NHS reform or die

Are we ready to close the NHS and embrace private healthcare?

Can the UK afford private healthcare?

The evidence from the United States is that private healthcare provisions are considerably more expensive and the United States spends a far greater portion of its GDP on healthcare than other countries.

There is a lot of money to be made from private healthcare though, people will spend a lot of money on their own healthcare if they have it, so that obviously makes it very attractive for a lot of people.

When people don't have to pay for the thing, they don't value the thing.

When people don’t have to pay for the thing, they don’t value the thing.

Any evidence that people don't value the NHS because they don't pay for it directly?

Talking to the patients who screech at me about their entitlement, I see the evidence of it daily. Or perhaps I'm just cynical after [yet again] one of my receptionist was bought to tears already today by people who seem to be unable to behave like adults.

"The health service makes more people proud to be British than our history, our culture, our system of democracy or the royal family"

https://www.health.org.uk/news-and-comment/charts-and-infographics/how-the-public-views-the-nhs-at-75

But the public see "NHS" as a single branded company which makes them proud, this is propaganda as the reality is very much a different story.

It may say "NHS" on the shop front, but once your inside it's a private bazaar.

"Last year nearly 15% of NHS staff had physical violence from patients, their relatives or the public.

A BMA survey in January 2020 found:

 - 43% of 602 doctors were concerned about physical violence and verbal abuse from patients at work

 - 32% of 602 doctors believed that incidents of violence or verbal abuse had increased in the past year

- 43% of 644 doctors saw physical violence or verbal abuse towards staff

 - issues thought to be factors in the incident(s) of physical violence or verbal abuse included discontent with the service provided (60%), health related or personal problems (54%), and being drunk (30%)."

https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/creating-a-healthy-workplace/preventing-and-reducing-violence-towards-staff

As a non expert, it seems to me a lot of the investment needed needs to go to "non-hospital" areas to free up hospitals to do their bit more effectively - support to discharge patients back home or into convalescent homes, GPs to deal with less serious stuff, social care to keep people out of hospital.

More work on prevention, exercise, better diet, rehab - would reduce longer term NHS costs, increase tax paying employment.

We also are going to have to face the cold harsh fact that we can't afford to keep everyone alive. We are not designed to be immortal. We die. We should be able to have some say in how that happens at a time and with the dignity of our own choosing.

(If you can get tickets, I recommend seeing Ben Eltons current stand up tour, he does on amazing long running gag about how assisted dying might work, Granny's final meal)

Can the UK afford private healthcare?

Wages would need to increase.
More Companies would have to start including healthcare insurance.
In the US, even if you have insurance the deductible can be in the thousands.

Speaking from personal experience (here not the US), get sick, can’t work, on SSP.

Would be unable to pay for medical treatment to return to work.

Sure £400 for a scan would be doable, but an operation? No way.

When people don’t have to pay for the thing, they don’t value the thing.

But we do have to pay (at least us PAYE plebs not dodging our taxes), and I think most people do value the NHS, hence most are up in arms when it's decline is increasingly obvious.

Two decades of politically engineered decline with a RW press trying to coax us towards a national consent for destroying a key national resource still hasn't quite done it.

Coordinated NHS reform along with joined up social care and broader investment is very much needed. It's not just about money.

Most fundamentally (beyond the NHS in fact) the national discourse needs to get away from focussing on financial costs, but looking at consequences. Every time the question back seems to be "how much will it cost?" rather than journalists, politicians and the public asking "what are the consequences of not doing this?" 

The Neo-Libs have had their go (Someone does need to tell Reeve and SKS though) anyone still believing that Austerity works needs to be challenged and asked what they think 'Success' actually looks like.

Can the UK afford private healthcare?

Ask the Germans or the French. They both have a tightly regulated private insurance schemes backed by the govt. They both seem to have better healthcare outcomes on more or less the same overall % GPD spend. (Germany 12.7, France 11.9 UK 11.3) Not every private healthcare model = the US version.

backed by the govt

Do you class GP services as "private healthcare" then? If so the question has been answered - we already have private healthcare provisions.

The NHS will always be a victim of it's own success. Save a life?, the person comes back again and again for more treatment as they age and decline. Let them die first time round?, no more patient to drain future resources. <sarcasm> Simples!

Except it isnt simple at all. My octogenarian parents attend many more out patient and GP appointments than my children. They no longer contribute financially to society but did so for decades. They've earned their treatment from cradle to grave. One of the weans will become a net contributor to society, the other won't, both will need the NHS. Who chooses?

What type of treatment does the NHS withhold and from whom? Liver transplant for an alcoholic? Heart and lung transplant for a heavy smoker? Orthopaedic treatment for a mountain biker? All self inflicted, so sod 'em all?

It's an impossible situation in a humane society but keeping Tories, US insurance companies and shareholders as far away from the NHS as possible would be a great start.

I work in a completely different part of the public sector that has many of the same problems.

The answer isn't just reformation, the primary answer is more tax, mainly for the rich.

I'm a staunch believer in socialised healthcare, free at the point of use but the NHS is, by and large, an absolute shit show. Individual parts of it can work well but integration is severely lacking and if your health needs span several different disciplines then ime you've really got to be on the ball to improve your chances of a good outcome.

And it's a controversial view I know, but NHS employees at all levels are not a team of uniquely dedicated saints, they're mainly well intentioned ordinary people working for a wage like ordinary people do. Some of them are exceptional, and equally some are absolutely useless, just like in any large workforce.

I agree that the whole system is in need of reform, not least by integrating social and healthcare. It's a hugely complex "organisation" and I wouldn't have a clue where to start.

All I can add is, having been taken to an A&E well away from my home town not long ago with a serious condition, alone, tbh scared with a real fear of what it was all going to reveal, the NHS staff and service can be fast, efficient and a good experience, full of the best of humanity. It's had me thinking about where the NHS is a lot recently. That the staff are paid what they are is a travesty and we need to value them more than just performative clapping.

I have zero faith in privatisation, water and rail tell us all we need to know there and regulation is ineffective when money and big companies are involved. Ultimately the things we need most in life like heat, water, health are the things that we can be gouged the most for and the gouging is done by wealthy people who have private cover. I don't have an answer of course but if funding is the issue and increasing private business in the NHS is the answer, I suspect the frameworks that prevent beyond-reasonable profiteering need to be thought about. Is there anything like that in pharmaceuticals?

Do you class GP services as “private healthcare” then?

Depends on your definition of private healthcare I guess. To me, most of the NHS provision outside of Trusts - and anything that is a profit generating enterprise is [by definition] private healthcare. So that's GPs, Dentists, Opticians, Pharmacists To my mind, it's the "free at the point of care" for some healthcare that's the issue though not necessarily how it's provided. Some folks could (and perhaps should) pay for their care so that others who can't afford to do so, don't have to.

Most fundamentally (beyond the NHS in fact) the national discourse needs to get away from focussing on financial costs, but looking at consequences. Every time the question back seems to be “how much will it cost?” rather than journalists, politicians and the public asking “what are the consequences of not doing this?

This. Because this:

I work in a completely different part of the public sector that has many of the same problems.

Ask the Germans or the French. They both have a tightly regulated private insurance schemes backed by the govt. They both seem to have better healthcare outcomes on more or less the same overall % GPD spend. (Germany 12.7, France 11.9 UK 11.3) Not every private healthcare model = the US version.

Percentage of gdp isn't really a good way of measuring, if you look instead at the figures spent per person, then France outspends the UK by about 20% and Germany by nearly 60%.  If the health outcomes are nearly the same, then that would indicate that their systems are less efficient, which given how the NHS has been targeted by the Tories over the past 10 or so years is quite incredible that the NHS is still delivering such outcomes, and actually speaks to the efficiency of the system that they have been able to deliver under such poor political management and undermining.

Figure from 2022

United States $12,555
Switzerland $8,049
Germany $8,011
Norway $7,898
Netherlands $7,358
Austria $7,275
Belgium $6,600
Australia $6,597
France $6,517
Sweden $6,438
Luxembourg $6,436
Canada $6,319
Denmark $6,28
New Zealand $6,061
Ireland $6,047
Finland $5,676
United Kingdom $5,493
Iceland $5,314

but keeping Tories, US insurance companies and shareholders as far away from the NHS as possible would be a great start.

I worked briefly for a company that in turn was owned by one of the largest US heath insurance firms. Every representative I met (and some of those were senior executives) were pretty adamant that inflicting the US style healthcare on the UK would be a disaster that they'd not want to go anywhere near, despite what the likes of Farage and the Tories may say.

It's indicative I think of us that we look at how the US has evolved its private healthcare rather than at most European countries who are nearly all a mix of mandatory personal private insurance and govt backed schemes

water and rail tell us all we need to know there and regulation is ineffective when money and big companies are involved.

This.

Speaking to an ambulance driver the other week.
Serious RTA had them on scene for approximately 2 hours using 2 vehicles to both treat people and act as blue light road blocks to ensure safety of themselves and others on site.
Because the traffic police are also parred right back to the absolute minimum cover all it takes is multiple incidents and they can't be in 2 places at the same time.
I do feel we will end up with a pay to use system for NHS treatment, where you pay a percentage of the cost of treatment via savings, 3rd party insurance or a government funded loan scheme.
The costs are enormous though, and the cost of making it better is huge. Probably be the same as a high capacity railway line to Birmingham.

It is so complex, so huge and so challenging that I wouldn't dare suggest how to fix it. But a decent start would be to whack huge tax in unhealthy stuff, and use that to heavily subsidise healthy stuff. Make it cheaper to be healthy than unhealthy.

I'd also suggest trying to establish a cross party approach, similar to a war cabinet, and remove the NHS from party politics.

I feel an essay coming on...

Some quick bullet points:

• I don't think the characterization of NHS staff as "heroic" is helpful in any shape or form.
• It's not so much the way that things are funded, as what is funded that makes the difference.
• Historically, increases in funding have been associated with better outcomes in the NHS, and funding has fallen in real terms since 2010.
• There's no doubt in my mind that secondary care (hospitals and specialist services) have become less productive in the past decade, including community based specialist services such as mental health, despite receiving increased funding.
• GP services have become more productive in the same time frame, but that's come at the cost of retention of GPs which is a tragedy on many levels.
• Despite those past two points, there is a continued push to try and make GP surgeries work more like miniature hospitals, rather than make hospitals and community services work more like GPs.
• The focus on access is counterproductive and IMO self-defeating because of induced/uncovered demand.
• Despite our productivity, GPs are no substitute for well-conceived and executed public health policies.

Great to have input from people actually involved on topics like this - at the risk of @Kramer neglecting his professional duties to write an essay (wink emoji) could you give us some bullet points on how you think reform should look and/or where investment needs to be targeted?

Anybody who is obese, a smoker or a drug addict should simply have their right to free healthcare withdrawn.

Junk food needs to be taxed heavily, to the point where real food is cheaper.

GP appointments and basic treatments should be paid for by the individual.

Anybody who is obese, a smoker or a drug addict should simply have their right to free healthcare withdrawn.

You do not understand addiction.

In my limited experience we seem to waste an awful lot of NHS resources on giving people an entirely undignified death.

I have no clue how to fix it, so many things seem broken and it's such a vast organisation that it will take years and £billions to affect any noticeable (to Joe Public) change. I hope they do though and I'd gladly pay more income tax for it.

What happens when its a recurring condition or try getting a holiday insurance company to pay up when you have a medical emergency due to an underlying condition.

"The computer says no"

It’s an impossible situation in a humane society but keeping Tories, US insurance companies and shareholders as far away from the NHS as possible would be a great start.

This, most definitely this.

In my limited experience we seem to waste an awful lot of NHS resources on giving people an entirely undignified death.

This would require a grown up conversation which, in general in this country, we are not capable of.

Starmer on NHS reform here

"Let me be clear from the outset what reform does not mean first - it does not mean abandoning those founding ideas of a public service, publicly funded, free at the point of use, the basic principle of dignity, inspired, of course, by Bevan that when you fall ill, you should never have to worry about the bill".

Good god.

The tenents of failed capitalism are alive with this thread.

You want to improve things then stop with this idea that the private sector does things like this better.

Same pool of labour and same skills are available to government. At no cost to the public.

The private sector adds a layer of inefficiency called profit.

It's a terrible path. Fund it and fix with the state. Labour are certainly convincing people they've got a bridge to sell for sure.

Just about everything privatised is shit. Why more? It's ridiculous.

The tenents of failed capitalism are alive with this thread.

Actually, the majority of posters clearly don't think that. Have you thought about going to Specsavers for a (private) eye test?

Talking to the patients who screech at me about their entitlement, I see the evidence of it daily. Or perhaps I’m just cynical after [yet again] one of my receptionist was bought to tears already today by people who seem to be unable to behave like adults.

Without wanting to diminish the problems that your staff have, this isn't dissimilar to the stories that my daughters tell me about their workplace. The incredibly rude customers, people who shout about the most trivial issues and reduce the staff, mainly teenage girls, to tears. They work in an ice-cream parlour!

The issue is with how people treat each other these days. I'll bet that your staff (or a significant number of them) treat other 'workers' just as poorly as they get treated themselves.

@IdleJohn

They work in an ice-cream parlour

Before I became a doctor, my summer job was as an ice-cream man. Twas ever thus...

Although I do think it's become more commonplace.

I’d also suggest trying to establish a cross party approach, similar to a war cabinet, and remove the NHS from party politics.

100% agree with this.
The NHS shouldn’t be a political football which “needs”reform every time a new government is elected.

@MoreCashThanDash

could you give us some bullet points on how you think reform should look and/or where investment needs to be targeted?

• We need to cut funding to hospitals and secondary care and give it to Primary Care to retain and recruit doctors.
• Primary Care needs to be a GP (doctor) lead service supported by other professions, not replaced by them.
• Secondary care and community services need to support GPs, not the other way round as currently happens.
• In all areas of the NHS we need to stop trying to save money by replacing doctors with other professions, it's not working and IMV it's a root cause of the drop in productivity in secondary care.
• We need to look at the training of doctors, it's gone wrong and we are starting to see a generation of doctors who can only follow protocols and have little practical experience of  clinical decision making and leadership.
• We need to stop trying to get GPs on the cheap and start investing in getting our best and brightest doctors into the position where they can do the greatest good - primary care.
• We need to understand that patient satisfaction is a terrible measure of outcomes, it has little to no correlation with mortality and by prioritising it we inevitably deprioritise patient safety and effectiveness of treatment which are far more important - as shown in the Berwick Report.
• In all areas of the NHS we need to stop focusing on resource efficiency (costs) and start focusing on flow efficiency (outcomes).
• We need to realise that GPs add value through our clinical acumen, continuity of care and ability to effectively gate keep, and that to empower these qualities means compromising in areas such as accountability and resource useage.
• The complaints system needs to be streamlined so that spurious complaints can be dealt with quickly and GPs don't need to put up with serial complainers, who take up a disproportionate amount of time and resources.
• Now that we've separated negligence from compensation, IMV the "prudent patient" standard needs to be replaced.
• Medical leadership at Whitehall and various other agencies needs to come mostly from frontline GPs who are currently both under-represented as a specialty, and over-represented by academics in the few roles that are nominally occupied by GPs.

@Dickyboy

In my limited experience we seem to waste an awful lot of NHS resources on giving people an entirely undignified death.

We do, and it's one of the areas where well-resourced GPs who have a long-standing relationship with patients can both improve outcomes, patient satisfaction and save loads money to boot.

Except it isnt simple at all. My octogenarian parents attend many more out patient and GP appointments than my children. They no longer contribute financially to society but did so for decades. They’ve earned their treatment from cradle to grave. One of the weans will become a net contributor to society, the other won’t, both will need the NHS. Who chooses?

Ultimately I think this is a big part of the problem, not just for NHS but all public services - people are living too long, and whilst they did contribute financially whilst working they don't pay National Insurance once they are over pension age - many now living longer than their life expectancy at birth because of the benefits of the NHS.  There's people on pensions far above the average salary who whilst they will be paying tax on it are some of the most comfortably off in the country now contributing disproportionately less but using more...  removing the upper age limit on NI would unlock significant cash; it wouldn't affect the poorest pensioners; it would restore the link between contributing and using the service!  Having seen the furore about winter fuel payments I'm quite sure this would go down like a lead balloon but ultimately pensioners have had the most protected income for decades with the tripple lock - if they keep that something else has to give.

In my limited experience we seem to waste an awful lot of NHS resources on giving people an entirely undignified death.

This.  And not just the death itself - last week I was at the funeral of a 98 yr old.  Her final few weeks were actually probably exactly as you might hope. But pretty much the whole of the last decade has been grim, zero quality of life, alzheimers ridden rarely leaving her own bedroom and never leaving the home except for hospital trips - each of which her and her family thought would probably be the final one.

Anybody who is obese, a smoker or a drug addict should simply have their right to free healthcare withdrawn.
Junk food needs to be taxed heavily, to the point where real food is cheaper.
GP appointments and basic treatments should be paid for by the individual.

Ah the words of the lucky!  Smoking and other addictions are a byproduct of society.  Obesity may well fall into that umbrella too - once a sign of prosperity and wealth its now much more likely to be associated with poverty.  Nobody really agrees what "real food" v "junk food" means or how you'd define that without just providing manufacturers with a new marketing opportunity to exploit people.  It is almost certainly less financially efficient to charge for GP appointments than to encourage people to seek help early.  A small infection from someone who doesn't have £20 this week becomes sepsis next week and costs thousands.  A patient with a lump waits till after payday to seek the appointment they were dreading anyway - making a "caught quickly" problem a much worse one.  The person with addiction issues never seeks help as every penny feeds their habit.  The asthmatic kid with poor living conditions faces another barrier to life.  The 16 yr old who wants to go on the pill can't afford to see the doctor and becomes a new teenage mum.  Meanwhile I can afford to go and waste my GPs time discussing my varroucca and by god will NickC's life get worse if "I'm paying for my appointment so I expect better service", not to mention that "businesses" which were never set up to take customer's money will suddenly find themselves having to hire admin staff rather than clinicians:

Speaking to an ambulance driver the other week.
Serious RTA had them on scene for approximately 2 hours using 2 vehicles to both treat people and act as blue light road blocks to ensure safety of themselves and others on site.
Because the traffic police are also parred right back to the absolute minimum cover all it takes is multiple incidents and they can’t be in 2 places at the same time.

The law already allows NHS to recover treatment costs from insurers for RTAs.  My understanding is this is rarely used because we just aren't set up with the admin and procedures for tracking it.  In countries where it's the norm - they count every plaster, every needle, every minute.  That encourages "over treatment" because an insurer is being billed.   I've done some work with those healthcare systems - the IT providers are not asked "how can we improve patient care / experience / outcome" its "how can we track the billables better"!

Starmer:

The NHS must "reform or die" but this doesn't mean more money

10-year plan

https://www.bbc.co.uk/news/live/c0qejx03zjnt

Politicians should not be in charge of this, it's just another flavour of the same shite that they'll spoon feed us whilst blaming their predecessors.

What goods an unprotected 10 year plan when your stay in power is only protected for 4 years?

ambulance driver

The 70's called, and wants it's phrases back #laughingemoji

In all areas of the NHS we need to stop trying to save money by replacing doctors with other professions, it’s not working and IMV it’s a root cause of the drop in productivity in secondary care.

I'm intrigued by this - which professionals in secondary care do you think are the problem for inefficiently soaking up all the cash?  Physios, Pharmacists, Nurse Practitioners, Dieticians - I've had contact with all of them in secondary care and couldn't imagine a hospital doctor doing that bit of the care anywhere near as well?  The system seems really keen to have people self-refer to those sort of services in primary care too - and I generally think that greater public respect/understanding for those professions would actually help.

Perhaps you are alluding to PA's?  There's a lot of hostility to PA's from medics.  Some of it might be merited, some is definitely because the government bodged its creation and there's no proper regulatory/professional framework BUT the concept that some parts of doctors work are either so simple (admin) that they don't need a doctor, or could be just as well performed by someone who hasn't learned about every other part of the body and disease etc but is really experienced in this one specialist area actually doesn't seem too mental to me.

We need to stop trying to get GPs on the cheap and start investing in getting our best and brightest doctors into the position where they can do the greatest good – primary care.

Last night I met a friend who's daughter is an FY2.  She's considering going to GP rather than hospital after this because the work life balance is much more realistic for someone who one day will want to become a mother.  I do think there's an issue there - where the reason people want to be a GP is for a bit more home life rather than because of the medicine or impact they can have!  I'd say that's got to be as big an issue in surgery or other disciplines as for primary care - if your best* (female) doctors are opting out of some fields because 8 yrs of hell to maybe make it to a level where you can start to negotiate your hours isn't a great position.

*I've no idea if she is any good at doctoring or not;

Speaking to an ambulance driver the other week.

No such thing.

The NHS is a mess, it needs reformed it will cost billions and take decades. PFI needs scrapped, purchasing should be on an open market and they need to save costs by wastage prescriptions amongst meany other things.

I’m very glad to be out if it and hope it does improve.

Can the UK afford private healthcare?

Wages would need to increase.

A move to a full insurance model would see a significant reduction in income tax. Just checked my last available tax summary and over £5k of my income tax was spent on health. That's significantly more than my private health insurance premium

More Companies would have to start including healthcare insurance.
In the US, even if you have insurance the deductible can be in the thousands.

US system is completely unique. It simply cannot be used as a barometer of example of how private health insurance works. In short it's a basket case of a system. Typical deductible in the UK (and most other countries) is £100-£200 but often zero

(Source: me, who's spent their entire career pricing private health insurance)

Having spent way too much time in hospitals and GP surgeries recently, I think one thing that would make a massive difference would be if every single person dealing with a patient’s care had immediate access to every single piece of information about the patient, their history, and their medications in one place. The amount of times I’ve been asked to provide an NHS person with some piece of information or re-tell a history or tell them what drugs someone is taking is phenomenal. It’s an incredible waste of time, and has led to serious things being missed.

One system. One record. All information. No ability for a patient to ‘opt out’.

Oh, and put in place some sort of mechanism for a patient to be able to send medics information that doesn’t required booking another appointment. I can understand not publishing email addresses or direct phone numbers, but there should be an easy way you can add information you find out to your record so it can be viewed by treating medics without having to book an appointment.

Get rid of the layers and layers of managers who contribute nothing  but cost large amounts of money.

Get rid of the layers and layers of managers who contribute nothing but cost large amounts of money.

And make clinical staff treat patients and do all the management stuff too?

One system. One record. All information.

There are many projects underway to get things linked together better. But you would not believe (you probably would actually) the number of systems that need joining up. It's a total mess.

I've been involved in a local project to replace a particular system which hit major problems due to a constrictive time frame and a poor chosen product. The project should've started years and years ago and had a three year or so time frame, but the over arching trusts screwed the procurement and obfuscated time and again and we ended up trying to spanner it in in a year.

NHS England tried to prevent us going back to a different (better) supplier as an emergency recovery plan because they want to see competition in the market and don't want this particular company to have the greater market share.

The whole debacle has wasted a few million, should never have happened like this.

In the meantime, I went to work last weekend and had to work in a room that was 31 degrees all day because the air con unit has been broken for about 3 months. They wouldn't replace it because there's no money (it had actually been done this week finally, although it's not "plugged in" yet because we need a different contractor to come and sort the wiring.)

 which professionals in secondary care do you think are the problem for inefficiently soaking up all the cash?  Physios, Pharmacists, Nurse Practitioners, Dieticians – I’ve had contact with all of them in secondary care and couldn’t imagine a hospital doctor doing that bit of the care anywhere near as well?

All of them are great in their specific roles. They also tend to get good patient satisfaction, but see also my comments about patient satisfaction being an unreliable indicator of quality.

However when they replace doctor lead clinics in extended roles our experience in General Practice is that they tend to be less productive because they are limited in what they can practice, and anything that is outside their remit they need to refer on which is costly and unproductive. Unfortunately we are starting to see the same thing in specialist hospital doctors too.

More and more we're seeing patients being bounced back and forward between various specialist clinics in secondary care, without anyone taking clinical ownership of the patient, which is both unproductive and disastrous for the patients.

BUT the concept that some parts of doctors work are either so simple (admin) that they don’t need a doctor, or could be just as well performed by someone who hasn’t learned about every other part of the body and disease etc but is really experienced in this one specialist area actually doesn’t seem too mental to me.

Please see my comments about the ways that GPs add value being through continuity of care (good evidence base), and clinical acumen (anecdotal from my own experience, some evidence to support).

The idea that you can somehow hive off the simpler parts of being a GP, is, I think, one of the biggest mistakes that we are making.

You may argue that I would say that, wouldn't I, but as far as I'm aware there is good evidence that reasonable access to well resourced primary care doctors is expensive but overall very good value for the system for the above reasons.

@bensales what you're actually talking about there is continuity of care.

Yes I agree that it's important, see my previous answers. However I don't think that the one healthcare record is the answer, already GP records are starting to become so unwieldy that they are bordering on unusable. Better design may solve that, but you still have the problem of categorising the information that is put in there, and who is clinically responsible for acting on it.

Again I suspect that it probably would be cheaper and more effective to have a well resourced GP who knows you well who could write a relevant referral letter for other sevices.

Get rid of the layers and layers of managers who contribute nothing  but cost large amounts of money.

I believe that the evidence is that, if anything, the NHS overall is undermanaged, not overmanaged.

Again I suspect that the reason that GPs are/were so cost effective was that a small to medium sized GP surgery is a very efficient and agile unit of organisation, at least until we started to be micromanaged.

my one contribution is to fund studying medicine free, or heavily subsidised.  Studying medicine is ruinously expensive, and therefore junior doctors expect a large salary

provide the opportunity to many more to study medicine, rather than just those who are from money or willing to take on a huge debt.  Increasing the number qualifying will reduce pressure in the system

more qualified doctors makes the skillset less unique, and with less debt the pressure to pay more is reduced.

stop paying doctors ever more money whilst keeping the system shit.  All it does is enable them to retire earlier or go part time.  You need to sort out the conditions so it isn't shit, before you pay more money.  Increasing the number of junior doctors is one of the pieces in the puzzle

* I seriously considered studying medicine, I had the grades, I didn't because I was a self funding student and I couldn't / wouldn't take on that level of debt, so I went into IT.....

Just checked my last available tax summary and over £5k of my income tax was spent on health.

As I don't pay £5k in tax, thank you for paying for the care that keeps me able to work, rather than forcing me to break into your garage and nick your bikes to feed my family.

Consequences, not cost, as someone said on the first page.

A move to a full insurance model would see a significant reduction in income tax. Just checked my last available tax summary and over £5k of my income tax was spent on health. That’s significantly more than my private health insurance premium

Does your premium cover all aspects of healthcare, with nothing taken up by the NHS? Is there an A&E department etc? Genuine question.

Also how would you go about getting cover with pre existing medical issues, say cancer or a heart condition?

I’ve used French private healthcare a couple of times and was surprised how reasonable the costs were.

Get rid of the layers and layers of managers who contribute nothing  but cost large amounts of money.

Much as I admire my clinical colleagues, many of them make for terrible managers of both people and money. They haven't trained for it, and don't really want to do it, often don't understand it, and it takes them away from the job they're really good at.

Again I suspect that the reason that GPs are/were so cost effective was that a small to medium sized GP surgery is a very efficient and agile unit of organisation, at least until we started to be micromanaged.

Interesting. When I first started attending my GP practice some 40 odd years go there was two full time GPs with no other staff whatsoever. If the phone rang during a consultation one would answer it and if it was an issue which required his partner to deal with he would bang on the partition wall for the other one to pick up.

Now I have lost count how many part-time GPs there are at my practice and it would appear an even greater number of receptionists, plus nurses and physiotherapists.

Mind you we never had the multitude of blood tests, urine tests, scans, etc. and of course we were expected to die younger. Kids today, eh? ......they don't know they were born.

What goods an unprotected 10 year plan when your stay in power is only protected for 4 years?

Well if the electorate perceive you are doing a decent job you can get multiple terms. Look how long that last shower of shite got.

Buy yes, it is an issue. There is a lack of long term planning in UK politics.

Does your premium cover all aspects of healthcare, with nothing taken up by the NHS? Is there an A&E department etc? Genuine question.

Not on a typical UK PMI plan. That doesn't cover chronic, routine maternity and some other key benefits. If it did, it would still be significantly less than my tax contribution

Also how would you go about getting cover with pre existing medical issues, say cancer or a heart condition?

Pre-existing conditions won't be covered under an individual policy. They typically are on a group policy unless it's a very small group. For a definition of "group" think about employers buying health insurance for their employees.

However in simple terms, you can't  directly compare the existing UK private health insurance market with what a move to an insured setup would look like in the UK.

However as has been mentioned previously, other countries that aren't the US run perfectly adequate private insurance systems instead of state funded healthcare. The costs are regulated and controlled by the state. The poorest in society still have access to free care For the record, I would not advocate the UK scrapping the NHS and moving to an insured model. Mainly because I have no faith we wouldn't go down the US route.

I would also highlight that there's considerable confusion over what the term "private" means and I've seen it crop up a few times already in this thread

A) there's private health insurance

B) there's private providers of healthcare services, either frontline clinical stuff or behind the scenes management, logistics etc

B is the one you all need to be worried about

@ernielynch I think organisations that get above a size where everyone in the organisation knows the name of everyone else become inherently more complicated to manage.

The problem with the US system of healthcare is that inordinate amounts of ineffective work is done.

Which is the way we seem to be going in the UK.

They haven’t trained for it, and don’t really want to do it, often don’t understand it, and it takes them away from the job they’re really good at.

I went through numerous training courses for management the posts I held, including regular refresher courses. My experience and clinical knowledge meant I fully understood the roles of staff and what they were expected to do as I had done the job. Those that were management from outside others areas didn’t always understand or took a long time to learn.

@Kramer - thanks for answering about where you see the innefficiencies.  I know a consultant onchology pharmacists who would probably argue those issues are better now than before he lead clinics... but actually thats probably because hes a stubborn arse who works "around" the system than following it... he's also very heavily networked within the hospital with people who's ass he's saved from errors or drugs shortages at 4am - one issue may be that people who haven't had that "circulation" don't know how/where to get stuff done.  Like ernie - I remember when your GP not only knew you but knew the whole familty and you did get continuity of care.   That's long gone now.  its funny the forms you get from the school etc - still expect you to put the name of your doctor in - I've never seen the same person twice (not that I am a regular attendee but it turned out I'd been putting in a name for my Daughter's GP who retired before she was born!).

I believe that the evidence is that, if anything, the NHS overall is undermanaged, not overmanaged.

100% - if you believe we have layers of beaurocracy and admin then look at any other country's healthcare system it will be worse.  It might be more efficient because of it, but there will be managers and paper pushers.

Again I suspect that the reason that GPs are/were so cost effective was that a small to medium sized GP surgery is a very efficient and agile unit of organisation, at least until we started to be micromanaged.

And probably because GPs of old were doing a lot of shit out of the goodness of their hearts!   My Uncle was a GP and his wife was expected to be at home when he was on call to answer the phone to patients whilst he was out visiting others - can you imagine that now!

my one contribution is to fund studying medicine free, or heavily subsidised.  Studying medicine is ruinously expensive, and therefore junior doctors expect a large salary

It amazes me that we don't have bursaries for all the jobs society needs and underpays - not just Dr's but nurses, teachers etc.  Or a scheme where whilst working essentially for the govt your student debt is paid off for you (effectively that is a pay rise but wrapped up in a particular way)

Increasing the number qualifying will reduce pressure in the system

Not a great idea to train more doctors than we have jobs for.   They'll just leave the country.

more qualified doctors makes the skillset less unique, and with less debt the pressure to pay more is reduced.

that assumes training to be a Dr is just a spell at uni - its probably about 10 yrs from leaving school before you are doing anything useful!

stop paying doctors ever more money whilst keeping the system shit.  All it does is enable them to retire earlier or go part time.  You need to sort out the conditions so it isn’t shit, before you pay more money.

Mmm... says someone who went into IT for better rewards!

The problem with the US system of healthcare is that inordinate amounts of ineffective work is done.

Which is the way we seem to be going in the UK

One of many problems with the US system, but the issue you're referring to is the tendency to over prescribe treatments, tests, medications etc in the US.

2 main reasons for that

1) US medical providers are terrified of being sued, so will go way over the top to avoid accusations of misdiagnosis, mis treatment etc

2) Those providers are  typically working in for profit hospitals, clinics etc (see point B in my previous post) and are tasked with maximising their employers profits

For all the US insurers get vilified, they're the only ones keeping the medical providers and pharma companies in line. If they didn't, the US  healthcare costs would be even higher than they already are

As Jeremy Hunt himself said, the problem isn't getting enough doctors becoming GPs, it's retaining them. At the same time we're losing some to retirement, but an awful lot of them don't even become established GPs. Money is an issue, especially when you're competing for highly intelligent, highly motivated people who are likely to become doctors.

From my point of a view of as a GP, we've had ~ 15years of money being taken away from us to give to hospitals and secondary care, they're doing less and less, we're doing more and more, including their workload for them, and they've just been given a 20% payrise vs my 6%, which, despite Mr Streeting's protestations, I've yet to see a penny of.

I had a rather large crash in Spain last year, went to A and E and saw a doctor then a consultant then a scan then back to the doctor all in 4 hours. I was advised to have a follow up back in UK and had to wait 5/6 weeks for a scan here.

Is that Spain charging the NHS so going all out on treatment or just more efficient?  I only had to show my EU healthcard.

I have lost count how many part-time GPs there are at my practice

I'm part time. I'd love for it to be viable to be full time, because I genuinely love my job. I'm passionate about it (as people can probably tell) and it's generally a lot of fun and very rewarding.

But it's not viable to do more than four days a week, and even that's pushing it, because the workload is so intense.

20 years" frontline" NHS service tells me that whilst there are highly qualified and motivated staff in the NHS there are also a large number that are over promoted, under trained and  under resourced

Today I have witnessed Physicians associates running entire CWT clinics with no direct medical cover which led to deffered invesgations and repeat visits. The root cause being poor admin and booking of clinics as a result of insufficient admin cover and lack of medical time to triage.

It is these domino effects that are so prevalent in secondary care that lead to huge inefficiency and waste.

Delayed investigations or inappropriate falsely reassuring tests because of lack of access to high value diagnostics and expertise is a daily frustration meaning patients languish on wards adding to the spiral of cancellations and delays.

The problem with the US system of healthcare is that inordinate amounts of ineffective work is done.

That's what my (recently retired) GP would say about the German model. Many years ago he explained to me that low blood was generally not seen as a condition which needed to receive treatment in the UK.

Apparently treatment for low BP was seen as an unnecessary and simply an extra cost to the NHS. However he explained that in Germany low BP was treated because the treatment generated profit for someone within the German model.

I know absolutely nothing nothing at all about how healthcare is provided in Germany, nor whether this discrepancy in low BP treatment still exists, but I did trust my GP. I was gutted when he retired about three months ago.

the problem isn’t getting enough doctors becoming GPs, it’s retaining them. At the same time we’re losing some to retirement, but an awful lot of them don’t even become established GPs. Money is an issue, especially when you’re competing for highly intelligent, highly motivated people who are likely to become doctors.

where do they go?  I don’t think I’ve ever come across an “ex GP” in the outside world.

Some of them are exceptional, and equally some are absolutely useless

Are you a spy in my dept?

We are taking in lots of work from private clinics, presumably to "sort out the NHS waiting list for treatment" but ironically those specimens just end up in the backlog with the NHS specimens.

The backlog in my lab is caused by lack of staff, out of 30 people we have 7 vacancies, 2 off long term sick and 3 new starters, training takes up to 12 months to be up to speed.

Management have delayed recruitment to save on the wages a new starter would receive!

Staff retention is chronically poor as the career progression is so poor. The last 3 people we've trained have left for private sector as soon as the qualified

where do they go?  I don’t think I’ve ever come across an “ex GP” in the outside world

Abroad, retrain in other professions, consultancy, reduction in hours, private sector etc.

And why would they tell you, do you get the full CV of everyone you interact with?

On the news they're currently talking about how people could help themselves by eating more healthily, exercising and the like.

.

So on that note they should be leading from the front.

A look at Parliaments members dining room menus and it doesnt look that super healthy to me. So it should be out with the steak and chips, and in with fish and salads.

Their extensive wine list could be replaced with water and a selection of fruit juices

On the news they’re currently talking about how people could help themselves by eating more healthily, exercising and the like.

Ah yes, the old personal responsibility bull$hit.

When people don’t have to pay for the thing, they don’t value the thing.

I get what you mean but seeing as obesity will be one of the biggest drains in the near future one could look at the US and wonder why anyone is obese considering they pay for health care.

Of course if they weren't obese the health care industry wouldn't get paid. How do you privatise an industry and it still be in the interests of the general population when their profits come from treatment not prevention?

A move to a full insurance model would see a significant reduction in income tax.

Really?

Ah yes, the old personal responsibility bull$hit.

We do eat badly in this country. Drink alot. Don't exercise enough etc etc

Really?

Yes, but offset by whatever premiums people had to now pay.

Of course, the unknown is whether or not the government actually would reduce everyone's tax by the amount currently allocated to health costs, but if they did then yes everyone's tax should reduce.

My instincts tell me any UK government would palm the NHS off to the private sector and not reduce the tax take...

Ah yes, the old personal responsibility bull$hit.

How on earth is it bullshit?