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?

[nickelbabe]

The NHS thing - I think it would be okay to treat the person and then check their credentials later.

I personally don't believe that healthcare should be rationed - what I mean is that I don't think any person's life is more important than another person's life, so I don't see why you should have to prove you're a citizen (or whatever the criteria are) before you receive your healthcare.

I think that if the person receiving healthcare doesn't fulfil the criteria, then we should assume that they have insurance on their holiday/visa, and that maybe having health insurance should be checked when they get their entry visa (or whatever form that should be)
that would make it a lot easier - that they either prove that they have health insurance (to use the NHS) in order to get their visa, or that they take it out as part of getting their visa.
Then anyone in the country, in theory, is allowed to use the NHS.
The insurance thing can be done in their own country, if necessary, or taken out when they enter the country and get their stamp.

That makes it fair, and keeps up with the whole ethos of the NHS, that healthcare is free at point of service.

[ICBINEG]

nickel yes the problem is that it cost more to retrieve the payments than it cost to treat the patient....and you still have to check the validity of everyones claim...just after treatment.

This moves the problem along a bit (and in a good way - I totally agree it should be free at access) but it doesn't stop it costing real money.

[ICBINEG]

It would cost more than 1 pound per person just to issue us all with a card....or a barcode.

[AuntieStella]

Keep the status quo?

Yes, of course.

And that's what's happening.

Because if you unpackage what they are talking about, they really aren't changing a single thing from New Labour policies, and the opposition aren't offering anything new either. There are a few differences in implementation (why can no one let a decent Govt contract any more?). But the principles have been the same since 1997.

[nickelbabe]

silver "But surely all the NHS has to do is ask to see identification papers if they think a person may not be eligible. How much does it cost to ask to see such documents?"

Currently, in the US, you cannot get treated until they have proof that you do or don't have your insurance (according to comedians, so it might not strictly be true, but a close comment)

I would not want that to happen here - I want to be assured that if I get run into hospital for whatever reason, that I will be treated immediately (to triage, of course) and not requested to prove my credentials before that can happen.

[ICBINEG]

auntie yes I suppose most of it is just bluster isn't it.....

Is it maybe a little sad that the best we can hope for from our politicians is that they don't actually do any of the things they are suggesting?

[HelenaLindor]

I agree. I think that when introducing policies, they should be Common Sense checked.

I read somethign about the health care tourism, will see if I can find it.

We could do as many other countries have done, and require everyone to carry ID, or have health care cards. The implementation and bureaucracy costs more than it saves, if I remember rightly.

[OnTheBottomWithAWomensWeekly]

well yes, but most people aren't having a heart attack (and even if they are, you can usually speak just fine, unless its a massive one) so its not really a moot point, is it? You were talking about healthcare tourism, do many people fly in in the middle of a heart attack then?

[quesadilla]

In general YANBU but I think that policies which are to be enforced by law need to be seen to be as equitable as possible in order to get the maximum buy in from society. So with benefit cheats, for example, I don't have evidence but I strongly suspect that eradicating benefit cheating would barely touch the sides in terms of reducing the deficit. But the political wind as the moment is to crack down on wasteful public spending and that's an easy target.

If you followed policies purely on the basis of efficiency without taking into account the moral/societal impact you lose legitimacy. So for example it might be possible to eradicate the deficit in two years if you put everyone in the country on a 60 per cent tax rate. But you would lose legitimacy and probably lose the next election.

Not saying I think this lot are going about it the right way btw...

[Iamsparklyknickers]

Only if I a get badge I'm not adverse to a little distraction with shiney things

Broken - is that always a truism though? Are there never cases where the costs outweigh the benefits?

In any system that's on the scale of a whole country there will be a failure rate, do you spend without abandon to achieve 100% success (impossible) or do you have an acceptable failure rate and work to keep it within those limits and keep budgets consistent?

Do I think someone coming from another country with the sole purpose of gaining medical treatment is immoral? Yes I do, but I also think the figures associated with that are tiny in the grand scheme of things, also I'm not sure if it's an NHS problem, an immigration problem or an international relations problem - where do you most wisely invest the money to tackle it effectively?

[HelenaLindor]

This suggests health care tourism more widespread than stated, while this puts it into perspective as % of NHS budget.

And this report explains where the numbers come from.

I think that until we truly know the extent of the issue, we can't say what the truth is, so perhaps an audit is for the best.

[VoiceOfRaisin]

1. It may well cost more than is clawed back chasing the benefit cheats, but if you just shrugged and did nothing then there would be an awful lot more of them pretty quickly.
   

1. The NHS is owed much more than £30m in health tourism:
   

• A friend is a senior nurse at Great Ormond Street. She says that not infrequently wealthy foreigners fly in, book a suite at the 5 star hotel opposite and present their child with a serious heart defect requiring 6 months in hospital. GOSH does not turn them away but is unlikely to ever be paid. Word gets around. They come for the world class medicine and it just happens to be free at point of delivery. This is only really true of rich foreigners who can afford to fly in for treatment.
  

• a receptionist at a London Hospital tells me that when people arrive for clinic she is supposed to ask them if they are UK resident. Her manager tells her not to ask but to instead tick "couldn't ascertain" on the box. They all get treated for free. It is daft to expect a receptionist to be able to assess residential status but nobody else seems to...
  

• over £4million is owed to Great Ormond Street alone just by Middle Eastern Governments.
  

I would have a system where you show a card for free treatment at point of delivery (like the E111) or else you have to pay and then claim back if entitled (other than for emergency treatment which needs to stay free at point of delivery because you don't want to be looking for cards at the time of an emergency).

[VoiceOfRaisin]

x-posted with Helen. That Spectator article she links to says it all.

[oinkling]

silver I don't believe they should get away with it. I just think a situation in which a few people get more than they should is better than a situation where everybody gets less than they otherwise would.

The best situation would be a cheap way of identifying benefit cheats but without that we're left with one of two less ideal situations and we're forced to choose.

[cory]

Sometimes I think there are things that you have to do almost regardless of cost because they are quite simply right.

But the current government seems to specialise in introducing/suggesting new measures with the specific motivation of saving money without bothering to ascertain

a) how much money we are currently losing due to the absence of the measure
b) how much the measure would cost to introduce
c) whether the measure would actually be effective in clawing back that money
d) whether the measure might not cause further costs down the line.

I used to think the Blair government was the ultimate in people pleasing and knee jerking reactions. I have revised my views.

[cory]

What Sweden does is to have a number like the NI, but which is used everywhere, for all identification purposes, from the cradle to the grave, with the result that everybody knows their number by heart and you are not obliged to carry an ID card.

When I have taken dd to A&E in Sweden, this is the number they have asked for.

[nickelbabe]

I think in terms of healthcare tourism - it must only be bigger procedures that are done by that method, and that's not the same anyway, as you have to have referrals and consultations etc. It's not as simple as just treating someone.

I think, that anything that's classed as immediate (A&E, visits to GPs etc) should be free to anyone,regardless of immigration/citizen status.
They can sort it out by healthcare insurance afterwards if necessary.
Anything that requires anything further can be sorted out when the referral is made, surely?
Every time I've been referred further than a GP or A&E, I've had to fill out forms then, so I think that could be done by maybe having - if you're not a UK citizen/work here/have right to remain/whatever the criteria are, then provide insurance details.

That's the kind of thing that wasn't life-or-death anyway.

[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.

[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?

[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.

[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,

[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.

[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.

[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.