Collapse of emergency healthcare in England may be costing 500 lives every week

It is too bad that corrupt government officials keep systemically defunding Social Health programs with the objective of pushing private for-profit healthcare (which just doesn't make sense). Then they point to the deficient healthcare and blame the "socialized" aspect of it for the issues.

Here in Mexico we've seen it all play out: We had an amazing social healthcare system (in the form of the IMSS) in the 70s and 80s. But the corrupt government officials kept dismantling it and allowing corruption to run rampant within the system. All to get a piece of the private for-profit health system including Health Insurance.

Back in 2004 when I lived in the UK, the NHS was really good. And I remember hearing at that time that it was nothing compared to the NHS in the 80s and 90s. I seriously hope it doesn't have the same outcome as our system had in Mexico. For-profit health is inhumane.

> libraries and early years provisions

Seen exactly this in my local area. Libraries closing or cutting hours/resources. The number of children's centres (where you go for check-ups/weigh-ins of young kids, to get feeding advice, etc.) reduced by 80+% in some counties. It's dire.

Some relevant graphs here: https://www.instituteforgovernment.org.uk/explainers/local-g...

This certainly makes a lot of sense, and although I am happy to believe you I am having a hard time convincing my grandma that you are right.

Do you maybe have a source for your claims that would convince her? A simple news article from a reputable source would probably suffice.

It appears NHS funding has increased year over year: https://fullfact.org/health/spending-english-nhs/

>Social care is now on the council to fund and many councils have squashed social care, along with libraries and early years provisions. The trap of outsourcing caught many councils out.

It could be phrased as - social care was a way to paper over cultural and societal cracks, by paying peanuts to people with limited job choices.

As in most things, our response to Covid has just exposed the endgame much quicker than expected.

> This isn't a collapse of emergency healthcare, it's a very predicted collapse of community social care: hospitals can't discharge if they need a care home place that doesn't exist. Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door.

How does that manifest as ambulance wait times? Do you think ambulance drivers are sitting around for an hour before responding to calls for help because... the hospital is full? That's like saying my train to the airport was late because the airport was full, it doesn't make much sense. How does one back up into the other?

It’s almost as if centralized control of resources doesn’t allocate them optimally.

People can’t be sent home because English people don’t give a shit about their family members. Brits think that the government should provide everything for them, even something simple as looking after an elderly person who is otherwise fine. What happened to family bonds and a bit of responsibility? Every winter around Christmas young family members (40-50 year olds) refuse to take their parents home because “they don’t want them at home over Christmas as it’s inconvenient for them” so they literally demand from the hospital staff to keep them in hospital for 1 or 2 weeks longer. Unfortunately the NHS is not allowed to dump these patients on the street. The problem is brazen entitlement. The NHS needs reform. Zero tolerance for those parasites, charge people for not showing up to appointments, charge people for simple medicines, charge people for choosing to be obese through an obesity tax.

I don't understand. Social welfare spending, as a share of GDP, has never been higher in the UK:

https://ourworldindata.org/grapher/social-spending-oecd-long...

And this is amidst rising inflation adjusted per capita GDP, meaning even more rapid rise in real per capita social welfare spending.

Where is this "Tory penny-pinching" happening?

I'm happy for them that they made it to the point they can actually take time off. A big issue over here (NL) is that the doctors and nurses have fallen ill themselves, either from the 'rona or long covid, or from being overworked for so long. And because of the workload, a lot of people have quit as well.

Family member recently received emergency care in northern NY. Several of the nurses were Canadian coming over the bridge for better pay.

As always, it very much depends. We just went to the emergency room and experienced less than 30 minutes of wait time.

There's a public sector salary cap in many parts of Canada, despite roaring inflation.

And a general vibe from the public and the government that generally despises public sector unions and would almost certainly backlash against nurses and teachers should they sensibly decide to go on strike.

For two years they busted their asses for the public in tough straits and now COVID numbers in the hospital system are still crazy but the public is pretending they aren't, and basically expecting the health care system to "deal with it."

A prov government here in Ontario that screwed the public health care system and nurses in particular all through the COVID crisis, and has every intent on doing more of that ... was just re-elected with a landslide majority.

If you put foxes in charge the hen house, it's not a surprise when the nurses^H^H^H^H^Hhens start to disappear.

As someone in the U.S., don't expect the timeliness to improve any with private healthcare.

Not that it helps, but this is happening in most Western countries.

In Canada, healthcare has similarly collapsed. Decades of mismanagement and absurd government policy finally broke the system during the COVID lockdowns and now the system is worst than many third world countries.

Like in your example, it will take hours to get ambulance and I don't mean in some rural town in Canada, I mean in downtown Toronto. Most people are just Ubering or getting driven to the hospital and camping out at the ER - and I do mean camping because it could easily be a day's wait for something fairly urgent. We've had plenty of people die in waiting rooms this year.

The worst part is there is no private system allowed here - in fact the provincial BC court recently ruled that private health clinics operating outside the public system are not allowed[1]. As a Canadian you no do not have a right to healthcare if that healthcare is private - your choice is die in the public system's waiting room or hopefully be rich enough to fly to the US for care.

---

[1] https://www.canadianlawyermag.com/practice-areas/litigation/...

>The NHS is a tragedy and I almost wish they'd just hurry up and privatise it so I don't have to pay with it with my taxes anymore, which means the Tories achieved their goal.

I hear this bandied about a lot, but do you have any evidence to support this claim.

"In 2006/2007, 2.8% of NHS spending went to private providers, rising to 4.4% in New Labour’s last full year in government and 4.9% in the first year of the Coalition. About 7.6% of NHS revenue spending in 2015/16 went on purchasing care from private providers.12 In the three years from then to the Covid-19 pandemic, private spending flatlined, with the combined non-NHS spend of Commissioners and Trusts being under 8%.13 The Chief Executive of the NHS predicted in 2015 that the proportion of NHS work going to the private sector would be unlikely to increase beyond ‘the margins’.14 He has been proved right." https://journals.sagepub.com/doi/full/10.1177/01410768211049...

From what I've read Labour was also responsible for the privitisation of healthcare.

Not that I'm personally opposed to some privitisation in a sensible manner, but the privitisation debate just seems to be some form of political attack with little grounding in reality.

It's worth clarifying that the issue with the government infrastructure is with the regulatory agencies, rather than the water infrastructure itself which is privatised.

There's also a good text article version; https://www.theguardian.com/environment/2022/aug/04/sewage-s...

It's a failure of privitisation 30 years in the making since water and waste management was privatised in 1989 here in the UK. Of course you can lay some blame at the door of the regulator but let's not forget the tens of billions that have been siphoned off to shareholders and fatcat CEOs, some of whom are arguably criminally negligent and should be put on trial for the catastrophes that have become apparent in recent years.

The Conservative Party have been in power for 12 years. When they gained power they pursued a policy of "austerity" to reduce the size of the govt and local govt, reduce the funding of nationally funded things, and to replace such govt owned things with "public private partnerships". This can be seen everywhere from social care (private care homes), schools (academy schools), transport (where area contracts are bid for by private companies), etc.

With health specifically the goal is to have more privately owned profit making companies in the NHS. The NHS as it is constructed doesn't allow for this. But for the Conservatives this opportunity for them and their backers. For the public, there is a national pride in the NHS.

So we entered the pandemic with an already under-funded and stretched health care system.

Much to the chagrin of those in charge though... this has not led to any calls for privatisation. Nor has it led to a boom in people taking out private health care cover.

It turns out that the British stiff upper lip response to something they're nationally proud of is that they'd rather die than embrace health privatisation. So we're in uncharted territory... the playbook that had allowed the privatisation of almost everything else isn't working now, it's just killing people.

For years people have been raising the warning about the pressures on healthcare system, and for years the conservative party have asked the NHS to do more with less.

What does collapse look like?

Well, in the early days, it looks very gentle. The four hour wait for ED treatment goes up a bit. Healthcare people say "Look! This is concerning!" and politicians say "eh, it's just winter pressure, we know things are rough in winter."

Or you say "Look at the waiting list for community eating disorder treatment, this is concerning!" and politicians say "we're taking people out of mental health hospitals and giving them treatment in the community, so there's a transition period" (they cut beds for ed treatment, but didn't also fund community ed treatment, so wait lists have gone up a lot).

It's like Buckaroo or kerplunk or jenga. You can load the donkey, pull the straws, pull the blocks, and stuff still sort of works (less safe, less effective, more harmful) but then something happens and blam you've tipped over into catastrophe.

What would collapse look like?

If people are queueing in an ambo for 12 hours why isn't that a sign of collapse?

If people are dying of stroke or heart attack at greater rates, because they can't get ED care, why isn't that a sign of collapse?

> They subtract COVID deaths from excess deaths to get the baseline, forgetting that COVID deaths were counted somewhat liberally, and some percentage of non-COVID deaths were counted as COVID deaths if someone was infected close to their time of death.

If COVID deaths were counted liberaly and even after subtracting those inflated numbers you still have excess deaths, then that only further underlines their point that these excess deaths are not COVID-related.

Just because you think the criteria for counting COVID deaths were wrong doesn't make every conclusion based on those numbers incorrect.

> This does suggest the general problem is really that we don't know where to put all these incapable poor health old people.

This has been the case for years: there are plenty of people who should not be discharged home to fend entirely on their own, but there's no social care in place to look after them, so they aren't discharged. This is also technically the responsibility of the local council rather than central government.

During the pandemic there was almost unlimited money available for Test and Trace, some for the entirely temporary "Nightingale" hospitals, .. and basically no effort to increase staffing levels or solve the social care issue.

Aaah, so this might only be a paid shill with a bait for the pro-privatization of healthcare looking to push for a for-profit health system.

Even more worryingly is that London has some of the fastest response times in the country.

Last two times I had to call 999, for ambulance and police respectively, I was on hold for more than 5 minutes before even being connected to an operator. The overall ambulance target response time is 8 minutes.

Increase in demand - much of which is attributed (by the NHS itself) for people having poor life-styles (meaning tending to obesity [0] and not maintaining physical and mental fitness), and the tendency for people to be kept alive longer existing with chronic conditions that a few decades ago would have naturally expired (dead!).

There's been an endemic problem for the last 30+ years where-by a large proportion of the population has a sense of entitlement to NHS care without at the same time bearing responsibility to keep themselves reasonably fit and healthy.

@ [0]: "Nearly two-thirds of adults in England are overweight or obese. In 2016/17, 617,000 admissions to NHS hospitals recorded obesity as a primary or secondary diagnosis"

[0] https://www.longtermplan.nhs.uk/online-version/chapter-2-mor...

NHS has been underfunded for years. These issues are, in a way, not new. But it just kept getting worse and worse, COVID added burnout and a huge backlog of treatments and missed diagnoses.

It probably doesn't help that a lot of the medical staff were from the EU and just before COVID were PTFO.

I'm still waiting for those hospitals to be built by all the money saved by Brexit.

Both. Demand has increased faster than expected because of covid, and supply has been hampered by covid, but even in the counterfactual world that has not faced this pandemic the UK has not funded enough nursing places to meet the previously forecast demand (the ageing population told us demand was going to go up, but the government cut funding in 2017 that reduced nursing degree applications in England and Wales by 23%), and Brexit reduced the number of nurse applications from the EU.

Its always the same answer. People stuffing their faces with garbage food and chilling on the couch all day. Apparently there was an explosion of obesity in UK during covid. These people clog up all the available supply leaving very little for the rest. Its the same story everywhere. Ppl whine about funding, shortages ect but no one cares about if we can do something about the demand.

Govt pushed covid vaccine on young healthy people saying its good for the community if we all get it and its our duty to society. So why isn't getting off the couch and going for a walk considered duty to society.

Lack of qualified staff willing to work at the current pay rates. There are shortages in plenty of sectors at the moment so medical personnel who have had enough are leaving or retiring early and they can’t be replaced because pay rises are not keeping up with inflation. I’m going to look for my source just now but I read that there are 100,000 vacancies in the care professions currently. Postal workers, train drivers, bus drivers, dockers and barristers(!) are all planning to strike in the next month or two because of inflation effectively causing large pay cuts.

It's complicated.

In England social care (care homes) are funded by local authorities, not the NHS, and are overwhelmingly provided by private providers. We've had decades of under-funding of local authorities, and the Conservative government has made it very difficult for LAs to raise funds via taxation.

So, during a time where we have an ageing population we do not have nearly enough beds for these people to be cared for.

When people go into hospital, either as a planned (elective) admission or as an emergency, and they get treatment, and they're ready to leave hospital they have to have somewhere to go to. Lots of people will go back to their own home, but some people will be unable to do this because it's not safe to do so. These people need a care or nursing home. Because there aren't any available beds, and because there aren't any available suitable home care packages, these people stay in hospital on the wards.

Those beds are now not available to be used.

So, now you have a problem of flow of patients through hospitals. You can't discharge patients from the ward, which means that ward can't now accept patients from elsewhere (surgery, ED) in the hospital. This means that elective care reduces, and emergency care slows down. People wait in Ed for very long times. And because ED is full people can't get in to ED, so ambos queue outside ED for hours. This means many ambos are queued outside ED waiting to transfer a patient, and not available to travel to people. So now people in life-threatening emergency or with severe injury are waiting far too long for an ambo.

Fixing care homes and nursing homes would do a lot to fix patient flow, but it's not going to happen because we have a government that hates the NHS and hates LAs and hates taxation.

On top of all of this we have an incoherent approach to staffing. The English NHS is full of staff who've come to England to work. We need these people - they improve the quality of care and they increase the amount of care we can deliver. We should be making it easier for people to come here, but we don't, we put up a load of weird bureaucratic blocks. (Because we have a government that hates immigration.)

We need to train very many more staff (there is something like 100,000 staff shortage, at least 10,000 doctors and 50,000 nurses) but we've made it more expensive to train to become a nurse, or a doctor; we've cut pay for all staff (for junior doctors to achieve pay restoration they'd need something like a 25%-30% pay increase).

We need to retain the staff we already have, but there are a range of things that make working for an English NHS trust pretty terrible. It's not just pay, but poor pay doesn't help. There's a weird thing around pensions that means many doctors can either retire early or face a massive increase in their taxes. Lots of staff have trouble getting paid on time when they start work at a new organisation. People have to pay for car parking, and they're fined if they overstay even if that overstay was caused by saving the life of a very ill patient. (These can be over-turned but why should it happen at all?). Rest areas are generally awful and expensive. Hot food is generally not available 24 hours a day. Rotas are chaotic. Doctors can apply for leave a year in advance and then have that denied with very short notice. Some NHS trusts have toxic work cultures and problems with racism, sexism, and bullying. And these are just the things I can remember, the real list is very much longer.

About demand: there has been an increase in demand for healthcare. GPs are seeing more people than they were before pandemic, but there's a perception that it's quite hard to see a GP. (I don't have much trouble, but I have cancer and my GP is pretty good, but I recognise other people have difficulty with weird access restrictions). This trickles through to ED - a few people turn up to ED needlessly. Before pandemic we had clear evidence that it wasn't really enough to make much difference to the overall ED demand. The picture is less clear during pandemic - certainly people going to GP not ED if they need GP is a good thing because they get better care, but it's hard to know if it's making the ED problem much worse.

The first one, and now the second one on top.

There's a big problem where social care got moved from the department of health to local government a few years ago.

Then, shortly after, the government cut local government funding massively. It used to be funded by a mix of local taxes and funding from central government that was about 50/50. This was part of a strategy to insulate richer areas from the impact of cuts, while poorer ones (which relied more on central funding) took the hit.

This means there's a huge problem with elderly patients who need to be discharged into social care not having the support they would need to go home or a spot in an old people's home to go into.

Which, combined with covid still being around and the fact that even before covid government obsession with efficiency meant that there were a relatively low number of beds which already had a high occupancy rate.

So there was no spare supply to begin with, increasing demand due to a growing and aging population and covid, and lots of people who are stuck in hospital because they need support to leave which doesn't exist.

Yes there are significant and multiple areas where private healthcare companies are being paid to 'provide' services to the NHS in a classic outsourcing process similar to what you would see in IT.

Private company charge a lot more, pay their staff a bit more to attract workers from the NHS, extend their contracts to provide more services where there are NHS staff shortages. Taxpayer money turns into company profits. I wouldn't object if it provided more efficient care but it doesn't seem to.

What are you talking about?

Decriminalization of physician-assisted suicide is becoming more popular in a lot of places because it is far more humane than the status quo.

It’s an article on the Financial Times

Blogs don’t make sense for the most prolific creators. Here’s something I saw recently

> I gave up blogging after decades because the ROI simply wasn’t there any more. Why spend hours on a post that will get hundreds of views when a tweet composed in minutes gets tens of thousands to millions?

https://twitter.com/carnage4life/status/1559852146601799683

And it’s the same with Scott Hanselman, who’s quoted in that tweet. Hasn’t blogged since last year, stopped after 20 years. He’s big on YouTube and Tiktok now.

Sure, here you go: https://www.ft.com/john-burn-murdoch

As somebody else in this thread pointed out the numbers don’t stack up. This thread is subjective at best

The best thing about NHS (from my perspective as a US person, although I lived in the UK for a while) is the use of QALYS to allocate budget, rather than spending huge sums on a small number of interventions at extreme cost and limited benefit. Has that focus shifted?

(My personal belief is there should be a level of universal medical care funded by some public entity, probably the nation state currently, but it should be capped at a relatively low level, probably closer to 1% of GDP and allocated on a QALYS and emergency or communicable biased, with private care in a relatively unregulated market outside of that. Probably would end up in the 5% range overall, but with universal access to basic and cost-optimized care and probably a wider variety of private, charity, experimental care.)

We should not spend excessively on medical care vs. other interventions -- it's absurd that in the US we can have homeless people on the street with extremely limited assistance on housing or lifestyle interventions, but as soon as they develop some medical condition, they get essentially unlimited much higher cost intervention to remediate those things, but still nothing to address the underlying cause. There are a bunch of cases where we could shift $1k out of medical spend for $10 in other spend and achieve a better outcome for the person and for broader society.)

Funding may go up but demand increases more because UK population is old and overweight… and getting more so. This is the reality of an aging population plus socialised health care.

> Yet there is still outcry about how we need MOAR MOAR MOAR!

Was the budget increased enough in the first place to what the experts recommended? "I generously give my employees a raise every, single, year, of 0.5%, and yet all I hear is that they want MOAR MOAR MOAR"

Note that your bma source contains a graph titled "Regular healthcare expenditure if it had kept pace with the historical average over the last decade"

> how much more do people want?

I believe they voted for 350 million pounds a week to fund the NHS

https://leftfootforward.org/2022/02/where-is-the-350-million...

Is it possible the NHS took on lots of 'bad deals' in the 2000's, and is now having to repay them? Things like a "Get this cheap building, but now you're locked into paying inflated rent and service charges on it every year for the next 50 years"

It's because they're acting as an emergency care home.

My local 450-bed DGH has over 150 medically fit patients waiting to be discharged into community care that isn't available.

And this happened secondary to central government funding being withdrawn from social care.

So hospitals like this one are actually running at 120% in summer. They do need "MOAR MOAR MOAR" but that more is a place to look after the patients that don't need to be in hospitals.

Other countries spend more (10 - 20 % more) and get better outcomes, so it seems like the solution is indeed to spend more. The fact that it has been climbing slowly and we haven't seen radical improvement doesn't contradict that. Sorry.

The solution is for young people (tax payers) to form a "Youth Union" and start demanding that older people pay more towards their health care.

When this doesn't work, the solution is for the members of this union to leave.

From your first source; The combination of a mismanaged economy plus an aging population has meant that the NHS spend is 50BN less than projected but is a now a larger share of GDP compared to other EU economies because the UK economy has performed so badly compared to the rest of the EU. Productivity has flatlined while people bought more and more expensive houses of each other on credit. My theory is that the conservatives have fucked the economy by being too tight fisted with public sector pay causing a drop in disposable income for about 1/4 of UK workers leading to lower spend in small businesses like pubs and hairdressers etc which has caused 10 years of general stagnation.

There are potential answers to your questions in other comments in this discussion that have been there for hours, it might be more useful to move understanding forward to address them rather than just opening a new thread as though they aren't there...

The issue is undoubtedly multifactorial.

I agree with you that we cannot persist with above-inflation spending increases. This is economic fact. Moreover, we're currently enjoying an artificially cheap healthcare system by underpaying nurses and doctors.

My partner and many friends and family work for the NHS, and these are my general observations, in order of significance.

1. The biggest problem is underfunded social care. If we took money out of the NHS and moved it into social care, we'd have a better NHS. At the moment, the NHS is full of inappropriate patients with nowhere to go. We also need to consider how we handle the elderly in this country. The idea of having elderly people stay at their suburban homes while the state pays for nurses and doctors to visit is hugely expensive. I suspect caring for your elderly relatives at home is going to need to become more common.

2. The NHS is inefficient BECAUSE there are to too few admin staff. In NHS terms, this includes IT and other similar roles. Currently, my partner spends over an hour a day just waiting to log in on one of her department's three computers. She then spends ages sending emails, following up transfers and doing a whole load of other jobs that should be done by an administrative person. Technology is massively underexploited because investing in technology costs money that we don't want to spend. It's like that death spiral that I'm sure many of us have seen in our careers, where you get nothing done because you spend all day firefighting, and everything eventually grinds to a halt.

3. We need to focus more on preventative care. Right now we largely leave problems until they are much more difficult to treat. This is in large part cultural, and partly due to the firefighting I mentioned before. We have a very unhealthy population (myself included) and more needs to be done to fix that. Other countries have deployed very successful strategies that we've so far failed to apply ourselves.

4. We need to look more at how we handle the end of life process. Sadly, death is an unavoidable reality currently, and we spend a ridiculous amount of resources trying to slightly delay the inevitable. Many of my partner's patients are in their 80s or older, and it seems borderline immoral to be performing such invasive surgeries on extremely unwell elderly people. Interventions continue to get more incredible, but also vastly more labour and resource intensive. Many of these patients may live an extra few months due to these interventions, but we really need to be honest with ourselves and ask whether it's worth it. Currently an intervention is deemed value for money depending on the average QALY added across all patients, but obviously in reality, the same intervention would be usually much more value for money on a healthy 40 year old, and much less on a frail 90 year old. This is an extremely controversial and morally difficult area with extremely challenging issues around every corner, however.

This isn't a problem of funding, either. This is a problem of basic population dynamics. We could throw hundreds of billions more at the problem, but where are we going to get all these new carers, nurses and doctors? Who's going to be left to build their houses and grow their food? If we import all these people from overseas, which is politically unpopular, how are we going to integrate them?

We could look into whether we continue with the Beveridge Model. Certainly some things about it don't work brilliantly. But honestly I don't think the model matters so much as the fundamentals, other than better aligning incentives will make it marginally easier to fix.

Don't forget our prison camp in Rwanda!

The replacement candidates are also both sure that the main issues facing the UK public are "woke" politics and trans people[0], and seem entirely unphased about the pending crisis around energy bills and the price of food. And the opposition seem pretty uninterested in taking advantage of this massive open goal. Incredible.

[0] no, not in a nice "let's all remember to treat LGBTQ+ compassionately and with respect" way

Yep it's the people's own fault that they died while waiting in the emergency room. The politicians are sacrosanct and must not be criticized under any circumstances. So, you see, all these excess deaths are really suicides.

I don’t buy that explanation. Democracy turned out to be easily manipulatable with large sums of money and media control.

At this point, an average person can’t have much of an affect on how government is acting. Very few people can take a day off to protest, and even if they do, protests tend to be meaningless too.

I’m not saying that average person is blameless but most of the fault lies with the ruling classes.

No they didn’t.

More people voted against the conservatives than voted for them, but due to the first past the post system they got a massive majority in Parliament and can do whatever they want.

This would only be true if democracy was fair, but it isn't.

It’s not just first past the post, but with capitalists controlling all media (even the BBC, which is mostly led by Tories).

This is not what the majority voted for.

"This Twitter chap" is a journalist at the Financial Times and is a senior fellow at the London School of Economics. He's not just some rando bashing government...

> Any and all government bashing

They're doing incredibly badly despite friendly press support, are leaderless after the misconduct got too much even for the Tory party, and are facing some really serious problems this winter if energy prices match projections. In the meantime they waste time on culture war nonsense. They're not being bashed enough.

the 12+ hour wait times, the hospital occupancy, the aging population and slashed social spending are all hard data. if you want just ignore everything about the excess mortality, and you'll still get the same picture, it's not gonna look nice anyway you dice it.

healthcare (and education) are both incredibly big outliers in the last decades of technological progress (incredible diminishing returns, just look at US spending, brutal Baumol effect, since almost everything is still manual labor .. every MRI/CT requires more professional labor, every new drug requires more tests and consultations, and so on).

no wonder it's looking worse and worse when compared to total GDP of aging populations.

Private enterprises are already running a significant chunk of UK health care at the moment; the Tory government is dismantling the socialized health care in favor of short-term profit. It's not about whether people are willing, it's whether they can afford it or if they have no choice but to go into debt.

Anyway, the NHS has also paid private clinics already because their own facilities are at capacity.

Yep, your money or your life is a strong economic incentive indeed.

Emergency care specific private enterprise seems incredibly predatory. I also wonder where the infrastructure and staff for these surge clinics would come from.

The USA have tried, it doesn't work. People still wait hours and hours in the ER. They just have to pay thousands for the privilege.

Tell me, if you are having a heart attack or have had a stroke, how likely are you to have the mental fortitude required to realize that not only is there a for-profit emergency service, but you can pay to get seen now?

Probably not very likely. If your emergency is urgent but not actually life threatening, then you might. You might - might - think of it if you have gall bladder or appendix types of pain, if you aren't in too much pain to think about it.

And how, exactly, would this go into place? Would you call the emergency line, who proceeds to upsell you on a premium emergency room that will see you right now if only you pay money upfront? Does this also mean that poor people's lives are worth less since they cannot pay up? How about teenagers, who might be calling the emergency line yet don't actually have money to pay?

"What if the government allowed private enterprise to open emergency clinics in times of great need?"

Using what for doctors?

The problem is a supply side shortage of medical staff. Praying to the god of the private sector won't magically cause doctors to appear.

I'll remind everybody again. Primary care in the UK has been in private hands since 1948. It's the lack of capacity in the private part of the NHS that is driving people towards A&E for basic stuff.

Hell no. NHS as a public service is currently fighting for its life. Opening up to private enterprise would accomplish the goal of killing and/or privatising it even quicker.