To think the time has come to abolish the NHS healthcare model

[OptimismvsRealism]

Free at the point of use also means denial of care to a lot of people. What torture to know that new medications are arriving regularly (eg lecanemab) but it's only for the very wealthy.

The UK is different from how it was in 1948. We should be brave enough to move on from then.

YANBU. and I haven't read the whole thread.

Pre-Covid.
Luckily we didn’t have a Labour government in Covid (Jeremy Corbyn -much? ) We would be eating grass now.

It's already failing, and already being privatised. The UK public are in for a nasty shock though, because once it's done we won't be able to go back. It'll be too late. And we won't like the alternative.

Thing is we will end up with the usa system if we don’t reform the nhs. It will happen by stealth. We need to reform towards some of the successful European systems of co pay, state backed insurance to make it future proof and viable. It’s the people who won’t accept it has to change who are the ones who’ll cause the inevitable collapse resulting in the USA system which no one wants.

Actually the most damaging thing for the NHS since 1948 has been our "first past the post' voting system. The swinging pendulum has removed mindful consensus and turned the NHS into a political football. Proportional representation may have helped the arguments pertaining to the provision of healthcare more balanced and with some continuity.

It's not always as simple as NHS is good, private is bad. Some services are better delivered privately. Would you rather phone up and book an appointment at a sexual health clinic, travel to the clinic, find somewhere to park, wait in the clinic, get seen, have tests done, drive home and await results?

Or: order a testing kit online, it arrives in the post next day, test yourself, send kit back, get results within 24 hours?

The NHS can't do the latter, but private companies can.

Yep, nail on the head.

I have hearing aids. For the first two pairs, it had to be the audiology dept at our local infirmary. First time took best part of a year to get them issued and adjusted from the first GP appointment to walking away with correctly fitted/set aids. Second time quicker as it didn't need the initial GP appointment again as I was "on the system", but still took a few months. That's with several different appointments for different things with different staff in different places.

Third time I went to Specsavers. Everything done within the single appointment which I had complete freedom to make at a time and branch of my choice. Appointments were available within 10 days! That the hearing test, consultation, fitting of the aids and initial adjustments. Able to go back any time if they need "tweaking", again easy to book an appointment within a week or two at a time and date of my choice.

That's exactly what can be done better by the private sector without the weight of NHS bureaucracy and outdated procedures.

The specsavers staff involved were also more friendly, professional and had more respect. Sadly the NHS staff involved in the prior two occasions were usually running very late, happy to leave me sat waiting in reception whilst they gossiped at the desk, and had the usual "you're lucky we're doing this for free" attitude!

There’s no reason why the NHS can’t do the latter. That’s precisely the kind of reform that’s needed. There are many, many tests the NHS already does that way. The STI example is pretty pointless unless the provider delivers the appropriate antibiotics along with the test result. I’m sure you’d have mentioned it if it did.

Presumably the NHS paid for your Specsavers hearing aids @taxguru? The service has been subcontracted to them for at least a decade and is a prime example of the NHS reforming and working more efficiently.

The reason the NHS can not provide these services

does not the resources
does not enough trained staff
does not have the finances to provide this
does not have the finances to put in to continuously improve services provided

With a positive test (or after in some cases a consultation) you can get medication after a telephone consultation with a doctor (often services are 24hr) and pick them up from a local pharmacy the same day (if they have correct medication in stock which often now they do not)

Exactly, yet people on here are saying that any privatising of parts of the NHS is bad. Clearly some things work very well like hearing aids. My MIL also got her cataracts done by a private provider which likewise went like clockwork with easy to book appointments at our convenience (lots of choice, again within a couple of weeks), good follow up checks, etc. All done within a month of referral from the optician - cutting out the "NHS" completely in terms of not having to go to the local hospital for referral etc.

It what the NHS needs more of. Get rid of the antiquated inefficient practices and get them subcontracted to private providers who can do it better without the NHS baggage. Likewise, reduce the "gatekeeping" role of GPs and let more people "self refer" for common issues. It's what happens with NHS dentistry and NHS opticians (and I believe starting to be rolled out for NHS physiotherapy). You contact them directly and they kind of "triage" you at a first appointment to see what needs doing, then claim from the NHS for treatment/consultation under the NHS guidelines with no involvement or referral required from your GP. More of it please!

Just needs good control of the contracts, i.e. proper competitive tendering, quality control over the service, proper contract negotiation by people who understand legal contracts. (Unlike the ruinously expensive PFI contracts that seem to have been checked over by idiots who've never seen a contract before)! Just need to make sure that the private providers do the job properly and aren't screwing over the NHS via contracts in their favour (extras, limitations, auto price increases, etc etc).

I earn just above minimum wage and I have problem with the NHS being privatised. It’s needed and it doesn’t have to be the USA system. People say that to scare people. It needs to stop.

People aren’t saying that private providers in any part of the NHS is bad. They’re saying wholesale privatisation is, two entirely different things. Provided the cost is the same or less and the standard of the service the same or better I have no issue with private providers. The real problem, as you identify, is the absence of expertise in the NHS in negotiating contracts.

But why @BIossomtoes can an outsourced provider provide their services conveniently, on a timely basis and with courtesy whilst the NHS can't. In my opinion it's a cultural issue and the NHS repeatedly falls down on service standards because of the entrenched view that the staff are doing the public a favour.

I don’t know why. Nobody working for the NHS has ever treated me as if they’re doing me a favour. The difference between the NHS and private providers for me has been immediate treatment in rather plusher surroundings.

The "plusher surroundings" is a red herring.

When my OH goes private for his MRI scans, he couldn't give a toss whether the waiting room chairs are softer or he gets offered a coffee (they aren't and he doesn't!). What he cares about is the ability to easily phone to make a convenient appointment. What he cares about is that it's the only way to get an "open" MRI scanner because he needs a full spinal scan every year which otherwise means over 45 minutes in the NHS tiny tube which he can't tolerate, even with sedation. The NHS can't offer an open MRI scanner, so he has to go private to get it!

But yes, more efficiency is definitely a price worth paying too. The sheer luxury of being able to phone up easily the person making appointments (no long waiting times, no having to leave messages on an answerphone never to be returned), no having to call between 10 and 12 on the week when there's a full moon (ok slight exaggeration, but that's how it feels sometimes). Just call the number, discuss what times/days are best for you, they make a few suggestions, you choose one, email/text ping immediately confirming, and you're all done in a couple of minutes!

But if 60% of an NHS service (cataract surgery for instance) is performed by private providers - isn't that wholesale privatisation? And if we have more of that as is planned for orthopaedic surgery etc - isn't that wholesale privatisation?

I agree that most people do not care who is delivering the service as long as it is efficient, safe and high-quality. However, I am not convinced backdoor privatisation delivers cost-efficiency in the long run, which is why an open and transparent review of the funding model is required. To be clear - a review of the funding model is required because the current one does not work and is not the funding model being utilised in an exponentially growing proportion of the NHS.

Huge sums of money are going to private contractors, however they are taking the 'easy' cases

Many, complex cases get thrown back to GPs and NHS services who have less funding available due to the contracts

Waiting times for complex cases are increasing as a result

Precisely this.

Of course it isn’t privatisation. Those surgeries are paid for with taxpayers’ money via the NHS which is only authorised after an NHS diagnosis. Privatisation is the bulk of UK dentistry now where there’s no input from the NHS and no public money involved. It’s not the funding model that needs review, it’s the delivery model.

Of course not. The diagnosis is not authorised by the NHS. The private provider assesses the patient, determines the diagnosis and treats them. Why do you think the NHS determines the diagnosis?

There is a difference between private providers who are there to catch up on wait lists - so diagnosis already determined and they are essentially clearing a backlog of already diagnosed patients. Then there are private providers who are paid to deliver care. They can be commissioned to do so but anyone with inspected premises that meets safety standards is able to open a facility and bid to deliver 'NHS' services

•Why do you think the NHS determines the diagnosis?•

Because it sets the standard for the level of diagnosis it will pay for. Private providers don’t have the level of autonomy you appear to think they do. According to you they can write a blank cheque.

I don't think- I know - because I work in the system. It is effectively a blank cheque, which is why there is data on how expensive it is to deliver NHS care this way. And also cherry-picking, because the private provider needs to be a able to turn a profit.

Your ICB may decide they need to provide hip replacements or cataract surgery to the people of Bromley for example. The local hospitals cannot deliver it due to lack of capacity. Joe Blogs and Co set up a company and kit out a building with consultation rooms and a theatre, and pay consultants to assess and operate. Patients from Bromley are referred by their GP and assessed by the consultant. Treatment offered is according to NICE guidance but that is it.

There isn't some alternative threshold beyond that and is dependent on the diagnosis of the clinician making the assessment.

NICE sets standards - not NHS. And many interventions are based on the patients symptoms - which is subjective. Let's be clear - clinicians and patients should decide about interventions - not 'the system' - so I absolutely agree with the way it is done. I just wanted to clarify that the decisions about who needs intervention is not top down - it is (as it should be) based on the clinicians assessment

Let's be clear - clinicians and patients should decide about interventions - not 'the system'

Quite right. And those decision making clinicians should be employed by the NHS. No wonder it’s a bottomless pit. That’s bloody scandalous. Hopefully this model will be changed as part of the coming review because that’s a very obvious way of improving value for money.

But why should they be employed by the NHS? That means that heath care becomes more becomes more politicised.

If we look at successful healthcare services in Europe, the decision making clinicians are generally not employed by the state. But in almost allcases the funding, via various types of insurance/social fund provisions, is. History shows that our approach, whether we starve it of cash or throw cash at it always deliverers worse outcomes for patients than other European models.

There’s a particular British arrogance in assuming that our way is the best way - not just in the NHS , and a peculiar ‘little England’ approach to change. That’s to say, we don’t like to. There needs to be a root and branch review, and it needs to separate funding from delivery. And it needs the politics taking out and patient needs put first.