What should the NHS not fund?

[Username721]

Saw a thread on IVF for lesbians and some people felt that IVF should not be for anyone on the NHS. So it got me thinking.

Is there anything you feel should be exclusively private treatment? The ones often debated are things like weight loss surgery, cosmetic procedures, treatment for avoidable illness such as smoking-induced ones, liver failure through alcohol abuse, drug rehabilitation…

Thoughts?

Also a blunt instrument. I had to have a hysterectomy including ovary removal, which put me in medical menopause. Do I not deserve hrt?

Honestly, the pay packets of a lot of doctors. So many people go their whole lives suffering with things that could be simply resolved but they never get the correct diagnosis due to incompetence or just human error. Yes if you've got something obvious like a broken leg or a massive tumour they can see it but let's be honest technology is rapidly catching up and I believe in many cases we'd be better off with AI replacing a lot of doctors. For a few more years there'll be still room for some of them but it's quickly diminishing. It's the arrogance of the upper middle classes that will hold us back in this way.

For the rime being, I think the idea of the government stopping fertility treatment is hilarious given there's virtually no one being born in the UK. I'm sure that despite this government's contempt for the masses, they'd actually like to have masses to push around.

The defence budget is a form of life insurance and everyone in Europe has an insurable interest.

By the way £77k x 400,000 is £31bn so I don’t think that’s going to happen somehow. Blame the drug companies not the Govt.

Also, we need to stop funding as much reliance as we have on drugs and certain treatments that actually do more harm long term. 'First, do no harm' were words written literally thousands of years ago and yet there are millions of people with autoimmune disorders caused by being needlessly given antibiotics as a child. Antibiotics are fantastic- if you have a life threatening infection and would die otherwise. The rest of the time they simply trigger an inflammatory process that destroys your body and any chances of it working normally.

There is very little that I think should never be funded - but treatment should be scientifically proven to be beneficial and value for money - so that rules out gender reassignment surgery. lt is also true that people having breasts removed compete for resources with cancer treatment and breast reduction for physical health reasons. The NHS should also refuse to pay for puberty blockers unless there are extremely compelling reasons to do so. IVF should be age related, so that those with more chance of success get more attempts.

We should stop aggressively treating people who are dying in pain and if they wish to have assisted dying allow it. BUT - more controversial - we also need to stop aggressively keeping very premature babies alive if their quality of life will be poor. The viable age keeps getting pushed back without sufficient consideration of what quality of life they will have.

AI would have been precious little use during the pandemic, I think we'll need human doctors for a good while yet. But it could be used more for history taking and ensuring the right questions are asked to get a good diagnosis. .

Gender reassignment surgery
Cosmetic surgery for aesthetic reasons
IVF over 40
Automatic free prescriptions for over 60s.
Actually, free prescriptions at all and I think the prescription charge should then be lowered to a nominal amount for all, say £3 which would reduce the amount of prescriptions given out for things like paracetamol. Actually again, no prescriptions for things that are easily available over the counter such as paracetamol, anti histamines etc.

National consistency is actually a really bad idea. The needs of people in different areas can be quite different.

In NI there are more shootings than the rest of the UK (even now a quarter of a decade since the GFA) it makes sense to have specialists in gunshots there and not elsewhere.

There would be no point having a specialist in ski injuries unit in London because there are no ski slopes.

IVF, I struggle with this, from a purely financial POV the NHS should not have any IVF services because the best outcome, a healthy baby will cost the NHS as s/he grows up.

On the other hand I understand how devastating it can be to want a child and not be able to have one.

So I think IVF for lesbians should be funded if it is funded for other women.

It's very difficult to say 'you caused that' when it comes to some chronic illnesses, there are reasons people abuse alcohol and drugs.

If your family were murdered at Lockerbie how would you react?

www.theguardian.com/uk/2000/aug/27/lockerbie.ameliahill

the biggest drain is the ageing population & social care costs which have a knock on effect but i'm not sure how we fix that. I would scrap free prescriptions & means test them for older people.

Quite.

Yep. I've been prescribed paracetamol once in my entire life, and that was when I had covid triggered trigeminal neuralgia, so was having to take it religiously every 4 hours along with an anti-inflammatory, just to do anything beyond lying down in a darkened room. There was no way I was going to make it to the shops every few days to buy more.

I've also got arthritis, and have to take ibuprofen on a similar schedule to your paracetamol usage, and my surgery still won't prescribe it for me. That means I have to buy the high strength tablets (which are a lot more expensive) when I'm able to get to a proper chemist, AND get the standard 2 packs of 200mg tablets with my weekly shopping delivery AND use ibuprofen gel on the area that's hurting worst when I'm running low on tablets. Like you I've often thought that if the NHS won't prescribe them, then we need to have some kind of scheme that allows an override on the purchase limits for patients that are registered as needing them more often.

It's really horrible reading the lack of compassion or sympathy from some posters for anything they or their family aren't suffering from.

It’s not incredibly small. IVF success rate is 32% for patients under 35. Should the NHS fund only life saving things? Lots of things the NHS does aren’t life saving (contraception, vasectomies, physio, a lot of gynae treatments, breast reconstruction after cancer, I could go on and on).

Trying to make any sort of judgement based on fault or desert is a dead end. What we should do less of is invasive and expensive treatment on people who are approaching their natural life expectancy.

All treatment should be taken on whether it's in the best interests of the patient but to consider their age versus expense is just age discrimination.

Yes it is, but not all discrimination is wrong. My grandmother was in her eighties when she died with advanced dementia and Parkinsons. Her quality of life was nil. Her last few years were a series of medical crises, each time requiring am ambulance from the nursing home to the hospital, immediate aggressive intervention, and a further decline in her mental and physical state. Why is that the default? In the end, the family had to instruct the hospital to stop treating her pneumonia and for God's sake just make her comfortable.

Taxes are already sky high on tobacco.

You’re proving my point exactly.. of course if it effects you, your mother, your grandmother, you feel the funding is essential. But because GRS is unlikely to effect you, people think it should be scrapped.

It is not up to us to decide who deserves healthcare.

I'm sorry for what your grandmother went through at the end of her life but that says more about how end of life care in the U.K. is managed horrifically and not that we should allow discrimination to seep into treatment.

It would mean that a very wealthy 80 year old could pay for treatment that is in their best interests that if they were poorer the NHS would say was not a worthwhile expense. I also don't think it backs up what your saying about not all discrimination is wrong, I think not treating the elderly purely because they're elderly is the thin end of the wedge. Of course if it's not actually going to improve their quality of life that's different and that's also a judgment that can be made for anyone at any time of their life.

Whilst many of the conditions listed within this thread are not necessarily life saving, they are life changing for many. It is not taking away from cancer patients as it is not the same department/same consultants/same funding. People that go through gender changing operations have to go through many years of psychiatric evaluations beforehand.

Where would the line be drawn as already mentioned someone dying of lung cancer, yet never smoked. It could be argued that many things people do are self inflicted. If we stopped doing anything that could be perceived as self inflicting then we would never leave the house.

@Toomanybooks22 you make a good point regarding the wealth disparity and that's a perspective I hadn't considered. I know what I'm trying to say around unnaturally prolonging life with multiple severe morbidities but I can't quite put it in a way that seems entirely fair.

If we got rid of it all, then people should pay for their own maternity care. You want to have a kid, you pay the ££££ is costs the NHS every time you want to have one. It’s not a right to have kids after all, and it’s self inflicted. So why not? No one ever wants to know when the argument is turned on its head!

Your argument doesn't have a leg to stand on. Because being pregnant comes with clinical risk and needs maternity care for better outcomes. Maternity care is essential or do you want women to give birth alone and risk both their own lives and their baby?

Better outcomes means better start in life for babies and we all benefit as a society from that.

Broadly, I think if you've deliberately done it to yourself, it shouldn't be free. So septic tattoos and piercings, being so drunk you need medical help, aftercare for ski injuries or other high risk hobbies...all that should be chargeable.

Infertility isn't something you've done to yourself, so I do think it should be funded to the NICE guidelines, ie three rounds of ivf.

NHS should fund ALL medically necessary treatment/diagnostics. However, I personally would not be against a minimal financial contribution not unlike NHS dentitsry but less. Where there is free eligibility based on means testing but some sort of banding with the highest band only being £100 or so for a full treatment plan.

For example, with a broken leg the £100 would cover the full plan of diagnoses tools (xray, bloods etc), surgery, hospital stay, physio and follow ups.

This banding would not apply to GP services though. This would remain free.

I think there should be much more emphasis on prevention. Lots of health conditions can be prevented by better life style choices. There needs to be a lot more education around healthy eating and exercise, being active, smoking, alcohol. Targeted to the groups that don't get this message at the moment. Maybe cookery courses. I think there is a lack of knowledge about how to cook from scratch healthily and cheaply in some parts of the population. Getting fit at a younger age and then staying fit is probably going to give you a better quality of life in older age, although I realise nothing is guaranteed. Which will lead to less costly health interventions and mean people are happier as they are also to do more. This would need a large budget to make a big enough difference long term, whilst still dealing with the reactive health care issues until the prevention strategies start to have an impact. But long term I think it would be worth the initial investment.
I can't imagine denying people treatment for things like GRS and IVF, leaving people to be utterly miserable when there are preventable conditions which could free up the budget. Drunks in A&E - a lot of this will be people who misjudged their limit and make a one off mistake. A knee operation was discussed for my Grandma before she died but her dementia was so severe the doctors judged it would do more harm than good so I think in some cases treatment is considered on a case by case basis.
My other grandma was hospitalised a couple of times before she died at 98, it was very distressing for her and she was dying of old age, there was nothing to be done. She was already in a care home. Discussions about this need to be had with families in advance. I don't think the care home staff can make that decision so they will send them to hospital.

I do think more consideration needs to be given to elderly care. People live longer but sometimes with very poor quality of life. I cannot find a good way to phrase this but a comfortable death a bit earlier is to me better than a prolonged life that is just suffering. It seems to be life at all costs at the moment.

@ForTheLoveOfSleep But your idea is flawed because those just above any benefit threshold would be hit, again, as usual.

For example, a family in the squeezed middle right now don't even have enough to buy a lunch out. There are countless threads on this. People earning a normal average salary. They'd have to pay the sum you're asking