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?

There was a thread earlier where it claimed that you can get NHS funding to remove face and neck tattoos.

I do not know if this is true. And I imagine it would be justifiable in some circumstances. But I did feel a bit conflicted about it.

Fair enough, though it's not the same procedure so I'm not convinced doctors who perform top surgery are equally qualified to perform cancer surgery - but let's assume they are. Breast surgery is a very small part of all cancer treatments though, so is that truly the cause for the long cancer treatment waiting lists ? As a large number of cancer patients :

• have a different type of cancer, not breast cancer
• a lot of cancer treatments are not surgical (various types of chemo, etc)

I think suggesting that the cancer waiting lists are due either totally or significantly to top surgery being available on the NHS does not reflect the reality.

ORTHDONTICS!
And I say this as an NHS Hospital Dentist who does no private work, and I am paid the same as a very junior doctor. Yes, severe malocclusions have a huge impact on many aspects of life, but it just isn’t sustainable.

The very severe cases should be managed in a Dental Hospital (like the one I work in) on a referral basis, which would mean those with life-affecting dental conditions are treated.

The remainder should unfortunately have to pay privately (or better still - have insurance that will pay for it, like many other countries such as the US). In the UK, we’ve somehow been conditioned into believing that having ‘straight’ teeth is a given right - it has to change.

Now I’m on this note, NHS dentistry should only cover emergency treatments and special cases such as dental trauma or those with dental anomalies such as Amelogenesis and Hypodontia. I agree there should be specialist services to care for these patients.

However, 90% of NHS dentistry is management of decay and tooth loss (caused by decay) which is usually preventable (and yes, it really is preventable!). In the UK, we need to move on from the days of ‘dodgy dentistry and a mouth full of fillings’ and start to focus on prevention - again, most dental problems are preventable with good oral hygiene and diet).

The most socially-deprived areas in the UK (around 5% of the population) harbour 95% of the decay that is treated (and paid for by the NHS) - a hugely skewed statistic that hasn’t changed since the introduction of the Dental Health Survey in the 1950s. It’s shocking.

The NHS should not fund any non-attended appointments with community or hospital based professionals, unless there is some good cause for not turning up. The amount of non-attended appointments is startling and the staff are still paid to sit there waiting for the patient who never turned up. There should be a fine system or some kind of sanction due to the waste of public funds. I know the various reminder services that are deployed in the NHS to remind about appointments work a bit, but if people knew they would be fined for not having the courtesy to cancel or reschedule then it would shorten wait-lists.

Never a truer thing said.

I'm really saddened to learn that people have such a strong opinion against this.

So there are no costs involved with GRS? Because some people believe that that funding would be better directed to other services.

Personally I think there should be charges for taking up A&E resources for alcohol related injuries. If you've got so mortally drunk in a Friday night that you've given yourself concussion or a broken leg, then it's on you.

The problem you have with this is that sometimes patients aren’t informed of appointments or they aren’t cancelled when requested. I know I wouldn’t have been happy if I had gotten a fine for an appointment which I had asked to be cancelled.

Fair enough, though it's not the same procedure so I'm not convinced doctors who perform top surgery are equally qualified to perform cancer surgery - but let's assume they are.

They definitely are the same surgeons performing these operations. It's called a double mastectomy btw.

So if people are saying ivf / fertility treatment should go then as a person who had IVF due to a MEDICAL condition then the following should go.

anyone over the age of 70 should have all treatment withdrawn
all alcoholics should be kicked to the kerb and left
drug addicts the same as alcoholics
mental Health - yup we can forget about them people as well.
diabetic’s - nah don’t need to support them either
asthmatics - ha just cough a bit more you’ll be fine
can’t hear - tough
can’t see - well good luck with life
cancer - here’s your funeral catalogue have a
look at it
childhood disease (only for the lucky ones) no not covering that either your child can suffer in horrific pain….

see what I’m getting at here …. Every single case should be looked at on a needs basis with common sense and full investigation….

or we can all just stop this “they don’t deserve medical support because I don’t agree with it” and support every single person who has a disability or difficulty

oh and one last thought …… imagine a pandemic that left every single female infertile without treatment ….. what would happen then?? Oh I know we’d be extinct ….

Elective procedures unless linked to significant health benefits. Ivf, gender reassignment etc can't be prioritised over life saving if there's a limited pot

Cosmetic surgery for one.

Moles - of course, they may be cancerous

Cysts that aren't life threatening and aren't visible normally - No

Bilateral breast enlargements for women with body dysmorphia - No. They need good mental health treatment

Breast reconstruction or enlargement in the event of abnormal growth, trauma or cancer - Yes.

Breast reduction for those with abnormally large breasts - Yes. The strain on their bodies must be horrendous

The NHS must shift from reactive to proactive - prevention, lifestyle education and screening

Those with a strong family history of cancers - screening

Those in industries prone to certain health problems (shift, chemicals, manual, mining etc) - more on site visits from mobile clinics and nurses

Those in deprived areas with low screening and vaccine uptakes - more mobile clinics, more invitations and more education programmes.

There must be a greater emphasis on people taking responsibility for their health

This.

This. I do not understand how people can say GRS is not essential when we know the repercussions denial to GRS has on mental health, is life threatening.

The percentage of trans people in the UK must be fairly small, but from what I see on MN, you would think they are the route of all problems 🙄.

How about MRI scans for spinal damage? Because I just had to pay for my own.

Did you need any sort of assisted conception OP? If not, you're not in a place to judge whether it should be offered on the NHS imo.

^^why? That doesn't make sense

And they should be sent the bill after

It's not so much not funding things on the NHS, but two things in particular that would radically redraw the health of the nation:

• cheaply available healthy food and plenty of opportunities for free leisure and exercise, plus a ban on ultra processed food.
• dignified euthanasia.

Gut health, sleep, exercise and nutrition are hugely linked to good health outcomes. Including mental health disorders. You can't prevent a broken bone nearly so easily as you can obesity, anxiety, heart problems, etc.

And if people lived healthy, fulfilling lives, then maybe they'd be more at peace with giving them up rather than fighting death with invasive and dehumanising treatments.

It’s easy to say a treatment shouldn’t be funded until you’re the one who needs it. If you had your children without the need for IVF it’s easy to say it’s not needed because you know it will never effect you. If you’re happy with the way your body looks it’s easy to say no to cosmetic surgery because you know it will never effect you.

Almost nobody is saying no to hip replacements in 80-year-olds or no to treatment when you have terminal cancer cancer which might give an extra few months because old age and cancer are things that can happen to anybody at any time, even though logically most treatments on the very elderly or the terminally ill are hugely cost-ineffective in terms of impact. If we want to save the NHS money then these things would be the first to go, but if it’s your Mum with terminal cancer then most would agree that treatment to give an extra few months pain free before dying should be funded on the NHS despite the huge expense.

IVF and plastic surgery etc can have a huge, positive impact on mental health and quality of life and will usually be carried out on people who still potentially have decades and decades of a healthy life ahead of them so should absolutely be funded.

Cosmetic surgery without health benefits. so breast reduction due to back pain fine breast enlargement because you want bigger boobs no.
Gender reassignment surgery - we need to deal with the cause and support people to be who they want without doing physical damage, and gender surgery and opposite hormones do do damage and have long term consequences so this needs to stop.
Prescription wastage is massive we should not be giving prescribed paracetamol for example.
We also probably need to do a complete shake up of whole NHS with better community support to reduce hospital admissions.
Better use of pharmacy and over counter drugs. IE use more pharmacists and nurse prescribers. Seriously under used resources out there.
We also do need to have a bit of a think about appropriateness of some treatments IE should a 95 year old really be admitted to ICU when everyone knows the outcome is likely to be awful??? Should alcoholics be offered liver transplants? Socially this is unpopular but the reality is neither will have a good outcome.
A lot of money is wasted on obesity, smoking, drink and drugs but unfortunately we lack the early interventions to stop this early enough.
Wasted appointments, mis use of ambulances also massive issue.
Basically the NHS is doomed

Well probably every NHS procedure is life threatening in that case as it could cause mental suffering leading to suicidal ideation.

But let's not forget about about all important trans, their suffering clearly trumps everyone elses

I think you need to read the OP again.

This is such a rubbish argument. We all have opinions on things which we haven’t personally faced. FWIW I struggled to conceive and I wouldn’t have gone for IVF anyway. But the average cost of IVF is around £10000 and on the whole the NHS advises three cycles because of the low success rate. Plenty of people have IVF who never end up having a child. So that’s money’ wasted. The NHS is there to improve and save lives, not to create new ones.

Do you also think that people who think gender reassignment surgery shouldn’t be funded are unreasonable? After all, nobody who hasn’t faced the heartache of feeling they were born into the wrong body can possibly know what it must be like and therefore should not be allowed to judge? No? Didn’t think so.

I don't think these people are standing in the same queue.

Another thread showing the march of fascism. Some are deserving, some are not, what's the populist view? Leaves me cold.