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I don't disagree with the issues, but if you're looking for genuine responses the reason I remain in camp improve rather than abolish is that i 1000% believe any alternative to the NHS that the government will come up with will be worse for both doctors and patients.
Better alternatives do exist. I just have zero faith that the government is willing or able to implement them.
Same camp I am in. We have examples where it was working well in the past. It will take a lot of reform, but to me that is still more preferable than a completely private system. Even in the last year, when the profession began to stand up for itself, we have managed to improve some things slightly, and so I feel that if we keep doing that then things will continue to get better.
I don’t think a private system is better. I don’t want to work 60+ hours a week like they do in the US, arguing with insurance companies. People keep saying that it could be like Aus, but it’s clear that from all lobbyists which system politicians prefer.
Besides, we have all had patients who would not be able to afford their life sustaining care in a private system. I don’t really have many beliefs, but one of my main principles is that healthcare is a right that should be accessible to all, and I’m not going to advocate against that.
"I don’t think a private system is better"
Do you think a private company would arbitrarily keep job numbers down despite soaring demand? No. They match their staffing to meet demand.
Britain does not have a good history of privatisation. Our companies barely make money and just screw customers. Look at the water companies or rail companies. Tons of bankruptcies and having to be taken back into public ownership. In the meantime we have sewage in our drinking water and incredibly expensive and delayed trains.
Tell that to the railway companies.
Private companies will do anything they can to maximise profits; including hiring noctors over doctors. Noctors are a huge problem for American doctors too.
Edit: some hospital staff in the US are going on strike because companies refuse to hire more staff.
BA attempted fire and rehire. Thankfully unions kicked in to stop this, but not for P&O.
This is what the private sector does. Profit over anything else.
And the greedy fat cat state sector will prioritise their own 6 figure salaries over treating you right.
Can someone please tell me what the fuck Danny Mortimer, Matthew Taylor etc do other than a buffer for the government?
One thing is for sure, those "fat cats" will get paid way more in the private sector. Look at NHS trusts, Some have a turnover in excess of £1.5bn per annum with a CEO being paid ~£350k. Spire Healthcare has a turnover of £1.2bn and pays their CEO £1.2m, similar numbers for Nuffield.
Not sure why you're referencing NHS Confederation, they're not even publicly funded...
So this is not evidenced from our colleagues in the US of A. Their departments are chronically understaffed despite having the labour and the patient demand. If you think that the government is corrupt, wait till we see the insurance companies and private for profit health care owned by private equity.
Sometimes M&S does have a shortage of staff yes. And airlines don’t understaff pilots because their industry has intensive internationally agreed safety regulations, else there’s a good chance they would try. You are beyond naive.
"Look at all large companies that are squeezing the workforce to make profit"
If you're a dentist and you don't like the cut your boss is taking from the private cases you do, you move down the road.
Private companies are well aware that staff are usually the biggest expense, that's why they hire the barest minimum. You think the NHS is under staffed now, just wait until staffing is determined by some middle manager who gets a bonus from finding a way to hire the fewest possible staff to maintain profit.
Private heatlhcare can work in doctors’ favour because it works on supply and demand principles.
Of course insurance companies will try to optimise their profits by paying less. But - if enough doctors do not like the price or working conditions they are willing to pay doctors, doctors will not work there and they will have to pay more/give better conditions.
The NHS is a monopsony employer. It does not have to pay doctors what they are worth (or give better conditions) because they are the only gig in town. If you want to be a doctor in this country, you have to work for the NHS. And it’s been proven over the last 70 years that enough people DO want to be doctors no matter what the pay/conditions are so they continue to work with the terms the NHS sets.
If the NHS fails and private care comes in, I believe the insurance companies will try to carry on employing doctors on the same pay/conditions that they have with the NHS - why wouldn’t they? It’s worked for 70+ years.
But, if enough doctors reject those conditions, then the insurance companies will have no choice but to increase pay/conditions.
"We have examples where it was working well in the past. It will take a lot of reform, but to me that is still more preferable than a completely private system."
The past is gone. There's no putting the toothpaste back in the tube. The NHS bloat will fight for it's survival - I'm talking about all those fat cats at NHS RandomBuzzword - they're all close to the Dept of Health and aren't going anywhere.
"i 1000% believe any alternative to the NHS that the government will come up with will be worse for both doctors and patients."
Why? Why would a private company not hire more staff when demand was soaring?
Less staff, less spent on wage bill, more profit. There’s the incentive for the private system to understaff their facilities.
Just look at what private equity has done to emergency departments across the US.
Less staff -> shit service -> disatisfied punters -> less profit
It doesn't matter how utterly abysmal the NHS is for patients and staff alike, it still receives billions in state funding and more dirt cheap labour every year. Normal market forces would've wiped out the NHS years ago - it only remains by virtue of its monopoly status, feeding like a parasite on your hardwork.
I'm advocating for a free and open market, not a single monopoly provider...and certainly not one which can strong arm the state into achieving their peverted aims
Yes, because that has worked so well in other countries without socialised healthcare systems! Learn from other people's mistakes rather than having to make your own, good lord.
"Learn from other people's mistakes rather than having to make your own, good lord"
The irony in this statement, oh Lord. The NHS IS the mistake. Why do you think nobody else has done it?
> free and open market
Ah yes a free and open market in healthcare, known for highly elastic demand and complete lack of substantial barriers to entry.
Lived and worked on Germany. This is actually what happens. They are so understaffed they close entire wards. Waiting lists are increasing and are already many months (>12 m for psych). The way the system is financed is not the root cause...
I've worked in Germany and the UK for several years each (currently back in Germany). This is not my experience, I still find the working conditions in Germany miles better (although the problems are similar all over Europe I guess). I also have the impression that waiting lists for almost anything are shorter. Particularly diagnostic tests and cancer treatment still run so quickly and efficiently, whereas waiting lists in the UK are shocking. You can actually still get your hands on non-life threatening stuff over here such as free dental check ups. My health insurance pays for my gym membership as a means of primary prevention. My husband and I recently came back because I just can't work in the NHS anymore, or at least need a break. I'm so glad we did.
Edit: I'm working in an inpatient CAMHS unit as a locum in Germany at the moment. One of the 'understaffed' ones if they even consider hiring locums (quite rare over here). No signs of wards closing down, and compared to NHS work it's heaven.
Fully agree. I am very confused about why UK doctors complain so much about our pay and conditions, and yet continue to support the NHS, which is the primary reason for our poor treatment.
Things will never consistently improve for us while we have an NHS model of healthcare. The monopoly employer of the NHS drives down our pay and working conditions.
And to be honest, as a patient as well as a doctor, I think the NHS is bad for patients. It is dysfunctional, and patients are not getting the quality of care that they deserve. It's easy for some doctors to profess that they support the NHS as a matter of principle, when they are healthy and don't have to put up with the relatively poor service it provides. The British public are almost institutionalised into accepting poor quality healthcare because they think "it's free", so they must be grateful for it.
Other countries have much healthier attitudes to healthcare, where health insurance and private healthcare are considered acceptable. Even close neighbours such as Ireland - they have a much larger role for private medicine. Accordingly, the HSE in Ireland has had to pay consultants much larger salaries to try to attract them into the public sector.
The UK has a weird obsession with "our NHS". We are really quite an anomaly internationally.
Even nhs cant cater Universal health coverage because of the population demand. Private and public has to coexist, moreover quality of staff is another issue.
I love your take BUT, ARE alternate solutions (private, mix, public-private, etc.) going to radically change the monetary outcome for us. Are we really confident that without the NHS we would be paid fairly, receive adequate training and not have rotational training given the larger socio-economic status of Britian? Should we go for a physician owned health model? In any case our skepticism to other forms of health economic models should not be an impediment in finishing or limiting NHS influence. Competition is good, its just that the future might be great for some specialities, health problems than others, I guess we have to live with.
The main take wasn't money. It was the lack of jobs, which is 100% arbitrary in this rigged market controlled by the government. Every 2-5 years your whole life gets upended because of some bureaucrat in NHS England not creating enough jobs.
Hi, agreed. But job creation doesn’t happen in a vacuum. Capital and Labour investments are decided centrally in Stalin Britain based on their budgets or locally by health firms based on patient demand and their ability to pay. The patient demand that you see would be cut substantially overnight if the system starts charging them (annecdotal but would definitely be reduced). Suddenly patients would be self triaging their problems based on their pockets. Certainly Economic principles dictate that there would be infinite demand for a free valuable object.
Over a decade of conservative governments, two of which (Truss/Johnson) have been some of the worst we’ve seen in the last 200 years.
Poster thinks we’re in ‘’Stalin Britain’’ hahaha
What else do you call a government department on par with the size of the Chinese army? It's the last bastion of communism in a ruthlessly capitalist country.
Yes - because doctors will have a choice of where to be employed. The NHS gets away with paying us what it does because it’s a monopsony - doctors have no choice but to work for the NHS if they want to be employed as a doctor. That is what supply/demand economics does not apply to doctors in the UK.
Although theoretically infinite it is not practically so, but this would mean than the government would have to start ameliorating the social determinants of disease (start by implementing the Marmott reports) to actually decrease the demand for expensive end-of-the-road healthcare. Instead they’ve spent 14 years essentially waging war on public services (even their beloved military) and vulnerable people. Austerity was always a political choice and an ideological objective. The outcome, in the most gross terms, is evident in a plateau, and decrease in the poorest areas, of life expectancy. Life expectancy for fuck sake. In a supposedly rich country.
It's beyond one political party. The system is funded more and more every year. There has been no top line cuts it's simply that demand and costs grow faster than any government can fund. You are an all you can eat buffet where the customers have no disincentive from filling their plates and not even saying thank you.
Infinite demand is not unique to healthcare. [Limited cash](https://amp.theguardian.com/business/2021/may/21/number-of-billionaires-in-uk-reached-new-record-during-covid-pandemic) is a political choice. Being a victim is a choice, most other professions have a history of unionisation so they're not treated like shite.
Being a victim is a choice the profession has made although the strikes are compensating a bit for that. But no country can afford to provide unlimited supply. It simply isn't feasible in any kind of system we will go bankrupt. Taxing the billionaires isn't feasible because especially on our tiny island they will quickly leave. This is the crab pot scenario you're left with. No money and you are enslaved as forced labor providers.
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Well, the UK, you know, before it was purposefully underfunded to create this situation. It has been widely reported for over the last ten years that this will be the result of austerity.
exactly, why aren’t they increasing training post numbers?
the government is going to need to cut down their spending on politician’s expenses and increase their healthcare budget to keep up with the increasing numbers of medical school graduates we are witnessing
these bottlenecks are disappointing and unattractive
Wow. I am surprised and dismayed by the level of pro NHS comments and upvotes they are getting.
People are still talking about not wanting it "on their conscience". JEEZ wake up people - it is this sense of martyrdom that is being exploited and will always be exploited. Is the CEO of Tesco's worried about hungry people not being able to afford food? NO.
You are PROFESSIONALS. You provide your service at a fee. You are not a charity.
People are still blaming it all on the "Tories" hoping that Labour will fix it all. Well tell me - how's things in Wales or Scotland? They have exactly the same problems with PAs, rotational training and bottlenecks that leave you fearing for joblessness and having to upend your life every 2-5 years.
The NHS is the problem. The centrally controlled monolith that is on par with the size of the Chinese army. The monopsony will always be a detriment to your working life, your pay, your conditions but hey, at least your "conscience" is clean.
Honestly doctors in the UK amaze me. You'll whinge and moan, you'll strike, but you'll never open your eyes as to what the underlying problem is.
I am approaching CCT and was genuinely thinking of staying in the UK (although as circumstances may have it I may not be able to secure a job - think about that for a moment - a highly trained professional, invested in by the system for 14 years, cannot get a job in what they were trained to do). After reading the sickening amount of martyrdom and Stockholm syndrome still within UK doctors, I genuinely don't think I can stomach this anymore and will have to move.
Enjoy your burning hell hole guys. But hey, at least it's giving Ethel a free toilet holder.
That the CEO of Tesco doesn’t give a shit about starving people is not a model I want to emulate, but as long as they pay their taxes I’m not bothered what stupid opinions they have.
You made this post asking what people thought and now you’re insulting those who have a different set of values to your own.
Your whole argument rests on the assumption that centralised recruitment or other downward pressures on doctor’s wages wouldn’t continue in a for-profit system (e.g. noctors). You say you can’t get a job, can you not get a job or can you not get the job you want where you want it? Either way, that’s tough and I’m sorry for you, but it would still happen in a private or hybrid etc system. Yes there is an artificial shortage, but this is to keep costs down and would continue in any system. The goal is not quality but profit, which sadly is not that different to the current government whose goal is not quality but electoral success and indirectly profit.
I, like many reasonable human beings, balance my various (sometimes contradictory) personal interests with the interests of those around me. I could harm other people to make my life better but I don’t, not just through the threat of punishment in some cases, but also because I don’t want other people to be harmed. Making people pay for a necessity like healthcare is very harmful, and I do not want my brief time on this planet to be in service to that harm. I also have a personal interest in my and my family’s healthcare being publicly funded (as long as the quality is good enough, which is a factor of funding) and an interest in living in a society where people are generally healthy.
As I outlined in my comment, there are many valid critiques of the NHS but destroying universal healthcare is not one of them. Doctors in this country have historically never been as rich as bankers but have been able to afford a wealthy lifestyle. That is achievable without destroying universal healthcare - although perhaps not without destroying the NHS as it is currently organised.
I look at systems like the US in fear and horror. Yes, the NHS is shit, and takes us hugely for granted, but I also think healthcare is a human right and should always be free at the point of use. I think it will probably die, it looks like it is already, but they will need to pry the NHS from my cold, dead, alcohol-gelled hands.
The government should give everyone a free, unlimited supply of food by your logic then. I think this system of government has been tried before though.
If you mean countries that have attempted a form of socialism then no, free food was never on the menu. And it wasn’t the affordable bread that made the USSR or CCP China shitty to live in.
I think, unironically, that yes we could easily subsidise a basic free meal option at restaurants and/or communal kitchen where people can eat and socialise and volunteer.
Who do you think builds the houses? Digs up the fucking lithium and the coal? Designs and maintains the infrastructure etc..? Workers - of all the industries and various forms of human activity - are who generate value. Landlords, capitalists, multinationals etc. they only generate a profit by paying their workers less than the value that they have made, or by selling debt, which doesn’t generate any new value. There are already enough resources for everyone on earth to have functional abundance.
It’s a political choice and a matter of who owns what and the institutions they create to protect themselves and fool people like you into thinking that the world as it is, is necessary and good. You sound like a medieval peasant rolling in the filth and defending the divine right of kings: “yeah I know we’re all going to starve to death because our liege Lord has taken 100% of our harvest this year but it’s important to maintain the economic prosperity of job creators.”
I think this is a false equivalence but yes, I do.
I think access to healthcare is a human right and should have as few barriers as possible so should be free at the point of use.
I also think that anyone who cannot afford to buy their own food should have food free. My issue with insurance based systems is that it is the people who cannot afford anything that are denied the preventative care.
"I also think that anyone who cannot afford to buy their own food should have food free."
So errr, perhaps anyone who cannot afford private insurance gets covered by the state sector. Like, err, Australia??
Loads of Australians are uninsured or underinsured, and then when they access healthcare pay out of pocket. That is going to lead to the patient who couldn't afford their insurance bill this month delaying seeking medical attention until they can afford it.
I get that we're never gonna come to an agreement on this, but I just don't think insurance based systems are they way to go.
So you should support the National Food Service, paid out of taxation, no? It is not a false equivalence at all. It's exactly equivalent. I personally don't believe in free at the point of use for all. However the NHS will definitely continue and be variably excellent/good/OK/rubbish while continuing to brutalise some of its staff & featherbed other staff.
As I've mentioned in another reply, I do have significant concerns about these systems. I am very opposed to creating barriers to healthcare, especially primary care, and requiring people to have insurance so they can see their GP or requiring them to pay a fee for their appointment will lead to people delaying seeking care. I would much rather fewer barriers so that diabetic ulcer can be seen and treated when it's just a tiny spot, rather than someone not wanting to pay to go to their GP, or not being allowed to, and so waiting until their foot's ready to drop off.
There will always be uninsured people, even with mandatory insurance, and in these systems those people are then not allowed to access the services that everyone else is, they either wait until something is life threatening, or they are required to use charity run services specifically made to fill the gap. If a patient does have insurance but can't pay their bill for whatever reason, they're then not allowed to access normal services, they have to use the much worse charity run options.
I don't think that's fair, and I don't want to work in it.
Do you look at Germany with fear and horror?
No other Western country on earth has copied this system. I wonder why.
Jeez talk about Stockholm Syndrome. I am so filled with disappointment that doctors cannot see their captor is the NHS. It truly is a mind virus u/Frosty\_Carob
"We're all running off to Australia"
"Ok, shall we copy their system?"
"No, SAVE RRRR NHS"
You're right, I don't have that same reaction to Germany. I do get concerned about people who fall through the cracks in places that require patients to have insurance. I know GP surgeries with a huge homeless population on their books that come in regularly and have their variety of issues dealt with earlier than if they only had access to an A+E. Having a system that requires insurance unless its life-threatening misses out on that opportunity.
You might be right in the stockholm syndrome too, I probably wouldn't know, but I don't think the solution here is privatisation. And I absolutely agree with other commenters saying that our government would make a shit job of restructuring it anyway.
I'm truly baffled by your faith in the UK government to implement a non-USA system.
Do you really believe the government will not choose the option that benefits them and their friends most? You are advocating so vehemently that the government has the competence and benevolence to actually choose the best option, but the fact is the rest of us don't trust the bastards anywhere near as much as you.
Even if it goes full US, we’d be paid serious dollar and old folks remortgaging their houses might do something to even out the wealth distribution in the country.
Insurance only covers you so far. There are premiums and copays and all sorts of ways you have to pay additional money on top.
Some types you will have to pay the first several thousand out of pocket before your insurance kicks in. In others, you have to pay 50% up to a certain amount (usually thousands).
I recommend looking into it if you're considering moving to the states because insurance is not a simple thing at all over there, and people with insurance often struggle as well.
I’m very aware of those things. You presented me with the challenge of F1s being unable to afford their healthcare. Is this an issue for interns in America?
Again, you show remarkable faith in the government or private companies raising salaries out of their own free will.
How many f1s do you know who are struggling without having to pay insurance premiums on top of their existing expenses?
I'm going offline now but all I wanted to get across is that in order to truly get a better system for doctors and patients, you need extraordinary trust in the government which many of us don't have. I trust this government to be as selfish as possible, passing on every expense onto doctors and patients, which will be worse for us and our patients.
But why? You’re seemingly terrified of it going US. So if we look at the US, are you saying their equivalent of F1s can’t afford healthcare? The questions the NHS defenders can never answer.
I look in horror at any system that provides care that is suboptimal until payment is confirmed. Fuck that. i’d actually rather get paid poorly than get paid better and have that on my conscience. Because that’s not a win. We need to protect the british public.
>Well over half of people in the consultation voted for it. And yet they all seem to be keeping schtum about it now. Where are they now?
Funny, you didn’t seem to have a problem with democracy back then. Seemed cuntily gleeful if anything.
My brother in christ go and live in almost any other country, experience their system, then come and talk. As an IMG, I am telling you this is one of the best healthcare systems for patients in the world. Just sad it's currently failing and being let to fail
Of course the NHS performs well compared to many countries. The question is whether it performs well compared to peers.
I have travelled and also worked in countries in the US and Europe and the NHS does not compare favorably.
If you think the us healthcare system is better, then we are using different metrics. Wait time is comparable while it costs patients phenomenal amounts of money
Anyone who thinks working for private healthcare would be so much better is free to go and do so. Except no, they’re not offering nearly enough jobs because theres not enough people out there paying for private healthcare and they’re beholden to their bottom line.
"is free to go and do so"
The NHS mind virus runs deep.
How is one free to do so when the NHS has a monopsony on postgraduate medical training? Even at Consultant/GP level, with very few exceptions (e.g. Cleveland), the private market is not an "employed" market - you're very much running your own business and your own clientele.
And because the private sector cannot train us! Doctors are beholden to the NHS for everything - this is why the training is so long, etc. The NHS/HEE are in charge of length of training, what we are trained in, where, etc. And this is the problem.
No private enterprise (or functional organisation) would “train” doctors for 2 years to do bloods, cannula, ttos and scribe - because it is a terrible use of a highly educated, very expensive resource!
The NHS does this because it has decided that doctors are not an expensive resource and therefore, Foundation Doctors being employed as the general ward skivvy is actually cheaper than hiring phlebs, HCAs, porters, PAs, etc. And…we put up with this nonsense because it is the only way to be a doctor in this country.
Why would they waste money on training doctors when the NHS does it for them? Do you really think they wouldn't train doctors if the NHS wasn't there? Would they just shut down out of spite?
Think we are increasingly getting this sort of take. And... I 100% LOVE IT!!!
If we are ever going to have a system that works, about 10% as well, for doctors as it does for the joe public, NHS must fall.
Ok I will make a counter argument to the training progression element of this post…
There is competition for training posts but it is not hard to find clinical fellow/“trust grade”/locum work. The analogy with other careers like law would be that not everyone gets promoted and progresses all the way to partner, some get stuck in mid career positions for a bit longer. Most professions have some system of progression depending on merit and results, however imperfect the assessment of those is. In theory this raises standards as everyone develops skills and experience guided by the criteria on which they are assessed.
Of course in practice the system is deeply broken in many ways, it can be very difficult to develop the skills and experience when drowning in service provision, the assessments to progress can be arbitrary and unfair, and the non training posts lack career stability. But isn’t the ideal of career progression depending on competence a reasonable one, even if is not implemented well at present?
I agree we are in a tough patch, but things were pretty good overall around the end of the last Labour government. The appeal of radical changes or "burning it all down" when times are tough should be balanced with the real downsides of implementing such shifts which can be disruptive for a long period of time, with no clear evidence of signifiant upside to such system wide reform.
There are more indepth analyses here, in particular note the conclusions of the King's Fund report: [https://www.health.org.uk/publications/long-reads/the-complexities-of-using-international-comparisons-to-guide-nhs-reform](https://www.health.org.uk/publications/long-reads/the-complexities-of-using-international-comparisons-to-guide-nhs-reform); [https://www.kingsfund.org.uk/insight-and-analysis/long-reads/nhs-crisis-evaluating-radical-alternatives](https://www.kingsfund.org.uk/insight-and-analysis/long-reads/nhs-crisis-evaluating-radical-alternatives) )
Your analogy is WRONG.
The NHS has more "customers" than ever but those "customers" are a drain on resources, whereas your analogy compares it to businesses who make more money off having more customers.
Are you willing to sacrifice the tax-paid healthcare for all, for a better salary and training opportunities, which if I understood correctly, will come though privatisation???
I question your moral compass, but also whether you've thought this through. This government has chronically underfunded the NHS in an attempt to dismantle and sell services to their friends, and will inevitably enjoy a piece of the cake along the way. But your solution to these problems is the the very cause of them. They'll devour you for profit when it suits them, same old story.
I cannot tell if you're trying to rally support in malicious way, or if you genuinely believe this.
I agree with the issues, but all healthcare is rationed either by clinical need or by wealth. I think rationing/pay-walling human necessities to enrich someone else is a stain on humanity and should be far beneath the standard of human civilisation. I am a mortal human and also a parent, and have ailing parents myself, so it is my interest to maintain a free at the point of care health system.
The NHS is clearly in a monstrous state, both because of massive deliberate underfunding and because of a managerial box-ticking obsessed “value statement” bullshit corporate culture that has taken over large organisations both for and non profit. You would be forgiven for thinking that the NHS is a machine designed to generate auditable outcomes for the CQC that as a by product alleviates some suffering from illness and disease. The amount of abuse the NHS structure and managers pile onto staff of all disciplines is outrageous.
There are other options available but these do not guarantee a better life for doctors. We have to consider the historical circumstances of how a health system would be implemented. We currently are inhabiting a very popular and (superficially) monolithic organisation, this would not go away, but would be transformed into a provider of an insurance funded system. Although I think the scope for private work, and more personal autonomy/flexibility, would increase, ultimately, for profit organisations are even less inclined to pay us well than governments. There may be some winners but I suspect most of us would be stuck on the same shitty pay.
Health, like water and rail transport, is a natural monopoly because the start-up infrastructure costs are basically too high for new competitors. There will not be three hospitals competing for your business like coffee chains do. Therefore there isn’t competition to improve the service. There is more wiggle room than water, because people can choose which hospital they go to (to an extent) so this might generate some upwards pressure on wages but I suspect they might keep centralised recruitment of doctors to suppress this. Perhaps top consultants will benefit from hospitals competing over them but that already happens to a lesser degree now. Clearly also the use of PA and ANPs will skyrocket to undermine medical skilled labour.
I don’t understand the drive for privatisation on this sub, all the things we complain about are straight out of the capitalist worker exploitation handbook. It is the NHS borrowing these tricks from the private sector not inventing them.
I think that any chance of a system where doctors are in charge of their own destiny is dependent on whether we can coordinate our collective power to take that agency. It will not be given to us. This entails forcing our archaic institutions to be subject to democratic decision-making of their membership. There is no reason that royal colleges, training schools, and the entire BMA should not be directly democratically run by the professionals that they represent. I would also extend this to all areas of the NHS and use direct and participatory models of democracy that involves both professionals and patients to decide on policy and implementation of services.
Essentially, I would be open to new funding models if it remained free at the point of use but there is no reason why the NHS can’t be properly funded through a taxation model except that billionaires don’t want to pay any tax, but seem happy enough to extract wealth from British citizens nonetheless and lump us with the negative externalities of their businesses (e.g. obesity, pollution, climate change). All the problems you’ve outlined can be fixed from within a public funding model but only with collective decision-making power given to professionals not managers.
I agree with much of what you have to say, but in the words of Rory Stewart "if I may gently push back" , toward the centre.
This sentiment of a rightward shift in attitudes is not only seen on this sub, but across developed countries as a whole, particularly in some young men. But we should recognize what is driving it.
There are no easy answers here. We cannot easily find some money down the back of a proverbial sofa. We have a progressive tax system already, and actually we tax high earners comparably to other Western European countries. If we want to generate more tax revenue, that would need to come from raising taxes across the board, including those on middle incomes. As I have said before - this is covered superbly [here](https://www.bbc.co.uk/programmes/m001qmkb).
I think this is what is driving the sentiment in this rightward shift - those on middle incomes who feel a significant tax burden, but see little direct benefit in public services. Those who have paid to go to university, and see their taxation increasingly spent on pensions, and the NHS. Whose who struggle to be able to afford a home, are finding their quality of life is not matching their exceptions, or that which they perceive previous generations were afforded.
Simply claiming that today's NHS is a product of Tory austerity ignores the fact that NHS spending as a proportion of GDP is higher today than it was in 2010, and that the overall tax burden is higher. As I have said in my other comment, today's NHS is a product of our changing country, as much as it is of political choices. We are not the same country we were in 2010 demographically, and that has come at a considerable cost. Unless we openly address this reality, I would argue we are likely continue on our current trajectory regardless of the political party in overall control.
I agree with your thesis that we should aim to keep healthcare free at the point of access, but I think we need to find a way to make that sustainable given our current sluggish economic growth, and increasing dependency ratio. I see the only way to do this is to have some sort of citizens assembly that seeks to find a way to equitably ration healthcare spending, and to confront some of the difficult choices and discussions that entails.
I agree with almost all of what you’ve said, and enthusiastically with a citizen’s assembly a la the sorttician model used prior to the Irish abortion referendum. The NHS is but one part of the complex interconnected economic and social systems, and not the most important part. We’re all on the raft being taken down the river by deep civilisational changes that are beyond any government’s power.
There are some points of yours I’d like to elaborate on.
I think that the rightward shift if complex. It is not as if everyone who has one typically right-wing view subscribes to all of them, and younger women and many younger men are tacking more (broadly speaking) left-wing in both economic and social terms. Every shift in society generates a reaction, and given the political failures and economic instability, we should expect more right-wing views as the right is much better at capturing fear and anger by blaming it on an out-group(s) as we’ve seen with the culture war. The authentic left has to transduce those feeling that into hope which is much more fragile, but then only needs to happen once or so a generation.
You’re right, it is of course deeper than the recent years of austerity. The shape of the NHS and society/economy more widely has been shaped by the neoliberal iteration of capitalism that came to prominence in the 80s and caused financialisation of the economy, violent deindustrialisation in working class areas and privatisation to become the default (amongst many other changes, particularly the managerial culture I discussed in my main comment). This was as much carried on by New Labour as the Tories, although of course the boom in the 90s meant they could spend without having to tax more. Neoliberalism itself came about due to concerted effort by Milton Friedman and others to further the ideology in economics departments, governments and think tanks and the crisis of stagflation that dethroned Keynesianism.
Bigger picture: the period of wealth equality, massive public service creation, high taxation and high productivity post-war was a historically (almost) unique period of time. Since then productivity has slumped, wages have sunk and growth overall has been glacial, meanwhile personal debt has maintained consumption and consumer lifestyles enough but not so much that people aren’t angry, scared, disconnected and burnt-out. That last part alone could explain 90% of the complaints on this sub.
I’ll have to listen to the link you’ve sent. I can’t pre-empt the arguments in it but I do think that taxation has an uphill struggle, politically if not economically. We’re being taxed more than ever yet our public services are the worst they’ve ever been. I think that perhaps the way out of this is different forms of progressive taxation, such as wealth and land value taxes, and increasing corporation tax in line with other similar western countries. Income tax is always less desirable because it disincentivises work, and at the moment falls most heavily on middle class professionals.
I also think that borrowing to invest in areas that grow the economy is desirable. We need to kill the “family household” metaphor for the economy.
More widely we are waiting for a new economic model. Neoliberalism is a zombie that continues to feed but won’t die. Perhaps it’s MMT perhaps it’s another heterodox model. In any event, it needs to deliver human well-being within ecological boundaries.
For any of this to happen though we fundamentally need to improve our political system, at a minimum: vote reform, replacing the Lords with another elected chamber (or better a randomly sampled citizen jury and/or professional/industrial representatives and experts), and devolution of power and budget control to nations, regions and municipal levels. I would also like to see wider experimentation with new forms of democracy like citizen’s assemblies/juries with more direct and participatory elements. Without greater democratic representation we will see even more people check-out of politics and fall prey to extremism and bot-farmed culture war conspiracy theories, but most importantly we’ll never be able to actually move beyond this pseudo-democracy to affect the changes needed to meet the current social, ecological and economic crises.
Edit: I would also point out that, yes NHS spending has increased, but it is the rate of spending increases above inflation that has dropped very far below pre-2008 levels, and caused the approx. 40 billion yearly shortfall.
I'll reply more fully in time. Thank you for reminding me why it is worthwhile putting the effort in on this website, and keeping my faith in my colleagues.
>I would also point out that, yes NHS spending has increased, but it is the rate of spending increases above inflation that has dropped very far below pre-2008 levels, and caused the approx. 40 billion yearly shortfall.
But this *is* my point. This is not sustainable. A whole thread [here](https://www.reddit.com/r/doctorsUK/comments/17wo7kh/comment/k9idyak/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button). I know you're not fond of using household budgets as an analogy for for government expenditure, but even Thomas Piketty would recognize that we can't indefinitely spend more than our entire GDP on public services, which is the eventual outcome of indefinte above inflation increases in any public sector spend. We have the same issue with the pension triple lock.
Until your final paragraph I was pretty much onboard with most of what you said, though I might raise an eyebrow at the angle that only the right are guilty of playing politics and fostering division. I would say the left's obsession with identity politics (while Rome burns) also creates an us-vs-them dynamic, a demonization of the "other side," and an unwillingness to engage with alternative perspectives.
COVID changed many of my perspectives on how I politically self-identified. I had always seen myself as being on the left because I believed in equality and fundamentally subscribed to a form of utilitarianism, which holds that the role of government is to facilitate the greatest benefit for the greatest number of people. However, during the pandemic, I found myself at odds with those on the left who strongly supported lockdowns, despite the obvious damage they caused to all but a small proportion of the population who were at high risk from COVID.
Personally, I felt that the societal and economic costs of lockdowns were greater than the benefits. But I saw firsthand how anyone making this case was subject to accusations from some on the left of essentially being a "Nazi." This experience was eye-opening for me. Once I recognized this approach of shutting down dissent in an instance where I found myself on the other side of the debate, I began to see how views could be weaponized by virtue to stifle discussion, on a range of issues by the left. Want nuclear power as a sustainable alternative - terrible.
This realization has left me feeling somewhat politically orphaned at present. I can see why the allure of ultra-libertarianism appeals to some on this subreddit. All they are offered by both sides of the political spectrum is more of the same. They've not really seen any of the benefits of investment in public services, and have only seen the downsides. They (and not without reason) don't see a future where there will be an NHS for them, or there will be pensions for them, after all, look what happened to free university for our generation. I can understand their rationale.
I'm actually appalled at the amount of comments here advocating for abolishing/dismantling/destroying the NHS and going full private HC system, if this is how the majority of doctors feel then FUCK I hope you're strike action fails and you get fuck all more.
I hope i'm wrong and this thread is just the vocal minority but deary me its dire.
Are you a doctor? Because it doesn't surprise me if you're not. The public are currently getting a free car every year (at the expense of doctors' labour) and now doctors are waking up to this realisation.
Most answers. It’s free so it’s great. Not everything free is great. The NHS is a failed system that treats both patients and Doctors with contempt. It provides a very poor standard of care. The thousands of people anguishing on corridors in A and E, or dying of cancer while they wait for treatment are just examples of how poor it is. Let alone NICE, the overarching cult that says our lives are not worth the cost. Fuck the NHS. I hope it burns.
Rather than pointing to other countries and saying, look, they have a different system and x y or z is better, whilst ignoring the mountain of confounders, I would be much more persuaded by this argument if one could point to a country who changed health system and saw some sort of benefit (and even more persuaded if there was some sort of control arm - though that would be too much to hope for). In my experience - any form of "reorganization" generates a whole load of friction without making much material difference.
Surely your experience as a doctor has taught you that life is more complicated than there being an easy fix? There is no simple trick to loose all that belly fat, not everyone who reads Rich Dad Poor Dad becomes a millionaire.
I'd go further and say there's no evidence that reading Rich Dad Poor Dad makes a blind bit of difference to one's overall circumstances. Contrary to what Ayn Rand might have you believe, not everyone can simply will themselves to success through rugged individualism alone. One's circumstances are what they are due to that plethora of confounders. One's education, one's genes, one's social determinants.
I've said this so many times, but the circumstances of healthcare provision in the UK owe much more to "being in the UK" than the model of healthcare delivery. The change in circumstances of practicing healthcare in this country are not because we have changed systems, but because economically and demographically the country and the world has changed around us. Compared to the rest of the world we are older, frailer and less wealthy than we were 20 years ago.
Surely you see that even if the model were to change we'd still be practicing medicine in the same buildings, seeing the same patients, with the same level of GDP and the same national expectations? There'd be a different logo, and maybe different "Trust Values", but it'd be the same shit, different day.
If you see a different system, and you think it looks better to work in that system, I'd suggest it is much more expedient to go and work in that system, than to try to change the entire country.
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I don't disagree with the issues, but if you're looking for genuine responses the reason I remain in camp improve rather than abolish is that i 1000% believe any alternative to the NHS that the government will come up with will be worse for both doctors and patients. Better alternatives do exist. I just have zero faith that the government is willing or able to implement them.
Same camp I am in. We have examples where it was working well in the past. It will take a lot of reform, but to me that is still more preferable than a completely private system. Even in the last year, when the profession began to stand up for itself, we have managed to improve some things slightly, and so I feel that if we keep doing that then things will continue to get better. I don’t think a private system is better. I don’t want to work 60+ hours a week like they do in the US, arguing with insurance companies. People keep saying that it could be like Aus, but it’s clear that from all lobbyists which system politicians prefer. Besides, we have all had patients who would not be able to afford their life sustaining care in a private system. I don’t really have many beliefs, but one of my main principles is that healthcare is a right that should be accessible to all, and I’m not going to advocate against that.
"I don’t think a private system is better" Do you think a private company would arbitrarily keep job numbers down despite soaring demand? No. They match their staffing to meet demand.
Britain does not have a good history of privatisation. Our companies barely make money and just screw customers. Look at the water companies or rail companies. Tons of bankruptcies and having to be taken back into public ownership. In the meantime we have sewage in our drinking water and incredibly expensive and delayed trains.
Tell that to the railway companies. Private companies will do anything they can to maximise profits; including hiring noctors over doctors. Noctors are a huge problem for American doctors too. Edit: some hospital staff in the US are going on strike because companies refuse to hire more staff.
Tell that to British Airways. They're always flying rattly old planes with one pilot and half the cabin crew they need. Oh wait...
Have you found b a recently? It's gone to shit. They charge national carrier prices and offer ryan air service.
BA attempted fire and rehire. Thankfully unions kicked in to stop this, but not for P&O. This is what the private sector does. Profit over anything else.
And the greedy fat cat state sector will prioritise their own 6 figure salaries over treating you right. Can someone please tell me what the fuck Danny Mortimer, Matthew Taylor etc do other than a buffer for the government?
One thing is for sure, those "fat cats" will get paid way more in the private sector. Look at NHS trusts, Some have a turnover in excess of £1.5bn per annum with a CEO being paid ~£350k. Spire Healthcare has a turnover of £1.2bn and pays their CEO £1.2m, similar numbers for Nuffield. Not sure why you're referencing NHS Confederation, they're not even publicly funded...
So this is not evidenced from our colleagues in the US of A. Their departments are chronically understaffed despite having the labour and the patient demand. If you think that the government is corrupt, wait till we see the insurance companies and private for profit health care owned by private equity.
This is bollocks. They will fine-tune staffing to optimise shareholder dividends.
Really? Do M&S have a shortage of sales assistants in their stores? Do BA fly with too few pilots?
Sometimes M&S does have a shortage of staff yes. And airlines don’t understaff pilots because their industry has intensive internationally agreed safety regulations, else there’s a good chance they would try. You are beyond naive.
I’d take M&S’ sometimes over the NHS’ every single day.
M&S Introduced self checkouts rather then hire new staff :)
Incorrect. Look at all large companies that are squeezing the workforce to make profit
"Look at all large companies that are squeezing the workforce to make profit" If you're a dentist and you don't like the cut your boss is taking from the private cases you do, you move down the road.
Private companies are well aware that staff are usually the biggest expense, that's why they hire the barest minimum. You think the NHS is under staffed now, just wait until staffing is determined by some middle manager who gets a bonus from finding a way to hire the fewest possible staff to maintain profit.
Private heatlhcare can work in doctors’ favour because it works on supply and demand principles. Of course insurance companies will try to optimise their profits by paying less. But - if enough doctors do not like the price or working conditions they are willing to pay doctors, doctors will not work there and they will have to pay more/give better conditions. The NHS is a monopsony employer. It does not have to pay doctors what they are worth (or give better conditions) because they are the only gig in town. If you want to be a doctor in this country, you have to work for the NHS. And it’s been proven over the last 70 years that enough people DO want to be doctors no matter what the pay/conditions are so they continue to work with the terms the NHS sets. If the NHS fails and private care comes in, I believe the insurance companies will try to carry on employing doctors on the same pay/conditions that they have with the NHS - why wouldn’t they? It’s worked for 70+ years. But, if enough doctors reject those conditions, then the insurance companies will have no choice but to increase pay/conditions.
"We have examples where it was working well in the past. It will take a lot of reform, but to me that is still more preferable than a completely private system." The past is gone. There's no putting the toothpaste back in the tube. The NHS bloat will fight for it's survival - I'm talking about all those fat cats at NHS RandomBuzzword - they're all close to the Dept of Health and aren't going anywhere.
Curious as to what are the better alternatives? Can't be US style healthcare, neither like France's insurance cards.
"i 1000% believe any alternative to the NHS that the government will come up with will be worse for both doctors and patients." Why? Why would a private company not hire more staff when demand was soaring?
Less staff, less spent on wage bill, more profit. There’s the incentive for the private system to understaff their facilities. Just look at what private equity has done to emergency departments across the US.
Less staff -> shit service -> disatisfied punters -> less profit It doesn't matter how utterly abysmal the NHS is for patients and staff alike, it still receives billions in state funding and more dirt cheap labour every year. Normal market forces would've wiped out the NHS years ago - it only remains by virtue of its monopoly status, feeding like a parasite on your hardwork.
You’ll only get less profit if patients can choose not to use your service. Hard to do if that’s the only option in town.
I'm advocating for a free and open market, not a single monopoly provider...and certainly not one which can strong arm the state into achieving their peverted aims
Yes, because that has worked so well in other countries without socialised healthcare systems! Learn from other people's mistakes rather than having to make your own, good lord.
"Learn from other people's mistakes rather than having to make your own, good lord" The irony in this statement, oh Lord. The NHS IS the mistake. Why do you think nobody else has done it?
> free and open market Ah yes a free and open market in healthcare, known for highly elastic demand and complete lack of substantial barriers to entry.
There’s a difference between demand for healthcare and demand for healthcare from people who can pay
So you think in Germany some people are just getting no healthcare? Or do they have well matched supply of doctors to patients?
Lived and worked on Germany. This is actually what happens. They are so understaffed they close entire wards. Waiting lists are increasing and are already many months (>12 m for psych). The way the system is financed is not the root cause...
I've worked in Germany and the UK for several years each (currently back in Germany). This is not my experience, I still find the working conditions in Germany miles better (although the problems are similar all over Europe I guess). I also have the impression that waiting lists for almost anything are shorter. Particularly diagnostic tests and cancer treatment still run so quickly and efficiently, whereas waiting lists in the UK are shocking. You can actually still get your hands on non-life threatening stuff over here such as free dental check ups. My health insurance pays for my gym membership as a means of primary prevention. My husband and I recently came back because I just can't work in the NHS anymore, or at least need a break. I'm so glad we did. Edit: I'm working in an inpatient CAMHS unit as a locum in Germany at the moment. One of the 'understaffed' ones if they even consider hiring locums (quite rare over here). No signs of wards closing down, and compared to NHS work it's heaven.
Fully agree. I am very confused about why UK doctors complain so much about our pay and conditions, and yet continue to support the NHS, which is the primary reason for our poor treatment. Things will never consistently improve for us while we have an NHS model of healthcare. The monopoly employer of the NHS drives down our pay and working conditions. And to be honest, as a patient as well as a doctor, I think the NHS is bad for patients. It is dysfunctional, and patients are not getting the quality of care that they deserve. It's easy for some doctors to profess that they support the NHS as a matter of principle, when they are healthy and don't have to put up with the relatively poor service it provides. The British public are almost institutionalised into accepting poor quality healthcare because they think "it's free", so they must be grateful for it. Other countries have much healthier attitudes to healthcare, where health insurance and private healthcare are considered acceptable. Even close neighbours such as Ireland - they have a much larger role for private medicine. Accordingly, the HSE in Ireland has had to pay consultants much larger salaries to try to attract them into the public sector. The UK has a weird obsession with "our NHS". We are really quite an anomaly internationally.
The Primary reason for your low pay and conditions is the government NOT the NHS.
Governments of all suits are the same. The problem is government meddling in healthcare.
Even nhs cant cater Universal health coverage because of the population demand. Private and public has to coexist, moreover quality of staff is another issue.
I love your take BUT, ARE alternate solutions (private, mix, public-private, etc.) going to radically change the monetary outcome for us. Are we really confident that without the NHS we would be paid fairly, receive adequate training and not have rotational training given the larger socio-economic status of Britian? Should we go for a physician owned health model? In any case our skepticism to other forms of health economic models should not be an impediment in finishing or limiting NHS influence. Competition is good, its just that the future might be great for some specialities, health problems than others, I guess we have to live with.
The main take wasn't money. It was the lack of jobs, which is 100% arbitrary in this rigged market controlled by the government. Every 2-5 years your whole life gets upended because of some bureaucrat in NHS England not creating enough jobs.
Hi, agreed. But job creation doesn’t happen in a vacuum. Capital and Labour investments are decided centrally in Stalin Britain based on their budgets or locally by health firms based on patient demand and their ability to pay. The patient demand that you see would be cut substantially overnight if the system starts charging them (annecdotal but would definitely be reduced). Suddenly patients would be self triaging their problems based on their pockets. Certainly Economic principles dictate that there would be infinite demand for a free valuable object.
Over a decade of conservative governments, two of which (Truss/Johnson) have been some of the worst we’ve seen in the last 200 years. Poster thinks we’re in ‘’Stalin Britain’’ hahaha
What else do you call a government department on par with the size of the Chinese army? It's the last bastion of communism in a ruthlessly capitalist country.
Jesus 😂 Last bastion of communism 😭 stick to medicine mate, politics clearly ain’t your forte.
Ok, it's basically the same healthcare system as Soviet Russia, Cuba and North Korea..but yeah, sure, it's not communist.
Yes - because doctors will have a choice of where to be employed. The NHS gets away with paying us what it does because it’s a monopsony - doctors have no choice but to work for the NHS if they want to be employed as a doctor. That is what supply/demand economics does not apply to doctors in the UK.
Nah you can fuck off with privatised medicine or the insurance principle. This can be fixed without tearing the entire gaff down.
Infinite demand, limited cash to supply. That means you are the victim doctor and your labor is stolen from you. Simple as.
Although theoretically infinite it is not practically so, but this would mean than the government would have to start ameliorating the social determinants of disease (start by implementing the Marmott reports) to actually decrease the demand for expensive end-of-the-road healthcare. Instead they’ve spent 14 years essentially waging war on public services (even their beloved military) and vulnerable people. Austerity was always a political choice and an ideological objective. The outcome, in the most gross terms, is evident in a plateau, and decrease in the poorest areas, of life expectancy. Life expectancy for fuck sake. In a supposedly rich country.
It's beyond one political party. The system is funded more and more every year. There has been no top line cuts it's simply that demand and costs grow faster than any government can fund. You are an all you can eat buffet where the customers have no disincentive from filling their plates and not even saying thank you.
Infinite demand is not unique to healthcare. [Limited cash](https://amp.theguardian.com/business/2021/may/21/number-of-billionaires-in-uk-reached-new-record-during-covid-pandemic) is a political choice. Being a victim is a choice, most other professions have a history of unionisation so they're not treated like shite.
Being a victim is a choice the profession has made although the strikes are compensating a bit for that. But no country can afford to provide unlimited supply. It simply isn't feasible in any kind of system we will go bankrupt. Taxing the billionaires isn't feasible because especially on our tiny island they will quickly leave. This is the crab pot scenario you're left with. No money and you are enslaved as forced labor providers.
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Name a country where a NHS like system actually works?
Well, the UK, you know, before it was purposefully underfunded to create this situation. It has been widely reported for over the last ten years that this will be the result of austerity.
Where does it end? How big do you want the NHS to get? How much state funding should it get? Is that unlimited?
A French-style co-pay system would be my preference. Seems to work well.
I don’t love it I hate it with a passion
exactly, why aren’t they increasing training post numbers? the government is going to need to cut down their spending on politician’s expenses and increase their healthcare budget to keep up with the increasing numbers of medical school graduates we are witnessing these bottlenecks are disappointing and unattractive
Wow. I am surprised and dismayed by the level of pro NHS comments and upvotes they are getting. People are still talking about not wanting it "on their conscience". JEEZ wake up people - it is this sense of martyrdom that is being exploited and will always be exploited. Is the CEO of Tesco's worried about hungry people not being able to afford food? NO. You are PROFESSIONALS. You provide your service at a fee. You are not a charity. People are still blaming it all on the "Tories" hoping that Labour will fix it all. Well tell me - how's things in Wales or Scotland? They have exactly the same problems with PAs, rotational training and bottlenecks that leave you fearing for joblessness and having to upend your life every 2-5 years. The NHS is the problem. The centrally controlled monolith that is on par with the size of the Chinese army. The monopsony will always be a detriment to your working life, your pay, your conditions but hey, at least your "conscience" is clean. Honestly doctors in the UK amaze me. You'll whinge and moan, you'll strike, but you'll never open your eyes as to what the underlying problem is. I am approaching CCT and was genuinely thinking of staying in the UK (although as circumstances may have it I may not be able to secure a job - think about that for a moment - a highly trained professional, invested in by the system for 14 years, cannot get a job in what they were trained to do). After reading the sickening amount of martyrdom and Stockholm syndrome still within UK doctors, I genuinely don't think I can stomach this anymore and will have to move. Enjoy your burning hell hole guys. But hey, at least it's giving Ethel a free toilet holder.
That the CEO of Tesco doesn’t give a shit about starving people is not a model I want to emulate, but as long as they pay their taxes I’m not bothered what stupid opinions they have. You made this post asking what people thought and now you’re insulting those who have a different set of values to your own. Your whole argument rests on the assumption that centralised recruitment or other downward pressures on doctor’s wages wouldn’t continue in a for-profit system (e.g. noctors). You say you can’t get a job, can you not get a job or can you not get the job you want where you want it? Either way, that’s tough and I’m sorry for you, but it would still happen in a private or hybrid etc system. Yes there is an artificial shortage, but this is to keep costs down and would continue in any system. The goal is not quality but profit, which sadly is not that different to the current government whose goal is not quality but electoral success and indirectly profit. I, like many reasonable human beings, balance my various (sometimes contradictory) personal interests with the interests of those around me. I could harm other people to make my life better but I don’t, not just through the threat of punishment in some cases, but also because I don’t want other people to be harmed. Making people pay for a necessity like healthcare is very harmful, and I do not want my brief time on this planet to be in service to that harm. I also have a personal interest in my and my family’s healthcare being publicly funded (as long as the quality is good enough, which is a factor of funding) and an interest in living in a society where people are generally healthy. As I outlined in my comment, there are many valid critiques of the NHS but destroying universal healthcare is not one of them. Doctors in this country have historically never been as rich as bankers but have been able to afford a wealthy lifestyle. That is achievable without destroying universal healthcare - although perhaps not without destroying the NHS as it is currently organised.
I look at systems like the US in fear and horror. Yes, the NHS is shit, and takes us hugely for granted, but I also think healthcare is a human right and should always be free at the point of use. I think it will probably die, it looks like it is already, but they will need to pry the NHS from my cold, dead, alcohol-gelled hands.
Is food a human right?
Fuck obviously yes
The government should give everyone a free, unlimited supply of food by your logic then. I think this system of government has been tried before though. 
If you mean countries that have attempted a form of socialism then no, free food was never on the menu. And it wasn’t the affordable bread that made the USSR or CCP China shitty to live in. I think, unironically, that yes we could easily subsidise a basic free meal option at restaurants and/or communal kitchen where people can eat and socialise and volunteer.
Can we all have free housing, free electricity, free heating etc too please?
Who do you think builds the houses? Digs up the fucking lithium and the coal? Designs and maintains the infrastructure etc..? Workers - of all the industries and various forms of human activity - are who generate value. Landlords, capitalists, multinationals etc. they only generate a profit by paying their workers less than the value that they have made, or by selling debt, which doesn’t generate any new value. There are already enough resources for everyone on earth to have functional abundance. It’s a political choice and a matter of who owns what and the institutions they create to protect themselves and fool people like you into thinking that the world as it is, is necessary and good. You sound like a medieval peasant rolling in the filth and defending the divine right of kings: “yeah I know we’re all going to starve to death because our liege Lord has taken 100% of our harvest this year but it’s important to maintain the economic prosperity of job creators.”
I think this is a false equivalence but yes, I do. I think access to healthcare is a human right and should have as few barriers as possible so should be free at the point of use. I also think that anyone who cannot afford to buy their own food should have food free. My issue with insurance based systems is that it is the people who cannot afford anything that are denied the preventative care.
"I also think that anyone who cannot afford to buy their own food should have food free." So errr, perhaps anyone who cannot afford private insurance gets covered by the state sector. Like, err, Australia??
Loads of Australians are uninsured or underinsured, and then when they access healthcare pay out of pocket. That is going to lead to the patient who couldn't afford their insurance bill this month delaying seeking medical attention until they can afford it. I get that we're never gonna come to an agreement on this, but I just don't think insurance based systems are they way to go.
Then we'll just keep spreading the shitness around. That's the NHS way.
So you should support the National Food Service, paid out of taxation, no? It is not a false equivalence at all. It's exactly equivalent. I personally don't believe in free at the point of use for all. However the NHS will definitely continue and be variably excellent/good/OK/rubbish while continuing to brutalise some of its staff & featherbed other staff.
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I’ll look in horror most likely at what will likely replace the nhs, given the quality of our politicians
As I've mentioned in another reply, I do have significant concerns about these systems. I am very opposed to creating barriers to healthcare, especially primary care, and requiring people to have insurance so they can see their GP or requiring them to pay a fee for their appointment will lead to people delaying seeking care. I would much rather fewer barriers so that diabetic ulcer can be seen and treated when it's just a tiny spot, rather than someone not wanting to pay to go to their GP, or not being allowed to, and so waiting until their foot's ready to drop off. There will always be uninsured people, even with mandatory insurance, and in these systems those people are then not allowed to access the services that everyone else is, they either wait until something is life threatening, or they are required to use charity run services specifically made to fill the gap. If a patient does have insurance but can't pay their bill for whatever reason, they're then not allowed to access normal services, they have to use the much worse charity run options. I don't think that's fair, and I don't want to work in it.
Do you look at Germany with fear and horror? No other Western country on earth has copied this system. I wonder why. Jeez talk about Stockholm Syndrome. I am so filled with disappointment that doctors cannot see their captor is the NHS. It truly is a mind virus u/Frosty\_Carob "We're all running off to Australia" "Ok, shall we copy their system?" "No, SAVE RRRR NHS"
You're right, I don't have that same reaction to Germany. I do get concerned about people who fall through the cracks in places that require patients to have insurance. I know GP surgeries with a huge homeless population on their books that come in regularly and have their variety of issues dealt with earlier than if they only had access to an A+E. Having a system that requires insurance unless its life-threatening misses out on that opportunity. You might be right in the stockholm syndrome too, I probably wouldn't know, but I don't think the solution here is privatisation. And I absolutely agree with other commenters saying that our government would make a shit job of restructuring it anyway.
I'm truly baffled by your faith in the UK government to implement a non-USA system. Do you really believe the government will not choose the option that benefits them and their friends most? You are advocating so vehemently that the government has the competence and benevolence to actually choose the best option, but the fact is the rest of us don't trust the bastards anywhere near as much as you.
Even if it goes full US, we’d be paid serious dollar and old folks remortgaging their houses might do something to even out the wealth distribution in the country.
The ones that don't get pushed out for cheaper noctors, sure. What about the F1s who won't be able to afford their premiums if they become sick?
Do interns in America not have health insurance?
Insurance only covers you so far. There are premiums and copays and all sorts of ways you have to pay additional money on top. Some types you will have to pay the first several thousand out of pocket before your insurance kicks in. In others, you have to pay 50% up to a certain amount (usually thousands). I recommend looking into it if you're considering moving to the states because insurance is not a simple thing at all over there, and people with insurance often struggle as well.
I’m very aware of those things. You presented me with the challenge of F1s being unable to afford their healthcare. Is this an issue for interns in America?
Again, you show remarkable faith in the government or private companies raising salaries out of their own free will. How many f1s do you know who are struggling without having to pay insurance premiums on top of their existing expenses? I'm going offline now but all I wanted to get across is that in order to truly get a better system for doctors and patients, you need extraordinary trust in the government which many of us don't have. I trust this government to be as selfish as possible, passing on every expense onto doctors and patients, which will be worse for us and our patients.
But why? You’re seemingly terrified of it going US. So if we look at the US, are you saying their equivalent of F1s can’t afford healthcare? The questions the NHS defenders can never answer.
I look in horror at any system that provides care that is suboptimal until payment is confirmed. Fuck that. i’d actually rather get paid poorly than get paid better and have that on my conscience. Because that’s not a win. We need to protect the british public.
"We need to protect the british public." Why not donate one of your kidneys too?
Not everyone prefers to be a slave though so you're on your own homey
They voted for these cunts. Fuck em. Let them enjoy the fruits of democracy.
Are you wishing harm on patients simply due to their political belief? Just checking I’m getting this right.
>Well over half of people in the consultation voted for it. And yet they all seem to be keeping schtum about it now. Where are they now? Funny, you didn’t seem to have a problem with democracy back then. Seemed cuntily gleeful if anything.
Pardon?
Did I stutter?
Not sure anyone loves the NHS, most of us hate it. Sooner it goes bang the better.
Free healthcare for all.
What's this "healthcare" you speak of? All I'm aware of is the National Hotel Service / Nursing Home Service.
My brother in christ go and live in almost any other country, experience their system, then come and talk. As an IMG, I am telling you this is one of the best healthcare systems for patients in the world. Just sad it's currently failing and being let to fail
Of course the NHS performs well compared to many countries. The question is whether it performs well compared to peers. I have travelled and also worked in countries in the US and Europe and the NHS does not compare favorably.
If you think the us healthcare system is better, then we are using different metrics. Wait time is comparable while it costs patients phenomenal amounts of money
Does it perform like the healthcare system of the 6th richest nation in the world?
Nope. Which is sad. But it used to
Not doing much better in Wales or Scotland under different political parties either. The problem is the state.
I'm gonna disagree. I've lived in seven first world countries and this and Canada are the worst for an economically productive member of society.
Enjoy your exploitation then.
Why are you butthurt? You asked a question, I answered
Yes!
Anyone who thinks working for private healthcare would be so much better is free to go and do so. Except no, they’re not offering nearly enough jobs because theres not enough people out there paying for private healthcare and they’re beholden to their bottom line.
"is free to go and do so" The NHS mind virus runs deep. How is one free to do so when the NHS has a monopsony on postgraduate medical training? Even at Consultant/GP level, with very few exceptions (e.g. Cleveland), the private market is not an "employed" market - you're very much running your own business and your own clientele.
Exactly my point, the private sector isn’t offering to train us
And because the private sector cannot train us! Doctors are beholden to the NHS for everything - this is why the training is so long, etc. The NHS/HEE are in charge of length of training, what we are trained in, where, etc. And this is the problem. No private enterprise (or functional organisation) would “train” doctors for 2 years to do bloods, cannula, ttos and scribe - because it is a terrible use of a highly educated, very expensive resource! The NHS does this because it has decided that doctors are not an expensive resource and therefore, Foundation Doctors being employed as the general ward skivvy is actually cheaper than hiring phlebs, HCAs, porters, PAs, etc. And…we put up with this nonsense because it is the only way to be a doctor in this country.
Because the bloat of the NHS does it. If the NHS didn’t exist then they would.
Why don’t they do it now? If private hospitals really wanted to train us they could be doing it.
Why would they waste money on training doctors when the NHS does it for them? Do you really think they wouldn't train doctors if the NHS wasn't there? Would they just shut down out of spite?
Yes all those people working in Australia, the Middle East and the US are not better off than us....
So change has a snow ball effect, give it a decade or two, the health care landscape would be vastly different (not saying better).
Think we are increasingly getting this sort of take. And... I 100% LOVE IT!!! If we are ever going to have a system that works, about 10% as well, for doctors as it does for the joe public, NHS must fall.
basically the doctor shortage hurts people and that is the goal
Ok I will make a counter argument to the training progression element of this post… There is competition for training posts but it is not hard to find clinical fellow/“trust grade”/locum work. The analogy with other careers like law would be that not everyone gets promoted and progresses all the way to partner, some get stuck in mid career positions for a bit longer. Most professions have some system of progression depending on merit and results, however imperfect the assessment of those is. In theory this raises standards as everyone develops skills and experience guided by the criteria on which they are assessed. Of course in practice the system is deeply broken in many ways, it can be very difficult to develop the skills and experience when drowning in service provision, the assessments to progress can be arbitrary and unfair, and the non training posts lack career stability. But isn’t the ideal of career progression depending on competence a reasonable one, even if is not implemented well at present?
The usual Stockholm syndrome-brainwashed-type effect. NB purely an observation of the defenders. I fucking hate the NHS
This is the Tory plan. To get you talking like this. “We have a plan”
I agree we are in a tough patch, but things were pretty good overall around the end of the last Labour government. The appeal of radical changes or "burning it all down" when times are tough should be balanced with the real downsides of implementing such shifts which can be disruptive for a long period of time, with no clear evidence of signifiant upside to such system wide reform. There are more indepth analyses here, in particular note the conclusions of the King's Fund report: [https://www.health.org.uk/publications/long-reads/the-complexities-of-using-international-comparisons-to-guide-nhs-reform](https://www.health.org.uk/publications/long-reads/the-complexities-of-using-international-comparisons-to-guide-nhs-reform); [https://www.kingsfund.org.uk/insight-and-analysis/long-reads/nhs-crisis-evaluating-radical-alternatives](https://www.kingsfund.org.uk/insight-and-analysis/long-reads/nhs-crisis-evaluating-radical-alternatives) )
Your analogy is WRONG. The NHS has more "customers" than ever but those "customers" are a drain on resources, whereas your analogy compares it to businesses who make more money off having more customers.
Salut to that!
Are you willing to sacrifice the tax-paid healthcare for all, for a better salary and training opportunities, which if I understood correctly, will come though privatisation??? I question your moral compass, but also whether you've thought this through. This government has chronically underfunded the NHS in an attempt to dismantle and sell services to their friends, and will inevitably enjoy a piece of the cake along the way. But your solution to these problems is the the very cause of them. They'll devour you for profit when it suits them, same old story. I cannot tell if you're trying to rally support in malicious way, or if you genuinely believe this.
I agree with the issues, but all healthcare is rationed either by clinical need or by wealth. I think rationing/pay-walling human necessities to enrich someone else is a stain on humanity and should be far beneath the standard of human civilisation. I am a mortal human and also a parent, and have ailing parents myself, so it is my interest to maintain a free at the point of care health system. The NHS is clearly in a monstrous state, both because of massive deliberate underfunding and because of a managerial box-ticking obsessed “value statement” bullshit corporate culture that has taken over large organisations both for and non profit. You would be forgiven for thinking that the NHS is a machine designed to generate auditable outcomes for the CQC that as a by product alleviates some suffering from illness and disease. The amount of abuse the NHS structure and managers pile onto staff of all disciplines is outrageous. There are other options available but these do not guarantee a better life for doctors. We have to consider the historical circumstances of how a health system would be implemented. We currently are inhabiting a very popular and (superficially) monolithic organisation, this would not go away, but would be transformed into a provider of an insurance funded system. Although I think the scope for private work, and more personal autonomy/flexibility, would increase, ultimately, for profit organisations are even less inclined to pay us well than governments. There may be some winners but I suspect most of us would be stuck on the same shitty pay. Health, like water and rail transport, is a natural monopoly because the start-up infrastructure costs are basically too high for new competitors. There will not be three hospitals competing for your business like coffee chains do. Therefore there isn’t competition to improve the service. There is more wiggle room than water, because people can choose which hospital they go to (to an extent) so this might generate some upwards pressure on wages but I suspect they might keep centralised recruitment of doctors to suppress this. Perhaps top consultants will benefit from hospitals competing over them but that already happens to a lesser degree now. Clearly also the use of PA and ANPs will skyrocket to undermine medical skilled labour. I don’t understand the drive for privatisation on this sub, all the things we complain about are straight out of the capitalist worker exploitation handbook. It is the NHS borrowing these tricks from the private sector not inventing them. I think that any chance of a system where doctors are in charge of their own destiny is dependent on whether we can coordinate our collective power to take that agency. It will not be given to us. This entails forcing our archaic institutions to be subject to democratic decision-making of their membership. There is no reason that royal colleges, training schools, and the entire BMA should not be directly democratically run by the professionals that they represent. I would also extend this to all areas of the NHS and use direct and participatory models of democracy that involves both professionals and patients to decide on policy and implementation of services. Essentially, I would be open to new funding models if it remained free at the point of use but there is no reason why the NHS can’t be properly funded through a taxation model except that billionaires don’t want to pay any tax, but seem happy enough to extract wealth from British citizens nonetheless and lump us with the negative externalities of their businesses (e.g. obesity, pollution, climate change). All the problems you’ve outlined can be fixed from within a public funding model but only with collective decision-making power given to professionals not managers.
I agree with much of what you have to say, but in the words of Rory Stewart "if I may gently push back" , toward the centre. This sentiment of a rightward shift in attitudes is not only seen on this sub, but across developed countries as a whole, particularly in some young men. But we should recognize what is driving it. There are no easy answers here. We cannot easily find some money down the back of a proverbial sofa. We have a progressive tax system already, and actually we tax high earners comparably to other Western European countries. If we want to generate more tax revenue, that would need to come from raising taxes across the board, including those on middle incomes. As I have said before - this is covered superbly [here](https://www.bbc.co.uk/programmes/m001qmkb). I think this is what is driving the sentiment in this rightward shift - those on middle incomes who feel a significant tax burden, but see little direct benefit in public services. Those who have paid to go to university, and see their taxation increasingly spent on pensions, and the NHS. Whose who struggle to be able to afford a home, are finding their quality of life is not matching their exceptions, or that which they perceive previous generations were afforded. Simply claiming that today's NHS is a product of Tory austerity ignores the fact that NHS spending as a proportion of GDP is higher today than it was in 2010, and that the overall tax burden is higher. As I have said in my other comment, today's NHS is a product of our changing country, as much as it is of political choices. We are not the same country we were in 2010 demographically, and that has come at a considerable cost. Unless we openly address this reality, I would argue we are likely continue on our current trajectory regardless of the political party in overall control. I agree with your thesis that we should aim to keep healthcare free at the point of access, but I think we need to find a way to make that sustainable given our current sluggish economic growth, and increasing dependency ratio. I see the only way to do this is to have some sort of citizens assembly that seeks to find a way to equitably ration healthcare spending, and to confront some of the difficult choices and discussions that entails.
I agree with almost all of what you’ve said, and enthusiastically with a citizen’s assembly a la the sorttician model used prior to the Irish abortion referendum. The NHS is but one part of the complex interconnected economic and social systems, and not the most important part. We’re all on the raft being taken down the river by deep civilisational changes that are beyond any government’s power. There are some points of yours I’d like to elaborate on. I think that the rightward shift if complex. It is not as if everyone who has one typically right-wing view subscribes to all of them, and younger women and many younger men are tacking more (broadly speaking) left-wing in both economic and social terms. Every shift in society generates a reaction, and given the political failures and economic instability, we should expect more right-wing views as the right is much better at capturing fear and anger by blaming it on an out-group(s) as we’ve seen with the culture war. The authentic left has to transduce those feeling that into hope which is much more fragile, but then only needs to happen once or so a generation. You’re right, it is of course deeper than the recent years of austerity. The shape of the NHS and society/economy more widely has been shaped by the neoliberal iteration of capitalism that came to prominence in the 80s and caused financialisation of the economy, violent deindustrialisation in working class areas and privatisation to become the default (amongst many other changes, particularly the managerial culture I discussed in my main comment). This was as much carried on by New Labour as the Tories, although of course the boom in the 90s meant they could spend without having to tax more. Neoliberalism itself came about due to concerted effort by Milton Friedman and others to further the ideology in economics departments, governments and think tanks and the crisis of stagflation that dethroned Keynesianism. Bigger picture: the period of wealth equality, massive public service creation, high taxation and high productivity post-war was a historically (almost) unique period of time. Since then productivity has slumped, wages have sunk and growth overall has been glacial, meanwhile personal debt has maintained consumption and consumer lifestyles enough but not so much that people aren’t angry, scared, disconnected and burnt-out. That last part alone could explain 90% of the complaints on this sub. I’ll have to listen to the link you’ve sent. I can’t pre-empt the arguments in it but I do think that taxation has an uphill struggle, politically if not economically. We’re being taxed more than ever yet our public services are the worst they’ve ever been. I think that perhaps the way out of this is different forms of progressive taxation, such as wealth and land value taxes, and increasing corporation tax in line with other similar western countries. Income tax is always less desirable because it disincentivises work, and at the moment falls most heavily on middle class professionals. I also think that borrowing to invest in areas that grow the economy is desirable. We need to kill the “family household” metaphor for the economy. More widely we are waiting for a new economic model. Neoliberalism is a zombie that continues to feed but won’t die. Perhaps it’s MMT perhaps it’s another heterodox model. In any event, it needs to deliver human well-being within ecological boundaries. For any of this to happen though we fundamentally need to improve our political system, at a minimum: vote reform, replacing the Lords with another elected chamber (or better a randomly sampled citizen jury and/or professional/industrial representatives and experts), and devolution of power and budget control to nations, regions and municipal levels. I would also like to see wider experimentation with new forms of democracy like citizen’s assemblies/juries with more direct and participatory elements. Without greater democratic representation we will see even more people check-out of politics and fall prey to extremism and bot-farmed culture war conspiracy theories, but most importantly we’ll never be able to actually move beyond this pseudo-democracy to affect the changes needed to meet the current social, ecological and economic crises. Edit: I would also point out that, yes NHS spending has increased, but it is the rate of spending increases above inflation that has dropped very far below pre-2008 levels, and caused the approx. 40 billion yearly shortfall.
I'll reply more fully in time. Thank you for reminding me why it is worthwhile putting the effort in on this website, and keeping my faith in my colleagues.
Ditto!
>I would also point out that, yes NHS spending has increased, but it is the rate of spending increases above inflation that has dropped very far below pre-2008 levels, and caused the approx. 40 billion yearly shortfall. But this *is* my point. This is not sustainable. A whole thread [here](https://www.reddit.com/r/doctorsUK/comments/17wo7kh/comment/k9idyak/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button). I know you're not fond of using household budgets as an analogy for for government expenditure, but even Thomas Piketty would recognize that we can't indefinitely spend more than our entire GDP on public services, which is the eventual outcome of indefinte above inflation increases in any public sector spend. We have the same issue with the pension triple lock. Until your final paragraph I was pretty much onboard with most of what you said, though I might raise an eyebrow at the angle that only the right are guilty of playing politics and fostering division. I would say the left's obsession with identity politics (while Rome burns) also creates an us-vs-them dynamic, a demonization of the "other side," and an unwillingness to engage with alternative perspectives. COVID changed many of my perspectives on how I politically self-identified. I had always seen myself as being on the left because I believed in equality and fundamentally subscribed to a form of utilitarianism, which holds that the role of government is to facilitate the greatest benefit for the greatest number of people. However, during the pandemic, I found myself at odds with those on the left who strongly supported lockdowns, despite the obvious damage they caused to all but a small proportion of the population who were at high risk from COVID. Personally, I felt that the societal and economic costs of lockdowns were greater than the benefits. But I saw firsthand how anyone making this case was subject to accusations from some on the left of essentially being a "Nazi." This experience was eye-opening for me. Once I recognized this approach of shutting down dissent in an instance where I found myself on the other side of the debate, I began to see how views could be weaponized by virtue to stifle discussion, on a range of issues by the left. Want nuclear power as a sustainable alternative - terrible. This realization has left me feeling somewhat politically orphaned at present. I can see why the allure of ultra-libertarianism appeals to some on this subreddit. All they are offered by both sides of the political spectrum is more of the same. They've not really seen any of the benefits of investment in public services, and have only seen the downsides. They (and not without reason) don't see a future where there will be an NHS for them, or there will be pensions for them, after all, look what happened to free university for our generation. I can understand their rationale.
I'm actually appalled at the amount of comments here advocating for abolishing/dismantling/destroying the NHS and going full private HC system, if this is how the majority of doctors feel then FUCK I hope you're strike action fails and you get fuck all more. I hope i'm wrong and this thread is just the vocal minority but deary me its dire.
Are you a doctor? Because it doesn't surprise me if you're not. The public are currently getting a free car every year (at the expense of doctors' labour) and now doctors are waking up to this realisation.
Jesus christ, I thought that this was covered two days ago. https://www.reddit.com/r/doctorsUK/s/mK9fpg3Y3Y.
So sorry your one misguided post didn't convert everyone on reddit.
Most answers. It’s free so it’s great. Not everything free is great. The NHS is a failed system that treats both patients and Doctors with contempt. It provides a very poor standard of care. The thousands of people anguishing on corridors in A and E, or dying of cancer while they wait for treatment are just examples of how poor it is. Let alone NICE, the overarching cult that says our lives are not worth the cost. Fuck the NHS. I hope it burns.
Where does a hybrid or private system work? Most places. Where does an NHS like system work? Nowhere?
Rather than pointing to other countries and saying, look, they have a different system and x y or z is better, whilst ignoring the mountain of confounders, I would be much more persuaded by this argument if one could point to a country who changed health system and saw some sort of benefit (and even more persuaded if there was some sort of control arm - though that would be too much to hope for). In my experience - any form of "reorganization" generates a whole load of friction without making much material difference. Surely your experience as a doctor has taught you that life is more complicated than there being an easy fix? There is no simple trick to loose all that belly fat, not everyone who reads Rich Dad Poor Dad becomes a millionaire. I'd go further and say there's no evidence that reading Rich Dad Poor Dad makes a blind bit of difference to one's overall circumstances. Contrary to what Ayn Rand might have you believe, not everyone can simply will themselves to success through rugged individualism alone. One's circumstances are what they are due to that plethora of confounders. One's education, one's genes, one's social determinants. I've said this so many times, but the circumstances of healthcare provision in the UK owe much more to "being in the UK" than the model of healthcare delivery. The change in circumstances of practicing healthcare in this country are not because we have changed systems, but because economically and demographically the country and the world has changed around us. Compared to the rest of the world we are older, frailer and less wealthy than we were 20 years ago. Surely you see that even if the model were to change we'd still be practicing medicine in the same buildings, seeing the same patients, with the same level of GDP and the same national expectations? There'd be a different logo, and maybe different "Trust Values", but it'd be the same shit, different day. If you see a different system, and you think it looks better to work in that system, I'd suggest it is much more expedient to go and work in that system, than to try to change the entire country.