NHS – what’s the Tory end goal?

Mrs_oab and I just had a chat, and I don’t know and can’t find the answer.

Her treatment is apparently nearly £1k a week in drugs, plus nurse specialist, consultant and GP time.

If things get ‘privatised’ – who pays that? Does taxpayer money purely go to new private companies? Does end user have to pay some or all?

🤷‍♂️

The insurance company would pay.

You would then pay the insurance company.

If the insurance company won’t pay, you do. Get fundraising.

In an ideal (Tory) world.

People who vote for this think they won’t ever get ill.

Does taxpayer money purely go to new private companies?

I’d imagine that’s the end game. American model, etc.

2nd biggest reason four personal bankruptcy in the US is medical bills.

Ever time the likes of Farage etc tout what a wonderful model the US system is, they should have that shouted at them.

Ask Liam Fox.

This from Foxglove gives a flavour of what’s going on…

A leaked email has exposed the controversial US-based spy tech corporation Palantir’s “secret plan to deepen its relationship with the UK’s National Health Service without public scrutiny,” Bloomberg reports.

The business-focussed news outlet, which broke the story, describes Palantir’s plan as “to buy up smaller rivals that already had an existing relationship with the NHS…to avoid further scrutiny in working with one of the largest depositories of health data.”

The subject of Palantir’s leaked email: “Buying our way in…!”

Foxglove believes there’s no place in the NHS for a company with Palantir’s track record of working with US military operations, mass surveillance, and predictive policing – let alone its links to Donald Trump. We’re proud to have brought together the “No Palantir in our NHS” coalition. If you’ve not yet signed up in support, you can do so, here:

No Palantir in Our NHS

The leaked email, as reported by Bloomberg, came from Palantir’s regional head, Louis Mosley. It was sent in September 2021, and outlined a strategy of “hoovering up” small businesses serving the NHS to “take a lot of ground and take down a lot of political resistance.”

The big prize for Palantir is a £360 million contract to run a new NHS data platform. It looks like it saw buying up smaller companies as a way to extend more and more tentacles into the NHS before the massive £360m deal was in play.

The very fact that Palantir landed on this “buying our way in” strategy shows that our campaign to stop them is having an impact. They know there’s “political resistance” – and have been looking for ways to bypass it. We need to keep standing firm. Please help add to the pressure, by signing the “No Palantir in our NHS” campaign petition, here:

No Palantir in Our NHS

Thanks for being involved,

The profit hungry private sector has been after the lucrative multi-billion NHS budget for decades – since the Tories had sold off the rest of the family silver.

John Major’s Conservative government initially introduced PFI so that private companies could make vast profits from building NHS hospitals.

Tony Blair’s New Labour governments then massively expanded PFI pouring huge amounts of taxpayers money into them and saddling NHS trusts with mindbogglingly debts – diverting money away from patient care:

https://www.theguardian.com/politics/2019/sep/12/nhs-hospital-trusts-to-pay-out-further-55bn-under-pfi-scheme

“Some spending one-sixth of entire budget on repaying debts from Blair-era policy”

Then in 2012 the Conservative-Liberal Democrat coalition government’s Health and Social Care Act removed responsibility for the health of citizens from the Secretary of State for Health, which the post had carried since the inception of the NHS in 1948, and threw the doors wide open for the private sector to grab all bits of the NHS which they feel might be profitable.

The NHS been under sustained neo-liberal attack for the last 30 years. IMHO

I doubt they’ll pay out for an existing condition.
Just like the dog insurance some people seem to rely on…

The aim is to strip the state of the ability to do run anything. Any public services which remain will be contracted out to private companies for profit.

Actual thread title

NHS – what’s the Tory end goal?

This is probably more important than your detailed questions because “the Tory’s” as a party don’t have a specific end goal (outside of making themselves and mates richer).

The “current” (i.e. this week) Tory party policy are the extremes who knows what brand will take over when Truss is ousted and what their end goal will be or who their mates are? Under Boris the strategy seemed to be a slow asset strip whilst giving contracts to mates… under Truss I think she knows she’s not going to be around that long and that she and her mates can do better by concentrating on making sterling yo-yo.

The NHS is just something to be sold or otherwise make money so I’d look on this as a “how does a Tory sell a bike type thing”?

That is if they can get a decent price without washing the bike and some pleb will collect then they’ll do that.
If it doesn’t shift they might pay someone to wash it for them… but equally they might just take it to a bike shop to sell or just give it away to a mate or sell it to someone to strip the bits off and sell for them.

I’d imagine that’s the end game. American model, etc.

Other successful “co-pay” models exist. The choice doesn’t have to be between the UK’s version of nationalised healthcare and the US system. Nearly every European country operates on a version of either co-pay/private insurance.The German healthcare system is more or less entirely in private hands for instance, and you don’t hear scare stories about it. The Spanish system is regionalised, and they sort out their own models of payment. etc etc

Other successful “co-pay” models exist.

They do, but quite a few Tories seem enamored with the US model, mainly as there is so much money to be made out of it, some of which will then find its way back to the same Tories….

The current lot don’t seem to know what to do with it, they don’t want to spend any money on it as they just want to give the rich tax cuts and also balance the books. I guess they’re still genuinely surprised that Brexit didn’t miraculously fix it with the extra £350m a week.

They do, but quite a few Tories seem enamored with the US model

Not even all the companies involved in the US system think that it’s a successful model of healthcare. Almost nobody thinks it is. Like I said, Private insurance/co-pay isn’t necessarily a bad model – we already have a teeny version of that here already (dentistry, spectacles), and  just look at Germany for instance.

The German healthcare system is more or less entirely in private hands for instance, and you don’t hear scare stories about it.

My GP doesn’t appear particularly impressed with the German model. He has told me that the profit motive encourages them to treat “conditions” which in the UK are seen as conditions which don’t necessarily require medical intervention. That was his observation, I can’t comment.

Almost nobody thinks it is.

Agreed, but it pays for the most lobbyists who ensure that the status quo is maintained….

There is an issue of failure with the current model though. We are chronically short of everything in the NHS. Some of this is medical progress with treatments/drugs etc which cost lots, some is the growing population, there is expectation and not seeing a wait for a non-urgent issue as acceptable (and TBH some of the waits really are ridiculous because of staff/capacity shortages – and pain is an awful thing to live with) and some is a result of people not treating the NHS with the respect it deserves. I had 3 DNAs on a scanning list of 12 this week and thats not unusual. Problem is you cannot overbook in the anticipation a DNA as when people then all do turn up, they can’t all be seen.

Fixing staffing numbers is a real challenge – training all forms of carers takes time so there is a lag from investment to result and that also requires a boost in spending which means more taxes. The country is broke, inflation is high and people not only don’t want to pay more tax, but most can’t.

I accept Bevan’s adage “We shall never have all we need. Expectations will always exceed capacity. The service must always be changing, growing and improving – it must always appear inadequate.”

With that in mind I think we ought to look at all models to improve deliver, access and costs.

My 2p. Competing interests – none. I’m a doc but do no private practice because I don’t really believe in it.

I’m not sure there is an underlying conspiracy to sell off the NHS by the tories, maybe there is but holding it up as the problem misses an important point.

I think there’s a more pressing inconvenient truth and that is that the NHS as things stand is unaffordable. Whilst no-one admits it, plenty of people who run / staff it and politicians secretly understand this.

Since its inception the cost of providing the care that is expected has spiralled ever higher – aging population, rising expectation of treatments availalble, rising cost of buying those treatments, rising cost of staff etc. The NHS budget has not kept pace. Its stuck trying to provide everything for everyone without the money to do so.

It needs a massively increased budget ( & i mean massive) which would involve much higher taxes ( politically tricky for whoever is in power) or it needs to reduce what it offers for free ( again politically unacceptable ).

I don’t have the answer but Tories trying to sell it off is not the fundamental problem IMO

I think there’s a more pressing inconvenient truth and that is that the NHS as things stand is unaffordable.

Is it really?

E.g. the current building back log, to fix all NHS buildings, is £20bn. We just gave away £40bn in unfunded tax cuts in the mini budget….

We have also committed to £150bn (IIRC) in fuel price caps….

training all forms of carers takes time so there is a lag from investment to result and that also requires a boost in spending which means more taxes. The country is broke, inflation is high and people not only don’t want to pay more tax, but most can’t.

The UK isn’t broke. It is a member of G7 – one of the wealthiest nation on Earth.

It is in terms of expectation of service delivery to tax receipts to support the spending.

https://www.ons.gov.uk/economy/nationalaccounts/balanceofpayments

My GP doesn’t appear particularly impressed with the German model

It’s consistently ranked among the top 5 (mostly always higher) in the world, and most of the measurements aren’t patient satisfaction models (those are the ones that drive “over-treatment” concerns). They are better at prevention, outcomes, and cancers – all the things that the NHS is particularity poor at.

It’s not to have a crack at your GP, lots of clinicians are ignorant (not pejoratively) about other heath care systems.

It is in terms of expectation of service delivery to tax receipts to support the spending.

Yeah the NHS might be broke but the UK isn’t.

@footflaps it is unaffordable in terms of its current budget and the service it expects / is expected to provide. Thats why there are problems with staffing, waiting lists etc.

I’m not saying that the uk can’t have a fully functioning NHS it just needs an awful lot more money to work properly. Its currently grinding to a halt and that is because it hasn’t been funded at the correct levle in many areas for a long time. Whether that money can come from the magic money tree or needs to be collected in tax or there needs to be some kind of co-pay system is perhaps the question.

Personally i dont think the US insurance model works that well either.

I’m not saying that the uk can’t have a fully functioning NHS it just needs an awful lot more money to work properly.

It can have an awful lot of money and still not work properly if an awful lot of that money is going into private profit. And not healthcare.

Some hospitals are spending more on PFI debt than they are on drugs

Sherwood Forest Hospitals NHS Foundation Trust spent more than double on its PFI repayments (£45.8m) than on drugs costs (drugs inventory consumed and purchase of non-inventory drugs, which amounted to £22.6m). That works out as more than £1 in every £8 of income it received from patient care activities, finance income and other operating income being spent on paying off PFI debt.

Then in 2012 the Conservative-Liberal Democrat coalition government’s Health and Social Care Act removed responsibility for the health of citizens from the Secretary of State for Health, which the post had carried since the inception of the NHS in 1948, and threw the doors wide open for the private sector to grab all bits of the NHS which they feel might be profitable.

Agreed – but now the tories have realised this was a really bad idea and it has been reversed

Tony Blair’s New Labour governments then massively expanded PFI pouring huge amounts of taxpayers money into them and saddling NHS trusts with mindbogglingly debts – diverting money away from patient care:

Agreed – Labour really are responsible for huge saddling of debt to the NHS when they were last in power.

@footflaps it is unaffordable in terms of its current budget and the service it expects / is expected to provide. Thats why there are problems with staffing, waiting lists etc.

But that’s a totally arbitrary constraint, we could afford to fund it properly, we (the Tories) just chose not to.

but now the tories have realised this was a really bad idea and it has been reversed

Let’s be specific about this, Theresa May/Boris Johnson reversed the policies of David Cameron/Nick Clegg.

There is a lot of bollox talked about that all Tory prime ministers are worse than the previous Tory prime minister.

Personally i dont think the US insurance model works that well either.

it’s excellent in places but overall the US pays twice as much for worse outcomes on a population level than here, and illness can mean bankruptcy.

A health system is a way of pooling risk. You can do this for the general population through general taxation or through insurance models as per many Euro countries, but with the latter model there are always going to be incentives for insurers to leave out high risks.

It’s always ‘unaffordable’, in that demand is bottomless, there just needs to be a rational way of allocating resources against that demand. NICE does a pretty good job of that as far as it can, though it’s inevitably getting chipped away at.

@footflaps i think you’d find its labour and tory governments, neither have tackled the issue, certainly in my personal experience of working with / in the NHS for 25 years

@johnx2 the degree of unaffordability is the issue though, the width of the gap has grows ever wider as the population ages, treatments get more costly and budgets dont increase at the same rate

the degree of unaffordability is the issue though, the width of the gap has grows ever wider as the population ages, treatments get more costly and budgets dont increase at the same rate

That’s the case however you decide to design and fund the system.

I’d go for minimum waste (creamed off dividends, insurance admin overheads, cost of defensive practice); maximum coverage (all propulation), with resource allocation decisions made transparently and rationally, rather than being hidden in insurance company small print. Regardless of how and how much you fund healthcare you will always have those decisions to make.

[and oh dear, just read the OP and my mistake for not having done so earlier so sorry about dispassionate language. That’s the point of pooling risk – some of us will need more than others. We go into it together or take our chances alone or in subgroups – and you don’t want to be in a higher risk one. There may be something of a deep right wing/left wing split here but that’s probably for another thread)

I used to work in finance in Private Health, what happens at the moment is that private hospitals do NHS work and are paid the same as the NHS hospitals are for the care.

The big problem / issue is the costs of everything. For all its faults the NHS buying power is huge. They were buying heart values for 20% of the price that we could buy the same thing from the same supplier, same with drugs

I think the Tories would like to privatise it but havent had the courage to do it or worked out a way to do it that they think they can get away with. I dont think it was coincidence that Simon Stevens, the ex head of the NHS, left running a large healthcare provider in the US to take up this post. Or that the the largest private healthcare company in the UK is owned by a US Health insurance company.

@footflaps i think you’d find its labour and tory governments, neither have tackled the issue, certainly in my personal experience of working with / in the NHS for 25 years

In terms of as a % of GDP, the last Labour government was the most generous in the last 30 years….

NHS spend as GDP by Ben Freeman[/url], on Flickr
https://www.economicshelp.org/blog/21664/economics/nhs-spending-cuts/

My GP doesn’t appear particularly impressed with the German model

That may be influenced by the difference in models. In the UK most GPs are business owners and paid as directors of those private businesses that contract with the NHS. In Germany GP’s are salaried staff like hospital doctors, nurses and the rest of the medical profession.

This is much less financially advantageous that the UK system from a tax perspective, before you get into the differences in pay

This is much less financially advantageous that the UK system from a tax perspective, before you get into the differences in pay

GPs there earn a lot less than here. And you won’t believe what German dentists earn…