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To think the NHS would have a few more quid if...

(118 Posts)
DolomitesDonkey Wed 13-Feb-13 09:22:41

They had even half a handle on health tourism?

I left the UK to go abroad in 99. I'm back visiting and on Monday needed a doctor for conjunctivitis. I was seen without any verification of who I am, I was asked to provide a name, local address and home address. None were checked.

At the chemist I caused much hilarity when I asked how much it was or if a passport was ok as ID.

Oh, and the doctor asked if I wanted a prescription for paracetamol. confusedLike that's not available for 15p in tesco.

I am saddened by the whole thing. Being EU I'm entitled to reciprocal healthcare and I'd have been happy to pay and claim back later. But the whole thing was a fucking joke, ok my treatment was cheap - but that's 30 quid not in the budget of "your" child's treatment now.

slhilly Wed 13-Feb-13 15:05:40

Contrary to what people seem to think, the NHS doesn't spend a large proportion of its budget on health tourism, no-shows, managers, incompetent procurement or management consultants, or any of the typical list of bugbears of the right and left. The vast majority of the money goes on patient care. The NHS could save most money by treating people more effectively and specifically, keeping people with long term conditions well, and out of hospital, and then closing some hospitals down.

Hower, given that we can't even move from 10 to 7 children's heart hospital centres in this country without two decades of shroud-waving and outrage (all the while, ignoring the actual dead babies and children resulting from too many centres not seeing enough patients to provide care safely), any change is likely to be slow, noisy and painted as the death of the NHS. The only high-profile success there's been in changing care to work better in recent memory is the change to stroke services in London, saving 400 lives a year, providing miles better care for patients, and being lots cheaper.

Re procurement in particular - the main problem is that the rules for public sector procurement are completely counter-productive. They're designed to provide best value but they deliver the opposite, by making the process mechanistic, inflexible and focused on the wrong things. Procurement has gone back and forth between being centralised and localised, and has never been great at either end. But the main costs of the NHS are the staff and the buildings, and those aren't set via procurement but by negotiation with the unions and PFI rules.

Salbertina Wed 13-Feb-13 15:34:52

Slhilly - completely agree, people get too emotional and too local-centric about nhs care. My story was just anecdotal about totally different health system where health is "valued" by the patient user simply * because* one has to pay -so much--

5alive4life Wed 13-Feb-13 15:52:06

yes it is a big problem.
having lived in canada and the UK i can tell you that only residents in canada get treated for free at hospitals. everyone who is entitled to free healthcare has one with their name,dob,photo etc on it (like a drivers liscense) these expire every few years and need to be renewed. no card then they bill you for your treatmeant,simple.

Nancy66 Wed 13-Feb-13 16:00:41

I know somebody who had a baby on the NHS - when she was not entitled to free treatment.

She was, however, perfectly willing to pay. She gave her details but never received an invoice. She even chased it up and still never received an invoice. The child is 7 now.

ReallyTired Wed 13-Feb-13 16:01:16

I think a major issue in the NHS is non win no fee lawyers. People are now able to sue over the most trival things without risk to themselves. I feel that a return to crown immunity would be a big mistake, but there needs to be a cheaper way of sorting out legal disputes over NHS mistakes. A the moment the only winners are the lawyers.

It is understandable that people want local-centric care. Infact in some circumstances local-centric care is more efficent and gives better outcomes. Ie. this scheme where GPs could perform simple ENT procedures.

Encouraging home births in low risk women is also a situation were local centric care is cheaper on average. Good local centric care like care in the community for mental health and the elderly keeps costs down and improves life for many people.

Operations are rare events in most people's lives. Having big units for heart surgery improves outcomes. I am not sure that large units improve patient outcomes for every area of medicine.

CarlingBlackMabel Wed 13-Feb-13 16:10:32

A&E is free, no-strings, becauser that is the humane way to treat people. (Unlike the footage I saw from the aftermath of Hurricane Katrina where a hospital ward full of elderley patients was being evacuated and only those with private health insurance made it onto the helicopter. The rest stayed on the roof of an unstable building in a lashing storm.)

But if you are admitted or need follow up treatment then they do do checks on your eligibility and charge you..

I have stood in the x-ray department queue and watched the international patients fill out forms, be referred to this desk or that desk. I have also watched the patient x-ray reception staff deal with incredibly rude people demanding that they go to the front of the queue because they are paying and the resident NHS patients are not. The deal is, of course, that you get standard NHS treatment but your government or insurance pays the cost for that.

CarlingBlackMabel Wed 13-Feb-13 16:12:13

Nancy- I have seen Expats on MN talking about coming home to have the baby on the NHS. Eligibility is down to living here and / or working here. I think there is some mis-use.

BraveLilBear Wed 13-Feb-13 16:30:08

To the original OP - while I may not agree with a blanket ban on EU treatment on the NHS, I'd say that on the whole, YANBU

Yes, there should be free treatment to anyone who needs it in case of accident or emergency. I don't care where you're from, it's a basic human right and something that we should be proud of in this country.

There is, however, room to tighten up people coming here for planned procedures, ie giving birth. I note that a key exception of the EHIC card is that it does not apply if you go somewhere planning to give birth, however I would be amazed if someone could categorically prove that women do not come here purely with an eye on taking advantage of some services - including, as CarlingBlackMabel reports, expats who would presumably be paying into a different country's healthcare 'pot' in one way or another.

As I am planning a holiday to Greece in the near future, I have been looking at EHIC coverage and tbh you can still expect a charge of up to 25% if you need anything major doing or there is a need for any 'major appliance' during treatment. I saw a feature on the BBC website not long back about Greek mothers being held to ransom by hospitals demanding payment for childbirth care - thousands of euros. The hospitals were refusing to let the baby go home with family in some cases until that was paid.

Would I want to see that here? Of course not. But if we had such a system in place, it might make people think more closely about their travel plans and cover.

rhinobaby Wed 13-Feb-13 16:44:50

Re the contraceptive pills and only needing one month but getting 3 - they come in packs of three, it is not allowed to split a 3 pack therefore is is the minimum she could have been given. See it as having a supply in for the next time she needs it thus saving a (£35 worth of ) GPs time

chocoluvva Wed 13-Feb-13 18:03:53

Ok smile GP not wasteful after all.

I'd still have paid for DD's mind.

Salbertina Wed 13-Feb-13 18:30:04

Yes had some South African friends happily brag about saving £1,000s by giving birth in UK before coming back here. In next breath slagging of nhs managers hmmbiscuit

slhilly Thu 14-Feb-13 15:00:42

ReallyTired, the idea is more and better local care for less complex stuff, and more concentrated and better care for more complex stuff. Take maternity -- the best mix is home births, birth centres for the straightforward cases, with riskier births happening in larger units that can provide consultant cover 24/7. There's no point in a risky hospital birth if you only see the knackered junior docs and not the consultant. But we're stuck at the moment with middling sized centres providing less than 24/7 consultant cover for risky births and overly interventionist care for low risk births. Because any change is labelled as "shutting down" and patients (or in this case parents and children) and politicians get on the streets.

ReallyTired Thu 14-Feb-13 16:33:02

slhilly, how far do you think its sensible for a woman in labour to travel?

Giving birth is not a totally planned proceedure. Some women do give birth very fast. I think with labour units there needs to be a balance between accessiblity and size. I am so relieved that my second child was born at home as we would have never made the hospital.

Maybe technology can be used to support middling size birthing centres so that the consultant can advise the junior doctor or the home birth midwife.

It would be lovely if consutants could use robodoc to save elderly patients long journeys. Prehaps Robodoc could be in a GP surgery to allow remote consultations.

slhilly Thu 14-Feb-13 18:53:37

Travel time is an important factor. But it's not the only one. Stroke patients are routinely now driven straight past the local A&E and taken to a stroke unit in London. The travel time is longer, but the greater expertise saves lives. The same applies for risky births that require consultant oversight.

Technology can help, for sure, but it's going to be a looong while before it make enough of a difference to allow a middling sized unit provide the same level of care as a large unit with continuous consultant cover.

dollyindub Thu 14-Feb-13 23:24:39

I'm a UK citizen living in Ireland. Every time I go to the GP it costs me €60, the same for my baby shock
I have an arthritic condition, the meds for which cost me €144 per month (the prescription charge) without which I couldn't look after my baby, work or generally function.
Also, if you are unfortunate enough to end up in A&E, they charge you €100 before they'll even look at you...
And I used to moan about the NHS!

Kaida Fri 15-Feb-13 07:25:06

What you're saying makes sense slhilly. I don't understand why there isn't more support for home births - women report less pain and greater satisfaction, outcomes are just as good and it's cheaper. But women are routinely told they can't have one if the ward is busy. I do query though in your model, what happens if complications arise in a previously low risk pregnancy whilst giving birth in a birth centre or at home?

slhilly Fri 15-Feb-13 10:42:37

Kaida, there are two schools of thought on this:
- school 1 says that most complications are not actually that complicated, and that you simply transfer, and that's why you have two midwives in the first place
- school 2 says that the inherent risks are too high and that birth centres should always be co-located with obstetrics wards, and home births should be very carefully risk assessed, for precisely that reason
Whichever school you tend towards, this is still a significant step away from the typical UK model of birth. I tend a bit towards model 1 - my DS was born in colocated birth centre and my DD was born at home two years later, plus I think that the experience is so much better for most women that it's not worth restricting access even though that would probably save a few lives a year.

ReallyTired Fri 15-Feb-13 10:44:56

I think that the hope is that complications are picked up a lot faster with a homebirth. Some parts of the country are more supportive of homebirths than other. I found it quite easy to get a homebirth, but I know other people aren't so lucky. In our area the homebirth midwives are all community midwives. No one is taken off the ward to attend to a home birth. They have arrangements that if more than two people are giving birth at home in my town then they get a community midwife from the neighbouring twon to attend to the third woman.

Most complications in a homebirth are picked up faster as the woman has one to one care from an experienced midwife. Stastically a homebirth is as safe as a hospital birth for mothers who have given birth without complications before. Risks like a prolapsed cord are minimised as you have to have the baby in a good position to be allowed a homebirth. Midwives are trained in resussitation and what to do if the woman herrenages.

I can't see any real advantage of a stand alone birth centre over being at home. It seems to be the worse of all worlds. Our local hospital has two maternity units next door to each other. If a woman in the birthing centre has complications or wants an epidural then she is taken up to the consultant led unit in a lift.

slhilly I can see how your model would work in London or any other big city, but many areas of the country are nowhere near as heavily populated.

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