NHS Privatisation/Reform

[JLArthur]

What does everyone think of privatisation of our NHS system? As someone that is in complete support of privatisation, paid prescriptions and appointments to alleviate pressure on our healthcare system I'm interested in what others think. I feel like we have no alternative, no money, not enough resources and skilled healthcare professionals are available, many are choosing to work over seas.

Unless you're destitute or an immigrant/asylum seeker in need of immediate medical assistance on arrival then we should be paying for the healthcare and prescriptions received. Whether that's paid for by private insurance policy or without. With private treatment you'll benefit from reduced waiting times, more time to talk to your doctor, less time in waiting rooms and you sometimes be assigned a case worker who will support you through treatments.

@SnakesAndArrows

Why will a co-payment system be cheaper/fairer/more efficient than just funding the NHS properly?

This is just a personal opinion, but to fund the NHS properly I think we will need to pay more tax. This is not a bad thing because there definitely needs to be higher public spending. At the same time I’m resistant to the idea of paying more tax because I don’t trust the current government to spend it wisely, and I don’t feel like I’m currently getting many benefits proportionate to the tax that I pay. I do realise this is illogical because money should be raised before it is spent.

With a co-payment system (more European style than US) I’d know exactly where the additional money I’m spending is going and I don’t think it would be unfair if the requirement to pay more is based on income. If you think about it, it’s already happening, MC people or their employers already pay for insurance, the problem is that poor people can’t access those services. With a copayment system, maybe they could.

Yes I’m not opposed to the principle of exploring an alternative model, and whatever we do it will/must cost all of us, except those on the lowest incomes, more, but the PP’s idea that somehow introducing an insurance model will reduce bureaucracy and therefore increase is just nuts. I’m not entirely convinced that money given to insurance companies will be spent wisely either. I’d rather not line shareholders’ pockets.

@SnakesAndArrows I admittedly, don’t know much about this topic, so forgive me if I’m misconstrued your point. To me there is no difference between money being blanket wasted and a profit being made. I would rather the latter if services were better. At least in a model which includes insurance I imagine there will be competition so hospitals and other healthcare providers are incentivised to operate efficiently whilst providing the best quality and insurers are incentivised to negotiate lower rates so they can pass the savings on to employers. The issue I see is actually employers focusing on cost more than value but maybe if employee representatives were somehow involved in decision-making, all there was some sort of reasonable regulation somewhere that might be surmountable

Competition only works in a saturated market. There is waste caused by inefficiencies in the NHS, but the root causes of that are largely lack of investment in designing and implementing sustainable changes, and in proper in-house quality management rather than throwing some management consultants at discrete problems for a few months. So, you’re right in one sense, but hoping that the market will provide is madness.

@SnakesAndArrows

Competition only works in a saturated market.

I disagree.

I struggled with NHS audiology and NHS hearing aids for around 10 years - poor service, poor quality equipment, etc.

I decided to try private. Private hearing is hardly "saturated", but there was competition between the various local providers. Different charges for initial consultations, different convenience points, different ways of working. For some, I could get a next day appointment, for others there was a wait of 2/3 weeks. The first I went to was dire - first appointment cancelled at short notice then kept me waiting for ages at the second appointment, then she seemed to struggle to get the hearing test equipment working and then she didn't have a hearing aid to issue and vaguely told me it may be a couple of weeks to order one in! Basically the same crap service you expect on the NHS but they were expecting a few thousand for it!! I didn't go back.

The second I tried was far better - appointment bang on time, seemless and quick hearing tests, give me a choice of aids they could give me there and then, offered a one month trial without payment. I had a small problem and got it sorted the same day I phoned them - they just gave me a time to pop in with it and "tweaked" it there and then.

Guess which firm I'm still using a few years later!!

Competition really doesn't need a saturated market at all. Lots of businesses don't operate in a saturated market but still work on a principle of competition, ie unique selling points, points of difference, price, or just good old fashioned competence and quality of service.

You’re talking about relatively simple, low risk, non-urgent medical devices that are readily available from multiple providers and so are more analogous with other desirable commodities.

Elderly medicine, pancreas surgery and neonatology are somewhat different.

@SnakesAndArrows I would also have to disagree, but it might be somewhat dependant on where you live. I have countless doctors and at least five local private hospitals, and that’s before I even think about going into central. There is definitely competition.

That said I think in the European style systems things like elderly care are still provided by the state because at that point, they’re not in employment. I imagine more hospitals might start covering neonatal medicine if insurance premiums started covering maternity.

You do not have any hospitals competing for the types of care that I have listed.

Yes, and as I said in European style systems, those services are provided by the state, not private providers so you don’t need competition.

Yes sorry I think we’re not too far from agreement really. I confused you with a previous poster. I was distracted by the appearance of the quote button in a sensible place!! The key is going to be ensuring availability of the low tech services to all, and not having a re-run of the dentistry fiasco.

The NHS isn't free - it's paid for from taxes.

If you privatise it what happens is:

• A few people see no impact, as they already use private healthcare
• A few more get better healthcare, by paying lots more for it
• Some people get less healthcare because they can't afford it now
• Many people get similar healthcare but at a higher cost because they now have to cover the cost of the private company profits in addition to the healthcare

I'd rather see taxes increased and the current NHS improved.

@snowlaser

I'd rather see taxes increased and the current NHS improved."

+++
That has already been tried by Labour who increased NI specifically for the NHS and it failed.

You could increase NHS spending by 10 or 20 % and it would still make no difference because whilst it remains free at the point of use there is no control over demand.

Yes indeed. I remember Blair/Brown's NIC rise to "SAVE" the NHS - that worked well didn't it? Just another shed load of cash in the leaky bucket. It was a bit like Blair's new GP contract which was claimed to "SOLVE" the GP crisis 20 years ago - likewise that worked well too!!

No government can solve this without a massive increase in funding and some difficult decisions, which the public won't go for. We spend less on healthcare per person than most other European countries,until the general public accept that healthcare is expensive and if they want good healthcare they need to pay for it then nothing will change.

We have an increasingly aging population who is living long-term with chronic, costly health conditions. They need community support if we want to allow them to stay in the community, If we had this it would reduce pressure on NHS beds and reduce bed blocking.

Every new hospital was built with reduced bed numbers, this was a political decision but was short-sighted as the care in the community was not there to replace them and neglected the fact that the population was aging. This has caused massive pressure on beds and a population of patients who are sicker and require more care than ever before, they need more staff to meet these needs, but we still staff like we used to when 80% of the ward were self-caring and mobile. In fact, we staff less, because students used to be in the staffing numbers.

This pressure and the moral injury of feeling like you have failed your patients has caused a mass exodus of staff who had compassion fatigue. This was compounded by Covid and the slap in the face from the government with a paltry 1% payrise (effectively another pay cut after 9 previous years of paycuts This then becomes a vicious cycle of increased staff pressure, inability to recruit, and more staff leaving.

Taking away training places and training bursaries has caused a huge drop in trained staff, brexit was the nail in the coffin, removing a huge pool of highly skilled European staff.

Inefficient systems cause loads of unnecessary time wasting but no one will invest in streamlining these,

Procurement is a nightmare.

This lack of patient flow means no one can get into the hospital until someone goes out causing increased wait times in A&E and preventable deaths.

I don't know how you would even start to solve this.

The aging problem is a massive issue that no party seems to want to deal with because it involves increasing taxes to pay for it. Theresa May tried to raise the issue of people self funding more and the outcry was huge and it was quickly dropped as a vote loser.

There are lots of things that could be done for which we, as citizens, may have little to no appetite.

I agree with everyone who indicates that we need a social conversation and discussion of the issues so that we can have affordable and sustainable healthcare systems.

The London assemblies are excellent.

Most political parties will not want a conversation because the most plausible pragmatic choices are almost certainly vote losers and their advantages will take decades to play out for what will feel like a lot of short-term disadvantages.

You may think it is affordable now, but once you start to rack up pre-existing conditions and get older it can get into the hundreds and hundreds per month. I switched from a work policy to a personal private policy while waiting for my new job's policy to kick in. If I had wanted a minor dermatology issue I was in treatment for to be covered by that new policy, it would have been £550 a month. I decided to leave that out of my cover and it went down to £60. I could do that because a) it was a minor condition and b) it was only to cover a 3 month gap. But £550 a month for an otherwise entirely healthy 30-something...!

The US system is absolutely rotten and incredibly wasteful and expensive.

I do agree however that a hybrid system like Germany and France and Australia have is far superior. To those saying "what if you don't have £50 for a GP appt", those systems exempt people on income related benefits etc. But those who can afford to pay, pay. That seems fair to me. And those systems are so much better in terms of quality of care than the NHS. I was completely blown away by how amazing the French experience was after a year or so of living there.

I do agree however that a hybrid system like Germany and France and Australia have is far superior.

There's a readable (short) series of articles on Nuffield Trust that address those systems.

I look at common recent critiques of the NHS model, which are generally found under the following four interrelated arguments:

1. We already spend too much on our health and despite this our outcomes are poor
2. The NHS is a ‘sacred cow’ and has not been reformed
3. We should copy other countries and adopt a social insurance model
4. There is not enough use of competition and choice

https://www.nuffieldtrust.org.uk/comment-series/through-the-looking-glass-myths-and-magical-thinking-about-the-nhs

wrt the specific point about countries with social insurance:

Myth #3: “We should copy other countries and adopt a social insurance model”One solution often proposed for the NHS’s problems is to change how it is funded, and move instead to a social insurance model. In the latest in his series of mythbusting commentaries, Nigel Edwards describes why such a move in the UK would be unlikely to provide most of the benefits that its advocates hope for.

I know it will be unpopular, but I think we need to start looking at opening new "homes" for convalescence, elderly people, mental hospitals, etc. Go back a few decades and there were places where people went for "care" rather than medical reasons, they were centralised so there were economies of scale with staffing, premises costs, catering, etc.

Yes, they were often pretty unpleasant grim places. But they don't need to be like that. We could build them to modern standards, with better facilities, communal facilities, etc. The old ones which have mostly been bulldoze'd were probably rightly demolished as they came from a different era. Nothing to stop us building a modern replacements.

Maybe a bit like student accommodation, with "clusters" of flats around communal living areas. Like sheltered accommodation but with more support. Or a "lite" version of the care homes for those who are able to do some things themselves but need support.

I know it's a nice idea to have "care in the community" but it must be ruinous in terms of all the costs of support staff either effectively living on site looking after few people, or driving around from house to house for an hour here and an hour here. All that "wasted" travel time and travel costs. Having more people in one place would be far more efficient.

I just don't think we can afford to have support workers, healthcare workers, etc driving around all day between people's homes, and of course "bed blockers" stuck in hospitals whilst social services create care plans etc., when there could be a modern version of the old fashioned "hospitals" for care rather than healthcare!

@Kazzyhoward That suggestion is unworkable especially for MH. It would put up a barrier for people with otherwise manageable serious MH conditions and all you’d see is decreased adherence to treatment regimes and consequently more acute cases.

there does need to be a halfway house of some sort. Like the old convalescence homes. where patients who are medically fit for discharge but unable to cope alone at home could go while care packages were put in place to get them home, this could have physio/OT rehab and social services on site and be more homely than a hospital, with a focus on rehab to home.
Having the rehab services and social care on site means better multidisciplinary working and frees hospitals up for acute patients and reduces the time nurses and drs spend trying to coordinate a discharge plan with multiple services.

I never understood why our council got rid of day centers. They took 60 clients and provided breakfast, lunch, and afternoon tea, and chiropody and hairdressers visited. Clients could get assistance with a bath and more importantly, they had activities and social contact.
Now those same people are stuck at home, with carers popping in for the minimum time, with heated microwave meals, and very limited social contact. Surely economically the centers were more cost-effective?

Presumably your council received a cut to their budget so large from this Tory Government that they made immediate cuts to these local services for older people.

Ironic since it is the old who vote Tory in the main. But usually rich old people so unbothered by community centres, but really engaged by potholes and house building near the homes. We really do need a vision for our country that isn't basically for the over 60s

Yep they did. over 50% of government support lost since 2010, leaving a massive shortfall right when social care is skyrocketing

I know it's a nice idea to have "care in the community" but it must be ruinous in terms of all the costs of support staff either effectively living on site looking after few people, or driving around from house to house for an hour here and an hour here. All that "wasted" travel time and travel costs. Having more people in one place would be far more efficient.

I think that's known as warehousing. Bristol Council recently put forward a scheme like that and it's been roundly defeated.

Last month, I reported on cash-strapped Bristol city council’s proposal to move disabled people into residential care if it was deemed “best value” compared with providing support in their own homes. Readers took to social media with their outrage. Others used the council’s public consultation to voice their objections. Next, campaigners in Bristol engaged pro bono lawyers to challenge the legality of the proposal.

Then came the U-turn. In light of the growing backlash, the council has now scrapped the policy entirely.

https://www.theguardian.com/commentisfree/2024/feb/09/disabled-people-warehoused-bristol-victory-campaign

As it should have been, thats just institutionalising disabled people, and it's a step backward.
A convalescent hospital should be geared up to get people rehabilitated to go home. It should be a mid way point not a permanent residence.