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Monday, 4 June, 2001, 10:38 GMT 11:38 UK
Public health, private money?
The NHS is suffering from a shortage of staff, beds and resources. Accessing the private sector seems to be an increasingly attractive option.
Labour's manifesto implies a greater role for the private sector in delivering NHS services. The Royal College of Nursing are accusing the Government of "privatisation by stealth".
The Conservatives propose to encourage more employers to offer private healthcare schemes by removing existing tax penalties. The Liberal Democrats are "relaxed" in their approach to the NHS utilising the facilities of the private sector.
Should the NHS have to rely on the resources of the private sector? Or do you believe that the state should still be responsible for providing high quality healthcare for all? What do you think about incentives to take out private health insurance?
This debate is now closed. Read a selection of your comments below.
The only health services I've used are in this country, so I can't make comparisons with abroad. More money may be going into the NHS but as a regular patient I can't see much change. Private resources may help short-term, but as a long-term solution it will always be more expensive for the government (and ultimately us taxpayers).
It looks like a lot of posturing I'm afraid. Doctors don't 'strike' as such - but this is a way of trying to infer it. I'll wager that over 95% of GP's need the NHS just as much as the NHS needs them -doing private jobs pays for the big house, and a couple of cars but the steady NHS revenue is a nice little secure earner thank you very much and it would rather be like cutting off their nose to spite, etc.
GPs are overworked and let's face it, who wants a Doctor who looks worse than you feel?
GPs are overworked and demoralized, under-funding, bureaucracy and a good deal of unpleasant media coverage has them on their knees. The media coverage is hard to combat except by better regulation, solving individual problems before they arise and is probably a matter for doctors themselves. Personally I don't think anyone has all the answers, especially not the Tories, they have been the party who have managed the NHS for most of its life and it is them we have to thank for its current state.
All these promises that are being made seem to be a clear indication of desperate tactics to recruit the public to vote for them. Not one party has the interests of the NHS at heart.
The treatment of Doctors and Nurses, both GP and in the hospitals is a scandalous waste of talent at a huge cost to the taxpayer.
At the moment the NHS is a catastrophic hilarity. An absolute shambles.
Who cares? Politicians clearly do not as they all go to private hospitals!
I always believed Tony Blair when he promised that the NHS would be safe in his hands, but now I know that it isn't. The technique of running a public service down to the point that it no longer works, then denigrating those who work in the service, was one used by the Tories to soften public opinion to the prospect of privatisation. I find it hard to understand why, as a nation, we seem to have failed to recognise that this strategy is being used again by the present government with respect to the NHS, the police force and education. Already, we are being prepared for eventual privatisation, and it will become most obvious at about the time when the current investment begins to bear fruit; this to make the business more attractive to potential private investors.
David Britten, Ripley, Surrey. UK
I feel strongly that Britain should emulate the French National Health System, so definitely more money for the NHS. I also think nurses and doctors should be better paid for their services. I would rather pay more tax to this end than have cheap shot tax cuts.
American healthcare is dictated by insurance companies whose boards are occupied by political heavyweights, ensuring that both economic and political power remains corporate. Individual choice only exists for those who have financial independence, since US healthcare is tightly linked to employment. The unemployed, chronically sick or between jobs are uninsured - about 40m Americans have no health insurance. And private insurance systems are unlikely to cover the costs of chronic illness.
The UK has universal healthcare with 100% coverage, free at the point of access and independent of health status, employment or socio-economic class. If you corner most US doctors in a dark room they are really rather envious of the NHS.
I am a UK resident but I am also a US citizen. I prefer the UK's NHS to the nightmare of red tape, expense and iniquitous medical resourcing that is inherent in the US private system. I cannot imagine how anybody, including Blair, can consider a private healthcare system that diverts precious financial resources to profits as being "efficient". I am appalled that Labour will invest in "public-private" partnerships rather than simply investing in the NHS.
Labour thinks that throwing money at something that is under performing will solve the problem. They need to change this attitude, just look at what happened when they did this with the dome! Throwing masses of money at the NHS will only result in more people being employed to fiddle the waiting list statistics even more.
I feel that the NHS desperately needs to be overhauled. It is not 'free at the point of delivery' for many who need treatment. People who need to wear glasses have to pay for examinations and the spectacles they wear (even though their standard of living would be greatly reduced if they had no glasses.) If more employers were to offer healthcare schemes, perhaps there would be more money to be directed towards where it really needs to go.
If I ruled the world, NHS consultants would not have a contract with no minimum hours in it. This way they do the minimum in the NHS hospital and then scuttle next door to the shiny private ones. If I ruled the world nurses would not have to have degrees. I would want to be nursed by someone with a driving belief in the job, which more often than not involves the unglamorous last six months of life, not by some clever clog who lacks the familiarity and confidence to carry out basic procedures.
At last people are starting to face up to the fact that laws of supply and demand apply to healthcare and that you only get what you pay for. You cannot have lobster and champagne for a fiver, a Rolls Royce for the price of an Escort, or first class health care on a tight budget. I hope we can soon move on to the next stage of the debate and ask the question about why Britain is the only country that has state controlled healthcare if it is so good. I have been an NHS doctor for 20 years and I am seriously fed up with having my professionalism overridden by political dogma and my idealism crushed by meanness and lies.
Stephen, Southampton, UK
Why not privatise the hospitals completely and give vouchers to those who can't afford insurance?
The simple fact is that in the UK the private sector is condemned before its been given chance. If those that can afford private healthcare can receive and benefit from it then why shouldn't they? I pay for healthcare and have received excellent treatment. The decision is my individual choice and I sleep well at night knowing my family and I are well cared for and would not have to wait for an under-funded, overworked and generally dysfunctional NHS to help us in our time of need.
Claims on pensions as people live longer, means more finances are required for paying the increased pensions. The private pensions schemes are encouraged to take the pressure from the State. The same for health - as we demand more and people live longer, private health schemes are only too eager to help.
If private schemes don't cost more than state systems then the incentive is to go Private. Increased taxes would enable a less expensive solution to providing necessary pensions, health and education.
The Government should develop taxes by agreement and avoid the private system gaining the monopoly it wants.
Otherwise we will go the way of the USA and they want to develop an NHS - wake up!
I am a dental surgeon and do appreciate private work but it is exclusive.
Why should anything including healthcare be free? People nowadays do not respect anything or any service given free. It is better that everyone pays for any service or product at the point of entry. Then we will immediately see doctors, nurses and teachers being better paid, rewarded and respected by everyone, especially those who can afford to smoke drink and gamble and generally do everything with their money except pay for health and education.
Can I say one thing about what triggered this off. It was an article that appeared on this website in which the hospital consultant in charge of the unit where Mr. Storer was being cared for completely rejected the claims made by his wife, so publicly, to the Prime Minister. It said many patients were also dismayed by her behaviour. The NHS has far to go to be the service we all want. A change in mind set towards accepting higher taxes is required to finance a better service. Otherwise we should expect to have to pay for health privately, if we can afford it.
Nick Tebbit, England
I suffer from a lifelong illness and I have observed the NHS at close quarters for 40 years. There have been massive improvements over the last four years. I was recently an inpatient and there were that many staff on the ward that some appeared to be looking for things to do. What has also changed is patients expectations. 40 years ago you would visit an A+E department as an emergency and there would hardly be anyone there. Now you visit and the places are overflowing. Last year my husband was seriously ill in the resuscitation room and when I pointed out to a member of staff that a large proportion of the people in the waiting room seemed to be either drunk or drugged or had mental health problems - they said: 'poverty illnesses' Surely there is a better way of dealing with these illnesses. If we demand so much from the NHS we should be prepared to pay more for it.
NHS universities are an excellent idea. As long as the people they train have to remain loyal to the NHS for a specified time before they can move to other jobs or to the private sector it will help. Restructuring the nursing profession to increase the number of people who can do the job would be a good idea too. After all, why should a nurse who is trained to give vital treatment to a sick patient also make the beds, empty bedpans and do the hundred and one other jobs needed to give complete patient care? Free up nurses to do the more 'technical' jobs and let unqualified staff do the day-to-day stuff for a lower salary, and everyone wins.
Isn't it convenient that the government announces a £1 billion spending spree on the NHS just before the elections. Water it down and it becomes clear that this money is to be spent over a spread of three years. If the government invested realistically in the NHS then perhaps we wouldn't have community nurses looking after areas of 58,000 patients alone, and with a caseload of 60 patients. It disgusts me and it seems that all the political parties are the same. They are only thinking of their own gains.
We have amongst the poorest healthcare in the EEC. The question to all politicians should be. What is your programme for bringing our healthcare up to amongst the best in the EEC
There will never be enough cash for the NHS but that does not mean that it doesn't matter how it is spent. At present new NHS hospitals are being built with private money (PFI) purely to avoid Government capital expenditure. Perfectly good buildings are being closed to avoid maintenance costs and planning beyond the 'next election' is avoided. It¿s all a short term fix to balance the books for the existing financial year. Net result more is spent for less, for every new hospital 3 are closed. The public rightly see that services are being reduced.
John Mason, Gravesend. Kent, UK
23 years as a full time NHS GP has me convinced that unless all patients are charged a small fee to access the doctor the NHS is doomed due to staff shortage and over use.
Speaking as a biochemist, as the human genome project progresses insurance companies will be able to get a hold of some very powerful predictive tools for analysing an individuals health. If the private sector is used as a crutch for the NHS, the human genome project will swiftly kick it out from under the NHS, because those who most need care will be uninsurable and cut out of the private sector. This short termism has got to be stopped primary healthcare should be the sole domain of the NHS, if taxes need to be raised for this to be the case then so be it. Care (much like safety) should not be linked to money.
I pay for private health cover for my family. Luckily we have not made too much use of it. However when people we know found out about this we were regaled as 'trying to get ahead of the queue' and deserting the welfare state. The same people have no problem in spending £2000 on holidays or fancy electrical goods. We all seem to want something for next to nothing in the case of health and take it for granted that the NHS will deliver. If you expect good service you have to pay for it.
The NHS has been and is a huge success story. The problem now is that with so many advances in medicine and our ageing population, it has become a victim of its own success. The demands placed upon it grow more and more each year. We have got to realise that to meet these expectations, private medical care has got to run alongside the NHS. This does not mean that the NHS has failed, far from it. It means that we are asking the scheme to do something that is becoming increasingly impossible.
Colin Mackay, UK
There is no such thing as a free lunch. The idea that private industry is somehow going to perform work for the NHS free of charge is a total fallacy. Let's get it straight here and now, private industry works for
private profit. If we allow Blair to implement these proposals, we will live to regret it for a very long time. This is nothing other than privatisation by stealth. He is merely doing the Tories' dirty work for them and they must be very proud of him. I hope all those who have so far shown no interest in this election now realise there is an issue worth voting for.
When are people going to realise that if we want a decent health service the whole system is going to need a radical rethink. A 1950's system is no longer suitable for providing 21st century treatment. If you look at other European countries like France and Germany, they spend more money on health, and get a better service, however they also have a bigger private sector. It seems obvious that if more people were encouraged to go private it would free up some capacity in the NHS.
Is it not time that politicians had the courage to define the purpose of the NHS in this country and then make sure it is correctly resourced? It may be that the use of private firms is appropriate or it may be that private healthcare should be abolished. I do not know the answers, but everyone seems in agreement that something should be done. Before throwing more money at the NHS let us re-invent the service to be the best in the world - providing state of the art treatment in the most efficient manner.
Stephen, Ely, UK
Although a dyed in the wool capitalist and free-marketer, I am a great believer in a National Health Service. Maybe not on the UK model but certainly in principal. It is thoroughly wrong, in this day and age, that in a rich western country, the quality of my healthcare is dependent upon my financial resources. And although not praising the NHS in the UK, if you think that's bad, try the US model!
When is a tax not a tax? It would seem to others when it is compulsory private medical insurance. I think that those who advocate privatising the NHS need a check up from the neck up!
As a staff nurse working in the NHS I am fully aware that at present it does not have the capacity to deal with the demands placed upon it. I have no particular problem with treatments being provided at private hospitals as long as it is still free at the point of use to the patient. I am however concerned that there is a misconception that private healthcare equates to better care. There may be luxuries, but is there 24 hour medical cover onsite? Do they have nurses that are experienced and capable of dealing with emergencies?
Derek Ramsay, London, UK
I don't know why, but all state-sponsored bodies seem to be wasteful. The Americans have health care insurance, and a very efficient healthcare system. Perhaps we could adopt at least part of that system.
I am horrified on a daily basis of the state of the NHS, and it seems to be getting worse, not better. The people who work in the NHS deserve gold medals and huge pay rises. Surely cleanliness is the top priority for the hospitals, and it is outrageous that nurses should have to clean them, as has reportedly been the case. It never ceases to amaze me how unclean and smelly hospitals are. More money, better cleaners and more staff are what is needed. I'm afraid I do not have the full solution but surely the Government should.
I am not a nurse but it strikes me there is too much emphasis on paperwork and degrees rather than hands-on patient care which is what nurses joined the NHS to do. Tony Blair's proposal to create a nursing university seems to go even further in the wrong direction. Nursing is surely a practical trade. With one million employees I cannot see that the recruitment of 10,000 untrained nurses is going to make any difference.
Ian Brealey, Northampton
What other realistic solution is there in the short to medium term if the NHS is to remain free at the point of use? It takes three years to train a nurse, five years a junior doctor, seven years a GP and fifteen years a consultant. Other suggested solutions like stopping consultants from doing private work are all very well but only address part of the problem, and complaining that it is just back door privatisation simply flies in the face of reality. The only other short-term alternative is to ration quality health care by income, which is effectively what the Tories want.
Five years ago I developed a lump in my breast, and after waiting five weeks and still no hospital appointment, I opted to have private treatment. Again, this year I had a similar problem, but was seen at an NHS breast clinic within two weeks of seeing my GP. To me, that's an improvement.
Private practice is conducted in the consultant's own free time. According to a BMA survey, the average consultant works approximately 70-80 hours per week solely for the NHS for a pittance. The consultant is surely entitled then in his/her own free time to try and top up this pittance by engaging in private practice.
I would like to know how many nurses and doctors have been TRAINED by the private sector.
I find it rather silly of people who advocate spending vast sums of money to prop up relics of the past - the NHS and the welfare state. I am a high band taxpayer. By the time I retire the state pension will not be there and I don't use the NHS. I don't mind contributing to a fairer society but I think there's a point beyond which we all won't like to be stretched. What I think politicians ought to do is increase tax on breweries, pubs and tobacco companies to fund the NHS as their products put a heavy strain on NHS resources. People like me should be allowed to keep more of our earnings and not be taxed to death by a bunch of leftist fantasists who like to spend far more than they could earn.
Steve, London, UK
One of the reasons the UK system is so under funded is because of people thinking that everything should be paid for. Why not adopt the French system. Here everyone has social security and health insurance, which is normally £9.00 a month. Social security pays out 100% for essential treatments and there is a sliding scale for 'comfort medicines'. The remainder is then refunded by your health insurance. Waiting lists are virtually non-existent here because patients are only treated for ailments that need to be attended to and are not wasting the doctor's time. The delays for reimbursement are minimal and the process is simple. It also saves the government millions.
A hybrid between the two extremes of the UK and US systems may be a step forward from the public sector model.
I have seen private finance initiatives at work, and they don't work very well. They are managed by a contract between an NHS Trust and a contractor. Unfortunately the NHS is not very good at negotiating or monitoring contracts. There is a lack of skills and resources to do this effectively. The result is usually a service out of the control of the NHS, which doesn't perform well, providing a very inflexible service. The most important prerequisite for moving down the road of public private partnerships would be to improve the resources and skills for negotiating and managing contracts within the NHS.
Ken Warren, London, UK
It's about time people stopped expecting first class treatment for free. I can afford better treatment so I choose to take it. For those on lower incomes, they can get freebie operations from my taxes, but they need to stop complaining that it is a rubbish service.
All my working life has been spent in the NHS and I would have strongly resisted private influence of any kind until recently. Although this government have actually put more money into the NHS than I've seen before, it's not enough to cure every ill, carry out every operation and refurbish every building. As a responsible population, we have to accept that taxes go up, private money comes in or we accept rationing. Another uncomfortable truth is that private industry spends up to 18% of its budget on managers whilst the NHS is constantly under political pressure to reduce its much lower management costs. Good healthcare doesn't come on the cheap.
I can't understand how people could be willing to sit back and watch short-minded governments propose the privatisation of something as important as the NHS. People seem to forget that at the end of the day private companies are only out there to make money.
Helen, London, England
In part the idea of private healthcare is a good one for non-priority appointments or surgery. It should also be used in the training of new medical staff, which is currently at breaking point. However the private sector can never truly take over the running of the NHS especially with regard to important operations. What is needed is a combination of both private and public healthcare, a balance that should hopefully address the important issues of healthcare in the UK.
When I used the NHS in the UK it was a nightmare. After enduring run-down hospitals, no continuity of care, and having to wait weeks for an appointment I went private for my own sanity. But I could afford it. The UK should adopt a system like the Australian one - it is fantastic. People who can afford it i.e. working people have to pay for their treatment but receive two-thirds back. When I go to a doctor, I spend 20 minutes there, not two. I pay the equivalent of £25 for the consultation and receive two thirds back. The system reaches out to the people who are in need and there is still a cushion for the elderly and unemployed who get free healthcare. The NHS is one of the reasons I could never live in the UK again. It is an embarrassment
to a developed country and it needs to be sorted out.
Anyone who thinks that a privately run healthcare system is a good thing should look at the present state of the US healthcare system. The average age of our population is rising, along with the age of healthcare staff. Many people in the US are without healthcare. This places a heavy burden on families and on the healthcare agencies who treat no matter what level of income the patient has. State and federal governments are cutting back on reimbursements for this "charity care" and the HMO's are being more restrictive with treatments for the insured. Most hospitals in the US today face a heavy financial burden that some will not survive. This is the way things are now. I can only shudder to think what will happen in the future.
I lived in the UK until seven years ago. I work for a good company with health insurance for which I pay $40 month for my family. When we get sick we get seen to right away and if it is serious we are seen by a specialist immediately. I remember the UK way of doing things. My best friend waited four hours with a broken arm and even after they saw him they set his arm wrong. The USA way is the only way to go.
Why is it that in Britain people have this strange idea that medical treatment, of all things, should be free? Why not bring in an earnings-related system of compulsory contributions that is working in the rest of Europe?
I am an NHS Manager and was recently 'work shadowed' by someone from a highly rated, large private company as part of a training scheme. For such a large NHS organisation, he could not believe the small size of the management team, the long hours worked, the productivity and the low salaries compared to similar size and budget in the private sector. There is no chance that the private sector can run the NHS more efficiently at current funding levels. Any additional money would be swallowed up in more bureaucracy, inflated private sector salaries and a reduction in services. Allow the people currently running the service to get on without constant changes, political interference and irrelevant targets. By the way, how many private companies allow their biggest asset, consultants, to go and work for the competition.
Deb McDee, East Midlands, UK
The private sector manages to feed me, house me, water me, heat and power me. Why then does the state need so much of my tax to fail to provide a decent standard of healthcare? I could buy numerous times my healthcare needs for less than the NHS element of taxation, but I'm not given the option.
I am currently experiencing the wonders of private healthcare! At the moment I am yet again trying to retrieve money owed to me from the insurance company for a payment made over a year ago. Every time I go the doctor I have to pay a payment. If the prescription is 'approved' by the insurance company I have to pay a further co-payment. If you move employment you have to hope the new insurance company will cover your existing medical complaints. Many US insurance policies do not cover you for the first few months of employment. Many employers only cover the employee and not the family. If you are employed, have money and are generally healthy, life can be good. However, if you are poor or unemployed life can be wretched. Think about that every time private health is brought up and weigh up the costs.
The simple fact of the matter is you can't have German style health with US style taxation. I certainly don't want German style taxes so I think compulsory private medical insurance should be enforced for those earning over a certain amount. Only those who can't afford or can't get medical insurance should be able to use the highest quality state facilities. This is a radical plan but will increase the effectiveness of the health system overall.
Dave M, Bristol, England
I am tired of people saying that you cannot cure the NHS by throwing money at it. The truth is that the NHS has been grossly under funded since the Thatcher and Major years. New Labour has been very slow in recognising that more cash is very urgently required. Considering how little we spend on health in this country we are lucky to get such a good service. That we do get such a good service is due to the wonderful work being done by the doctors, nurses and other staff who work under intense pressure. We owe them our support and must ensure that any new government gets on with providing proper funding - even if we are asked to pay more.
As a staff nurse and a socialist I find the whole idea of any private involvement in the N.H.S. deplorable. I would leave nursing before I would have anything to do with any private sector organisation. How would involving agencies whose prime function is to make a profit benefit the people of this country in any way. How can paying money to these greedy companies save money and improve services. Would they operate on a no-profit basis? I think not.
On the face of it, it looks like a good deal to get "free" NHS treatment in "private" health establishments, but, what about the people who pay for their "private" treatment? Will they not be aggrieved that they are paying whilst others are using their facilities "free"?
Waiting lists will not drop dramatically until consultants stop private practice. The one benefit of private practice is no waiting list but long NHS waiting lists stimulate lucrative business for the private doctors. Bring consultants totally within the NHS, guarantee incomes and watch the lists fall.
John Thorne, Shetland, Scotland
I firmly support some sort of individual accountability for medical costs. Lifestyle choices strongly influence the cost of care. I highly resent being forced to pay for someone else's poor lifestyle choices when I take good care of myself. When someone can come up with a solution to that dilemma, I'll support their system.
In an ideal world everything would be free. But it is about time that people realised that you don't get anything for nothing, a price has to be paid somewhere along the line. I pay my National Insurance and I know that in the event of a serious illness I will get medical treatment without the fear of financial ruin as in countries like America. The main problem here seems to be that hospitals, especially emergency units are mostly full of non-emergencies that could easily be treated by a GP or local medical clinic the next day. Private treatment should be encouraged so that if the need arises in cases that are not life threatening, patients can go private. The main problem with going private is the exclusion of treatment for existing major ailments.
The UK should move to a system of health care similar to the one enjoyed by the British Forces and their families in Germany. The German system is modern, efficient and above all, fair. The NHS is a great institution that has served our country well over the years but is now outdated, expensive and inefficient. If they were honest I believe that all the main political parties would love to get rid of the NHS, but sadly public opinion will not allow them. The British public should be more informed on what other health care options are available. After all how much money do we want to spend on health care? This is not a problem that can be solved just by throwing money at it.
The private sector can only fail to provide good value for money in health care. Private medicine relies on people like me. I've trained in the NHS and I estimate my training has cost in excess of £100,000. I continue to work in the NHS, but maybe not for much longer. As far as I've experienced, private medicine is less effective and efficient than the NHS, as it doesn't invest in training and equipment as much as the NHS is capable of. The NHS is not perfect but private medicine is about making the books balance. It's also a bit of a problem when the private sector is awarded a contract to relieve stress on the NHS and they recruit the overworked disenfranchised staff from the very departments they were supposed to be helping - causing an increase in the NHS waiting list.
G McGill, UK
Bring the private sector into the NHS too? Oh yes, because that worked so well for telecoms and the railways...
The private sector is no guarantee of quality of medical care. The US example proves that. We have a dire nursing shortage and waits for common surgery every bit as long as the national health. (A wealthy, fee-paying friend of mine waited four months for a simple hernia operation.) What has happened to National Health - and I lived under the British system quite happily for several years - is the direct result of the undermining by private insurance. How can the two systems compete when one is seen as inferior and not the option of those who can pay to avoid it? Privatise at your peril.
Do we really need more money and resources in the NHS? How often do we hear of people turning up to casualty with nothing but a cut finger or a headache? These very few people take up a lot of finance and resources. Let those who are injured because they were drunk or who injure themselves and/or others whilst driving foot the hospital bill. I am willing to pay my share but I find it tasteless to pay for timewasters and criminals who are a constant strain on the NHS.
I think the NHS should be funded wholly by the government. There should be no private partnership.
The NHS is simply a black hole into which our money is poured. Hospitals should be privately run while the state provides the national health insurance.
Glen Evans, Telford, Shropshire
As a proportion of GDP, we pay less on healthcare than almost any other comparable country. Judging by the election campaign it seems the parties generally think tax is now an anathema. If so, it might be time to do away with some cherished ideals in order to deliver the greatest benefit.
New Labour reforms, including public/private partnerships in transport, the NHS and schools, as well as recent legislative reforms to policing signify a gradual transition of traditional public services to the private sector. This is something that Mrs Thatcher started, William Hague supports and Tony Blair will continue.
Until the private sector bears the cost of training its own staff and deals with all illnesses including mental illness and long term geriatric care, it will remain subsidised by the state - not the other way around. If the private sector has so much extra capacity that it is able to take NHS patients then it must be very badly managed indeed.
Living in the USA it would be wishful thinking to have public health coverage. People in the UK should consider themselves lucky to have such a facility and should defend that right. The evils of private healthcare are prevalent everywhere in the US. As the saying goes 'if you are unemployed and sick in the US, God help you'. We are entirely at the mercy of the whims of the "health care providers" and have to endure harassment whenever claims are forwarded. The whole business of health insurance in the US is bereft of the human factor and the cruel nature of selective treatment should be condemned outright.
Atri Guha, Bergenfield, NJ, USA
You only need to look at what happened to the railways to see the effect of privatisation of large-scale public services. The state could have a perfect public health service running within a matter of years. The fact that our political and social system is inferior and flawed shouldn't force us to adopt immoral economic practices. When our hospitals start to fall apart and only the wealthy can afford good healthcare then even the hardcore capitalists will be denouncing the privatisation of the NHS. Why go down that road at all.
Both Labour and Tory governments have sadly under funded the NHS for many years. Unfortunately I believe that it has now got to the point where some services may need to be either paid for by the individual or contracted out to the private sector. My GP told me today that it will take around forty weeks for me to get an appointment to see an NHS consultant for something that may or may not be serious. Her advice was that I would be better off seeing the same consultant privately in order to speed up diagnosis and treatment. Apparently many people are now paying for initial consultations in order to get onto the waiting list for treatment. Given this I would argue that the private sector is already a part of the NHS service.
Sara, Northampton, UK
The government and voters need to define what we expect from the NHS and then decide what is the most cost effective means of achieving it. We have had a number of years where the answer appears to be more money and the media highlight every small and large "failure" as a sign that the NHS is pathetic. It is not pathetic but inefficient as with every government organisation staffed by civil servants with no real idea of cost control.
What exactly does Labour mean by 'free at the point of delivery'. All this spin talk makes me feel uncomfortable as an NHS worker about partnering up with powerful private sector companies. I notice in the manifesto that labour promise extra nurses, but not specifically extra NHS nurses. Where do we stand in all this?
We should stop treating the NHS as a sacred cow and consider all options for improving it. I don't mind how it's run or funded so long as everyone - regardless of their wealth - has equal access to the same high quality of service.
We have to expect politicians to keep looking for ways of reducing NHS costs by exploring private sector alternatives. After all the government spends nearly 10% of their overall budget on healthcare. I prefer the Labour approach to that of the Conservatives. Do we really believe that all employers will happily fund health insurance for all of their employees? Unlikely. The American model shows us that a large minority have to do without, and even those that have some health insurance can still have their families bankrupted by a serious or long illness.
Don't forget that the same staff work in both sectors. So by using the private sector you are sucking resources away from the public sector.
Also the medical staff that do work in the private sector are only in it for the money. Expect good food but not necessarily good medical care.
I pay my national insurance into a private medical insurance scheme. The national insurance contribute to my pension, and my NHS coverage. The NHS is great for emergency cover because it does not discriminate. Everyone gets help regardless of who they are. But public sector medical staff are too stretched through no fault of their own. That is why I pay for private cover. I insure my car and my house, so why not have the best health insurance I can afford.
There wouldn't be a need for this debate if the health service had been funded appropriately over the last 20 years. If we really want a high-class service there should be massive investment well over and above inflation. There would then be no need to rely on the private sector
Simon king, Leeds, UK
Having already paid out for the NHS and then paid again to go private, I would resent very much having to accept a lower standard of care in the private sector to boost the NHS. I'm already saving the government money by paying for private health insurance, isn't that enough? I certainly wouldn't want to rely on the NHS for treatment. The waiting lists are far too long and the standard of service very hit-and-miss in general. People like me who pay twice for healthcare are freeing up lists for those who can't, or won't, pay. A two-tier system may not seem very fair, but what's the alternative?
In theory, contracting-out of some service provision makes a lot of sense. In practice it rarely works well, as this government should know! (look at Railtrack, railway-operating companies, prisons, maintenance of RAF aircraft, school cleaning and the dozens of contracted out Information Technology projects and services, which have failed). There are several reasons. Contractors will only be interested in long-term contracts: once they are in it's difficult to get them out, no matter how bad they are. Contracts are a crude way of managing performance and are only really of any use when everything has gone horribly wrong, which is often too late. The contract management is carried out by the same people who are responsible for the current shoddy service and they rarely have much commercial sense. The contractors rarely think of the customer first, shareholders must be their first priority. I could go on!
The UK's healthcare is poor by comparison with other developed countries. The UK has the lowest percentage of private healthcare-provision of the developed countries. Could this perhaps be the reason the service is so poor? I welcome the breakdown of the old bigoted socialist view that the State can be the only provider of public services; the sooner we get a government which encourages a mix of provision - encouraging people to provide for their own healthcare by way of insurance - the better.
Pete Morgan0Lucas, Wiltshire, UK
I have had private medical insurance as long as I can remember. My father did too. My philosophy is that if you can afford it, then you have a responsibility to have it. There should be US style Insurance Schemes to allow us all to afford it. In 90% of current hospital cases it is unnecessary for the patient to go to hospital in the first place. If you need treatment, then you should pay for it or learn some first aid. This is not Communist Russia, this is Great Britain.
As long as the government intends to get value for money and not let private health care businesses 'rip off' the state then I'm all for it. Most people who have experienced the type of care given to private patients know that by and large there is no difference. All going private now gets you is quicker treatment. As there will never be enough money to properly fund a fully comprehensive health service then I'm afraid the government has bowed to the inevitable.
Don't believe for one minute that all will be well under a private system. Many can't afford it(the US has millions without health insurance), employers are not required to offer it and catastrophic illness has bankrupted many people. The NHS may not be perfect and could stand improvement, but at least medical personnel make treatment decisions, not an insurance company hack. Don't let the Tories bully you as our Republicans try to here.
Keith Hagerman Maryland, USA
It is clear that there are simply not enough public funds to cover every last medical need that the British public may have. Rationing of one form or another is the inevitable result of this simple fact. Mr Blair ought to be easing pressure on the public system by creating incentives for people to take out private health insurance, such as tax breaks for those who take out a policy. The NHS still operates more or less adequately as a last resort treatment. It is time politicians started acknowledging this reality.
The private sector can never be the answer in Britain. To quote Roy Lilley "we do not have a private sector in this country just (NHS) medical staff who moonlight".
Blair's enthusiasm for public-private partnerships in medical treatment is disastrous. By paying profits to stockholders in the private companies, it will raise the cost of providing care. Salaries are higher in the private sector, so doctors and nurses will be lured away from the NHS. Also, can you imagine the bureaucracy involved in sorting out bills from the private companies to the NHS? I can - I have experienced both the US private/public system and the NHS and I prefer the NHS. Why not simply invest more in the NHS?
Eric Bowman, St. Andrews, UK
07 May 01 | Correspondent Analysis
The state of the UK's health services
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