Sajid Javid states patients should pay a fee for GPs and A&E visits

[MushMonster]

Just woke up this morning to this

www.google.com/amp/s/amp.theguardian.com/politics/2023/jan/20/sajid-javid-calls-for-patients-to-pay-for-gp-and-ae-visits

I so wish we could get early elections.
I had more than enough of this lot!
They will use the strikes to push in policies like this before we can chuck them out, following Thatcher's model to the letter.

You clearly struggle to follow the basic point I'm making, which is that you can't both cut taxes and improve services. It's not up to me to say what, if any, cuts should have been made but I'm not running the country and therefore don't have at my disposal all the economic information. What I object to is Governments lying to people that somehow they can have both. And what annoys me is that people believe them.

Just because you are happy for people to pay CGT and IHT is besides the point as I'm not just writing for you.

I'm implying that the result of your way of thinking is that public services will be cut. I don't know how you square that with yourself but that's just economics.

So what is it then?

Paying for the nhs via deduction from salary (but only for other people to use)
Then paying again at point of use.

How is that not double paying?

I don’t agree with Javid
But I do think those who are in hospital long term should pay for their food.
I know this is controversial and lots of you will disagree but if you’re in hospital you’re not buying food for yourself. My MIL saved masses of money every time she went into hospital

It could help in some way with a vastly underfunded nhs.

Does anyone else have ideas on how to get more funding. Not including raising taxes as that’s an obvious one.

Well I have auto immune diseases and am always at the GP. You can't go by prescriptions because two of my conditions would lead to serious disability and/or death without meds but I have to pay.

I do get PIP but we are middle earners but after our rent (which keeps increasing) and all other bills we don't have much disposable left. If I had to pay then I would definitely not go to the GP unless it was urgent. Who is going to pay for smears or similar so the rates for those will drop off a cliff. If people are paying they will also demand value for money so no 5 min appointments.

It also doesn't fix the issue that we cannot get staff. I work for NHS and we cannot fill posts. A local GP surgery closed as three GPs all retired at same time and they couldn't replace them.

Clearly

That makes two of us then!

Wages have not dropped 50% in real terms since then but the basic rate of tax has dropped from 33% to 20%.

But as I said you can't look at those things in isolation. What has VAT done for example. Why do you think poorer households are now worse off? Our tax system isn't particularly progressive.

I'm sorry but you are deluded if you think holding the basic rate of tax down was going to save the NHS.

Will they die though? When I lived in Ireland, there was a €50 per GP appointment. I didn't see droves of people dying because they couldn't afford to see the GP.

You clearly struggle to follow the basic point I'm making, which is that you can't both cut taxes and improve services

No you are misunderstanding my point. Im sorry, I don't think it's confusing but perhaps I'm not explaining it well.

You cant improve services with little investment & an ageing population when that service is "free" to so many.

You can't increase taxes in a low productivity economy that has little wage growth, high costs & bad public services.

I'm implying that the result of your way of thinking is that public services will be cut.

Im saying that increasing the basic rate of tax won't save the NHS.

So we will have to agree to disagree.

@MichelleScarn it’s how all systems work in Europe. We all pay a base level to maintain the service and then this will reflect our service use. We need to get away from this idea of double paying - we don’t pay enough tax to support the service we want so we either pay (significantly) more tax or start to pay at delivery.

This will have the double use of generating more money and reducing abuse of the service which is taken for granted.

As a Pp said if other countries can do it so can we.

With the obvious caveat of support for those that can’t pay.

Like the appointment that I missed last week because the letter didn't come until the day after?

@EarthPunchingBack I agree the European systems are far better but I don't see how you switch to that system from the current one.

If you’re in hospital long term you don’t get much money. DM has been on an NHS unit since May slowly dying of dementia - she’s under 60 so no pension, only gets ESA - nothing else at all . PIP was stopped within 4 weeks of admission .

No house to sell, no savings . Her ESA is used to pay for toiletries, snacks, clothing (as she’s constantly losing weight) . Asking us to start paying for her dinner too would be ludicrous. She can’t be discharged as there are - understandably - very, very few care homes in the country that can take a 57 year old with a very rare form of dementia and extremely complex medical/social history .

It’s the same for most people in hospital long term, they’re either very old or very ill, or psychiatric care - very few people are long term patients raking in cash . If you charge them for food most people will come out penniless - and likely end up straight back in hospital again.

@EarthPunchingBack what's the level of 'can't pay' though? Anyone who earns anything at all are they seen as can pay?

If it's not us, then who's going to pay for it then?

Jamie Oliver has tried this with improving healthy evening. He practically became public enemy number one. People who it's aimed at think it's patronising and say they can't afford fresh ingredients.

We lost a lot of our overseas doctors to Brexit. When I was last visiting people in hospital there were a lot of overseas doctors but I think a lot have probably gone back now. We need to train our own doctors but our wonderful government would rather award over priced contracts to their mates than fund medical training places

totally agree with funding more social care but that's definitely been an issue since the 90s at least and no one ever seems to resolve it. I think it's because it's an easy thing to cut to 'save money' until the knock on effects arise. Successive governments are short termist and don't plan for the future.

yes we can cut waste but this is a perennial issue and doesn't address the problem of underfunding

I agree about the number of managers but that's also something that never seems to be resolved either.

*eating not evening

@MichelleScarn no idea but other countries work this stuff out so I guess we need to do some research and work some stuff out. Refusing to accept we need to start paying isn’t the answer though - there is so much that could be done differently.

@Tremblingtigers

i think most GP practices are triaging now by phone or E consult. It’s really really unpopular with the general population though- it’s the reason people think GPs aren’t doing any work although GP consultations have gone up compared to pre pandemic- and very hard to do safely and correctly, and something the current GP cohort has not been trained to do as it wasn’t the model in use when they qualified (nor are they training us current trainees either which is bizarre but the royal college is part of the problem imo)

Algorithm based triage is what 111 do and it is utterly useless, it really is. Maybe better algorithms exist but I’m not sure that they can ever truly weed out the time wasters from the sick. So much of seeing if a person is truly sick comes from a second sense that is hard to quantify and even harder to do over the phone and even harder than that to put in an algorithm. It’s a really hard balance between discouraging time wasters but not discouraging those who need to be seen. Better basic health education of the population would really help.

I feel a lot of it comes from fear of litigation And risk avoidance. Slightly off topic but ambulance call outs for elderly falls. Carers won’t help up those who have fallen because they are worried if they do it and the person has a neck fracture they will be sued. So the person waits on the floor in the cold and gets muscle damage and kidney failure waiting for the ambulance which then has to wait to drop them off in a and e and can’t go and help a person with a heart attack and then even if they do have a neck fracture because their frail they are not able to have surgery so it’s just left and then they need a hospital bed for a week to deal with the kidney failure and the. another ambulance to get them home again.

this isn’t me blaming the carers - I was a care assistant to pay for medical school - no way am I making the call if a person is able to be helped up for minimum wage knowing the family and my employer will put all the blame on me if something goes wrong.

and since this has turned into a rant - why can’t people get old and die anymore. We don’t live forever and at a certain point the body gives out. Medicine can’t fix this but we spend so much time prolonging the death of people and making them suffer.
So many families who are angry and upset when I broach the subject that their 98year old relative is in the last few years of their life - but of course they are most people don’t make it to 98!. Families who want all the investigations to know WHY their 98yr old relative is struggling to walk or is more tired - because they are old! Families who after being told their 98yr old relative had a terminal illness complain about a DNACPR order because they want them to have “a chance”, a chance for what I want to say, a chance to die again in a few hours or days because they have a terminal illness. Dying is probably shit (I haven’t done it but it looks like it is) so why oh why would you want someone you love to die more than once? Until we accept that life is a terminal condition we will continue to have a care crisis…..

We already have more over 65s than u15s & in a decade this will increase.
Life expectancy has reduced & healthy life expectancy is around the early 60s & yet state pension age will be 68 or higher for many. Plus more older people will be renting then before & more older people now live alone.

And yet people still voted for Brexit

no idea but other countries work this stuff out so I guess we need to do some research and work some stuff out

I don't believe most older people will vote for paying more for their care though.

At the point of mum being diagnosed with dementia, when I was her full time carer, her GP was ringing me twice daily 3 times a week (ie morning and night every time she was on shift) for 2 weeks in a row - I wouldn’t have been able to afford to pay for that at all (£120 a week if £20 a time?) but equally if she hadn’t done that we’d almost certainly both be dead, those phone calls were the only thing keeping me from going through with what I wanted to do.

I dread to think in reality how much we’ve cost the NHS as a family but if it wasn’t for my mum’s GP providing that level of support, no waiting list, no questions asked and no fee charged, I’d have gone through with what I at the time wanted to do.

There’s no real equivalent service that can provide that level of support in the same way - we’d need to completely reform social care and social services too if we were going to remove free at the point of use access to GPs .

We've all seen what (nearly) 13 years of Tory rule has done to dentistry, for many people they either pay for private care or suffer.
Introducing charges to see GPs would quickly descend into something similar. You either pay a small set fee for an NHS funded treatment, or a larger amount for a private one, you'll see the same practitioners, in the same surgery.
As a business (as are pretty well all GP practices) they will want to have more private patients than NHS patents as they are more profitable. Once the genie is out of the bottle, we will soon see a situation in GPs as we already see with Dentists. The Tories will love it.

Re. Staffing
There are plenty of students wanting to study medicine
I dont know about nurses
But for Med students there are 9500 places / yr at Uni
The Medical Schools Council recommends there should be 14500 places / year.
No one is listening ( labour says they’ll raise numbers by 7500 / yr )

My son is on a year out to get a place ( although this could be due to 20/21 grades ). He took exams 2022.

£5 isn't a nominal amount for some people.

And if you have a chronic health condition or a persistent bout of illness for a while those £5 add up.

For example I have a long term health condition. This month I've needed to attend 2 routine doctors appointments, 1 nurse appointment for bloods, and a hospital appointment. I then had a second nurse appointment for an steroid injection. I have a follow up doctors appointment due in two weeks. Last month I had two doctors appointments for a persistent chest infection requiring two different antibiotics- I'm more susceptible to infections due to the above chronic health condition and it's associated medication.

So due to a health condition that I have, due to no fault of my own, that would have cost me £35 on top of the parking charges and the prescription fee.

Luckily this isn't a usual amount of times for me and it's normally only 1-2 appointments every three months.

But for some people with chronic health conditions it could be an awful lot of money they'd have to pay out!

The issue is that we shouldn't have cut taxes in the good years. We haven't always been a low growth economy in the last forty years. If you don't increase taxes then the services will continue to be poor.

It's exactly my point that you can't improve services with little investment and that requires higher taxes.

I'm saying that increasing the basic rate of tax, even by a couple of per cent would undoubtedly bring in more revenue, which would help the NHS. The Government could also bring in other measures to help lower earners, like increasing minimum wage but they don't want to do that as they don't want to upset their corporate colleagues.

They've helped to produce a lower growth economy by bringing in Brexit, which is the economic disaster that most economists said it would be.

But yes, we'll agree to disagree, and I'm sure we'll continue to vote for a Tory party that will give you both your lower taxes and appalling public services.

All this means is the Squeezed Middle would be paying for it. I’m sick of being squeezed. The last budget hammered the middle earners the most. When do we stop being squeezed?

The USA, Australia, and around 6-7 other countries all spend more in health than we do. Also , real terms spending on health has dropped, because it doesn't take account of inflation. Also, the BMA has recently said that less is spent on health than was actually promised in 2019. Nobody has refuted it.

Jarvis has a nerve to suggest it, when so many Tory MPs are really rich and £75 is small change, not to mention Zahawi and his tax dodging and the financial shenanigans of the likes of Boris Johnson.

Once people start to pay it will be the thin end of the wedge. No doubt about it. I'm old enough to remember when prescription charges were relatively tiny, pennies, and dentists going private was not going to prevent access to free dental care for all. Look what happened. There is no access to free dentistry at all within 30 miles of where I live.

And those were times when the government was far less daring.