Privatisation of the NHS discussion

[Dave1987]

The NHS has always been a hot potato for the Tories. I’m sure deep down that some of them would love to privatise it much like all the utilities are in private hands now. But it is an institution that is deeply held to heart by the British public and god help any politician that even thinks about trying to privatise it. The one good thing about Trump mentioning that everything is on the table for a trade deal is that journalists will keep on asking the Tory leadership contenders about whether they would sell the NHS off or not. This will keep it in the public consciousness and ward off any tiny thoughts about whether they could get away with it.

 

[DarloRich]

Nice words. It's a wonder he couldn't bring himself to support the Miner's Strike if that's what he believed ?

Because of the way Scargill conducted both himself and way in which he formed the strike.

 

[underbank]

I support using private companies to provide some NHS services, but I will not support privatising the NHS for any reason.

Some privatised NHS services work really well. Don't forget that dentists, opticians and pharmacies (also GP surgeries) are usually private businesses contracted to provide NHS services. I recently used Specsavers for my new hearing aids - the efficiency and convenience was FAR superior to my previous experiences of getting them through the local hospital ENT/audiology department. Just one appointment and all done in an hour or so on the High Street whereas to get my previous hearing aids from the local hospital took six months and involved several appointments with different people in different locations. We need to find a way to use private providers where it's efficient to do so, but at the same time, have adequate controls and supervision.

 

[433N]

Because of the way Scargill conducted both himself and way in which he formed the strike.

King Arthur, to you.

 

[Howardh]

Some privatised NHS services work really well. Don't forget that dentists, opticians and pharmacies (also GP surgeries) are usually private businesses contracted to provide NHS services. I recently used Specsavers for my new hearing aids - the efficiency and convenience was FAR superior to my previous experiences of getting them through the local hospital ENT/audiology department. Just one appointment and all done in an hour or so on the High Street whereas to get my previous hearing aids from the local hospital took six months and involved several appointments with different people in different locations. We need to find a way to use private providers where it's efficient to do so, but at the same time, have adequate controls and supervision.

In my kidhood glasses were extremely expensive, top end of £100 in today's money (possibly more) in the 70's.
Thankfully these days you can grab a pair for under £15; brought about by being free to take your px to any optician of your choice (ie cheaper prices) which I don't think was the case in the 70's; and of course on-line retailers with rock-bottom prices.
You mentioned Spexsavers; I wonder if it weren't for the ability to shop around and on-line sellers whether they would be offering "cheap" glasses & hearing aids, or still be part of the cartel where they keep a very tidy profit?

 

[Howardh]

We will. Brexit will deliver this. The country is falling apart and most people don't care.

They'll care when they find out what losing freedom of movement and free health care means when it hits them.

But it's too late then.

 

[hexagon789]

We need to find a way to use private providers where it's efficient to do so, but at the same time, have adequate controls and supervision.

That's basically my feeling - as long as quality is either equal or better to what the NHS itself can provide, why shouldn't they outsource to private providers particularly if it's more convenient for patients as it is in many instances.

 

[TheEdge]

The NHS has always been a hot potato for the Tories. I’m sure deep down that some of them would love to privatise it much like all the utilities are in private hands now. But it is an institution that is deeply held to heart by the British public and god help any politician that even thinks about trying to privatise it. The one good thing about Trump mentioning that everything is on the table for a trade deal is that journalists will keep on asking the Tory leadership contenders about whether they would sell the NHS off or not. This will keep it in the public consciousness and ward off any tiny thoughts about whether they could get away with it.

I think this is very true. Free movement, free trade, those are all very nebulous things to the general public. The ability to go the doctors and not pay, get a prescription for a nominal amount, not be bankrupted by a hospital trip, those are things that impact people every day. And I think if anyone genuinely tried to move the NHS towards private they'd be crucified.

 

[duncanp]

The ability to go the doctors and not pay

Somewhat ironic in that many EU member states there are charges payable at the time of treatment for seeing a doctor, eg:-

The standard GP consultation fee in France is €23, although you can claim some, but not all, of that back.

In the Republic of Ireland, a visit to A&E costs €100 unless you have a referral letter from a doctor, but the GP's visit can cost up to €40.

It is not necessarily the case that Brexit will lead to either the privatisation of the NHS, or the introduction of charges for NHS services that are currently free. Such decisions are for the UK government (or the devolved administrations in Scotland and Wales) The government will be accountable to the people for any decisions it takes with respect to the NHS post Brexit, and the people are entitled to elect a different government if they don't like what the government decides.

 

[Meerkat]

There is always this insistence that the Tory party want to privatise the NHS.
Whilst I am sure some of the economic extremists might like to I just don’t see how it would ever fly with the party membership....which is very much elderly and therefore major users of the NHS.

 

[edwin_m]

Their federalised structure of government is better than our federalised structure, but we've only really been doing it for a few decades. After that, though, I'm drawing a blank.

There are plenty of other federalised structures that work better than the US.

 

[Bletchleyite]

There is always this insistence that the Tory party want to privatise the NHS.
Whilst I am sure some of the economic extremists might like to I just don’t see how it would ever fly with the party membership....which is very much elderly and therefore major users of the NHS.

It very much depends on what you mean by privatise it. GPs are private businesses, so are dentists. Neither was ever nationalised.

I assume the primary thing people are concerned about is the risk of it ceasing to be free at the point of use, or about the risk of the funding structure changing to an insurance scheme in which the fee was based on risk rather than ability to pay.

There are many upsides of a compulsory insurance system with insurers banned from turning anyone down and pricing based on income/assets. One particular advantage is of no postcode lottery - you have an insurance document which states precisely what you are insured for. Everybody gets and must have the same basic package (free if they have insufficient income to pay), but you can top up with additional services (such as dental insurance, or private room cover, or out of hours GP type services, or whatever) at a commercially derived price.

 

[krus_aragon]

There are plenty of other federalised structures that work better than the US.

Sure. I was just giving one example where I think the US (specifically) does better than the UK, as defined by @Bletchleyite. That doesn't mean that they have the best approach.

The UK's federal structure is still in its nascent stage, and evolving (when we're not politically paralysed by issues such as Brexit).

(I'm more familiar with the Canadian federal system than the US, and am passingly aware of the German system. Beyond that, I'd have to either feign ignorance or do a lot of reading up.)

 

[Bevan Price]

Any UK government that let our NHS transform into a US-style health care system would be committing political suicide for at least the next generation.
Our NHS may be imperfect, but even the poorest people have a good chance of getting treatment when required.

 

[Typhoon]

Any UK government that let our NHS transform into a US-style health care system would be committing political suicide for at least the next generation.
Our NHS may be imperfect, but even the poorest people have a good chance of getting treatment when required.

I don't think it will be sudden, in fact it probably won't happen in my lifetime (I'm late 60's), but little steps may be taken, maybe insurance for certain types of procedure, maybe companies allowed to build and run new hospitals (extension of PFI). Whatever. Once these steps are taken it is difficult to stop. Yesterday I met members of my family - next generation, generation after - for the first time in years in most cases; most have got honest, humble jobs - they keep your streets clean, they cut your hair, they look after your old and your young, they sell you flowers. Not a lot of spare cash. I worry for them!

 

[Belperpete]

In my kidhood glasses were extremely expensive, top end of £100 in today's money (possibly more) in the 70's.
Thankfully these days you can grab a pair for under £15; brought about by being free to take your px to any optician of your choice (ie cheaper prices) which I don't think was the case in the 70's; and of course on-line retailers with rock-bottom prices.
You mentioned Spexsavers; I wonder if it weren't for the ability to shop around and on-line sellers whether they would be offering "cheap" glasses & hearing aids, or still be part of the cartel where they keep a very tidy profit?

Specs are only cheap now if you require a standard prescription. If, like me, you require something non-standard then you suddenly find that the small-print kicks in and the "2 for 1" offers no longer apply, the cheap frames aren't available and so on. As has been pointed out previously, the problem with out-sourcing to the private sector is that they cherry-pick the cheap and easy options, meaning those who require something non-standard suffer either a worse or more expensive service.

 

[Belperpete]

The main thing the USA wants is for the UK to pay American prices for drugs. As I understand it, the NHS uses its buying power to negotiate low prices on many drugs, and many other countries use these prices as a template for what they are prepared to pay. The American drug companies are very unhappy at the loss of profits this causes. Making the NHS pay "commercial" rates for drugs wouldn't be immediately obvious to the general public, so could be implemented without any great political consequences. Think of the pay rises awarded in the past to NHS staff without a matching increase in funding. It was easy to sell pay rises for doctors and nurses to the general public, but they were a real headache for the NHS which had to find the money from existing budgets. I can see something similar happening with drug prices, it will be sold to the public as a small price to be paid for the big trade deal, and no doubt there will be some positives that can be spun, such as patients having ready access to innovative (and expensive) drugs without NICE restrictions. However, I have no doubt the NHS would be left to find the extra costs from existing budgets, with a dramatic impact on services.

 

[433N]

It seems the height of irony that the greed of American corporations and their demand for access to overseas markets in the pursuit of growth which they can't find in the US, has left so many behind that they vote for Brexit against the Bogeyman EU, only for American corporations to demand more access to British markets.

As somone once said American corporations ARE the American government.

Marx understood that capitalism was good for growing economies but not for developed, low-growth economies. However, much it might hurt, it's best to face it. Capitalism is dead - it's just that few have realised it yet. Clinging to it is just pining for a lover who has left. We need to move into a post-capitalism phase , and no, that doesn't necessarily mean socialism or communism so please don't write in.

 

[Typhoon]

I can see something similar happening with drug prices, it will be sold to the public as a small price to be paid for the big trade deal, and no doubt there will be some positives that can be spun, such as patients having ready access to innovative (and expensive) drugs without NICE restrictions. However, I have no doubt the NHS would be left to find the extra costs from existing budgets, with a dramatic impact on services.

You are almost certainly absolutely right. There will be video clips of distraught parents sitting by the bed of a listless three year old, tubes hanging from the ceiling. The voiceover will say that unless Lisa receives some drug she will die. The parents understandably want her to have the drug, her lawyers understandably want her to have the drug. What will not be said is that the drug has minimal record of success, even if it is successful will lead to a highly dependent patient with no real quality of life, and costs stacks for each dose, maybe resulting in patients in absolute agony having their operations put off because budgets have been exceeded.

I know it is difficult, I recently was persuaded that a relative be made comfortable but no attempt be made to resuscitate. Not the same, I know, but medical expertise was so much sounder than my raw emotion.

"... it will be sold to the public as a small price to be paid for the big trade deal" - short term gain for long term pain!

 

[Butts]

Somewhat ironic in that many EU member states there are charges payable at the time of treatment for seeing a doctor, eg:-

The standard GP consultation fee in France is €23, although you can claim some, but not all, of that back.

In the Republic of Ireland, a visit to A&E costs €100 unless you have a referral letter from a doctor, but the GP's visit can cost up to €40.

That could make it a lot easier to get a Doctors appointment and drastically reduce the waiting times at A&E.
As Ireland is probably the most similar country to the UK both in terms of culture and history is this where we should look for a solution ?

Are people marching in the streets of Dublin, Kerry and Cork insisting their Government replicates the NHS ? - if not why not?

If the NHS system is that great why have they not copied it ?

 

[Bletchleyite]

That could make it a lot easier to get a Doctors appointment and drastically reduce the waiting times at A&E.

But utterly negates the point of A&E in the first place, which is somewhere to go when things are really urgent, when stopping to contact a GP is going to mean more pain and suffering or even a life threatening or life changing situation getting worse. I can barely imagine a more stupid idea than that.

You also don't want people putting off seeking medical care due to not being able to afford a doctor's fee. Medical fees (rather than compulsory insurance) are highly regressive - the more sick you are the less you are going to be earning.

If people prefer to go to the hospital site and be sent to the right person, why not simply provide more walk-up-and-queue GP and nurse services at hospitals (which would take the load off regular GPs)? Walk-in centres are near enough that I suppose and are a very good thing.

(I could half concede to a very small "plastic bag style" fee of around £5 or so - but it'd soon be increased, so best not to have it)

 

[Butts]

But utterly negates the point of A&E in the first place, which is somewhere to go when things are really urgent, when stopping to contact a GP is going to mean more pain and suffering or even a life threatening or life changing situation getting worse. I can barely imagine a more stupid idea than that.

You also don't want people putting off seeking medical care due to not being able to afford a doctor's fee. Medical fees (rather than compulsory insurance) are highly regressive - the more sick you are the less you are going to be earning.

If people prefer to go to the hospital site and be sent to the right person, why not simply provide more walk-up-and-queue GP and nurse services at hospitals (which would take the load off regular GPs)? Walk-in centres are near enough that I suppose and are a very good thing.

(I could half concede to a very small "plastic bag style" fee of around £5 or so - but it'd soon be increased, so best not to have it)

What about answering "The Irish Question" ? - the charges jibe was ironic !!

 

[yorksrob]

Perhaps we need to look a what we (as citizens) like about the NHS and other systems and try and work out what we like about it and what we don't.

• UK - We like the point that it is free at the point of delivery, universally funded as a citizens right, but not that the Government can ration the funding. We also like the ability of the NHS to negotiate in bulk and get good bargains with multinationals.
• USA - we like the superlative quality of some proceedures and the innovation of the industry, but not the overly commercial nature of service at the point of delivery, and the comparatively poor outcomes for overall public health.
• The Continent, We like that it seems to have good outcomes at the point of delivery - uncertain about the benefits of the insurance model.

Perhaps our ideal system would involve keeping the 'free at the point of delivery' element of the NHS, but de-coupling the funding aspect of it from Government. Perhaps we could start by ring-fencing the existing chunk of taxation for health spending and diverting it to a separate 'mutual' body which would look after it as a sort of 'national insurance' scheme (totally separate from the thing of that name, which is just another branch of national taxation).

We could then develop some way of indexing payments to this national insurance scheme to health costs, separate to the hurly-burly of national taxation. We could even develop this scheme so that people have an element of choice in which hospitals or surgeries, they use their chunk of the funding, if we wanted to be more 'market' orientated, but the universal funding, free at point of delivery aspect would be maintained.

 

[Butts]

Free at the point of delivery ????

NHS Dentistry certainly does not fall into this category !!

Do you believe it should ?

 

[yorksrob]

Free at the point of delivery ????

NHS Dentistry certainly does not fall into this category !!

Do you believe it should ?

Harold Wilson and Barbera Castle fell out with the labour leadership over this in the 1940's. I see no reason to re-run that argument (although I do believe that everyone should have access to NHS dentistry, free or otherwise).

No, the real issue for today is how much social care needs to be integrated into healthcare. It definitely needs a new funding mechanism from today's local authority funded model, although it won't be the same as the existing NHS today. Some sort of proper, universal insurance might work.

 

[Bletchleyite]

Free at the point of delivery ????

NHS Dentistry certainly does not fall into this category !!

Do you believe it should ?

Yes I indeed do. But certainly I would not make any more parts of the NHS not free at the point of delivery.

The prescription charge is silly too.

 

[yorksrob]

Whilst I'd never want the NHS 'replaced' as such, or opened up to voracious profiteers, I am interested in how it could be improved.

For our love of the institution, I've known a couple of people who've come up against physiological wear and tear issues, and felt that the assistance offered by the NHS hasn't been up to scratch. So much so that they have gone private. We need to find a way to reverse this so that people are confident in it.

 

[Butts]

Yes I indeed do. But certainly I would not make any more parts of the NHS not free at the point of delivery.

The prescription charge is silly too.

Probably why Scotland and Wales got rid of them ?

 

[Howardh]

One thing that should be charged are patients who fail to turn up for appointments without good reason. How you would get the money off them in "fines" I don't know, but maybe they should provide their credit card number on their details at the surgery/hospital?

Anecdotally, the receptionist at my doc's told me earlier in the day an old lady had rung the surgery up "Please can you cancel my appointment this afternoon, I'm not feeling too well....".

 

[Dave1987]

I actually have nothing against anyone that can afford it going private. In fact I believe things should be in place to encourage as many people who have the means to go private to do so, and in so doing reliving pressures on the NHS for those without means to go private. BUT I never ever want this country to get to the point where a doctor will not treat you until they have established you have means to pay for the treatment or that drugs become so expensive people cannot afford to pay for their prescriptions. I don’t believe the current favourite for the Tory leadership, Boris Johnson, can be trusted not to offer the NHS on a plate to the US in return for a trade deal.