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

[DolomitesDonkey]

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. Like 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.

What about looking at the actual cost of so-called health tourism to the NHS? From what I could find, the annual NHS budget for 2011/12 was £106 billion. According the BBC (I refuse to quote the Sun or the DM because the are unable to be anything other than rabid on the subject) the annual cost of 'health tourism' is £40 million. I can't even work out what micro percentage that is, but it's tiny. Actually even if you go with the Sun figure of £200m it's still tiny.

Then there's the issue of whether health tourism actually exists in any great numbers. For those of you that were able to read that Guardian article without having a nosebleed, you'll have seen that project study which found that the average residency of those born outside the UK accessing health services was 3 years, and 78% of those seen by the project had their problems resolved with a single consultation. That's one hell of a fucking holiday for a quick chat with the doctor!

Still, let's not let the facts get in the way of a good argument.

When I take my DC's to the Doctors he always asks me if I have enough infant paracetamol. I always say I do but he is very willing to do a px for a big bottle if needed. Very kind of him but if he does that for every child patient he sees in a week the cost builds up. Same with Antibiotics. I went with a uti not long ago and he gave me enough anti b's for 3 months. It took a weeks worth to clear it up and I ended up taking the rest back to the chemist.
Costs like that need to be looked at imo.
The abattoir linked to the welsh horsemeat thing is 5 miles from me! Bloody yorkshire people (I'm kidding, I married one, I'm not having a pop!)

Gordy
the system behind it is different. You pay NI in UK and it goes into the big NI pot. You pay Krankenkasse fees in Germany and it goes into one of many pots. Each pot has their own staff. The costs are much higher, I would assume.

And everyone in Germany has a Krankenkasse Karte - without it you don't get treated. It even has a picture on it now.

It might be that this has changed since you were there though - I think that until the mid nineties you couldn't change Krankenkasse. You went with the one that your company used. Maybe that is how you didn't notice that it is a very different system.

I didn't know you could buy antibiotics over the counter - it wasn't the case 15 years ago. I was unable to attend a private doctor as the nearest is over 100 miles away and I'm unable to drive/see safely due to conjunctivitis.

The NHS is a massive public industry, employing many people and providing a relatively decent level of care to all. I am proud of it. I know for a fact that the NHS as an entity is working with UKBA to tighten up on NHS tourism.

The 'problem' if you like is that there are very few checks done at ground level (GPs) and once you are on a GPs list, you can be referred onwards for secondary treatment no questions asked.

However, I would rather that someone have treatment that they are not really entitled to and survive than be chucked out of the ambulance because they haven't got the right insurance as in other countries.

Flobbadobs
I haven't been to the docs with the kids since returning from forrin parts, but if I did, I would simply say that I don't need the paracetamol.

We can afford it, so I don't accept it.

You do get an exemption card for prescriptions. I have one as I have epilepsy and it's "on the list". I also have a couple of other issues which mean I take 4 or 5 other types of pill a day. I was only diagnosed with epilepsy a couple of years ago and was surprised that the free prescriptions apply to everything on the prescription not just the epilepsy meds.

Also on the saving money front they could look at having more phone consultations. A few weeks ago DH had to have the morning off work to take me to hospital for a neuro appointment. I waited 50 minutes to tell the consultant I haven't had a seizure for 8 months. We were literally in there for 30 seconds. However, when they were trying to get the meds right and I was having frequent seizures I was supposed to be on 12 week recall which was more like 5 months because of waiting lists. If someone who knew what they were doing called to check on frequent flyers it would free up consultant appointments for people when they really need them. And no, I'm not complaining about the time off work or the waiting time.

I think for GP surgeries who get only a few overseas visitors then the amount they'd get from treating someone for a minor illness privately having sorted out the paperwork wouldn't pay for the staff time and hassle. Charging overseas visitors is a legislative nightmare, and there is a reciprocal agreement for emergency treatment for many countries, and it could be argued conjunctivitis is an emergency as it isn't a chronic illness.
Treating a minor illness for free is completely different to health tourism. I think if the OP had turned up wanting referred or having a condition needing admission then the paperwork would come into play.

MmeLindor thats exactly what I do but many won't. My SIL goes to the Dr's alot with my nephew and always asks for paracetamol whether she needs it or not. She can afford a bottle of Calpol, she just sees it as her right to get as much as possible from the NHS.
I used to have a Mims book (snitched from when I worked as a gp receptionist) which showed the cost per px of all current medication. Wish I could find it, it was a fascinating read.

Also for cowmop's point a phone consultation wouldn't have saved the hospital money as she only used up 30 seconds of their time. It would have saved her time and money but the consultant would probably have spent longer dialing phone numbers etc than just calling her in, and there is more chance of a mistake if medication is changed over the phone when no prescription can be issued at the time than if it's explained in person.

It costs more to treat an obese person long-term, than it does to give them surgery. That surgery makes good financial sense. I don't see why people are against it.

I don't understand why procurement in the NHS is so pathetic (and Whitehall in general). If they sorted that out, they could afford a LOT more free stuff at point of use.

I've pitched retainer services into big retailers before. Once you get past the actual winning of the pitch, you get the procurement team negotiating the actual price and terms of contract. If you get out without them managing to knock significant chunks off your price, then you're a master negotiator. Every corner is squeezed, every breath you charge for is assessed and found wanting.

My company also pitched for a retainer contract with a big teaching hospital. No price negotiation necessary, I don't think they even really looked at the figures. (I've had similar experience with councils)

Either put the procurement teams into procurement bootcamp for a month until they come out hard as nails, or sack them for incompetence and hire one of the big retailer's procurement companies. Then the NHS can continue being lady bountiful to all comers as they will have more money than they've ever had before.

Bunfangs, I agree. Not just to save money but because it gives people their life back. Is that only for rich people? I had my ears pinned back on the NHS when I was 8, my appearance wasn't costing the NHS a penny but was bullied mercilessly and was pretty much unable to look at myself in a mirror. Not the same I agree but as an 8 year old girl it was a help. Health is health, whether mental or physical or taking your dog with you to give birth because you have serious MN problems.(DM again)

MH not MN but what a typo to make!

Its soo hard

I think anyone when asked can easily pinpoint a sensible method around how the NHS can save money

and yes, none of us want to move to the VILE USA model

How to have humane system become more commercially astute??????

an adaptive challenge for our age

But one to adress, definately

How about the 700m wasted on no-shows for appointments. Far bigger issue than health tourism but doesn't have an easy group of scapegoats to target, so might not be so easy to get frothing with rage about.

think the convo has moved on a bit lullabella

back to those DAMM romanians again!

I am not particularly bothered if the NHS treats a foreigner for conjunctivitis or a nasty ear infection. Both of these infections are desperately unpleasent, acute and relatively cheap to treat. Many UK doctors are more interested in helping people than being a policeman.

I have far more issue with heavily pregnant women rolling up to the UK and expecting to be allowed to give birth in a UK hospital for free.

I that visitors to the UK should produce proof of health insurance on entry. Prehaps foreigners could be given a temporary NHS number to cover emergencies in return for a fee depending on existing conditions. A heavily pregnant woman or an elderly person would be charged 7K for entry, a healthy child might be charged £20 if they were staying for a 2 weeks.

I understand that to check whether every patient is 'entitled' to free care would cost way too much for the NHS, but I do think there should be some kind of system in place to bill someone who says they want to pay

We do.

BUT all A and E care is free, to everyone.

Would your dd treatment have cost enough to have someone sitting in a payments office on Xmas day just in case someone with insurance came in?

I suggested on another board to some one from the USA who had received free treatment that if they normally have a copay then they could donate that to the hospital.

The OP lives in a country with a reciprocal agreement so she has only got what she is entitled to.

I've been admitted as an emergency in the last couple of years as well as a scheduled op and I have been asked about my citizenship and residency.

I have to pay for my perscriptions for allergy meds. But I found it too expensive, so stopped getting them. You can get a shit load of tissues for £7.40

Chairman,

My DD wasn't "looking after her sexual health" - she was making sure she didn't have her period while she was camping. An understandable thing to do, but hardly a medical necessity. And she only needed 1 packet, not 3.

I don't see how the nhs can cope with so many from abroad providing care for them all, however do I want to be in a country that refuses to treat a sick child or save someone having a heart attack because they can't afford to be seen

" however do I want to be in a country that refuses to treat a sick child or save someone having a heart attack because they can't afford to be seen !"

I would hate anyone to be unable to get treatment because of cost. I feel the best way is to insist that health insurance is a condition of entry to the UK. I suppose that if a an illegal immigrant had an heart attack we should treat them and then promptly ship them back home.

I am glad to live in a soft country where we don't allow people to die.

Am overseas and have several times sauntered out of the GPs having completely forgotten final stage of paying - and had to be called back, oh the shame
I do now appreciate where you're coming from...

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.