to think the NHS is a bit crap

[eyebags63]

And because it is treated almost as a kind of religion nobody is allowed to say anything negative about it at all. And actually just because it is "free" (a mere 110bn a year) doesn't mean we should be eternally grateful for bad treatment.

My experiences are of elderly relatives being mistreated in hospital, non-existent services in some areas, screw-ups, buck passing, treatment delays, being treated as a number with no dignity or privacy, a significant number of staff that appear not to care one little bit. I could go on.

In other health systems people can get referred and treated within days or weeks. Here we accept that waiting for months on end in pain is normal. We accept exhausted staff, lack of access, dirty hospitals, ambulances queuing outside hospitals and restricted treatment resources.

Yes it is "free at the point of use", but isn't that half of the problem? Walk into any GP surgery or A&E and you can witness so many abuses of the system. On the other hand genuine patients are often seem to be treated as a nuisance.

I'm not saying the NHS should be scrapped but surely it is about time we at least looked at different ways of doing things.

And when someone arrives at the surgery with no cash or card? It's not like a shop, where you can just send them away.

And, of course, there would have to be exemptions. How would you pay £10 on a JSA of £71?

How would you pay £10 on a JSA of £71?
I suppose the same way people pay for their gas/electric/water rates/council tax/rent/ and so on.

And when someone arrives at the surgery with no cash or card?
Well the simplistic solution is no payment no treatment. Although perhaps they could be charged double next time, allowed 1 emergency appointment, etc. But that gets more complicated to record obviously.

Here in Sweden you would still be seen if you turned up with no money. You'd be sent an invoice for the fee instead at the end of the month.

My Dad has an abdominal aneurysm. It was only diagnose due to new NHS screening. He is now part of a study into these aneurysms. Yesterday he was at his 3 monthly monitoring appointment and a link was made by the clinic between his numb toe and aneurysm. By the end of the day he had seen the head vascular consultant who has him on a treatment plan to disperse a clot which has moved and is located in his toe. I think the NHS is pretty bloody wonderful. Yes it is not perfect but the thought of living in country without it is pretty horrendous.

In the Netherlands no money changes hands in the actual GP surgery. Or in hospitals etc. They bill your insurer, who pays the doctor. The insurer then sends you a bill (if below your excess). At least, that's how I remember it working. Even if your insurer pays for the whole thing you will still get an invoice with how much it cost.

If you turn up with no insurance, which is quite rare, then you'll get send an invoice to pay. You'll still get treated, though GPs will be reluctant to take you on. You'll be down to absolute emergency care only.

Having worked for a large hospital in the accounts department, we didn't try very hard to chase up on these unpaid invoices, as the people involved tended to be very poor or foreign and out of the country. The cost of trying to get the invoices paid was rarely worth it.

If you don't pay your insurance invoices then the insurer will chase your for the money. The healthcare provider will already have been paid though.

Both myself and DH work in the NHS. He's a consultant, I'm not.

We both also work in the private sector.

After a particularly crap week at work I had an epiphany that actually, yes, the NHS is shite and ought to be dismantled in favour of a two tier system.

And then DH reminded me that most of the staff he encounters in private hospitals (apart form the consultants) are badly paid and many, many don't speak English well. Driving down costs through competition between private providers will only worsen the situation.

I have changed my mind about the epiphany.

OP - I really do feel you have very little understanding of the lives of people with less money than you.

You can put off paying the water bill for a bit, but if you're sick, you're sick and it needs sorting NOW. And you can't budget for illness. Lots of people have no savings because they need all their money to live on. And it affects the economy, too, because sick people can't work.

And charge them double next time? If they couldn't afford it once, they're not going to be able to afford double the charge on their next visit.

And, as Woolly pointed out, dentistry is not free. In fact, it's very expensive for people on moderate incomes. And once you've established a charge, it's easy for govt to increase it. Other countries might envy our health system, but 'British teeth' are an international joke. It's even been on The Simpsons.

Btw, go to the BBC website for the King's Fund findings on the Lansbury reforms - after an election campaign that promised 'no more top-down NHS reorganisation'.

Netherlands, Sweden people: how are people pursued for money they don't have? Do they get a waiver if they are on benefits? Is there lots & lots of paperwork either way?

It always amazes me how when you finish treatment with NHS you just walk out the door and don't have several forms to fill in.

Imagine if we had continued with food rationing after WW2 and retained it today. Instead of Tesco, Aldi, Waitrose, Lidl, Sainsbury's, Asda, Morrisons, Coop and so on, we had a 'National Food Service'.

Ask yourself this, would we have the same variety of food available to us? Would we be able to buy what are actually the most essential weekly purchases (i.e. food and drink) according to our own family budgets, or would we have a one-size-fits all model?

I suspect the latter.

If we trust ourselves to make our own purchases of food and drink, then let's do the same with healthcare.

The wilful inability of some to conceive of any alternative form of healthcare provision than this atrocious 'NHS' is letting us all down.

Dutch healthcare providers only really deal with insurers for money. Mostly, this is very straightforward as it's well regulated what is and isn't covered. When I worked for the hospital, we actually had access to the databases of the main insurance companies and we would just fill out the forms ourselves if we didn't have someone's insurance details. Insurance would pay us and that was it on our side. All very straightforward

If you don't pay your monthly insurance you will get chased. The insurance companies deal wil all the financial administration of getting people to pay their bills.

There are all sorts of allowances for people on low incomes to help pay for insurance. It's something that you just have to pay for, like gas and electric and rent. Not being insured is not really an option. You can't work if you don't have insurance.

I'm sure there are people who can't or won't pay for their insurance but I don't what happens in those cases. In my experience in the hospital, the only people where we had to deal with them directly tended to be either homeless or foreign. Mostly, they would have only received emergency care.

I should say, it's been 15 years since I worked in the hospital and 8 since I left the country. Things are probably slightly different than they used to be, though from what relatives tell me it still works the same generally speaking.

I didn't envy the NHS when I lived in The Netherlands. I do now I live in Ireland! It's all relative, isn't it. Ireland's system, and that in the US, is worse. Other places have got a better system.

As far as I know in Sweden people receiving social support (like income support) are exempt from charges. I don't know about unemployment benefits as they are very high so it wouldn't be needed. Again as far as I know there are no working benefits here. Employers have to pay a living wage. You just
don't see poverty here like you do in the uk.

Perhaps a system like the police now have where staff must maintain a certain level of fitness would fix some of the shortages of staff. People going off and having to have their posts filled by bank staff might decrease.

It beggars belief that running a hosp where the staff are so exhausted and demoralized that they are off sick so huge funds are needed for bank staff, is the way to go. Just crazy.

in other counties (can only speak about germany and austria) the nhs is regarded as crap and to be avoided if you can...that's the gist you get on expat forums.

yes well people on expat forums very often have an axe to grind and are bored and cynical and homesick.

very true

We need to change the NHS. It has become a catch all for all sorts of things and those things cost. We also need to get people to take personal respoonsibility for their own health, we have an obesity issue in the UK, people arent getting fatter by just thinking about food.

I went to my local pharmacy last week and the shelves were literally groaning with presciptions. The chemist told me a siginficant minority will never be collected i.e the patient has died, doesnt take the medicne anymore, has forgotton to collect and because they are free there is no need to bother to cancel and there are also the older patients who take a raft of medicnes who whether they can afford or not get them for free.

There are some on this thread who have used the NHS extensively for all sorts of reasons (and of course that could be us) who see no need to change the system and ceretainly dont want to pay 'twice'. Best that 'someone' else pays.

There are people who wont priortise their health, their priority is having a good time, flashy mobiles and a sense of entitlement that healthcare is for someone else to pay for.

We also need to tighten up on health tourists and allow hospitals to take E111 card as a matter of course. When you go into a shop you are expected to pay for the goods you purchase or provide a voucher.

The NHS is in two parts - the exciting part with Dr's swarming around your bed because something unusual is happening and the mundane side which goes from bad to worse.

Finally we need to cut back on non life threatening options. Nose jobs, and IVF (sorry but its not life threatening) are not endangering your life. You might not get what you dreamed of having but you shouldnt expect someone else to pick up the bill. I know this wont be a popular view and have my tin hat at the ready but no one gets everything they want and crave in life and we need to accept this. I have plenty I would love to have but for all sorts of reasons dont

The NHS isnt the envy of the world. Its free and you will be treated even if you havent paid a penny. That is what the envy is around..

I totally agree about the nose jobs and IVF Hillingdon.
Plastic surgery on the NHS, fine, but only if for eg something that disfigures or affects health.