[Politics] The NHS and funding

Giraffe · Oct 31, 2019

I recently attended A&E at Worthing Hospital, the short summary was that I sliced the top of my thumb off with a pair of secateurs. I am an idiot.

Anyway, the care I received was fantastic. Yes I had to wait but there were a lot of people with a more pressing need than mine.

However I came away after spending a good deal of time with a nurse all sorted, cleaned up and hopefully the thumb will be okay. I had no complaints whatsoever.

But it made me think, should I have paid for my treatment? Me being there was entirely my own fault and a quick glance round the very packed A&E department suggested at least half the people were there due to various forms of self inflicted pain, either through drugs or alcohol or gardening incidents like mine.

Had they said, well look this is your own fault, you are a nob end, this will cost you £100, I would have paid. Yes I pay my taxes, but I earn well and could afford it. Instead I have lobbed this amount into the hospital charity fund, but it made me think what would be wrong with charging a nominal sum for visits like this? We are so precious about our free NHS but the reality is there is a lot of self inflicted stuff going into the system through people not looking after themselves, being a clumsy idiot like me etc.

Should we have to pay if it's our fault? Should we start charging £10 for a doctors appointment. If it meant I could see mine on the day I wanted I'd pay for that. I'm sure others would as well.

I expect this thread will be bombarded with resistance but I genuinely think there is a large amount of people who could and would pay for such a treatment, especially if it improved the NHS as a result. Clearly I would not expect anyone on benefits to pay these amounts.

Bakero · Oct 31, 2019

Bakero · Oct 31, 2019

The introduction of fees would be a slippery slope. Aside from that, how would you judge who was at fault? How much would it cost to administrate?

ps. Fair play for making the donation.

Ernest · Oct 31, 2019

You pay for the NHS through tax and NI so it's not free, just free at point of use

Dick Swiveller · Oct 31, 2019

Giraffe said:
Should we start charging £10 for a doctors appointment. If it meant I could see mine on the day I wanted I'd pay for that. I'm sure others would as well.

Spoken like a true Tory. Have money = jump the queue. Don't have money = get sick.

Bakero · Oct 31, 2019

What's prompted the recent spate of 'we should pay for the NHS' posts? Russian bot propaganda?

LamieRobertson · Oct 31, 2019

If the OP feels that bad i am more than happy to relieve him of some cash ....in the meantime best of luck with your thumb which wasn’t as stupid as sticking some fingers under a mower deck with the metal blade spinning round...now that is daft..i mean what idiot would do that :moo:

vegster · Oct 31, 2019

Giraffe said:
I recently attended A&E at Worthing Hospital, the short summary was that I sliced the top of my thumb off with a pair of secateurs. I am an idiot.

Anyway, the care I received was fantastic. Yes I had to wait but there were a lot of people with a more pressing need than mine.

However I came away after spending a good deal of time with a nurse all sorted, cleaned up and hopefully the thumb will be okay. I had no complaints whatsoever.

But it made me think, should I have paid for my treatment? Me being there was entirely my own fault and a quick glance round the very packed A&E department suggested at least half the people were there due to various forms of self inflicted pain, either through drugs or alcohol or gardening incidents like mine.

Had they said, well look this is your own fault, you are a nob end, this will cost you £100, I would have paid. Yes I pay my taxes, but I earn well and could afford it. Instead I have lobbed this amount into the hospital charity fund, but it made me think what would be wrong with charging a nominal sum for visits like this? We are so precious about our free NHS but the reality is there is a lot of self inflicted stuff going into the system through people not looking after themselves, being a clumsy idiot like me etc.

Should we have to pay if it's our fault? Should we start charging £10 for a doctors appointment. If it meant I could see mine on the day I wanted I'd pay for that. I'm sure others would as well.

I expect this thread will be bombarded with resistance but I genuinely think there is a large amount of people who could and would pay for such a treatment, especially if it improved the NHS as a result. Clearly I would not expect anyone on benefits to pay these amounts.

No, the NHS should not be dragged in to charging for services. How long before those with more cash say I'm not prepared to wait 2 hours to have a thumb stitched up when people with little or no money have injuries that require more urgent or complicated treatment ? then you end up with a triage nurse who has to complicate priorities based on medical AND financial circumstances.

I would like to see a small percentage of everyone's tax/NI contributions highlighted on everyone's pay slip as being the amount of money an individual contributes to the NHS monthly. Then I think we will all have a better sense of pride and feel part of the NHS.

Palacefinder General · Oct 31, 2019

Use Google instead. I was going to make a doc appointment for a painful ingrowing toenail, Googled it and the NHS website said it wasn’t something GPs want to be bothered with and that you can treat it yourself at home. You should have stuck the thumb top back on with sellotape and got on with your day. Too many people book unneeded GP (and A&E) appointments.

Bulldog · Oct 31, 2019

No, I fear there are people in this country that want the discussion turned to, should the user pay, and away from, the government should put more in

Tom Hark Preston Park · Oct 31, 2019

Giraffe said:
Should we start charging £10 for a doctors appointment. If it meant I could see mine on the day I wanted I'd pay for that. I'm sure others would as well.

I for one certainly wouldn't - for the simple reason that my NHS doctors practice already has that facility. Download the app from the app store, login with your patient details, and you can do all sorts of wizzy things, like book your own appointment slot (and get reminders sent to your phone), order your repeat prescriptions, view your medical records etc. It's a total transformation of what was there before.

Seems to me that if the NHS were to increase the speed of rollout of technogical advances, there would be significant savings to be made as well as much enhancing what Barber would call The Matchday Customer Experience

Thunder Bolt · Oct 31, 2019

This is overly simplistic ie. one accident and one visit.

When people get life changing conditions, which aren't necessarily fatal, then are you advocating them having to pay £10 for every visit? Maybe they have to go to two different hospitals within a week? Maybe they are taking seven different forms of medication?

Harry Wilson's tackle · Oct 31, 2019

Bakero said:
No.

And.....end of thread.

'Those who can pay should pay' sounds initially a bit like the old commie dictum of 'from each according to their ability and to each according to their need', except I think the OP is saying 'from each according to their level of culpability, regardless of their ability to pay'. That's what they do in the US, and the poor suffer shockingly. You may think that American Teeth means like Klopp but the average American mouth has far more decay and missing teeth than the average in the UK. And that's just one example.

And then there is the cost of administration, assessing culpability versus ability to pay, collecting the money, taking non-payers to court - it would cost more than it saves.....or you could simply leave the pissed up lad with the glassed face outside on the street if he's forgotten to bring his American Express card.

FFS :facepalm:

highflyer · Oct 31, 2019

Giraffe said:
I recently attended A&E at Worthing Hospital, the short summary was that I sliced the top of my thumb off with a pair of secateurs. I am an idiot.

Anyway, the care I received was fantastic. Yes I had to wait but there were a lot of people with a more pressing need than mine.

However I came away after spending a good deal of time with a nurse all sorted, cleaned up and hopefully the thumb will be okay. I had no complaints whatsoever.

But it made me think, should I have paid for my treatment? Me being there was entirely my own fault and a quick glance round the very packed A&E department suggested at least half the people were there due to various forms of self inflicted pain, either through drugs or alcohol or gardening incidents like mine.

Had they said, well look this is your own fault, you are a nob end, this will cost you £100, I would have paid. Yes I pay my taxes, but I earn well and could afford it. Instead I have lobbed this amount into the hospital charity fund, but it made me think what would be wrong with charging a nominal sum for visits like this? We are so precious about our free NHS but the reality is there is a lot of self inflicted stuff going into the system through people not looking after themselves, being a clumsy idiot like me etc.

Should we have to pay if it's our fault? Should we start charging £10 for a doctors appointment. If it meant I could see mine on the day I wanted I'd pay for that. I'm sure others would as well.

I expect this thread will be bombarded with resistance but I genuinely think there is a large amount of people who could and would pay for such a treatment, especially if it improved the NHS as a result. Clearly I would not expect anyone on benefits to pay these amounts.

There is an 'in principle' argument for paying for care if it is something you have brought on yourself and if you can afford to do so. Theoretically you could set up a health care system to do that. theoretically I have some sympathy with the idea.

However there are a few major problems in practice;

1. All the evidence says that, no matter what is done to avoid it, in practice any form of payment built into a health care system will result in poorer people being excluded. For lots of different reasons, but always happens.

2. Deciding what counts as 'self inflicted' and what doesn't is almost impossible. As an example, I do a particular activity that carries some risk of injury, but also ensures that I stay fit and thus reduces my overall chance of getting certain diseases (it isn't rugby, but for sake of argument it could be). I turn up at the hospital with a broken arm. My fault? But when someone else turns up with a problem caused by inactivity...is it their fault? You were gardening - an activity that involves some physical activity and also helps mental well-being (I am told). But carries secateur related risks. Should you be encouraged to do something that is, on average, preventative, or be punished when the activity bites you?

3. There is likely to be a very high cost of administration in terms of working out who can afford to pay, whether or not you 'qualify' for free treatment based on fault etc. In the end universality of service nearly always ends up more efficient and more effective (not excluding anyone that should receive the service). It is better to provide everyone with free service and use other approaches to ensuring that payment is on the basis of 'who can afford it' (aka progressive taxation).

All that said, and while I 100% support free universal health care, I do not think it is helpful to refuse any discussion on potential reform of the NHS. As most of these that work in it that I have met would agree - it can certainly be improved.

Harry Wilson's tackle · Oct 31, 2019

Bakero said:
What's prompted the recent spate of 'we should pay for the NHS' posts? Russian bot propaganda?

One of the Mods is a tory boy (I tried to block him but couldn't block a mod). Could be this one.

Anyway, the future of the nation is now up for grabs, and it is very important to the Russians that we vote the correct way.

LamieRobertson · Oct 31, 2019

Harry Wilson's tackle said:
One of the Mods is a tory boy (I tried to block him but couldn't block a mod). Could be this one.

Anyway, the future of the nation is now up for grabs, and it is very important to the Russians that we vote the correct way.

You tried to put him on ignore

Unbelievable

Eeyore · Oct 31, 2019

highflyer said:
There is an 'in principle' argument for paying for care if it is something you have brought on yourself and if you can afford to do so. Theoretically you could set up a health care system to do that. theoretically I have some sympathy with the idea.

However there are a few major problems in practice;

1. All the evidence says that, no matter what is done to avoid it, in practice any form of payment built into a health care system will result in poorer people being excluded. For lots of different reasons, but always happens.

2. Deciding what counts as 'self inflicted' and what doesn't is almost impossible. As an example, I do a particular activity that carries some risk of injury, but also ensures that I stay fit and thus reduces my overall chance of getting certain diseases (it isn't rugby, but for sake of argument it could be). I turn up at the hospital with a broken arm. My fault? But when someone else turns up with a problem caused by inactivity...is it their fault? You were gardening - an activity that involves some physical activity and also helps mental well-being (I am told). But carries secateur related risks. Should you be encouraged to do something that is, on average, preventative, or be punished when the activity bites you?

3. There is likely to be a very high cost of administration in terms of working out who can afford to pay, whether or not you 'qualify' for free treatment based on fault etc. In the end universality of service nearly always ends up more efficient and more effective (not excluding anyone that should receive the service). It is better to provide everyone with free service and use other approaches to ensuring that payment is on the basis of 'who can afford it' (aka progressive taxation).

All that said, and while I 100% support free universal health care, I do not think it is helpful to refuse any discussion on potential reform of the NHS. As most of these that work in it that I have met would agree - it can certainly be improved.

My violent instinct was to announce the thread as a party political broadcast for the new Tory right. However, you explain with great clarity a proper reasoning. Good points well made.

Tom Hark Preston Park · Oct 31, 2019

I know it's been discussed elsewhere but this is an NHS Funding thread so...

Charging for NHS missed appointments needs looking at. 17 MILLION a year?! Charge could be nominal but experience in other other areas of society show that consumer behaviour can be changed overnight just by minorly tweaking the system. Hence the massive fall in use of supermarket carrier bags by introduction of a tiddly little charge. Why NOT charge people a semi-nominal fee for missed appointments? Of course there would need to be a list of exceptions but IMHO these could easily be aligned with the list of exceptions on the back of a prescription form.

beorhthelm · Oct 31, 2019

Tom Hark said:
I know it's been discussed elsewhere but this is an NHS Funding thread so...

Charging for NHS missed appointments needs looking at. 17 MILLION a year?! Charge could be nominal but experience in other other areas of society show that consumer behaviour can be changed overnight just by minorly tweaking the system. Hence the massive fall in use of supermarket carrier bags by introduction of a tiddly little charge. Why NOT charge people a semi-nominal fee for missed appointments? Of course there would need to be a list of exceptions but IMHO these could easily be aligned with the list of exceptions on the back of a prescription form.

i believe the fall in bag use is more attributable to supermarkets not offering disposable bags at larger outlets. i frequently see people buying new "bags for life" though. certainly agree with principle that charges along with other taxes changes behaviour, just highlighting there needs to be a wider view of changes.
btw applying same exceptions as prescriptions would probably be pointless, only about 10% are fee paying.

Giraffe · Oct 31, 2019

highflyer said:
There is an 'in principle' argument for paying for care if it is something you have brought on yourself and if you can afford to do so. Theoretically you could set up a health care system to do that. theoretically I have some sympathy with the idea.

However there are a few major problems in practice;

1. All the evidence says that, no matter what is done to avoid it, in practice any form of payment built into a health care system will result in poorer people being excluded. For lots of different reasons, but always happens.

2. Deciding what counts as 'self inflicted' and what doesn't is almost impossible. As an example, I do a particular activity that carries some risk of injury, but also ensures that I stay fit and thus reduces my overall chance of getting certain diseases (it isn't rugby, but for sake of argument it could be). I turn up at the hospital with a broken arm. My fault? But when someone else turns up with a problem caused by inactivity...is it their fault? You were gardening - an activity that involves some physical activity and also helps mental well-being (I am told). But carries secateur related risks. Should you be encouraged to do something that is, on average, preventative, or be punished when the activity bites you?

3. There is likely to be a very high cost of administration in terms of working out who can afford to pay, whether or not you 'qualify' for free treatment based on fault etc. In the end universality of service nearly always ends up more efficient and more effective (not excluding anyone that should receive the service). It is better to provide everyone with free service and use other approaches to ensuring that payment is on the basis of 'who can afford it' (aka progressive taxation).

All that said, and while I 100% support free universal health care, I do not think it is helpful to refuse any discussion on potential reform of the NHS. As most of these that work in it that I have met would agree - it can certainly be improved.

All great points well made in a balanced fashion. I shall stand down my argument on this. As said in the original post I am an idiot.

Now please explain why there isn’t just one medical IT system with all your records on it that you can access on an app or a website. Now that would be great progress.

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