Running down the NHS so it has to be privatised?

''“That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.” Norm Chomsky''

it is so terrifyingly simple, unfortunately.

Of course Chomsky, the private sector à la American is only interested in making a proft. When someone becomes expensive to treat, they will put premiums up so high that people can't pay, or palm off the expensive part on the NHS- excluding those conditions.

MadeInYorkshire Reading your post clarifies why I am so concerned about privatisation, it is people with chronic conditions who will be most affected. I'm sorry that you have to cope with this. Chomsky is absolutely correct and if you can ensure that you deflect the blame for poor performance onto those who are delivering it rather than those who make the decisions about funding, it's a double win.

Of course it's a plan to sell it off - it has been since Maggie Dearest. You can bet most MP's will have their grubby little fingers in the private healthcare/insurance pie.

I had a Facebook memory come up the other day - in 2011, I actually said that it was already changing and going downhill, with a view to privatise it, and sadly as a heavy user of the NHS, with an average of one surgery per year over the last 25 years, I have literally watched it die. I am now scared about my next admission. It will be an emergency scenario, I will self treat at home with Morphine to begin with in the hope that it is only a partial bowel blockage, of which I have maybe had 30 over the years. If after several hours I can't get the very severe pain to resolve then I know that I will need more help and call for an ambulance. IF that ambulance comes in good time and IF there aren't any backlogs in A&E, and they aren't queuing for hours outside, I MAY get seen in time before my bowel strangulates and dies, then burst and gives me sepsis. I am really not holding my breath ....

“That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.” Norm Chomsky

So the Junior Doctors have announced a further 4 day strike in August and the consultants will also strike again for two days just before the August Bank holiday. This is not going away.

Going back to the short speech/talk I flagged.

This knowledgeable person (others have different and equally valuable knowledge) says that we do not generally pay less than others for health but that our wonderful NHS suffers from age-related issues.

It simply hasn't caught up with modern-day applications, and our increase in longevity has led to a weighting of spend on older people. The speaker pointed out that 10% of our NHS spend goes on the last year of life.

To deal with this, he suggests we need to unblock the bottlenecks. They are in both hospital and General Practice. He also suggested that the NHS must embrace joined-up information technology and the early-age use of AI.

From what he says about us generally being in step with other countries in what we pay, it seems we are in a place that is very similar to most businesses that are early adopters. The people who set up the first weaving shops to have mechanised looms were overtaken some years later by those buying bigger and better looms. Such companies may have still been paying for the very expensive early loom. This is where the NHS is.

His suggestion for upgrading the service is to take the emphasis off the hospitals and GPs and bring hospital services into the community. This would be possible with the amount we are paying if we ignore the fact that we have high costs from a very elderly and frail part of the population. We get no help from those on the extremes crying for only state-run or only private health services. We must learn from them both. It was always the case that the Private sector could learn from the Public sector and vice versa.

My bias would be to always be towards a mixed economy. This doesn't necessarily mean hiving off parts of the public service but just allowing private businesses to offer the best they can. We then have models we can look to, when it comes to improving public service.

It seems we can either, using our present system of raising money, have a service focused on caring for the old and vulnerable or a service using analytical methods to preempt illness and known conditions. We now have to understand how we can pay for both if we are to keep our NHS.

I would suggest that we move towards the community-based system many are in favour of. In fact, it is actually happening with peripatetic visits to community clinics by various consultants. This, and tracking possible conditions early, would/could be paid for out of the current budget.

Since the founding of the NHS, life expectancy has increased by around 13 years. More people are living with cancer or dementia, and other diseases due largely to increases in life expectancy and a fall in the rate of premature death.

Ceasing to pay for National Insurance post State Retirement age may have seemed fair in 1948, but now, with so much of the country's wealth in the hands of those who have retired, I can't see how it is. I believe it's time for this extended longevity and the comfort we have known financially to be balanced.

I would suggest the introduction of SNI or Seniors National Insurance to be paid by everyone, possibly at a lower rate than NI, from state pension age to death. The cost of "Care" at younger ages should then be paid from the current budget. The cost of elderly care should go down as the early intervention system takes away some of the frailty and complexity of conditions.

Political parties keep saying that electors are only interested in low taxes. I have yet to meet anyone who isn't willing to pay extra taxes to get better services, whether health or road repairs.

M0nica

there is no intention of any political party to privatise the NHS, whatever that might mean. We are one of many countries providing a free public health service to their inhabitants and there are many and various waysof doing this.

When public helath services are ranked, we come seventh. The things we are worse at are giving patients access to resources and the quality of our health outcomes. the two real basics of care.

I thinkwe need to have a damn good look at the ways other countries do the same job better and learn from them.

We should certainly be looking at how other countries fund their health care, they pay higher taxes, hence Gov confound more. Can't see the British, who don't seem to want to pay more for anything health wise, going for that though. Perhaps each individual, along with pension subs should also pay into a long term social care fund, which supports people in need of long term care. After all even if young, one never knows.

The figures he is using are on graphs on the video I linked. I feel I can hear doors slaming all over GN as minds stay firmly closed.

I doubt any one person has all the answers but you are often single source researcher, if I remember rightly.

www.health.org.uk/news-and-comment/charts-and-infographics/how-does-uk-health-spending-compare-across-europe-over-the-past-decade
www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29
These are a couple of reports from pretty reliable sources that would disagree with him. We did spend a lot in 2020 though, more than most countries, I think we bought a lot of PPE and spent lots on track and tracing, Nightingale hospitals etc but that's not exactly indicative of overall spending, is it?

I wonder why you think he would risk his reputation by producing spurious figures, Maisie.

I have no idea, but the recent OECD figures contradict him.

I'd like to know which years he was talking about. Perhaps they were pre 2010 when the Labour government actually adequately funded the NHS.

And however well qualified he might be it doesn't guarantee that he agrees with the current model of NHS funding or has no biases...

If you actually watched the short video Maisie or read my post, you will see he said that in some years, we're second only to the US in terms of the amount of money we throw it our healthcare system but he also said that we're always in the top third. Which means that in some years we may well spend (far) less than Germany and France.

The two are not mutually exclusive.

He was very impressive and reassuring during Covid.

Duckduckgo.com or

Sir John Irving Bell GBE CH FRS FMedSci FREng
Who is a Canadian-British immunologist and geneticist. From 2006 to 2011, he was President of the United Kingdom's Academy of Medical Sciences, and since 2002 he has held the Regius Chair of Medicine at the University of Oxford

I wonder why you think he would risk his reputation by producing spurious figures, Maisie.

Frankly, DAR, I don't trust the OECD figures, when we have seen figures such as some posted, I think on this thread, which show that we spend far less than Germany and France.

This wikipedia entry uses OECD data and shows that the UK comes nowhere near the US in health spending, and spending by other OECD countries are in excess of the UKs.

en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

So the assertion that the UK's spending is sometimes second only to the US looks very dubious.

This links to an image search for comparative spending. Find one where the UK is second to the US...

duckduckgo.com/?q=comparative+spending+by+countries+on+health+care&t=chromentp&iar=images&iax=images&ia=images

Nor can I summon up much respect for a speaker who uses phrases such as 'the amount of money we throw it'. This is populist, emotive language which doesn't sit well with a purportedly objective examination of our current problems.

It's not due to lack of money. This is a chart from the King's Fund paper on OCD data. That 12.8 is the number for the UK. You can see that in some years, we're second only to the US in terms of the amount of money we throw it our healthcare system, and we're always in the top third. So the idea that we don't have enough money in Healthcare system is incorrect, and for that large amount of money, we've actually got a relatively catastrophic outset of outcomes.

This is avoidable mortality rates and you can see we're right ..., well actually not. Thank goodness for the USA because they're always the worst at all this stuff. But, just to be clear we're the second worst. So you know, there's a bit of work to do here for sure and one of the reasons is that the NHS has really become a technology averse Healthcare system. It's really almost bulletproof against new technology.

If you look at the amount of money we spend on drugs, particularly new drugs, it's much lower than most of our peers. If you look at our access to technology like CT scans and MRI scanners again with a little box right at the right, we just don't do it and as a result the system is really disabled because we haven't taken up the innovative options.

This is a small section from the talk (10 minutes) I linked. There are a satisfying number of graphs and models but I can't reproduce them here.

It seems to be less about a lack of money and more about the areas where the money is spent, Maisie.

I think most would agree with Prof Sir John Bell there are two main problems with moving to this model that I can see. Firstly, encouraging people to take responsibility for improving their own health is not straightforward. Take obesity, smoking and excess alcohol use, we all know that these are precursors to many diseases that currently make up the bulk of comorbities that cost the NHS so much but we also know that getting people to change their habits is extremely difficult. He talks about using data to inform us of risk but re-read the threads on here about statins and there is resistance from some to take them! The evidence of the efficacy of taking statins in later life is data driven yet some won't believe it applies to them. I've read posts on here about people who don't want their data used because they fear it will be used for the wrong reasons tbh they can have all my data with pleasure!
Secondly, whilst moving to a new model of healthcare, we would still need to fund the existing model properly and he doesn't tackle this at all. Even if a new model was set up now, there will still be a need for late stage disease treatment for huge numbers of people as they age and who won't have benefitted from a different way of looking at health.
I certainly don't believe this is the way our current govt is intending to take the NHS as prevention of disease is not as profitable as treatment except it might lead to more of us taking medication at an earlier stage of our life but with much better outcomes.

Aveline

Blinko

M0nica

there is no intention of any political party to privatise the NHS, whatever that might mean. We are one of many countries providing a free public health service to their inhabitants and there are many and various waysof doing this.

When public helath services are ranked, we come seventh. The things we are worse at are giving patients access to resources and the quality of our health outcomes. the two real basics of care.

I thinkwe need to have a damn good look at the ways other countries do the same job better and learn from them.

👏👏👏👏

I agree

I think you'll all find that the first thing that 'other countries' do to make their health services better is to put more money into them. We've seen the figures on spending in other countries.

Why on earth people think that there can be improvement to services without spending any money on it is a complete mystery to me.

Even just running a vast fact finding exercise to identify where and how to improve would be very costly. This is a point which MOnica refuses to address...

Blinko

M0nica

there is no intention of any political party to privatise the NHS, whatever that might mean. We are one of many countries providing a free public health service to their inhabitants and there are many and various waysof doing this.

When public helath services are ranked, we come seventh. The things we are worse at are giving patients access to resources and the quality of our health outcomes. the two real basics of care.

I thinkwe need to have a damn good look at the ways other countries do the same job better and learn from them.

👏👏👏👏

I agree

I have referred to this speech elsewhere but feel it could feed in to this discussion. At The Conference for the future of Britain 2023 This was in the section of speakers headed Transforming Public Services.

Transforming Health - Professor Sir John Bell explains the importance of life sciences to the UK economy and set out how science and technology can transform our approach to health and care by shifting the focus to prevention and health creation – vital for economic growth, a sustainable NHS and enabling people to lead longer and healthier lives.

www.youtube.com/watch?v=s6sK43iB0CU

Further to my post, Students entering med school at the same time as DD would have expected to be paid a basic rate of £58,750 p.a. at this stage in their career if salaries had kept pace with inflation, a difference of £15,225. Perhaps this explains why doctors are refusing to settle.

M0nica

there is no intention of any political party to privatise the NHS, whatever that might mean. We are one of many countries providing a free public health service to their inhabitants and there are many and various waysof doing this.

When public helath services are ranked, we come seventh. The things we are worse at are giving patients access to resources and the quality of our health outcomes. the two real basics of care.

I thinkwe need to have a damn good look at the ways other countries do the same job better and learn from them.

👏👏👏👏

The refusal of the govt to negotiate with doctors and the RCN is not helping matters but I think this is part of the govt plan. Three more of the doctors who graduated with my DD are leaving to work abroad. Before anyone says they should work for x years or pay back their training costs, they have worked in the NHS for 7 years. They are all midway through specialist training and are absolutely essential to the running of the NHS, often being the most senior doctor in the hospital outside daytime hours. My DD starts the second part of her training to become a consultant anaesthetist in August, basic pay £43,500, she will get an uplift for working nights and unsocial hours and generally works a 12 hour shift with at least 30 mins tacked on at either end for "handover" She won't get paid overtime if for some reason her shift over runs eg she needs to stay to talk to relatives or she's suddenly called to an emergency just before her shift ends. She's been working as a locum this year direct for a large hospital so no agency costs. She didn't get a further training post in a part of the country she wanted to work in, there's huge competition for places and anaesthetics training is especially short of training places, so many junior doctors have to mark time during their training, goodness knows how they are going to manage training even more junior doctors. She is getting paid £1,000 approx for a 12 hour shift, that's the "market rate" for the skills she brings, it's enabled her to pay off her student debt, given her flexibility to have a life outside medicine and tbh she looks better than I've seen her look for several years! It's becoming more acceptable for junior doctors to request part time contracts during training because they want to stay in medicine, avoid burnout and can make up their salary by working the occasional locum shift, thus reducing the staffing even further. These are the consequences of not paying or treating people properly.

These last posts are hitting the nail on the head.

Very emotional ethical dilemmas as its not just drugs, its expensive procedures too. And some unpopular decisions made to maintain levels of care on what we currently have within reason expected.

I keep getting adverts for ear syringing etc. It made me think back to when our GP did that. Then that stopped. Patients started to have problems seeing a chiropodist. Now it’s difficult to get an appointment to even see a doctor. I have a dental check up on Thursday. I’m half expecting them to tell me they’re going private. It’s like a drip drip thing that people are now just accepting as normal. They said on the news that they’re increasing the time at crossings because obese people take longer to cross the road. Years ago I used to see how many people in America were obese and thought to myself that we always seemed to follow America.why are we not doing more to reduce obesity here? ( I do understand that loss of mobility makes it difficult to keep one’s weight down and that’s no one’s fault but I see so many obese children now). I thought Johnson was going to do something about the obesity problem but that was another empty promise. Everything just seems to be getting worse and worse. And, I’ve just spoken to someone on the phone who’s told me how long she’s got to wait to have a telephone consultation with a doctor(5 weeks) and how many months a relative of hers has got to wait for a mastectomy

But this should apply to all- not just NHS patients, or in the case of expensive drugs, just private.