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.
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?
Bite on my leg from a walk has become infected and I need an antibiotic cream. No chance of a GP appt without playing the 8am “you are 23rd in line, please hold” game. However I have a private GP through work l, who I book on an app, she calls me an hour later having reviewed the photo of said infection, agrees diagnosis, sends prescription and I opt to take it electronically from my local pharmacy. This is the future and I don’t care about the private/public side of the arguments. People may claim to, but what they care about is access
Now if I could get past the 8am triage, my own practice could do the same, and have done in the past. But they can’t now as they have no capacity. In fact they were taken over and put in special measures. All the senior staff left/retired early, and I can’t blame them.
Reform will come to the state religion, not US reform, but I would start by taking the NHS governance out of the political system full stop. Run by some form of royal commission with 10% of GDP. Possible charging with reimbursement like the French system. And open three more medical schools (at least) and admit mature students on bursaries who’ve seen a bit of life. When you restrict supply side and have one purchaser, the labour market is screwed.
Because it doesn’t work. It never has and it never will. It fundamentally misunderstands the root causes of poor health, and implicitly blames people rather than looking for more effective interventions.
Your point around replacing GP's with other professionals and the associated costs when they have to refer on when they reach the limits of their speciality is interesting.
IME in prehospital care since specialist centres have been introduced (PPCI, Stroke and Trauma Centres) the evidence suggest clinical outcomes have improved for those patient groups. Even though it might mean a 45min journey to the specialist centre instead of 5mins to nearest ED. I had imagined that this model would translate to primary.
With regard to the costs associated with referrals from non-GP healthcare professionals, how does this differ to a referral from a GP to a specialist service. For example - I have a musculoskeletal problem, I see a GP who prescribes some pain relief and then refers me to a physio vs I see a physio at the GP surgery who gives exercises and treatment and then refers me to a GP if they are unable to prescribe? Clinical outcome is broadly the same as a measure, perhaps better as the physio treatment has started earlier.
Maybe I'm looking at this from an over simplistic point of view, based on my observations and experience. Maybe clinicians in primary, secondary and prehospital all feel they have a better understanding of how things work. I haven't a clue. I'd be interested in learning more to help me understand better.
I certainly agree that some roles and functions cannot be replaced with other healthcare professionals with limited scopes of practice, but I think there is a place for some, such as physio's, in primary care.
@TiRed I don’t think it’s safe or effective to diagnose an infected bite from a photo.
Possible charging with reimbursement like the French system
How are those who don't have the money to pay for treatment then?
Well obviously I had a video consultation (15 min) with full questioning of symptoms, medical history and alternative diagnosis (including was it a tick bite for Lyme disease). The photo was to help. The path to even talking with a GP is almost closed where I live. A pharmacist could perhaps have also prescribed, but not here. People care about access. They care less about who is paying (ideally not them as “free at the point of delivery”). When a hip is replaced, does it really matter if it cost 5% more to a private supplier but the patient was up and about a year earlier? I don't think so.
I agree with the needing more and better management. Ideally by people who run efficient organisations. My son’s life is optimised by a department who, if they get it wrong, will cost a lot of money and if they consistently get it wrong, the company goes bankrupt. Supermarkets and Amazon are optimisation and logistic Gods. These are the skills needed. And they cost.
Access to medicine is a commodity like anything else. And whether we like it or not, economic laws will still apply, even in the hugely distorted NHS market.
Not going to solve the NHS problem no matter who is in charged.
The major root cause of the health problems in this society can easily be attributed to the followings ... based on my own non-medical observation.
1 Lack of sun.
2. Dampness in house (causing dampness in the body and that is the root cause of many health problems)
3. Poor diet
Can't control the sun but the other two can be managed and they are symbiotic.
If you don't wish to suffer with your health then escape the winter is the least you can do.
based on my own non-medical observation.
Really?
As someone who works for the NHS a couple of observations often identified.
Too many highly paid managers managing managers, and not enough nurses nursing.
Too many people wasting NHS time and resources chasing diagnosis such as ADHD.
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.
And this was partially my point.
Too many highly paid managers managing managers, and not enough nurses nursing
My second point by someone who works in the NHS, my wife concurs.
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.
THis has been proven even in my world of trials within the civil service realm, many times over, only to be overidden because dave who has been here 55 years is up for retirement soon and as a senior civil says what goes, mainly because no one wants to tell him things have moved on
