The NHS is gone ...

You make some good points Dickens. I don’t believe that the government actually do have a master plan, I think in reality they are winging it, to see how much privatisation they can get away with. Boing is correct to a degree in that there are some ‘loss leader’ services that can be run more cheaply in the private sector.
The way I see it is that they favour the Aldi model, rather than the Tescos model. So, a cataract centre for example, buys in surgeons and theatre staff, does 50 patients a day at a cost of £500 each. The cost of a cataract on the NHS is £1000. That’s because they fit the cataract procedures around complex operations, emergencies, calls on medical time to go to A&E etc. etc. - so for cataracts it is less efficient. So, using the Aldi/Tesco analogy, it’s cheaper to provide high volume, low complexity procedures (goods) at Aldi. However, they can’t do low volume, high complexity procedures (goods) because they are low turnover and therefor costly. Hence, you can’t get your special dog food (or whatever) at Aldi. The government hasn’t found a way to match the two objectives. So I think we flatter them to assume they are going for the USA model, or that of any other country - when they don’t have any master plan, just an opportunistic eye on the main chance.

But this isn't anything new...my friend is a theatre nurse at a private hospital....they have been doing nhs work for at least the last 20 years to my knowledge...maybe longer.... I had surgery 12 years ago in a private hospital as an NHS patient....its not a new thing

DaisyAnne

MarathonRunner

I had a minor procedure done , day surgery
GP referred me to a consultant at a Private Hospital and I had the surgery a few weeks later , paid for by NHS . I'm not too sure why but I was more than happy to accept

How happy would you be to accept if it meant you had to contribute?

I've also had the same happen but my GP delayed investigation and I had a C scare. It was their problem to deal with and my whole family pay tax and therefore pay for the NHS. How is it my problem that the government aren;t choosing to fund it properly?

Is anybody in a position to explain why a private insurance-based model would in itself be more efficient and/or deliver better outcomes? I'm genuinely puzzled.

The NHS, free at point of use was the whole idea. We pay in what we can afford, then it's there for those who need it - regardless of income. It was a brilliant scheme, a decent safety net, the reassurance that we'd always be looked after. We were proud of it.

The problem now is - we simply don't pay enough in - so it's an underfunded, broken system. It's trying to do the impossible - yet the solution is simple - fund it (and yes, we can afford to).

Is anybody saying it would be more efficient or deliver better outcomes growstuff?

www.health.org.uk/news-and-comment/charts-and-infographics/how-does-uk-health-spending-compare-across-europe-over-the-past-decade

I agree Hetty. What I don't understand is why people think that the system in other countries, based on private universal insurance, would be better. The fact is that most countries mentioned pay more per head and/or as a percentage of GDP than the UK.

Casdon

Is anybody saying it would be more efficient or deliver better outcomes growstuff?

Well, maybe I've misunderstood, but that's what I've understood from some posts.

M0nica

Dickens How do we know that is what the governemnt have in mind.

I am not a supporter of the Conservatives, I am sure there are members of the Conservative party who would like an American type health system, though for the life of me I cannot see why, in the same way that there are members of the Labour party, who support a massive nationalisation of every significant industry in this country, but nobody suggests that that is on Labour's Agenda.

Where is the evidence that an American health system is what the Conservative party and government espouse?

I offered no evidence MOnica because I don't have any.

It is purely a personal opinion.

It is largely based on what I observe as a total lack of commitment in any concrete or meaningful way to deal with the crisis in the NHS. The fact that Sunak met with healthcare companies in California. The legislation that was pushed through the Commons which could (I repeat could not will) allow US private health care reps to sit on NHS boards.

Lots of other things too, MOnica but I don't want to write a thesis on my opinion. But when there is no agenda with bullet points to ponder and study, one can only guess and surmise.

I have no proof - I could be entirely wrong, and the government are working hard on trying to resolve the issues within the NHS, and with social-care because they are committed to the well-being and welfare of the nation.

Casdon

You make some good points Dickens. I don’t believe that the government actually do have a master plan, I think in reality they are winging it, to see how much privatisation they can get away with. Boing is correct to a degree in that there are some ‘loss leader’ services that can be run more cheaply in the private sector.
The way I see it is that they favour the Aldi model, rather than the Tescos model. So, a cataract centre for example, buys in surgeons and theatre staff, does 50 patients a day at a cost of £500 each. The cost of a cataract on the NHS is £1000. That’s because they fit the cataract procedures around complex operations, emergencies, calls on medical time to go to A&E etc. etc. - so for cataracts it is less efficient. So, using the Aldi/Tesco analogy, it’s cheaper to provide high volume, low complexity procedures (goods) at Aldi. However, they can’t do low volume, high complexity procedures (goods) because they are low turnover and therefor costly. Hence, you can’t get your special dog food (or whatever) at Aldi. The government hasn’t found a way to match the two objectives. So I think we flatter them to assume they are going for the USA model, or that of any other country - when they don’t have any master plan, just an opportunistic eye on the main chance.

So I think we flatter them to assume they are going for the USA model, or that of any other country - when they don’t have any master plan, just an opportunistic eye on the main chance.

... excellent!

I don’t believe that the government actually do have a master plan, I think in reality they are winging it, to see how much privatisation they can get away with.

... and again!

I think there might be quite a lot of winging-it - in terms of their stance towards the strikes within the NHS... hoping that the general public will back them (the government, not the strikers).

^ I could be entirely wrong, and the government are working hard on trying to resolve the issues within the NHS, and with social-care because they are committed to the well-being and welfare of the nation.^

What has this got to do with whether the Conservatives want an American type financed health service or not. All this says is that their idea of a solution is not yours. Nothing to do with the basis of how to fund it.

It is only recently that I finally realised how much of this debate is hot air and wild accusations, but is actually lacking any evidence to support it.

I think this analogy of management and bureaucracy in the NHS by Tony Benn sums up completely the problems we are facing.

andywinterbn1.wordpress.com/2021/01/02/tony-benns-analogy-of-management-bureaucracy-in-the-nhs-is-still-relevant-to-us-today-as-we-move-forward-within-the-context-of-covid-19/

M0nica

^ I could be entirely wrong, and the government are working hard on trying to resolve the issues within the NHS, and with social-care because they are committed to the well-being and welfare of the nation.^

What has this got to do with whether the Conservatives want an American type financed health service or not. All this says is that their idea of a solution is not yours. Nothing to do with the basis of how to fund it.

It is only recently that I finally realised how much of this debate is hot air and wild accusations, but is actually lacking any evidence to support it.

It's sarcasm MOnica. Forgive me, I'm just a tad cynical.

All this says is that their idea of a solution is not yours.

I don't know what their idea of a solution is - they haven't told us.

And I didn't offer a solution, just an explanation of why people might think we are headed in the direction of the American system.

Sunak was in California sitting round the table with US healthcare companies - as far as can be determined the companies specialised in social care. And he wanted to encourage them to work in the UK, but, I believe was rebuffed. These companies sell insurance to pensioners and connect patients with carers.

He wasn't in France, or Germany or anywhere else in Europe discussing the European model of healthcare.

Why the surprise that people think we're going down the American route?

MerylStreep

I think this analogy of management and bureaucracy in the NHS by Tony Benn sums up completely the problems we are facing.

andywinterbn1.wordpress.com/2021/01/02/tony-benns-analogy-of-management-bureaucracy-in-the-nhs-is-still-relevant-to-us-today-as-we-move-forward-within-the-context-of-covid-19/

Thanks for that link, it was an interesting read.

The NHS was very discouraged and set up a consultancy. The consultancy came to the conclusion that the Japanese had eight people rowing and one steering, whereas the NHS had eight people steering and one rowing. The NHS appointed people to look at the problem and decided to reorganise the structure of the team so that there were three steering managers, three assistant steering managers and a director of steering services, and an incentive was offered to the rower to row harder.

Oh, boy!

I used to work for NHS so have first hand knowledge of how some things work and it wasn't a very nice experience, very nearly cost me my life - bullies!

Dickens my enquiry is narrowly focussed on wanting to know where the evidence is that the Conservative party/government want us to move to an American style health system?

I am thinking in terms of a policy document, government statement, not just the fevered imaginings of the wild and wooly far right, some of them would probably bring back burning at the stake, given a chance and or/ the equally fevered imaginings of main stream Labour party members.

If it were true that the government wanted to move to an American-style health system, it wouldn't be transparent enough to publish a policy document. It wouldn't be a vote winner. The evidence needs top be sought in what is actually happening.

If it isn't a vote winner then they will not do it.

Exacty growstuff. All people have to do is open their eyes- the evidence is all there, for all to see.

A friend with serious cataracts had both of them done promptly at a fairly local specialist clinic, paid for by the NHS. Goodness knows how long he’d have had to wait otherwise - and there was no way he could have afforded to pay.

I honestly don’t see anything wrong with farming out certain procedures. When you take everything into account - inc. doctors’ pensions etc. I don’t suppose it works out that much different.

I do honestly think the days of the NHS providing everything we need, all free at the point of use, are now past. There is a vast difference between medicine generally and treatments available now, compared with 1945.

M0nica

Dickens my enquiry is narrowly focussed on wanting to know where the evidence is that the Conservative party/government want us to move to an American style health system?

I am thinking in terms of a policy document, government statement, not just the fevered imaginings of the wild and wooly far right, some of them would probably bring back burning at the stake, given a chance and or/ the equally fevered imaginings of main stream Labour party members.

Given the nation's attachment to the NHS and their reliance on it, it's hardly likely that any policy document detailing / outlining American-style health insurance, if one even exists, would be made public. So in terms of concrete evidence - there isn't any.

The speculation arises because no major plan has been put forward. There's the usual tinkering around the edges - the re-active as opposed to pro-active plans to deal with the crisis. But no-one in government has come forward to say, right - here's the plan for the future funding of the NHS...

So until that time, the speculation will continue - some of it fuelled by the fact that Sunak spent time in the US talking to healthcare companies.

I think he, Sunak, is focused more on foreign policy at the moment, and the domestic challenges are taking a back seat.

All we know is that 75 years ago the Tories opposed the introduction of the NHS having attempted in 1944 to impose charges and private insurance (according to Gordon Brown who believes "Conservatives are testing the water for a different kind of NHS").

There's not much to work with is there?

M0nica

If it isn't a vote winner then they will not do it.

They may well move further down the privatisation route, continuing in the unstructured, opportunistic way they already have, but it will be at a time when they have years in office to go, not when they are very much on the back foot as they are now.
I think you do mainstream Labour supporters a disservice, we are in the main a cynical bunch, and we aren’t stupid, we recognise that the government haven’t achieved the degree or scope of privatisation that constitutes the somewhat fevered title of this post, even in England.

In 2008-2010, “the private medical insurance industry was having kittens because the NHS was so good and so swift and so responsive at meeting patient need, that people were not buying health insurance policies. Why would you, because the NHS was so good. And we can get back there.”

This is the beginning to Phil Whitaker's on how to fix the NHS in the New Statesman blog (£). If I have a chance I will try and summarise it but I am busy at the moment. If anyone else can then it would add to the discussion.

For me it is simple. No one from the Conservative side has convinced me they are not setting out to privatise it after the American model. I am sure those people will scream that this is not proved and that we should still all vote Conservative because they give us such a wonderful life.

What discussions such as this prove to me is that I don't believe that me and mine could afford what we would otherwise get under the "pay while you can, use when you need" system we have all contributed to during our life times, if this were to happen.

I often don't completely trust what Labour supporters say. But on this I have no trust whatsoever that that Conservatives will not do this.

In an letter to the BMJ, in November 2022, Nick Mann, a GP says:

Privatisation of the NHS is not fictional. US Centene is now the largest single provider of GP services in England. It also owns Circle and shares in US Babylon. US UnitedHealth recently bought EMIS, and it and McKinsey have regularly advised the government and steered sustainability and transformation plans, accountable care organisations and integrated care systems on NHS "transformation". Hospital Corporation of America owns most private sector hospitals. Private health companies pull out of contracts if they're not profitable enough.

The is very well referenced and can be found at www.bmj.com/content/379/bmj.o2668.full

M0nica

If it isn't a vote winner then they will not do it.

Yes, they would. It would alienate large swathes of the electorate, if they were honest and transparent, but others, including the providers and those who could afford it, would benefit.