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.

Bombastix: "This whole thread is a none too subtle advert for private GP services, which, given that they will be dealing with someone who is prepared to pay, is fine. It's a self limited class of people with minor medical conditions taking themselves off the NHS. That is someone's choice but it shouldn't be mandated for everyone else. You won't get a better clinical judgment, you might get a better class of chair, and a wider range of pills."

Good point - OP, do you work for one of the American healthcare companies or an insurance company touting for business among wealthier MN posters? If so, this shouldn't be pretending to be just for a discussion thread - at least pay for advertising or a sponsored thread.

Because privatisation has really worked for the public transport system and the utility companies, hasn't it?

Foreign ownership of critical infrastructure should have been banned.a long time ago

We are reliant on the French and Chinese for our power stations, The Australians, French, Japanese and Italians for our train companies

No foreign power should have access to our medical records and by extension our medical and prescription needs

That's what's going to happen

Outsourced to the cheapest bidder, overseas call centres and processing centres will provide awful services, with shareholders and executives pocketing money which should gave gone into the healthcare system

I don’t like the idea, but you’re right, it is basic common sense, this system will not continue to work. Above a certain income it’s not unreasonable to ask people to have insurance (whether personal or a standard work benefit like a pension) to partially cover costs.

That being said, if we closed a lot of the loopholes which allow wealthy people and companies to get away with not paying proper taxes, the situation would be less dire. I wouldn’t mind paying more in taxes if it translated to more help for the squeeze the middle also.

I got run over when I was 16 (1998). It was my fault as I walked out behind a bus. The police came to my house a few days later to sort of tell me off and I'm pretty sure my parents were charged for the ambulance.

The NHS sucks and most foreigners (not Americans) seem to agree.

I come from a "third world country" with universal healthcare. As I was fed up with the lack of care here (for something the NHS couldn't diagnose in 12 years) I went to my local public hospital in my birth country. Was finally fully diagnosed within a couple of weeks. The best of all it didn't cost me a penny because it was my constitutional right.

There’s a lot of wastage in the NHS that they should clear up before privatisation though.

Things like shifting admin to appropriate workers and our reliance on locums. There needs to be a cap on locum salaries, a minimum amount of time you have to be a permanent staff member, minimum amount of time you have to work on a permanent contract in the NHS or pay back the cost of training (which is far higher than student fees) maybe even scrapping the use of agencies altogether. And of course improving working conditions for permanent staff because ultimately this is the cause of this problem.

I'm in NZ, and yes the system seems to work pretty well. I've never paid for a blood test?? Our health system is suffering from a lack of staff however, much like the rest of the world, and getting a GP appointment is not the quick and easy thing it once was. We are charged for ambulance call-outs (around $100), but you can pay a yearly amount and get them free.

No, the increase failed to keep up with inflation. It’s a cut in real terms.

You seem not to understand the difference between anecdote and evidence.

@reesewithoutaspoon agree with most of what you said but just to add that currently in my Trust (one of the largest in geographical area, 8000 staff) there is just one finance team. Each individual has their own areas they deal with but they do cross cover and act as one department

The answer is not to pay more, I don't want to pay more.

There needs to be massive reform within the NHS and benefits system. What about the shocking wastage, Labours PPI debacle and the main one - individuals taking more responsibility for themselves and their health. Maybe if it wasn't all free people would think more about what they ate and how they exercise.

Honestly it beggars belief, people moan about no dentist (which i agree is a massive problem and unacceptable) but can't even be bothered to brush their children's teeth and continue feeding them sugary foods/drinks!

The answer is not more funding, its reform, personal responsibility and a mixed system like that in France/NZ etc.

Honestly it beggars belief, people moan about no dentist (which i agree is a massive problem and unacceptable) but can't even be bothered to brush their children's teeth and continue feeding them sugary foods/drinks!

This is nonsensical. If anything, the lack of access to dentistry is contributing to poor dental hygiene, rather than the other way round.

And you’re going to have to pay more, one way or another, or have inadequate healthcare. The NHS is actually under-managed - privatised and insurance based systems have significantly larger management and administrative costs - and over-burdened by a failing social care system.

Your choice is whether you pay more for the NHS, or to pay more for privatised care from which insurance companies require a slice of your money to feed their shareholders.

So, Schroedinger's appointments?

Can't get appointments, yet everyone is getting appointments for stubbed toes?

Again, you sound stupid.

I doubt it @bombastix on what basis would I make a claim? It would be more bother than it was worth.

I wouldn’t say it’s my choice that my GP is crap either. 🤷🏼‍♀️ They have a terrible reputation, awful reviews. Huge language barrier, so that doesn’t help.
But all the other surgeries aren’t taking on. The last remaining decent GP left the practice. So I’ll pay privately- because I can afford to. Many can’t afford it and receive substandard treatment.

it's the inefficiencies and corner-cutting and short-termism that cost the NHS long term.
Some examples from when I worked there
The ward, the operating theatres, a and e, and the ICU all had different IT systems. When they had the chance to streamline it with a new hospital, they chose not to "because it would be expensive" instead they stuck with the old machines, servers, and software. Departments can't cross communicate so everything had to be printed out or photocopied. Tests are often repeated because they are not available on another department's software. X-rays, and scans had to be burned to CDs to transfer to other hospitals, because of software incompatibilities.
All of this takes time and wastes resources. It makes patient care disjointed.
This kind of continued short-term thinking has long-term impacts.
Lack of access to PCs and slow servers means staff take longer than needed to access results, input clinical observations, etc. One of our databases would take 20 minutes just to load up because they wouldn't invest in server capacity.
That's 20 minutes you're waiting for that instead of doing something useful.
Blood requests took 15 minutes, compared to writing a form out in a minute.
replicate that a hundred times a day and it's a waste of clinical staff time.
Getting rid of admin to 'save money' so now you have a highly paid Dr doing basic admin tasks at a much higher hourly rate instead of doing the job they were paid for.
This is the kind of investment that's needed, to release staff back to doing the job they actually want to do. Instead of drowning in paperwork admin and tick boxes.
You would spend 5 minutes doing a wound dressing and then another 20 documenting it, because of slow out of date systems

@egowise

"So, Schroedinger's appointments?

Can't get appointments, yet everyone is getting appointments for stubbed toes?

Again, you sound stupid"

+++

Because it is free at the point of use access to healthcare or appointments is determined by how time rich you are (or in practice how prepared to queue or wait) rather than need.

So to give an example a person with no children and no longer working is able to be completely flexible about when the appointment is or how long to wait to get an appointment about their stubbed toe.

Whereas the working mum with three children is not so flexible and cannot afford to wait so they ignore that breast lump or persistent shortness of breath until it turns into something much worse.

We have replaced access to healthcare based on how financially rich you are for access to healthcare based on how time rich you are.

Useful series on NHS Myths and funding models in other countries.

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

A final article explores some specific policy ideas that are even less well thought-through, but are still popular.

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

Another problem with the US system is once its monetised your oversold medication and treatments . I have seen this here with private treatment where your scaremongered into spending . I could give examples but I was pretty shocked at the greed plus the bedside manner of consultants and ill treatment in the private sector leaving lasting damage. I think we are in this terrible situation where neither is up to scratch truly I was worried to hear how badly friends family were treated when opting to go private. Seems like its a free for all at the moment in the private sector.

Why when someone mentions co payment options or similar people suddenly jump towards US method and start quoting people who cannot afford 10p! Other systems are working perfectly fine in parts of Europe.

The NHS is a monster and a PP states that now depts are billing each other which is nonsense. Procurment is made up of 1000's of people doing the same role passing around bits of paper and running a nice cottage industry.

Why not a cross party project to look at a co payment system? Most people agree it needs more money. They just dont want to fund it themselves.

Because we’re already more than half way to the US system. Because the introduction of the US system requires no legislation.

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

I always say it's just as well we don't have a National Food Service instead of Tesco and Ocado as imagine how it would be run. We would all be queuing for our bread rations.

Lack of investment in IT, political meddling that says non-clinical staff are a waste of money, complaining about spending money on IT consultants - all this political interference that stops improvements. I am mad that so much of my care is done on paper. Why do I pay so much tax when it is wasted on tech from the 1980s?

One thing the private sector is often good at is efficiency. A mixed model much like other developed nations may well be sensible. Anyway, the NHS is already partially privatised as has been noted in previous posts.

As for people worried about your health data: sorry to say but Google probably has a really good idea about your health just based on your search and browsing history.

As for costs - as we get older and unhealthier, we have to spend more on healthcare. Politically, either people spend their own cash on their health, improve their health (with the aid of public health policies) accept cuts in other parts of government spending, or contemplate much higher levels of tax.

Which is it? Lower state pension? Taxing these mythical rich people (there aren't enough of them to make a difference)? Abolish council tax and replace with land value tax (papers start screaming about garden tax and dementia taxes).

Unfortunately demographically our country is screwed and we only have hard choices left.

As for people worried about your health data

Why are American insurance companies soo excited at the prospect of laying hands on our data?

Why are people so keen to put our health needs in the hands of foreign companies, with links back to their governments

Imagine someone having the power to throttle the production/distribution of pharmaceuticals to price gouge or sicken us

We really don't need that

@Tracker1234

The NHS is a monster and a PP states that now depts are billing each other which is nonsense. Procurment is made up of 1000's of people doing the same role passing around bits of paper and running a nice cottage industry.

Exactly! My OH needs regular blood tests for his chemotherapy treatment and other issues arising from it, i.e. vitamin deficiencies, high blood pressure, etc.

Not only won't the hospital and GP surgery "share" his blood test results, they won't do bloods for the other. So he ends up with two appointments, often on the same day, one at the GP surgery for the things that the GP deals with, and one at the oncology dept for the chemotherapy review. It's absolute madness to take two appointments when it could be done in one.

Apparently it's because it's different budgets, and the GP surgery would be charged if they did the blood tube/label for the blood test that oncology need.

Same with the vitamins etc - the oncology dept won't issue the prescriptions because then it comes out of their budget, so they abdicate responsibility to the GP surgery, so it comes out of their budget instead.

We need to stop this stupid and artificial fragmentation and start to run the NHS as "patient centric" rather than a pretend business being run for the army of pen pushers and budget holders.

The point is that Google has so much search data that they can probably build models to guess with a decent degree of accuracy your health. Obviously not as well as NHS data, but I would be surprised if they couldn't do it.

I have no idea if the NHS has gone cloud already in some areas and if they have then data already being held by big American companies And if they haven't, then you'll probably never get IT efficiency (or I imagine it will be much much harder).

There is a lot of hand wringing about data, but Google and FB have so much already that we gave them for free.

Having proper data infra for the NHS would unlock tons of benefits if it doesn't already exist.

Anyone who voted Tory voted for the internal market and Lansley’s atomisation of the NHS in England. Presumably that wasn’t you?