to think the NHS can't charge for drunk treatment without charging for other self inflicted

[suziepra]

There is huge support for charging drunk people for a and e. I think this is being launched in Ireland.

I'm tee total but I don't agree with this as it is unfair just to pick on people that drink. Stats have been showing that young people drink less than ever these days.

Why should someone that has chosen to play a contact sport like rugby get free treatment if the drunks have to pay? What about someone who has chosen to live on junk for decades that has obesity treatment?

It is an appalling idea.

Life is not black and white, and people aren't neatly divided up into the deserving sick and the undeserving sick.

The nhs is built on these 3 principles

that it meet the needs of everyone
that it be free at the point of delivery
that it be based on clinical need, not ability to pay

those 3 principals need to remain at it's core.

Fairly straightforward, before having treatment that is a result of alcohol or obesity you sign consent for the cost to be taken from your salary/benefits at source. Could be done over time like student loans.

Not if you're a penniless alcoholic surely?

The fines are just going to add up and up until they're written off, I imagine.

I think there are a few issues with this.

Where are the boundaries set? Do we stop at alcohol-related conditions (which are blurry anyway) or do we include injuries too? How do we know that it's the patient's "fault" - is there an exemption for someone who has been roofied (and won't be able to prove it - a nasty addition to a nasty crime). Do we charge for sporting injuries? Do we charge smokers, drinkers, overweight people, those who practice sport, jaywalkers, bike riders... for treatment because they take risks? How on earth to police/ enforce it - if an A&E doctor is already wary of the blotto lad who has been in a fight, it'll really make their night to say "oh, and by the way, we're taking £50 off you too..".

The last thing the NHS needs is more admin, but this will potentially pile on a huge amount more in actually monitoring who to charge and taking the money from them in the first place (and will individuals try to sue if they believed they were unfairly charged? Of course they will!).

I think it will cost a lot more than it might recoup TBH.

We'll end up like the States, where your insurance is denied as you didn't "preplan" your car accident...

It's quite worrying that so many people are happy to Hague a situation on the face of things without stopping to consider that their may well be an underlying cause for that situation to have occurred.

i understand the logic behind it but it would never work. People would just never pay and the admin involved would probably end up costing more than they ever collected.

I broke my ankle when I was 18 after getting totally slaughtered on a night out. I was very young and stupid. A lot of drunken accidents will end up being one offs.

How can you tell they've been drinking a lot ? They'd have to do a blood test which you can refuse.

I remember someone thinking I was drunk when I was in the hospital once as a teen. I wasn't, i didn't even drink then. I was really really fucking poorly

Also with regards to the point in the ops last post - wasn't the NHS named the best system a few months back?

YABU - a sporting accident is just that. It could happen to anyone.

Going out and getting yourself drunk to the point of needing a and e treatment is a choice that person made.

The NHS should concentrate on recouping some of the money that it should already be getting from treating people who aren't entitled to NHS treatment. link

The idea that you chose to drink and you can learn to stop before being comatose therefore you should pay is ok if you are binge drinking once in a while.

The problem is what do you do with alcoholics? The ones who drink everyday and the ones who drink maybe once a week but binge drink so much that actually they still classify as alcoholics?
What do you do with the ones that have a couple of glasses of wine every night (you know the ones that are to on MN yes that's ok. It's normal to have a glass in the evening to relax from a day with the dcs for example) and then develop some health problem?

Most if not all of our health problems, including cancer is life style related. Died it mean that unless you get an infection like meningitis then you should never be covered by the NHS?

it's a very slippery slope.

I believe that a previous head-of-advisory-drugs-body or somesuch said that horse riding was more dangerous than taking Ecstasy (they got rid of him, I think, after saying that ), in which case should you charge a horse-rider more than an E-consumer, should either end up in A&E? Draw up some kind of list with a sliding scale of charges?

You can argue till the cows come home that drunk/drug addicted/smokers/obese people/whoever should have to pay. It's totally unworkable, and, I think, rightly so.

I'm almost tea total and the amount of time and money spent looking after drunk people in A and E appals me....but I don't think you can charge for it without opening a giant can of worms.

What about smokers, over eaters, druggies, people that do risky sports, people that get into fights, etc etc etc.

This is one of the reasons I would make a bad doctor or nurse as I think I would find it hard to treat a binge drinker equally to someone who is ill through no fault of their own. I would be way to judgey

Does anyone else remember the ridiculous idea of tony blaires for police to march drunks to cash points to lY their fines for being drunk.

Just as silly as this in my view.

Once we start judging then we might As well forget the NHS.
It's free at point of need for anyone for any reason.

Anything less and we may not bother.

Just something about France.
You don't pay for most of your treatments in France. With the 'new' system, you don't even need to pay to go to see your GP (you use to have to claim the money back). Most people then have a very cheap 'insurance' that covers what the NHS equivalent doesn't pay.

I would say, seeing that you pay for your medication here, there isn't such a big difference.
AND you do pay for the NHS. Maybe not when you go and see your GP. You don't take your wallet out. But you pay for medication. And you Pay through taxes too.

I'm amazed that it is ranking at the 19th place though. I though it would be even lower by now.

It's a good idea in some respects, but it is a slippery slope.

Accident claims people will have a field day with people saying 'I broke my collar bone because I slipped on water that wasn't cleaned up, therefore H&S should pay, not me'.

The definition of self-inflicted injury will also be questionable. There are some that will say that nearly all injuries and accidents have a self-inflicted element be that down to being tiddly/off your face on drugs to being a bit sleepy because you have a young baby, or not concentrating because your boss just shouted at you.

What about people with mental health issues who self-harm? Do you fine them for having a mental health issue? Or do you, what, look at their childhood (where many MH issues stem from in one way or another) and charge their parents?

Smokers are already charged an awful lot for healthcare through taxes.

I can imagine it would be fairly easy to charge people who rock up in A&E with a blood/breath alcohol over a certain level (probably would need to be quite a high level). But then you have the demographic issue that a percentage of those needing alcohol-related treatment will be from poorer socio-economic areas and therefore less able to pay. What happens then? The government picks up the tab anyway.

It's a minefield. YAB a bit U.

Yabu. I'd be happy if they charged drunks, and make them pay.

It pisses me off, that if one of my dc is unwell over a weekend, I have to try and avoid a&e as I don't want my dd exposed to it.

Now, I'd think it'd be different if it was someone who is an alcoholic, but these people who binge drink at the weekend, who don't know how to stop, are taking up valuable resources in the NHS.

There's so much vocalisation about drinking sensibly, but it all seems to fall on deaf ears.

To be honest as.a trained nurse who
Worked in A&E back in the day you get the drunks/suecide attempts/rugby injuries and people falling off ladders.

Why would you judge. People just need help when they need it.

Slippery slope.

So who judges? are medical staff supposed to grass people up? are police to be in every unit waiting to pounce?

It's unworkable. And unfair

Well I'm fat, because I'm bedbound and cannot eat or access normal foods so end up snacking on crap that I can eat.

I suppose it's easier to point and blame the fat person though right?

Very very wrong, but a sign of the unpleasantness of our culture. Blame not help. Persecute not empathize.

I think it's a terrible idea. Where does it end what about people suffering mental illness for example I suffer from scizoaffective and once thought a bug was implanted under the skin of my leg. So I started cutting into my leg and digging around making numerous holes to try and locate it.

That was self inflicted.

What about when I self harm due to mental illness?

What about suicide attempts?

Where will it stop?

Surely we can fine people for drunk and disorderly under existing laws. But this is not done regularly enough and there is insufficient investment in policing late night antics. This is what should be fixed. Charging at A&E would be impractical and the cost of administration would probably outweigh the revenue.

Going out and getting yourself drunk to the point of needing a and e treatment is a choice that person made

But I think the difficulty would be in proving that the injury sustained is as a direct result of drinking or could have happened anyway, even to a sober person. One or two posters up-thread have given examples of accidents they have sustained when drinking which could just have easily happened at any other time.

If you had a policy of testing the blood alcohol level and saying that over a certain limit then you must be responsible for your injuries and therefore pay for treatment then this would lead to too many anomolies IMO.

Supposing a group go out for the night and one designated driver stays sober while the others drink. If they are involved in a car accident and injured on the way home would they be held responsible then and charged? You might say "Obviously not" but the trouble is that any situation that relies on people's judgement and common sense to assess it just proves that those commodities are in short supply and therefore lead to reams of beaurocracy and rules and paperwork. Just what the NHS needs!

Oh joy, another fat bashing thread.

We already charge the medical costs of traffic accidents to drivers (via insurance). So it isn't an entirely new concept to have an activity fund its impact on emergency treatment.

I would be interested in seeing the results of some pilot schemes, but I wouldn't want to see it come in across the country without testing the impact first. There are a lot of possible unintended consequences, some good some bad, that need to be indentified before a decision should be made on whether it's a good solution. I also think the drubk tank idea should be trialled.