 It's time now for the big question in which we tackle a major news story of the day from multiple points of view. NHS bosses in England are urging former employees to come out of retirement and others to postpone their retirement to help tackle waiting lists. More than six million people are on waiting lists for treatments such as knee and hip surgery, and it's feared that waiting lists could grow upwards of 12 million. Meanwhile, a record 2.7 million people were referred to cancer checks in the last year as a result of fewer cancer patients being seen during the pandemic. This also comes after a major report into maternity failings at an NHS trust found that at least 200 deaths could have been avoided. Plus, if that wasn't bad enough, the ratio of patients to doctors in England has reached over 2,200 patients per GP, with millions now struggling to get an appointment even online. So is the NHS still fit for purpose? Is the principle of free at the point of need a sacred one which must be protected at all costs with the state delivering the bulk of health services, or do we think the unthinkable and take the service out of public hands? That is tonight's big question. Is it time to privatise the NHS? To debate this, I'm delighted to welcome Dr Julian Spinks, who's been involved in NHS clinical management and medical politics for 25 years, and has experience of clinical guideline writing for the National Institute for Health and Care Excellence. Also delighted to welcome a former nurse, Sarah Jane Palmer, who also worked in the NHS's cardiology, hospices and care management departments in the community, alongside having 230 articles published in medical journals. And last but not least, I'm delighted to welcome one of America's most popular online talk show hosts, Jaron Brooke, a man with a deep faith in free enterprise and open markets. Jaron has a PhD in finance and has been featured in major publications such as the Wall Street Journal, USA Today and Investors Business Daily. So let's get into this. What are your thoughts, by the way? Mark at GBNews.uk. Dr Julian Spinks, we'll start with a kind of insurance policy here, a health warning on this conversation, which is that those working in the NHS are world class, are frontline doctors, nurses, hospital porters, cleaners, they do an amazing job. But does the system need a rethink? Well, certainly the system doesn't work as well as it should. It's been underinvested for decades. And certainly in general practice, we found this, we are now losing doctors, we're hemorrhaging doctors at the moment, which is why we've got those big list sizes. And that's why people can't get appointments and so on. So certainly work needs to be done. But I think we've got to be very careful what we want. And because there's a danger that we might actually throw the baby out with the bathwater. I mean, money is obviously a factor. The issue is that Britain faces major economic challenges now, post-pandemic. The cupboard's bare, isn't it? I mean, we're going to have to look at efficiencies within the health service, rather than pumping more billions in. And I think that's what's so difficult. If we had loads of money in the NHS to start off with, we would have actually got through the pandemic much easier. If we had more beds, France has got twice as many hospital beds for the size of population. In particular, intensive care or just beds primarily? Generally, to be honest with you, because there were people who didn't end up in intensive care but needed to be in hospital. Germany's got three times as many hospital beds as we do. Now, I'm not saying we need that number, but it's gone down and down and down for about 30 years. We've got GP practices closing so the smaller numbers of those choice goes down. So that does need to be tackled. Having said that, for example, the GP services is incredibly financially efficient. The practices I run get around £150 per person per year to provide everything. And that covers all our costs, our staffing and so on. And for that, people get on average six consultations a year. So it's considerably less than you pay going to a vet or going to a lawyer and so on. And it's difficult to see how you'll replace that that cheaply. But if the private sector couldn't scan people more cheaply or do hip replacements or heart surgery more cost effectively, if they could actually tender for those jobs, what's not to like? Well, we've been trying that. And sometimes it is very successful. And others, it's been a disaster. We had a whole series of independent sector treatment centres that were set up, which were paid more than the NHS, ended up doing less work. And in fact, they were being paid even though they didn't do any work at that time. And they could cherry pick the easy patients. So all the tricky ones ended up in the poor NHS hospitals, and they were getting the ones. So you've got to be careful that you don't actually sort of buck the trend and actually make a situation worse. Having said that, using private providers, GPs are all effectively private providers. Because we've been partners, we're small businesses, we're not with the employees of the NHS with a budget. And in fact, I was a fund holder. And that was a very successful time. Because I worked with my patients, I had a pot of money so we could give them more choice, you know, without having to go down the idea of having an insurance policy or something like that. And I love our GPs and it's great to have a GP here. I'll show you my lump in a minute. But before we do that, there's another issue which is the culture of the NHS in relation to the patient. Some people take the view that if the public had to pay 10, 15, 20 pounds for a GP appointment, they would turn up on time and they wouldn't ask for that appointment if they didn't need it. Certainly my experience has been, for example, with weight loss. When we've had free weight loss, actually people don't turn up. Whereas when they pay to go to a commercial company, they are more likely to. But the other end of the spectrum is you're then coming into who can actually pay for it and who can't. And you know, I look at it and what I would dread is ending up having to deal with a health insurance company rather like a car insurance company or a house insurance company. If you've ever dealt with those, they're a nightmare. And when you talk to Americans, they really hate their insurance companies. Sarah, Jane Palmer, I'm going to come to you in a second. You're on Brook. You broadcast and live in the United States where the set-up's very different. It's completely privatised. What are your views of the UK system? Well, first, the US system is not completely privatised. It's dominantly government run. But it's credit card healthcare, isn't it? No, well, 50, 60% of all the dollars spent in the United States on healthcare are spent by the government. So it's a mixed system. In a sense, it's the worst of both worlds. And I don't advocate for hybrid systems. I want to see everything privatised. It strikes me as stunning that in every other industry we understand that central planning doesn't work. We've tried central planning bread production. We've tried central planning food. We've tried central planning, all kinds of things. It doesn't work. It creates shortages. It creates lines. It creates malinvestment. It creates unbelievable inefficiencies. And yet in healthcare, somehow we think is special and unique and different. It's not. It's an industry. It needs to be produced by GPs, by nurses, by hospitals, by people who produce the service, and they are customers to somehow believe that we can take this unbelievably complex system and centrally planted, given a bunch of bureaucrats, the power to decide how to allocate resources, who should get what, what are the best treatments, instead of letting a market work where it works so beautifully in where it's allowed to work. In every product where we allow markets to work, we get beautiful results. Why not try it in health? Well, we know that's often how unscrupulous dentists operate that they'll take out your molar because they want to make a few more quid. You know, will we have people profiteering from operations that patients don't need in order to make money, or dispensing drugs in order to fulfil the bottom line? Saving lives. Saving lives, you're on. I'm all about saving lives. I want to save lives and I think that we should be a matter of profit, should it? Of course it should be a matter of profit. Food is a matter of profit. Without food, we would all starve and yet food is a matter of profit. And we go into the grocery store, a supermarket, and it's amazing, the variety, and we get food from all over the world and we get better and better food, and particularly if we demand better and better food, we can go to different grocery stores. Each one of us can select what kind of food we get. So no, look, there's always going to be some unscrupulous somebody. There's always going to be crooks. But to design a whole industry, because there might be a few bad apples, to design it around the bad apples is a mistake. Don't root out the bad apples. Don't the insurance companies inflate the cost of health care, though, for profit. I mean, isn't that the point in America that the cost of treatment and the cost of medication is just inflationary? No, what inflates the health care cost in the United States is Medicare and Medicaid, which is like the NHS, is zero cost at the point of service. That's what inflates the cost of health care in the United States. And look, in spite of the fact that health care costs are very high in the United States, 70% of all medical innovations happen in the United States. That's not an accident. It's because a segment of the U.S. health care system is still private. But the principle here is don't we want to give consumers choice? Don't we want to give doctors and medical practitioners the ability to be innovative, to use their ingenuity, to think for themselves, to provide alternative services, to compete with one another so that we can get the best life-saving treatments possible. But if, God forbid, you're having a coronary incident in your living room, the first thing the paramedics going to say to you is show me your credit card. First of all, that doesn't happen. That doesn't happen. It doesn't happen in the U.S. It doesn't happen in the U.S. You get the bill at the end of it, though, don't you? Sure, you get the bill at the end of it, but the insurance company gets the bill. And the beauty is that properly constructed insurance markets, true markets, not the kind we have in the United States that are heavily regulated and controlled and put into these one-size-fit-all kind of models, but true insurance companies are cheap. They're not expensive. And if you're worried about the very poor, then subsidize them. Give them a voucher that allows them to buy a health insurance policy that provides them with all those basic coverages. And so when the medic walks in, he knows that you have insurance. He takes you to the hospital. They take their card. Everybody has one of those cards. And they give you the best treatment they possibly can. Why? Because they're trying to make money. And the fact is that when you go to any kind of business today, you get treated well. Why? Because the company that's treating you is trying to make money. It doesn't work to treat your customers badly. That's not a profitable way to service your customers. Sarah Jane Palmer, a former nurse. You've written hundreds of articles for publications in the medical field. What's your view? Is it time to think the unthinkable and privatize the NHS? I think that it would be an absolute travesty to privatize the NHS, if I'm honest. I think there's been a slow development since the Health and Social Care Act in 2012 of different services being sent to private companies rather than being managed under the NHS. And I feel that this slow growth of private companies taking over parts of the NHS has done a real disservice to the NHS and we need to be able to concentrate on building up the NHS and rethinking the funding that we have and with policy being changed, hopefully we could manage the current situation and improve it. But if it was commercialized, then we'd just see the disparity between different socioeconomic groups just widening. It would widen and as Jaron was saying, you know, I disagree, like you're saying that the poorest people can be subsidized with a basic voucher, but often the poorest people are the ones with the most complex conditions. So really, it wouldn't be enough to give them the cheapest policy anyway. So I think it would be a real societal problem. However, I mean, it started, didn't it, in the 80s, under thatcher and it carried on under Blair in the 90s, which is allowing cleaning companies, for example, to competitively tender for cleaning services and what they would say to, you know, a particular cleaning company would say to a hospital group is we will clean your hospitals and we will guarantee a certain standard of hygiene and we'll do it for half the price that the NHS is doing it. Surely that's positive and don't you want to expand that into other parts of health care? Well, you'd think that was positive, but it's less money and also accountability. I have to say, I was there and they bid very low and then provided a really dreadful service and in fact all the way through. It's not the fault of the contract. The contract should state that you must achieve these standards. Absolutely right, but I mean, they did things like, for example, saying we clean the walls once a week and then what happened was if someone had a nasty spillage on the walls, oh no, we don't come round until later and then they had to pay people extra to go in to do the additional cleaning. It didn't work very well and I agree with you, it's the way the contracts are written and monitored and the fact that they went for the cheapest rather than the best, most cost efficient. The worry I have about these sort of red in tooth and claw American style system is it's massively expensive and in fact it produces poorer outcomes. They have much poorer maternal mortality, neonatal mortality and so on, right across the board. They are one of the poorer performing health systems. I understand the cost to the U.S. taxpayer is double of a U.K. taxpayer in terms of health care provision. That's true. If you have cancer, you're much likelihood of survival is much higher in the United States than it is in Great Britain. If you have heart disease, your probability of survival is much higher in the United States. Then when you take into account the fact that the United States has a large population of people who treat themselves badly, obesity and bad habits and all of that, when you take all of that into account, outcomes in the United States are not worse than they are here and yes, we pay a lot of money to take care of myself. It's nobody's business. That's the beauty of a private health care system. Why is it your business how much I spend on health care? When you socialize things, yes, I care about how much you spend because I'm paying for it. Sarah Jane, I mean, is the NHS fit for purpose in its current setup? Well, I think at the moment it's really struggling and I think the waiting lists are really far too long and obviously a lot of operations are having to be sent to private companies anyway to deal with and I just, yeah, I think it's not managing well at the moment at all and if it carried on like this I can see why there'd be an argument to privatize it but ultimately I don't agree that that is a fair system that should be introduced and I think it would introduce a lot of societal problems. Isn't the issue though notwithstanding your concerns about the poorest in our society which I share, it's a question of accountability, isn't it, that at the moment the health provision is provided by the state and the accountability just isn't there and with the profit motive you always get accountability. So you're thinking as in there'd be public health behaviors improving. Or potentially but also if the provision of healthcare was done by the private sector they would have to demonstrate their performance. That's true but still it doesn't benefit everyone. They could say we've done this many scans this year, we've done this many heart operations and we did it at this price. They can meet targets and but the thing is is that prices will rise and there'll be a lot of different contractors all competing with each other and prices will rise further and the disparities will grow between socio-economic the competition not bring the prices down. I don't know. I mean what one thing I want to ask you is I mean you've been at the cold face as the good doctor is here as well as a nurse. What's it like working in the NHS at the moment? It can be pretty terrible. It can be very understaffed and you find that often the situation is that because you're so understaffed you end up with private agency workers who are doing the same job as you but for a much higher rate of pay then working with you on the ward and that seems unfair but it's also not very safe because they're not used to the ward or the patients or that speciality. So it's not functioning well in terms of that and then you've also got a lot of patients and relatives who are very frustrated by constant cancellations of operations and delays in various of their healthcare needs. I mean do you think money is the answer because many of my viewers are exasperated by how much the NHS already spends? Well I think it's how they use the funding is the most important thing and that the commissioning of the different services really needs to be thought about in a different way and expo panels need to be got together to really discuss how to manage the NHS better. I think the current management of the NHS is just not fit for purpose in the way that they... Yeah you're on many would argue that the NHS is the envy of the world because whatever happens to you as a citizen in this country you receive free medical treatment at the point of need and you also have this sort of singular unitary body which actually commissions you know the healthcare and the cleaning services employs the staff it's very coherent it's just one monolithic structure It's one monolithic structure when and as a consequence you get very mediocre and often very poor very poor outcomes and you... It's got great great buying power though I mean you know about big business you stand in line it's a very powerful customer of the NHS it is but imagine imagine if the United States became like the NHS and we started paying the same drug prices as you do because we were a big customer drug companies would not make any money there would be no new innovation in drugs so what happens today the fact of reality is today that the United States because we pay higher prices and drugs are subsidizing the entire research and development of new drugs in the entire world because you are using size in order to drive with down prices it's not always good to drive down prices profit gets reinvested into innovation into new products into better services yeah and I think fires are certainly aren't going to be going hungry anytime soon let's hope they continue with their research and development very briefly from all of you starting with you we should thank them for the for the vaccines right well I guess we should definitely definitely I mean absolutely two right as long as it's personal choice to have it yes you're on very briefly and all of you with the clock against us first starting with you you're on what is your prescription for the British health service well I'd say for any health service it is to privatize as much as possible and I think as much as possible is close to a hundred percent how about you Sarah Jane your prescription for the NHS if you were health secretary if I were health secretary secretary I would say that policy needs to rethink expert panels need to get together funding needs to be reorganized commissioning needs to be changed and I think we need to bring back some of the private services we've currently got with other contractors back to the NHS and so the NHS can work as one big system you're out of the NHS now are you going to go back into it at all I might do I'm thinking about it yeah well look our our gain is their loss and it was great to have you on the show tonight thank you so much as with the good doctor as well very briefly do you not think that the public need to meet the NHS halfway and take more responsibility for our own well being because you do wonder whether the national health service has become the national sickness service and we're just treating at great expense self-inflicted lifestyle related conditions absolutely health is not something that's done to you health is something you do with our help and so unless we take that as you it's not going to work it's not sustainable at the moment is it it isn't but what I don't want is to be in a situation like in the States where you can go bankrupt because of your health bills what is your prescription for the NHS then as a top GP I mean my feeling as a mixed economy is fine why not have some private providers properly monitored and contracted and so on to increase capacity because we desperately need that but ultimately you can't do any of this without actually paying sufficient to run the service Julian Sphinx thank you so much for joining us many thanks to Dr Julian Sphinx who's been involved in NHS clinical management and medical politics for 25 years top GP also my thanks to a former nurse Sarah Jane Palmer and the very popular online US talk show host he's an absolute what can I say wordsmith I could listen to him for hours even if we don't agree and I'm delighted to say that Yaron returns to GB News on Sunday night for an appearance on free speech nation can't wait for that what do you think is it time to think the unthinkable and privatize the NHS what has your experience been of health services in the last few months mark at GB News