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 agree that all sounds good, but how much more are you prepared to pay to get it?

That’s the conversation we need to be having, but neither Labour nor the Tories can countenance a discussion.

If Labour get in they have some hard decisions to take. If the Tories get back in we’ll have the US system before the 2029 GE, because all they have to do is nothing at all.

What accident and emergency provision does your hospital have?

I think that would be covered and dealt with in A&E. But I do think there should be (modest) charges for the first medical contact appointment whether GP or A&E. Not for children under 16, nor for anyone over 80, unless diagnosed with a chronic condition, so type 2 diabetics (often the result of obesity or a lifetime's poor food choices) would be a difficult call.

No private hospital is big enough to have full A&E services 24x7. A&E care would have to remain within the NHS.

No private hospital has an A&E department. What is the relevance of your question?

Tough choices need to be made somewhere and I'd rather pay £200 for an x-ray than £20'000 for major surgery. Ideally these would be minor, non invasive services which would be priced lower than major procedures. Do you have any alternative suggestions for which areas should be privatised?

I doubt that the staff would cop with the huge reduction in pensions on top of the fact that there would be no big increase in wages to compensate.

Most parts of the UK are poor and the reason we still have a national health service is because the market for private healthcare outside London is small.

I was hoping that my question might give you some enlightenment as to why your workplace is able to provide such great service and working conditions.

I'm another that would rather pay more tax to fund the NHS properly.

I would also pay more tax to better fund social care.

I can't see how privatising the NHS could make it better for either patients or staff.

I would, however, support a debate on proportionate representation. This would encourage the different political parties to work together to develop long term policies for issues, like the NHS, which span multiple government terms.

I don’t believe that picking and choosing areas to be privatised is either practical, achievable or a good idea in the slightest, so no.

For the people discussing European systems: Every European system is different.

Spain's is very like the NHS and has similar issues (e.g., waits for elective treatments), although nothing like as bad. A lot of people have private cover to get elective stuff done quicker and quite a few immigrants from rich countries use that system exclusively (you can get advanced cancer treatment privately and it's fairly rare for the private sector to send you off to the state system when things get tough).

France has a mixture of public and private provision, but you can use your state insurance in any of them. People have top-up insurance but it's a small premium for a small benefit. For example a doctor's visit costs €26.50 and the system reimburses you €18.55. That leaves €7.95, of which your top-up insurance pays €6.95 — they are not allowed to reimburse the last one Euro, which is designed to dissuade people with time on their hands from visiting 6 or 7 doctors per day to try and get antibiotics for their haemorrhoids.

Switzerland has a mostly private insurance-based system which is very expensive. It would be like the USA except that the Swiss government guarantees that nobody pays more than X amount for their insurance, and everyone is guaranteed cover even if they are very ill.

So "privatising" in the context of the NHS could mean anything. In fact it doesn't have to involve any changes in the way people pay (i.e., through taxes/NI and not at the point of delivery). If a case can be made that a private company could do the job for less, while delivering better service and still paying dividends, then I suppose that has to be looked at, although of course as we've seen with the Thatcher-era privatisations, these things tend to rapidly get sold to hedge funds and asset strippers, with the government having to step in as the provider of last resort anyway, so the savings end up being illusory.

My NHS work was always in a purely elective environment, no A&E involvement so neither your statement or your question is in any way relevant. No ‘enlightenment’ here - it is also categorically untrue that the state of working conditions in the NHS can be put down to critical & emergency care.

It's cloud cuckoo land. Private healthcare and health systems are more expensive than publicly funded ones.
At a population level, it leads to worse overall population health.

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?

Judging by what I see on Mumsnet, I, personally, am glad I have private healthcare. (Other Americans might think differently, before anyone jumps down my throat.)

I remember the thread about people who gave up waiting at A&E after 24+ hours, or people who sat in the waiting room bleeding for half the day - I’ve never heard of anything close to those wait times in the US, not even in inner city areas. I’ve seen many people on Mumsnet saying there’s a wait of over two years to have their child evaluated for ADHD. My kids are being evaluated about a month after I booked their appointments. Except for during the pandemic, it’s been pretty easy for people I know to find mental health counselors with openings, whereas I see people here saying all the therapists and counselors near them are booked solid.

UK women here talk about recovering from childbirth in maternity wards with three to five other women and their babies in the same room. That’s unheard-of in the US; most women end up with private rooms, or one roommate at most. People talk about being discharged around 24 hours after a C-section, which is mind-boggling to me.

I like the idea that with the NHS, everyone gets healthcare they need without having to pay for it. But even if I had to pay large medical bills, I’d rather be treated faster in the US than have long waiting times for medical care in the UK.

Not a penny more for an unreformed NHS. I am sick and tired of being messed about when I use it and having to deal with mardy admin staff, pass ag nurses and arrogant doctors. Not all but far too many in each category.

My elderly mother had a complex procedure at a London NHS hospital a couple of weeks ago. She had to travel 80 miles from her home with the threat of cancellation hanging over her. It had been cancelled once already. To be fair the surgeons and the nurses and other staff were excellent on this occasion. The admin around it was heinous. An 88 year old lady, who had to arrange a blood test, on the day, prior to her consultant's assessment appointment, months previously, was told by an administrator "well if you can't book it on-line, find someone who can do it for you". She made an 88 year old lady (and net contributor cry). That is the sort of unhelpful, entrenched, jobsworth attitude one encounters too often.

Mother's procedure though complex and not requiring a GA or open heart surgery would have cost £50k privately and not many private hospitals can do it as a lot of.people and equipment are required. It costs the NHS about £7.5k. Mother or I would have happily paid £7.5 for the service to have been end to end organised and for her to have had a private room overnight for peace.

Not wasted money BTW. Mother is as bright as a button, still drives, plays Bridge, holidays, has a younger husband and an excellent social life and hopes to get back to walking 2 miles per day within a couple.of.months,.now she has swerved heart failure.

@YankSplaining we do pay for it, it's just free at the point of delivery. Regrettably those who work for the NHS think they are doing us an enormous favour because they assume we all get it for nothing and should, therefore, be grateful, regardless of the standards.

You only have to mention money and right away reductions in costs of the NHS must be found. After a difficult conversation of course. We should look at old age, for instance, and whether it is useful or essential to the smooth running of society. Then there are the mentally handicapped and the disabled.Are they the best way to spend our cash? There are lots of other groups that some would.consider eligible for the shortcut into the Valley of the Shadow of Death.
I am not speaking of the right to choose.to end great suffering but am seriously concerned by ideas like selection of the unfit to live or the too expensive to live
It smacks of eugenics, of Dr Mengele sending to the right or to the left, of the Nazi euthanasia programme.
I have such a feeling that moves toward legal assisted dying will open the gates to others.

Of course it's relevant. Your private hospital only exists by piggy backing on the tax-payer funded NHS. It can't afford to provide emergency and trauma services and if it tried your wages and conditions would take a massive knock and probably end in bankruptcy. What your particular area of nursing is has no bearing on this fact whatsoever. Private hospitals couldn't exist in their current form without leeching off the NHS.

Private hospitals take on the less complex work and the work that generates a profit. That's why private emergency departments or ICUs aren't really a thing.
This can impact hospital funding as the "simple" stuff is siphoned off, leaving a more complex case mix in the public hospitals.
I've worked in emergency medicine and middle of the night transfers of very sick patients from private hospitals is a thing.

This isn’t true at all. The uk has lower cancer survival rates than most European countries and the USA and Canada.

They are definitely becoming a thing though - private ICUs are opening in more and more hospitals so that more complex work can be undertaken.

@User2460177 look at US life expectancy, then look at it across different ethnicities. Then look at maternal mortality. Health inequalities are horrendous there.
But again it's more complex than just private/public. There are social insurance models, taxation funded etc.

The US spends over 17% of their GDP for these outcomes, the UK spends 8 or 9%. The US isn't twice as good and the leading cause of bankruptcy for families in the US is medical expenses.

I agree with this.

The NHS should throughout be not for profit, like a giant community interest company. Contractors to the NHS offering healthcare services should be not for profit too. People can still be fairly paid for their work but there are no shareholders.

The minute the profit motive is introduced, it simply becomes more expensive for the end user and usually the services cut corners. Look at water and rail privatisation for example.

What we need to do is keep the bones of the NHS model and be prepared to pay more - aligned with the per head cost that German citizens pay.

clearly we need to spend more. Our healthcare is third world.

I had maternity care for one of my children abroad. It was a massive difference- personalised specialist care led by an obstetrician. Honestly, in the uk we do have very poor quality healthcare

Not sure this is meant to me? I haven't mentioned women.