[DanBC]

We've had privatisation experiments in English healthcare for years.

Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess. Large private provision of GP care? They can't do it and they hand the contracts back. Specialist commissioning in mental health? It's a fucking mess.

> It's run by Whitehall and politicians, with little input from those actually doing the real work.

If you say things like this it makes me think that you don't know that NHSEngland/Improvement is an arms-length-body, nor what that means in terms of command and control of the English NHS. It makes me think that you didn't know what CCGs were nor how they worked, and that you don't know what an ICS/ICB is nor how they work.

> If there is to ever be any improvement in the NHS, there needs to be competition.

What is "choose and book"? We tried competition, and it dramatically increased costs without doing anything at all to improve care. We're now spending considerable amounts of money rolling back some of that law.

[missedthecue]

"Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess"

A mess in what way? Do you have to wait 2 years for a private dentistry appointment? Because that's the current wait time for an NHS psychiatrist.

[DanBC]

Your dentist example is a bit weird - you're comparing private provision with NHS provision, and that doesn't work. If you want a private dentist, or a private psychiatrist, you pay and get rapid access.

If you can't afford private treatment you go on the NHS. At the moment NHS dentistry is simply not available for very many people. Those people cannot get treatment at all. But for psychiatry, the vast majority of people who need a psychiatrist will get same day or next day access. This is one of the problems - that's a statutory function, they must provide it, and so community care has been cut in order to meet the statutory function.

> Because that's the current wait time for an NHS psychiatrist.

This is untrue in the way that you've presented it. I'm not able to find this statistic any where - what's your source for it please?

There are long waits for some community mental health services, but these are mostly caused by decades of underfunding of MH treatment. Also, your argument says that this problem would be fixed with competition. We've competition and right to choose for first episode of mental health care since 2014[1] and that competition has done nothing to improve things and in many situations has made things worse.

For Early Intervention in Psychosis services (these are services for people with their first episode of psychosis) the current numbers[2] are that 83% of people were seen within 2 weeks after referral.

The number of people in contact with specialist mental health services has increased[3] since 2019 from 1.3m to 1.6m people. This is combined with a decrease in bed numbers and a complex change from CCGs to ICSs. New referrals data is complicated (one person can have multiple new referrals; someone already in contact with services can have a new new referral) but the trend is increasing[3]. The number of young people accessing MH services has increased a lot over the past 12 months, from 575,000 in Mar 2021 to 690,000 in May 2022.

[1] https://www.england.nhs.uk/wp-content/uploads/2018/02/choice...

[2] https://www.england.nhs.uk/south/our-work/mental-health/earl...

[3] MHDS Mental Health Time Series data dashboard

[rleigh]

Dentistry is a mess because of the funding model. It doesn't pay to be an NHS dentist, so most practices ceased to take NHS patients. If they fixed the funding model, the problem would resolve itself. The problem here was entirely self-inflicted by the NHS in its fixed price lists, which weren't sufficient to run a viable business on. The very opposite of a proper free-market economy. Finding an NHS dentist in some areas is impossible, but finding a private dentist is not. I've used both, and both were absolutely fine. The private dentist was more expensive, but they were charging a reasonable amount to fully cover their salaries, facilities and consumables. As with everything, you get what you pay for.

Regarding competition, the NHS hasn't really tried competition seriously now, has it? Not really. Not actually doing a complete decoupling the insurance funding and the service provision. The "choose and book" isn't that, is it? It's a small attempt, which is better than nothing, but it's not really surprising that it didn't drive a huge amount of change, when it's not really going to have a big impact upon the bottom line.