to care more about whether something works than whether it is politically correct?

[ICBINEG]

A general political musing...

It seems at the moment that there are lots of 'policies' aimed more at sounding good than at actually delivering good...

like stopping people not entitled to NHS treatment from getting it...

Sounds great. Costs vastly more than it saves...

Is it worth so much to us to say 'that's not fair' that we would rather spend our money on making it 'fair' than treating entitled patients?

Also benefits cheats. So a very very few people cheat...but it would cost more than you get back to chase them. Do we really want the system to be fairer or would we like more police on the streets?

We want to reduce the deficit (well some people do anyway...I am personally not overly fussed) so does it make more sense to take a little more from the multinational corporations or to cut back benefits (again) and scrape in the pennies? Actually I don't know the answer to this one...but I would decide on the basis of the bottom line income wise...not on whether I considered people on benefits to be work shy or multinationals to be greedy...(I don't).

So is it bonkers to care primarily about what actually works? And not so much on feelings/policies/looking tough on crime etc?

[cumfy]

These are politicians, remember.

If they had any interest in, or could do anything useful they would have chosen medicine, engineering or science as a career.

Expecting politicians to do anything sensible is akin to hoping water will run uphill.

The poor darlings just want to get re-elected.

[edam]

YY, that is very true about prisons.

Same with transport. Cheap, frequent public transport is a great investment. It pays for itself over and over again, in boosting the economy, reducing congestion and accidents, encouraging employment, helping people get out and about which is good for the economy and for health (esp. for the elderly and vulnerable, being able to get around and see people keeps them well). Taking traffic off the road saves lives and reduces costs to the emergency services. All this is proven - the experiment has been done.

Yet have governments listened? No, they've pushed up both subsidies to private rail companies AND ticket prices for passengers, so we have the most expensive rail in Europe, while bus services are being cut. Bad for taxpayers, bad for passengers, bad for the public, the economy, the emergency services... Ridiculous.

I don't think stupid policies penalising people on benefits do anything to reduce prejudice against people on benefits, btw, - quite the reverse. The government is deliberately stoking resentment, using entirely false figures (had to apologise to the ONS over this) and then pretending they have a great solution to a very minor problem.

It's a pathetic attempt to make the government look good. It's also hugely expensive - Universal Credit is shaping up to be yet another massively failing big government IT project (Blair, Brown and Cameron have all fallen into this trap). It will be bad for the taxpayer and miserable for anyone caught up in it... but who cares as long as the government gets to show off, briefly?

[ICBINEG]

fantastic example!

I will add that to the list...

[rainrainandmorerain]

To go back to your op, OP -

I feel this way about prisons. They don't work as a deterrent. They are very expensive. They can actually generate more crime (you put a young/minor criminal in prison, they make contacts and learn more crime - it's like crime school).

But any politician can score points by demanding criminals are 'locked up'. Even if you tell people prison doesn't work in terms of reducing crime or preventing re-offending, they still want to see criminals in prison because of some notion of punishment.

So what you get are people who like the idea of someone being punished even if it means MORE victims in the long run.

The things to do tend to work (interventions to stop reoffending), or work better than prison, are seen as not desirable because they are not nasty enough. Go figure.

[ICBINEG]

hmmm I am a negligent OP...

this became all about the NHs...which it isn't...it is about all the ridiculous policy driven initiatives....

This morning labour were banging on about identifying themselves to the public...with policy.

How about someone saying we aren't for or against anything in particular we policy wise and just sticking to trying to achieve the things that everyone genuinely does agree on...

like...erm...

equal opportunity for kids....
education regardless of income
health care regardless of income....
teenagers that know the difference between porn and real sex....

and will vow to do these things in the most efficient way possible, regardless of what that might entail.

[canyou]

many moons ago I ended up in a UK Hosp I gave them my holiday health insurance policy etc they never processed the claim for a week stay a&e and ambulance. Fast forward two yrs my Aunt was in IRL and visited a&e after a fall, 3 weeks home she was incensed to receive paper work from NHS asking her to confirm treatment etc from an Irish Hosp. The Irish Hosp Had billed her local trust from the details sh had given them. She could not understand why it was not free like in the UK where it is not free you just pay in before you need it

[MmeLindor]

Yes, I agree Sparkly. I was just thinking that it is unfair to delegate this responsibility and hassle to the poor receptionists.

The only way to do it, is to have a requirement that to access healthcare, patients must have a card - In Germany, it is issued by health insurance, and has name and address on the electronic chip, and photo on the card - see here

When you go to the GP, the receptionist puts the card into the reader and can see if you are insured. Not sure what they do if you don't have insurance, but having this system would prevent some fraud.

It won't be cheap to implement though, and that is where we are back to the OP's question.

[Iamsparklyknickers]

[Iamsparklyknickers]

I think it's more of an issue to ask our medical and support staff to act as immigration officers never mind the training and equipment used by actual border staff to spot forgeries in paperwork and interrogate a story.

Practically speaking I don't think your average £12k pa GP receptionist is going to want to confront a fraudster anymore than an A&E consultant wants to while they're trying to patch up an artery.

[NMercury]

Ten seconds after the implementation suggestion of any policy where the identification of country of origin of those seeking health care was required then I would imagine the Liberal party and numerous of the chattering masses would be up in arms about it being racist and divisive.
To go back to the common sense part, I could imagine that the triage nurse would be told to actively check those she / he thought foreign. Queue headlines of racial profiling - even though it might make common sense that those speaking poor English and not looking as if they were citizens of these isles might, actually be foreigners (and before anyone screams racist at me - I can usually pick out those of Slavic descent in my local Tescos, and not just due to their hovering around the Polska items).

[ShellyBoobs]

I don't know, Mme.

I just saw some documentary type tv programme which discussed the issue. I'll see if I can find more info.

[MmeLindor]

Shelly
So does each GP practice or NHS trust have to communicate individually with the foreign health insurers?

[MmeLindor]

I think we have to differentiate between those coming into the country to take advantage, presenting at A&E as an emergency because they know they will be seen, and the other scenarios in that Spectator piece, where people have been registered here and are now no longer living in the country.

The first is difficult to prevent, because no hospital should send a woman in labour away. The second much easier to prevent by making patients attend GP surgery once a year, rather than just phoning for repeat prescriptions.

And the question again is, how to do this without it costing more than we are saving.

[ShellyBoobs]

That seems to be quite basic - teach receptionists and GP management how to deal with foreigners requiring treatment in UK. Our German insurance would have reimbursed the NHS, but they didn't even apply for it

There is a fundamental flaw in this seemingly obvious 'fix', unfortunately. Once the practice, or the trust in the case of hospitals, etc, has established that the patient isn't entitled to free treatment, they become responsible for obtaining the payment. If they can't get the money, they can't claim the fee they earned for the treatment from the NHS.

The solution, for the service provider, is to not declare that the NHS is owed money from the patient of their insurer, in case they can't get it off them.

Bonkers.

[Iamsparklyknickers]

Just to make it clear - are we really saying that in the case of the maternity unit identities we'd turf out a woman in labour (whose already cost a pretty penny by that point) because it's become apparent she's not who she says she is.

Do we actually want our nurses, midwives and doctors to be responsible for and capable of that?

[Booboostoo]

I am with you OP. None of these policies have anything to do with actual justice or with saving money. They are all about politicians looking good and getting elected. 'Foreigners coming over here and using up our tax money' is an easy slogan that's not going to alienate anyone who can vote for you.

[Iamsparklyknickers]

Forms are only as good as the information people put on them.

Once somebody is in a place to have a form I would say you're probably already past the point of effectiveness - much like LondonMans quote illustrates.

How much would you be prepared to invest at every point of public service to be able to have the investigative power and resources to scrutinise and question every form submitted.

[LondonMan]

For people who think an identity number is enough, this quote from the Spectator article someone linked to.

In every maternity unit, identifying the blood group of the mother is obligatory. Over time, patients have given a registered name, address and NHS number ? but are found to have different blood groups from the one on record. This is conclusive proof of an identity being shared.

[HelenaLindor]

Personal anecdote here - we took DD to my parents GP while we were visiting from Germany. She was treated, and they didn't want to see our EHIC (replaced the E111). When I asked about it, the receptionist didn't know how to do that, so just put us down as temporary resident.

That seems to be quite basic - teach receptionists and GP management how to deal with foreigners requiring treatment in UK. Our German insurance would have reimbursed the NHS, but they didn't even apply for it.

MrsLyman
I would rejig the whole tax brackets - I find it unfair that someone earning £30k is in same tax bracket as those on £130k. It should be more gradual, which would help the 'squeezed middle', with a top tax payment of 45% and restriction of loopholes which enables top earners to pay less tax than their secretaries.

[Iamsparklyknickers]

Universal benefit is a great idea imo - cut through the bureaucracy and red tape - fantastic.

However I also think it's a very sly way to make benefit cuts and does absolutely f all to address the cost of living. Much like NMW, great in theory, in practice you're still entitled to support even if you work full time in many cases so is in practice nothing more than a distraction about the costs that could be shared by the state e.g. childcare, housing, transport (basically things that could cost less provided for on mass than privately through the free market) and enable people to actually be more productive and ultimately self-sufficient.

[BrokenSunglasses]

The costs of things like benefit fraud and healthcare tourism are not only financial. Even if it were, I don't believe the true cost could be measured accurately enough to be able to make a judgment on whether it is worth it based on that alone.

These things have social costs too. They increase hospital waiting lists for treatments, they result in stigma for genuine benefit claimants, they increase prejudice against certain groups of people.

I think the social benefits of our whole system being seen to be fairer, more transparent, more consistent and better organised would be significant,

[mrslyman]

Do you also support the lowering of higher level tax bands because they have been shown to generate more tax income?

Regarding your OP, I get where you are coming from but I'm not sure if you've factored prevention into your calculations. So whilst the systems in place may cost more money than they directly recoup, you also need to account for the money that wasn't spent on extra benefits or medical treatments to those outside of the NHS's remit.

Personnally, I think you need robust systems in place to stop the whole 'saints and scroungers' dialogue that goes on. People of all incomes work hard for the money that the government takes in tax and they deserve to know that it is being spent wisely.

[Iamsparklyknickers]

Just as a personal anacdote on the Health Tourism issue the only case I ever heard about been picked up by the NHS was involving a patient whose treatment option had to go before a panel (think transplant but not) due to it's cost and was refused on the basis they were an asylum seeker. It was most certainly a life and death decision.

I'm not convinced that any meaningful data has actually been recorded regarding non-citizens receiving treatment as it doesn't seem to be standard across the country to thoroughly check at the point of care - and there's an unknown black market for people getting registered with GP's - this of course makes me think that it's more of an immigration issue (root of the problem perhaps) than a straight forward NHS one.

Again - where do you invest the money if it's a problem you're serious about tackling? More importantly how do you invest it? If the problem would cost more to tackle and keep on top of to produce better results than we already have then is it really viable?

Lets not forget that we already have forms of border control, immigration and asylum procedures is it those that need investment or training receptionists, nurses and Dr's to start acting like immigration officers at the point of care?

[nickelbabe]

"What about "lifting people out of poverty" - giving them an extra £1 a week so that they moved across the 'poverty' boundary?"

I think if the government gets its way and changes the NHS, there won't be such a thing as lifting people out of poverty.
There'll be such a thing as not being able to afford even the basic healthcare - the first thing to go will be free prescriptions for those entitled, including children.