This all sounds good and all but the majority of these schemes look like they will need significant upfront investment at a time when Keir Starmer has already said he will not increase public health spending.
Take the idea of community diagnostic centres in shopping centres around the country. I am all for this but how is it going to be funded? Which other bit of the health budget is going to be cut to accommodate it?
I mean cost of a new CT or MRI scanner is £200k+ and can reach £1-2 million for a top of the range machine.
Ultrasound scanners are cheaper maybe £15-25k for a hospital quality machine and x-ray machines are probably similar.
On top of this you have to pay ongoing costs of employing radiographers and sonographers to actually do the scans and then the radiologists on top to report and review the scans. Needless to say there is a huge shortage of these workers in the UK.
Surgical hubs is a similar issue, these will be expensive to setup and staff where does the money come from? My worry is that this will be put out to tender and you will have more privatisation of the NHS.
We have social prescribers where I work and they’re fantastic the main issue I have with them is they are overwhelmed due to the demand meaning in my area they haven’t accepted new referrals for the last 6 months. Again this could be fixed by employing more of them but how is this funded if there will be no new investment.
cozyHousecatWasTaken on
All of those attract private investment down the chain which is why they can be good ideas.
wartopuk on
As someone who has experience 3 different systems, Canada, South Korea and the UK, there are some interesting differences.
Canada’s is by far the worst. While ‘free’ for the end-user like the NHS, the wait times are worse, and the government management is worse. The number of doctors in any region are strictly controlled by the government often leading to shortages, or specialists that are hours away, and thus ever increasing wait times. There are no same-day appointments in Canada unless the GP deems it absolutely necessary. Typically in Canada you ring your doctor for an appointment and it’s usally 4-5 business days before their next one. As a result Canadians seem to get far more home remedies from the pharmacy and keep well stocked supplies at home.
Korea is a hybrid system where everyone has universal coverage which they pay as part of their taxes, but you do pay a small amount when you use healthcare. You can also carry additional private insurance if you want. Unlike the US where bills are insane, in Korea going to the GP costs you the equivalent of about £2. The trade-off is that there are GPs everywhere and I never once waited more than 10 minutes to see my GP and never made a single appointment. When I needed to see them I just walked over and saw them. They also don’t require referrals to specialists. If you need a specialist, you just go. Earwax soften and harden over your ear drum? In the UK you get to ring your GP 200 times in the morning, get in to see the doctor who goes ‘Yup’ and then refers you a week later to the ear specialist. Korea? You walk down the street, pay them £3 and they suck it out 20 minutes later. The government controls the fee schedule so that all places charge the same maximum for every single procedure, and if you’re low income you get an exemption or heavy reduction to these costs. Same thing for tests. Tons of testing centers everywhere and many doctors have them in their surgery. There was a bone doctor near me who had a full x-ray and other testing equipment right there. If you needed a scan you walked out of his office and through a door 2 meters away, got your scan and sat back down and then he saw you 15 minutes later. Most doctors had many different kinds of treatments available in their office, why? because they could make money off them. If you have a lot of patients needed blood drawn, do it right there (no phlebomists there, nurses, doctors and lab techs were all trained to do it). The government does not restrict where GPs set up or how many can be in an area like Canada does. The only flexibility doctors and hospitals had to offer flexible pricing was on non-medical things, so some hospitals were known for having luxury rooms and services for people who wanted to pay for them. Any medical practicies which weren’t insured (like plastic surgery) had varied pricing depending on where you went.
Now in the UK, the UK also doesn’t seem to restrict where GPs can set up, but there doesn’t seem to be anywhere near the glut of doctors here that there are there. While Korea does have a small handful of fully private completely disconnected doctors and hospitals, it’s very rare. Far less then the UK has. I think the main difference is that in Korea, government funds are spent directly on treatments. Not administration. There are no local trusts like the UK. So a doctor who opens a clinic or a hospital runs on the profit it makes from services it provides.
It seems to me a hybrid-hybrid model might help things in the UK. Unlike Korea, the user shouldn’t pay anything. But the government should look at making all doctors and hospitals private in the same way. Create a fee structure so that all hostpitals and doctors get paid exactly the same for each procedure that they do, but make them responsible for their own running. They’d still be held to a standard, but the reduction in bureaucracy and administrative staff (which is apparently half of all NHS staff) would free up a ton of money that could be used to up the payments for individual treatments. You might ask what would happen to all that admin staff, but all these surgeries and hospitals going private (again not like the US, still free to the end user) would need adminstrative staff. They’d just hire and pay them directly based on their own profits.
The only real difference between the UK and Korea would be that the UK would take a slightly higher medical tax than Korea so that it could cover 100% of the fees directly rather than having a co-pay system. The current tax rate may even be enough.
You might think that going ‘private’ would drop the quality of care, but it’s the opposite. They’re competing with each other for patients. So it strikes a balance between them trying to be efficient but also give you a good experience so that you come back next time.
3 Comments
This all sounds good and all but the majority of these schemes look like they will need significant upfront investment at a time when Keir Starmer has already said he will not increase public health spending.
Take the idea of community diagnostic centres in shopping centres around the country. I am all for this but how is it going to be funded? Which other bit of the health budget is going to be cut to accommodate it?
I mean cost of a new CT or MRI scanner is £200k+ and can reach £1-2 million for a top of the range machine.
Ultrasound scanners are cheaper maybe £15-25k for a hospital quality machine and x-ray machines are probably similar.
On top of this you have to pay ongoing costs of employing radiographers and sonographers to actually do the scans and then the radiologists on top to report and review the scans. Needless to say there is a huge shortage of these workers in the UK.
Surgical hubs is a similar issue, these will be expensive to setup and staff where does the money come from? My worry is that this will be put out to tender and you will have more privatisation of the NHS.
We have social prescribers where I work and they’re fantastic the main issue I have with them is they are overwhelmed due to the demand meaning in my area they haven’t accepted new referrals for the last 6 months. Again this could be fixed by employing more of them but how is this funded if there will be no new investment.
All of those attract private investment down the chain which is why they can be good ideas.
As someone who has experience 3 different systems, Canada, South Korea and the UK, there are some interesting differences.
Canada’s is by far the worst. While ‘free’ for the end-user like the NHS, the wait times are worse, and the government management is worse. The number of doctors in any region are strictly controlled by the government often leading to shortages, or specialists that are hours away, and thus ever increasing wait times. There are no same-day appointments in Canada unless the GP deems it absolutely necessary. Typically in Canada you ring your doctor for an appointment and it’s usally 4-5 business days before their next one. As a result Canadians seem to get far more home remedies from the pharmacy and keep well stocked supplies at home.
Korea is a hybrid system where everyone has universal coverage which they pay as part of their taxes, but you do pay a small amount when you use healthcare. You can also carry additional private insurance if you want. Unlike the US where bills are insane, in Korea going to the GP costs you the equivalent of about £2. The trade-off is that there are GPs everywhere and I never once waited more than 10 minutes to see my GP and never made a single appointment. When I needed to see them I just walked over and saw them. They also don’t require referrals to specialists. If you need a specialist, you just go. Earwax soften and harden over your ear drum? In the UK you get to ring your GP 200 times in the morning, get in to see the doctor who goes ‘Yup’ and then refers you a week later to the ear specialist. Korea? You walk down the street, pay them £3 and they suck it out 20 minutes later. The government controls the fee schedule so that all places charge the same maximum for every single procedure, and if you’re low income you get an exemption or heavy reduction to these costs. Same thing for tests. Tons of testing centers everywhere and many doctors have them in their surgery. There was a bone doctor near me who had a full x-ray and other testing equipment right there. If you needed a scan you walked out of his office and through a door 2 meters away, got your scan and sat back down and then he saw you 15 minutes later. Most doctors had many different kinds of treatments available in their office, why? because they could make money off them. If you have a lot of patients needed blood drawn, do it right there (no phlebomists there, nurses, doctors and lab techs were all trained to do it). The government does not restrict where GPs set up or how many can be in an area like Canada does. The only flexibility doctors and hospitals had to offer flexible pricing was on non-medical things, so some hospitals were known for having luxury rooms and services for people who wanted to pay for them. Any medical practicies which weren’t insured (like plastic surgery) had varied pricing depending on where you went.
Now in the UK, the UK also doesn’t seem to restrict where GPs can set up, but there doesn’t seem to be anywhere near the glut of doctors here that there are there. While Korea does have a small handful of fully private completely disconnected doctors and hospitals, it’s very rare. Far less then the UK has. I think the main difference is that in Korea, government funds are spent directly on treatments. Not administration. There are no local trusts like the UK. So a doctor who opens a clinic or a hospital runs on the profit it makes from services it provides.
It seems to me a hybrid-hybrid model might help things in the UK. Unlike Korea, the user shouldn’t pay anything. But the government should look at making all doctors and hospitals private in the same way. Create a fee structure so that all hostpitals and doctors get paid exactly the same for each procedure that they do, but make them responsible for their own running. They’d still be held to a standard, but the reduction in bureaucracy and administrative staff (which is apparently half of all NHS staff) would free up a ton of money that could be used to up the payments for individual treatments. You might ask what would happen to all that admin staff, but all these surgeries and hospitals going private (again not like the US, still free to the end user) would need adminstrative staff. They’d just hire and pay them directly based on their own profits.
The only real difference between the UK and Korea would be that the UK would take a slightly higher medical tax than Korea so that it could cover 100% of the fees directly rather than having a co-pay system. The current tax rate may even be enough.
You might think that going ‘private’ would drop the quality of care, but it’s the opposite. They’re competing with each other for patients. So it strikes a balance between them trying to be efficient but also give you a good experience so that you come back next time.