If British identity is bound up with the NHS, what do we lose in going private?
Martha Gill
The correct question is why are we damn stupid enough to reify a method of health care delivery.
If British identity is bound up with the NHS, what do we lose in going private?
Martha Gill
The correct question is why are we damn stupid enough to reify a method of health care delivery.
Everyone loves the idea of the NHS (or, at least, the free treatment) until they actually need to use it. Then they discover it’s total shit.
The only things it’s good at is killing 100s people through incompetence, neglect and lack of compassion.
“You won’t even have to fill out a complicated form, or wait to be reimbursed by some unforgiving bureaucratic body. You can just turn up. ”
I think that more and more, this is one of the two biggest problems with the NHS. People clog it up with stuff that they should probably just have a chinwag with their neighbour about. Introduce a small fee or just add some level of pain (like filling out a form) and a lot of people won’t do it.
If Specsavers was free, people would be popping in just because they had an itchy eye. The £20 cost stops them.
Bevan’s original concept was good and sorely needed at the time. However, it’s shit like
the NHS Leadership Academy that the NHS has no business being involved in. It has nothing to do with health care.
https://www.leadershipacademy.nhs.uk/meet-the-team/
It seems like the Conservatives (in name only) have no easy mechanism for replacing the NHS, so seem intent on letting it strangle itself with its own bureaucracy and on its own internal inconsistencies.
Not very clean or graceful, but it’ll eventually do the job. Then we can move on to a European style private medical system based upon insurance with only a limited public capacity for the Ne’er-do-wells, the public sector Health unions can go phuq themselves and efficiencies / economies of scale that are blocked by the NHS system can run full flow.
I’d expect actual costs as a % of GDP to fall slightly and health outcomes to rise from the dismal level of today to around the Western European average or better.
The antiquated NHS and its infernal union dominated bureaucracy is preventing all of that. Since we can’t kill a national institution (almost a secular religion) it needs to be allowed to die of “natural” causes like all those old biddies on The Liverpool Pathway.
“Introduce a small fee or just add some level of pain (like filling out a form) and a lot of people won’t do it.”
This would indeed help. I can’t see why the its such a contentious issue. We are told we must pay more in taxes to fund the NHS, so why not just pay more in fees instead?
However the trouble would be that the NHS would probably just refuse to implement the payments, or rather implement them in principle but just not collect them at the granular level. The staff would just stick two fingers up at the government and refuse to do it, especially for the ‘difficult’ patients. So you’d get the little old ladies dutifully handing over their £20, while Stabby McChav would get seen for free. We see it now with the charges that the NHS is supposed to levy on non-UK citizens using the NHS – more observed in the breach than the observance.
@John Galt: I have always said the NHS must die on its knees before it can be replaced with something better. It cannot be reformed while it is still operating with even a semblance of efficiency. What a real Conservative Government should be doing is creating a parallel system in miniature that sits along side the NHS that could then be expanded when the political will for change is present.
I would do everything I could to enable people to go private and thus expand the amount of private provision there is, probably making health payments tax deductible, forcing the NHS to contribute to people’s private healthcare costs if they’ve been waiting for an op beyond a certain point, that type of thing. Do everything I could to allow as many people as possible to go off the NHS reservation, without actually changing the ‘free at the point of need’ nature of the NHS. Basically undermine the building so it collapses without ever having to take a wrecking ball to it.
@Jim – Ah, but you’re a smart man, not a Tory MP/Minister/PM. 🙂
Agreed about the tax deductibility of healthcare, I presume that the socialists understand that is exactly how you build a shadow healthcare system needed as a replacement and is exactly why they refuse to enable it.
Things like using private services where NHS waiting lists are excessive helps though. Especially where those private services cost less than the NHS service they are “helping”.
Reify or deify?
I may have mentioned this a few times but there is no need for a financial deterrent. The NHS acts as its own deterrent what with having to explain what’s up to the reception dragon and if you pass that obstacle to sit in a dreary waiting room with its (I’ve counted) forty-seven notices. The only benefit of a £20 fee would be if someone could set up a private service for the same money.
John Galt,
“It seems like the Conservatives (in name only) have no easy mechanism for replacing the NHS, so seem intent on letting it strangle itself with its own bureaucracy and on its own internal inconsistencies.”
I think that might be true. What the Conservatives also need to do is to get more medicine done by people like pharmacists and specifically trained people and let them charge a small fee for it. The NHS is like Linux – free, if your time is. Why did I pay Sainsbury’s £15 for my flu jab? Because they can do it Saturday morning while I’m shopping and I’m in and out in 5 minutes. The NHS would want me sat on a phone for an hour to book it, then have to leave work, probably in the middle of the afternoon (because they let old Mrs Miggins book the 6pm appointment even though she can come in all day) and wait for an hour.
Most of what GPs do for people could be replace with pharmacists. I don’t believe it takes more than a week of training to get someone to diagnose a throat infection, at which point, they can give you antibiotics. Let them charge a tenner for the diagnosis and we can scrap GPs and train more doctors to work in a hospital, doing the specialisms.
NHS waiting rooms need to have copies of The Joy of Tax and The Courageous State for people to read while they are not seen for hours.
Over the years and after many encounters with assorted health industry saff (and being married to one) I have heard of and occasionally seen staggering levels of waste and incompetence. Everywhere is overmanned – except actual patient facing staff or those directly supprting them (medical staff, porters, ward clerks, catering staff, cleaners, there are no doubt other roles). These posts, who actually do the messy, patient caring bit, always seem to be short staffed.
My solution is simple. Line up all NHS staff in alphabetical order, from health trust CEOs to Phillipino cleaners. All patient facing staff take a step back and go on about their business (so all the Phillipinos can get back to work, CEOs stay in line). Then, from all the rest, make every third one redundant on statutary minimum payments, doesn’t matter if the person is a chief exec or an HR drone – gone.
The big advantage of this approach is that nobody with the ability to preserve their own jobs (HR, C-suite) is making redundancy decisions – all are grist to the mill.
Trick,
“Over the years and after many encounters with assorted health industry saff (and being married to one) I have heard of and occasionally seen staggering levels of waste and incompetence. Everywhere is overmanned – except actual patient facing staff or those directly supprting them (medical staff, porters, ward clerks, catering staff, cleaners, there are no doubt other roles). These posts, who actually do the messy, patient caring bit, always seem to be short staffed.”
Because none of it is led by “health” people.
I did some work with a district nurse service on a project and I would have just put the most senior nurse in charge of it and fired the managers, and given that nurse total control over things like purchasing and hiring and firing. Yes, she’d have some administrators, but they’d work for her, do what she wanted.
The clinical people in the NHS are basically a decent bunch in my experience on that project. A lot of the nurses personally went out and bought sat navs because they couldn’t get one from the NHS. £200 of kit at the time. Total no brainer spending but you have to jump through all the hoops of central purchasing to do it.
@Trick with no sleeve – Nice take on the ancient Roman practice of decimation, but still too weak, since the phuquers will just start building up their empires again. Extermination is the only way, but politically unacceptable, hence building shadow services and waiting for the inevitable collapse.
Democracy is a shit way of doing things.
It seems like the Conservatives (in name only) have no easy mechanism for replacing the NHS, so seem intent on letting it strangle itself with its own bureaucracy and on its own internal inconsistencies.
Not very clean or graceful, but it’ll eventually do the job.
This assumes they’ll be there to see it through. It seems more likely that Labour will get itself elected on a platform of “refunding and restoring” the NHS.
[insert pictures of doctors and nurses – don’t worry about darkies and purple haired trannies this time]
Can’t see it happening bar a Labour/LibDem/SNP alliance which would be as stable as the final moments of the Chernobyl reactor. All the Tories have to do is put up posters of that plonker Sir Keir Starmer kneeling to the thugs and racists of BLM and it’s all over.
I doubt whether the Tories could win an election decisively, but Labour can no longer win alone at all. Not without major reform of which they seem incapable.
The part that wins is the ones that control their crazies better and that is still the Tory party by a country mile. Whereas Labour can’t even tell their electorate what a bloody woman is.
Joke parties don’t win elections and Labour is currently a joke.
For all their failings the Tories remain vaguely sane and electable.
I recently met a bloke who was waiting two years for a prostate operation. Regularly changing his catheter (to prevent UTI) has probably cost the NHS more than just doing the op.
The NHS block booked thousands of private beds during the covid panic. Some trusts are using them for elective operations now the panic has mostly ended. But some trusts don’t. You have to know, and demand. (There are rules about this.)
Prior to Brexit there was the S2 route. If your op was cancelled or delayed you could go to any EU clinic and get reimbursed the cost. Now you have to apply in advance, with torturous paperwork, to go to a specific public (not private) hospital with a fixed quoted price.
In conclusion, the NHS is doing its damnedest to preserve its monopoly.
“Bevan’s original concept was good and sorely needed at the time.” Balls. The wartime coalition government had produced a Bill to extend the welfare-state medical system but bloody Bevan tore it up because it contained a large role for the local authorities. He wanted a centralised Stalinist system – a crap idea.
Understand: the National in NHS stands for despotism from London. Ditto, the National in National Coal Board and, come to that, the National in National Lottery.
@dearieme
The wartime coalition government had produced a Bill to extend the welfare-state medical system
Yes and no. It was the labour element of the Coalition as a body which delayed implementation and that objected to the local element, with Bevin, not Bevan, as the prime objector.
“Many Brits are suspicious of socialism in the abstract. But it is through experience of the NHS that they have learned to love its species of socialism in practice – being treated for childhood illnesses there, seeing elderly relatives cared for at their last, and never having to pay.”
Brilliant! Sounds too good to be true!
(How is it paid for, by the way…?)
Yes, every British character in an American movie just goes on and on about the NHS. Nothing about tea or crumpets, no “cheerio, guv’na” or chimney sweeps, butlers, university professors, explorers on African safaris…they just keep yapping about wait times and Astra Zeneca. As British as Sunday roast.
““You won’t even have to fill out a complicated form, or wait to be reimbursed by some unforgiving bureaucratic body. You can just turn up. ”
Don’t know where they get their ideas about other systems from.
Couple of weeks ago took a friend to the local (public) health centre because she’d been suffering pains in the lower back. She was just a walk in at 13:30. She was seen within 15 minutes. ( They suspected kidneys. Not a surprise!) Sent her to the big hospital outside Marbella. Half hour drive & we’re in the queue. Hour wait for triage. Then another hour for a test & wait for results. Those indicated a further test so another wait. 23:00 she was installed in a treatment room hooked up to needles & piping for the night. (Dialysis?) Discharged midday next with prescriptions for antibiotics etc & a follow up appointment
Complicated forms? She’s got a health card. Doesn’t pay. They take the number off the card. No forms. Be the same for me since I’m over retirement & running on my transferred NHS entitlement. otherwise it’d be the insurance co card.
UK side I’ve seen people wait that long just to be triaged. And dripping blood on the floor while they waited.
“Many Brits are suspicious of socialism in the abstract. But it is through experience of the NHS that they have learned to love its species of socialism in practice – being treated for childhood illnesses there, seeing elderly relatives cared for at their last, and never having to pay.”
I think the bit about seeing their elderly relatives cared for in their declining years has been and is being tested to destruction. How many people with elderly parents can put their hand on the heart and say ‘You know what, Mum/Dad got excellent care from the NHS in her/his last few years’?
@BiS: According to the World Bank data, Spanish spending on healthcare is about $2.7k per head, and the UK is considerably higher, at $4.3k per head. So can someone tell me why you get that sort of service and we get the utter shambles that is the NHS? What is it about the Spanish system that provides such a better deal? Do people have to pay anything up front for healthcare at all? Are all the doctors and nurses employed by private businesses or the State? Is it because there is a barrier to care in that if you are an illegal you don’t get it, unless you pay cash? So the number of people who actually qualify is less than the entire population, whereas in the UK its not only anyone who happens to be residing in the UK, its anyone who can get on plane and rock up at a London hospital? Basically why does their system work, and ours doesn’t?
There is no direct link nowadays between expenditure and outcomes.
I think it works in the same sort of way that the University system works. Initially, when they freed the Universities to charge what they wanted, the wonks thought that the Unis would charge a fee (capped at around £10000 per annum) proportional to the cost of the course. Naturally, they all immediately bumped the price up to the max.
You have to be exceptionally careful to set the incentives correctly, otherwise you get the sub-optimal outcomes that happen when politicians do anything outside the bounds of their expertise.(which is everything outside of looking after no.1)
Spain, as with most European healthcare systems is run as a mix of private and public services on a highly decentralised basis with the Spanish Government dealing with budgeting, funding through taxation and regulation.
Overview of the Spanish healthcare system
The pre-NHS model was similarly decentralised with individual hospitals, large and small being financed by charities and community groups such as local employers. In the event of someone being ill they could obtain treatment through private payment, work related hospital / GP schemes, full-insurance or part-insurance with co-pays.
If the creation of the NHS had simply provided nationalised funding from taxation of this existing infrastructure then we would have ended up with a similar model to other European countries such as Spain through evolution of largely public taxation and mixed public/private delivery as appropriate for each local authority.
It is the NHS behemoth (especially the National aspect) that makes it unwieldy, subject to excessive political interference, overmanned (especially in administration), bureaucratic and slow to change. It is literally the worst model of healthcare excluding, perhaps the corporate capture of the US system.
“I would do everything I could to enable people to go private and thus expand the amount of private provision there is…”
The drift to increased provision and the willingness (out of choice or necessity) to go private is on the increase, not least because of the growing demographic of relatively well off boomers. I recently read that, in the interest of fairness, a number of NHS trusts are encouraging this by using an algorithm that prioritises patients from the lower end of the food chain.
When I go for my annual dental check I ponder what my £28 checkup would actually cost as an NHS service. Even when I’ve been unemployed and signing on I’ve been really reluctant to tick the “NHS claim” box on the form, hoping to lessen my dentists’ capture by the quagmire, and to keep myself personally invested in my dental health care.
When I had my throat operation I calculated a good estimate of what the procedure and drugs likely cost, and while there is almost no personal action I could have done to prevent throat cancer (never smoked, light drinker, just “one of those things”) – other than catching it and getting it treated before it turned into cancer, it keeps me aware.
“The pre-NHS model was similarly decentralised”
The two systems I know most about: Sheffield Council owned several hospitals and clinics, and ran a “penny in the pound” health scheme for anybody in the city. Pay 1/240th of your wages and and you were covered for city health provision. You didn’t have to be employed, you could opt in – important in a city founded on a huge amount of sole-trader workers, the little mesters, the foundation of the steel industry.
Whitby had the Cottage Hospital scheme, where I have less knowledge of, but essentially operated a combined savings plan and emergency assistance. Up the duff? Start collecting maternity stamps to pay for the midwife. Retired sailor? You better damn well keep paying into the Sailors’ Fund to support working sailors or you’ll not get served in the pub or the Co-op. Local wealthy worthy? You quietly pay inflated doctor’s fees without complaint, and ostentatiously donate to the town hospital, along with all the bains donating their sixpences from their pocket money. As with Sheffield, it worked because it was *LOCAL*.
And we still had 25 years on the damn mortgage when Bevin/Bevan stole the damn hospital from us.
@Jim The Spanish system’s a mixture of private & state. People in employment are expected to have & pay for health insurance. I used Helicopteros Sanitarios because I was living up in the mountains when I took it out. Gave me access to their air-ambulance service if needed. The State safety-net’s there for those who can’t. We certainly have a lot of private clinics & labs scattered about. I generally have a yearly blood test which is very thorough done at one of them. Costs around €200. I could probably get it done on the State system, although not so thorough. But I didn’t use the NHS when I lived in the UK, if I could avoid it. Why start here? My time’s worth more than the cost.
The little interaction I’ve had with the Spanish system, everyone seems to be doing an efficient job. There’s an absence of that front end of admin layabouts are a feature of entering the NHS system. Few years ago had a problem with a knee. Probably strained it, but thought it was worth having it looked at in case it was a precursor to anything else. Drove up to Malaga & parked outside the hospital in the free car park. Reception did the paperwork in a few minutes & I was (embarrassingly) wheel-chaired to triage. X-ray, diagnosis of damaged tendon (what I thought it was) back to reception to pay the bill on my card. 120€ if I recall rightly. Whole episode about 45 mins but I had lunch in the hospital restaurant before I left.
It was much the same with the xica with the kidneys. Both the clinic & the hospital, the front end’s someone behind a counter, gives you a wrist tag points you in the right direction. Takes a couple of minutes. A lot of the time we were in the hospital was the result of one test indicated the next test. So a lot of it was waiting for analysis. And very impressed how the end played out. Because she’d been waiting for her number to come up for the various stages of the testing we hadn’t eaten & by the time they had her plumbed in she was well past meal times. I went buy her sandwiches & drinks out of the vending machine & a nurse came down & escorted me to the treatment suite. I’d have never found it. And they let me sit with her for a bit although it was well past midnight when I left. Car park was free as well so I hadn’t spent 50€ on pay & display or had the wheels clamped á la NHS.
Should have added, I’ve lived in France. System’s much the same. I think they may well be a little less friendly to illegal immigrants though. There was a pregnant N.African who objected to something about a French hospital few years back. So she was told to go & drop her pup the street if she felt like that about it. Which she did. Caused a mild stir in the papers.