone from cradle to grave is more important today than ever.

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?

Michael Marmot did a 10 years on report in 2020 and found that life expectancy had stopped increasing. I think it's actually decreasing in some areas.

It's also mentioned in the Chief Medical Officers report about coastal communities - they have poorer outcomes than urban areas, less access to health care and higher levels of multi morbidity - some related to deprivation and age profile, but there appears to be a characteristic of these communities. See also the 2023 report about healthy ageing.

You can tell I live with someone who used to work in PHE!

There will be more people not working and more people on benefits because they won't be able to afford insurance, or be electively for insurance...with all the knock on effects that will have on the economy.

Do you have any evidence to back up any of that assessment or did you just make up the bit about the whinging?

I think life expectancy will take a dive if the current obesity situation isn't addressed. Problem is, you can lead a horse to water but you can't make it drink.
And please don't tell me its because they are in poverty because having worked in a very famous high Street food takeaway establishment I know how much money they spend on a more or less daily basis.

It's a myth that American healthcare involves 'paying through the nose' in all cases or even many cases.

The Affordable Care Act (aka 'Obamacare') has made a difference to health insurance.

There are several tiers of health insurance - private health insurance from an employer, private health insurance bought via the ACA, which can be subsidised to the point of paying $10 a month, Medicaid (including coverage for babies and children), Medicare for the over 65s, and the Veterans Administration health system, which covers and treats veterans and their families.

I received the kind of maternity care you describe while on Medicaid in the US. No bills. Excellent care, private room with sparkling clean ensuite (shower plus loo and sink), lovely food and plenty of it, someone walking around refilling water every hour or so, hospital gowns provided, along with maternity pads, dispers, swaddling blankets and little hospital clothes and hats for baby, a Medela breast pump, same attentive, courteous nurse for an entire shift, lactation specialist doing her rounds...