What do people believe is so special about the NHS?

GadgetObsessed

What I am trying to understand with this thread is why so many people have a strong attachment to the current structure of the healthcare in this country - publicly funded and publicly provided. Especially when this system is unusual when compared with other developed countries. (The USA is equally unusual in the other extreme, in having predominantly private provision and funding.)

Comparing the NHS with other health care systems was something I studied at university and I have remained interested in those comparisons ever since.

Public vs Private Provision
The UK is unusual compared to other developed countries in that it has a healthcare system that is almost exclusively publicly provided. In 2015 private industry accounted for only 4% of healthcare in the UK.

Most other health care systems have a mix of private and public provision. For example, in Germany the split between public and private hospitals is around 50/50 and in France 62% of hospital beds are provided by the state and 38% by private companies.

Public Funding vs Insurance Systems
In the UK care is generally free at the point of use and is financed directly by the state.
Most developed counties, have state supported insurance systems. Basically, a user pays a proportion of the fees and then gets reimbursed by the insurance system all or part of these costs. For example, to see a GP in France the net cost to a user is between zero and 6 Euros. How much you end up paying will be dependent upon income.
   
Comparison of NHS with Healthcare Systems of other Developed Countries
The key points are:
Positives - the NHS is efficient (higher rates of generic drug use and does not need financial systems to track costs and insurance claims) and does well in protecting people from the costs of ill healthNegatives - Treatment outcomes are worse. The NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death and is the third poorest performer on the overall rate at which people die when successful medical care could have saved their lives. It also has consistently higher rates of death for babies.Expenditure - the UKs percentage of GDP spent on health is average. Health care spending from taxation (and mandatory insurance in countries with such systems) is slightly above average (7.7% vs 7.5%) but spending funded by charging patients and from private insurance is below average, at 2% vs 2.7%.Resources - the UK has fewer doctors per head of population. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners.Here is a quote that I think sums it up quite well.

Paul Johnson, Director of the Institute for Fiscal Studies:
“The truth about the NHS is that by international standards it is a perfectly ordinary healthcare system, providing average levels of care for a middling level of cost. Access is good and people are protected from high costs, but its performance in treating people with cancer is poor, and international comparisons suggest too many people in the UK die when good medical care could have saved their lives.”

So what do you think?
Personally, I do not care if I receive treatment from a GP or hospital that is run by a private company or is state owned. I only care about the quality of the treatment and the outcome. (Something that the NHS is below average at even though its funding is average.)

Do you care whether your treatment is provided by a public or private hospital? (Assuming that there was no cost difference to you.)

Would a compulsory insurance scheme like that in France and Germany, that funded people according to their ability to pay, be a much worse solution than what we have at the moment?

Iain42

A very interesting post.

I think the whole funding and "free at the point of delivery" model needs to be looked at.  There must be a way to generate funds to top up those raised by general taxation.

For example, could better choice and quality of food be provided if people paid something towards it?  After all, you're not having to buy food for yourself at home at this time?

Bl4ckGryph0n

Since day 1, the private sector is one of the bedrocks of the NHS.

General practice. Unless anyone can show otherwise, I believe every GP practice is privately managed and owned - typically as a partnership.

Ditto for dentists and opticians.

Do we get less good care at any of those places because they aren't state owned?

Why would we care who owned a hospital if we had good care there?

I think the discussion is made more difficult by the discussion on charging. We could have much more private provision and still have an NHS free at the point of use. It seems people think of private business gets involved then you'd need to pay.

Pacifico

I grew up with systems where you have mandatory basic insurance. And you can choose to top it up with additional services if that is important to you. After all we all care about different things, such as a private room or being on a shared ward etc.

I think that in general there is too much emotional attachment in the U.K. to the NHS preventing any constructive update or changes to the system. I for one aren’t keen on a one system fits all approach. I also don’t think that just throwing more money at it is going to solve its issues. Further more when mentioning the NHS is such a huge organisation with so many facets that it is too big in my opinion to have any sensible debate about it.

Sure having a national health policy makes sense and that should cover the nation. The devolved regional rules and split don’t make much sense to me at all for something that is supposed to be a national service.

To me the size of it is one of its problems.

noiseboy72

Simply because the supporters of that system have been very good at PR. The NHS has been raised to the status of a national religion in the UK so any discussion about the model used is treated as heresy and not taken seriously.

Meanwhile the people of the UK continue to receive second rate health care.

Ruperts slippers

I had an interesting discussion with a staunch socialist about private healthcare. My company provides me with private healthcare for my whole family at a modest cost as one of my perks.

My socialist friend believes I am robbing the NHS of the surgeon or specialists time and am simply buying my way to the front of the queue. My argument is that there's no capacity within the NHS in terms of beds and surgical facilities to carry out additional procedures, so by me going private, I've actually opened up a space for an NHS patient. I pay tax on the private healthcare and do not get any sort of discount because my call on the NHS is potentially reduced, so hopefully this makes the service slightly more available for other users.

If more companies offered private healthcare as part of the employment package, this would improve things further. Imagine the difference if 15 or 20% of users went private, it would return a huge amount of money to the NHS for those who cannot afford private healthcare.

There would of course be a danger of a 2 tier system, but if the basic level is better funded than it is today, does this matter? Private hospitals might be smarter and private rooms the norm, but there's very few procedures you can only get going private and there's nothing to stop the few that are being offered to all.

Cliff

The same surgeons work in both private and NHS. Its just that throughput in the private sector is double or triple, swing door lists (Two theatres open at the same time) are common in the private sector. This means they also pioneer new techniques to speed up any operational process.

Personally I chose private for my hernia op, caveats were I had to be flexible in my availability, this meant I didn't have to wait months and months. However I got to choose the consultant I wanted who was recommended for the task. Flexibility meant the whole process took lesS than a month.

The problems with the NHS are the lack of cooperation between individual staff members, teams, departments, top down dictates', and consultants with too much power and influence, regulatory red tape, the organisation is just too cumbersome to make changes. Managers are managing mangers.

The principal agent problem. Managers may have objectives such as power, bonuses, large expense accounts, prestige and status. Very few have any real experience in motivating staff, nor do they have the flexibility in their decision making processes to do so. Clinical leads have zero experience of financially motivating staff, often extra hrs and cover is done for basic pay or no pay. Poor communication and strategies to deal with min by min issues and overall working practices are diabolical. Professional superiority damages, stifles information exchanges from those on the shop floor to those making decisions.

Basically to achieve a management position you have to interview well, do a great power point presentation pointing out clinical governance and a few other current buzz words, become a favourite and you'll get the job. Shortly you'll be in charge of departments, teams, budgets, hrs, sickness and then inducted and indoctrinated into the NHS framework. Zero IT, fiscal, quantifying, management training. No joke.

To finalise if I managed a business like the NHS is ran I'd be bust within 6 months, with poor capital distribution. Some depts. send taxis to obtain material shortages to other trusts because they cant count. Some depts., have millions of pounds worth of equipment (capital expenditure) sat doing nothing for yrs on end in locked store rooms. The NHS is a fiscal joke. Typical of an unaccountable socialist organisation.

EarthRod

I just wish the NHS wasn't such political football, and was treated like any other public service. If improvements are to be made, it is very unhelpful when you hear slogans like "Tories are nationalising our NHS". Or it's being sold off to Donald Trump.
If it was such a good service, why is it in the news almost every day?

Skyehammer

Because it is huge, in fact massive. The NHS employ about 1.5 million people.

richp007

I guess the sole reason we love the NHS and hold it so dear is because it's there for  us ALL whether we're in employment or not , whether we earn thousands or pennies , we're all treated the same .
There are private hospitals in the UK , in fact there's around 1200 private hospitals [ and Nursing Homes ] in the UK .
I've had more than my fair share of the NHS' facilities , I owe my Life to them , I can't put a price on that .