To think that *some* people paying for healthcare *some* of the time would be no bad thing.

[manicinsomniac]

I am a big fan of the NHS and think it would be terrible if we lost it.

However, I think we could help prevent that happening by it being not quite so free as we are accustomed to, iyswim.

I had to go to my GP today for help with my totally avoidable and self inflicted health condition. I was given an appointment just 3 hours after phoning and the doctor was calm, non judgmental and extremely helpful. I am independent adult with a good, full time job.

I can't see why I, and people like me, shouldn't pay a token amount towards GP appointments, just like we do for the dentist. Even just £10-£15 a visit could make a huge difference on a national scale, surely.

Obviously if you are a) poor b) have an illness or disability that requires frequent appointments c) are a child or d) need expensive treatment/care then the NHS is vital and must remain free.

But I don't see the need for this 'free at the point of use' thing for all people in all situations. If you can pay for standard, infrequent appointments then I think it would be fine to be made to.

AIBU?

[susurration]

I agree with this. And also I'd like it to be easier to mix and match services where possible.

For example, I had a serious breakdown two years ago that landed me in hospital. I was promised an urgent psych referral that never materialised. So husband took me to and paid for a private (fully qualified) psychiatrist who did a full mental health assessment, recommended treatment and medication and sent me back to the NHS. When we got back to the NHS GP there was a hell of a palaver actually getting the prescription fulfilled, in fact a three day delay during which my health obviously continued to deteriorate. If there had been a way to simply get the script in front of a GP without having to wait three days for an appointment it would have been much simpler. The second problem with this was that when the 'emergency' psych referral actually arrived TEN months later, they too did not believe that the fully qualified psychiatrist was just that.

The way I see it, we spent £300, but in theory saved the NHS money and time by finding and seeing my own psychiatrist, leaving an appointment for someone else. I wish we hadn't had to do so, but we were getting no where with the NHS anyway, so why can't we just mix and match to try and actually smooth things out anyway?

[BeaufortBelle]

What I haven't said is that I am still spitting feathers because whilst dd has had the best MH care available in the UK, other young people in my area who were in the same clinics position have not had care from the NHS and will not get it until their mental health escalates and they attempt suicide and have or are close to dropping out of school. It makes my blood boil and I have now met twice with my MP about it. I am getting the impression that it is as much about mismanagement of resources as it is about limited resources. It is absolutely unacceptable.

[hefzi]

No, absolutely, BB - I was just interested (and nosy - I appreciate it was none of my business) because I think our general opinions are fairly similar despite the significant income disparity ( and I also send flowers and write letters, as well as pay for appointments if I haven't given 24 hours notice of a change: again, though, when people know you're not a flake, they tend to return the cheque!) And like your husband, I also went into work after piles: though I wasn't there for all that long, as it was a GA and day surgery, so I only made it just in time for my 4 o'clock lecture: I was moving a bit gingerly all class, though

tin that's what I was told by several GPs at the practice where I was a child - they are the sort, though, who affect to be enormously offended by private medicine I don't think, if something was serious enough to need to jump a waiting list, I'd be in any mood to quibble, frankly (and actually, I think it's rather rude to barter with professionals as though it were a car boot sale )

I know my father needed to see a cardiologist urgently about four years ago (according to the GP): the waiting list was at least three and a half months - but strangely, if he paid the £180 consultancy fee, he could be seen the same afternoon.

[BeaufortBelle]

No offence taken hefzi but you did ask . I agree entirely with othehugemanatee. What I have difficulty reconciling is the fact that anyone should be grateful to the NHS. I am grateful for good, kind care from wherever it comes. I accept that if DH needed a procedure he would have to pay because it has to be convenient for him. We are however talking about the man who had his piles done at 9am and was in work by 1.30pm. Only a local though - and he did moan a lot for about a week.

When I get good care, I always write and say thank you because I think bouquets are as important as brickbats. But it concerns me that it is 50/50 overall. 80/20 vis a vis doctors, physio, radiologists, etc - probably higher for the latter two but sadly closer to 20/80 vis a vis nursing care. It is massive problem.

We are London or outskirts so experiences might be skewed, I accept that.

[BeaufortBelle]

My physio charges for a dna. I had to cancel at short notice because my stepfather was ill. Rang up and apologised and put a cheque for £50 in the post. She phoned me when she got it to say she'd put it through the shredder because she filled my half hour with an emergency. But then I'm very reliable and she pokes me if she sees me in waitrose

[EmbroideryQueen]

How about a system whereby an appointment charge is set and each time a patient is late or absent they pay, but each time the NHS is late of cancelled they pay the patient that's a system my bank balance would be in favour of!

Still cross that my DC had to be put on a drip as a baby due to a nil by mouth operation being delayed by 12 hrs! 20hrs total nil by mouth is not acceptable for a 3 month old!

[tinofbiscuits]

I know it has been recommended to me by doctors that I just put money away and then "barter" as necessary hmm instead of paying insurance

How many people are in a position to barter when they're feeling ill?

[hefzi]

BeaufortBelle sorry - I realise it was a personal question: I was just interested. I know it has been recommended to me by doctors that I just put money away and then "barter" as necessary instead of paying insurance, but I'm not in the position where I ever have a couple of hundred not doing anything to pay a consultant with - so it makes sense for me to insure. I know my DP faced a similar thing as you and your DP with regard to premiums some years ago - DF was younger than 50, but had already had heart trouble, and as a result, premiums just for him were over £1k per month.

I don't think anyone should have to pay to get better service - but the sad fact of the matter is that if you're paying, you do: and I absolutely agree that it makes sense to pick and mix where that's possible, no matter what the level of one's personal tax burden is.

I completely agree (I wonder how often I've posted that before!) with Manatee - the fact that there are issues with the performance of the NHS is in no way a criticism of the dedicated staff who work for them: and really, in the 21st century, we should have no "sacred cows" of the state. There is - for whatever reason - quite clearly a complex problem: as tax payers and service users/patients, we deserve a good service that is both fit for purpose and value for money.

[inlectorecumbit]

I would prefer that Patients were "charged" a fee for not turning up to appointments. I had 40 minutes of wasted time on Thursday morning due to no shows who had booked earlier in the week.
Just how you could gather the money or police it l have no idea.

[OTheHugeManatee]

I don't have a problem with asking critical questions about the funding and delivery model for healthcare in this country. I don't like this religious devotion that seems to be encouraged in this country towards 'our' NHS. It's not like we get choirs singing songs about how wonderful HMRC are. There are plenty of countries that mix private and state provision without creating huge health inequalities such as we see in the USA and I'm not sure why private provision has to be treated like some kind of satanic predator by definition.

There are loads of people working within the NHS who are immensely committed and caring, and do a difficult job to the best of their ability. But the system overall does not work particularly well, and to point this out is not insult individuals doing their best within that system.

[BeaufortBelle]

I checked the figure between thinking that post was lost and now.

[BeaufortBelle]

Because our annual premiums for a family of four hit £8,500 per annum about four years ago and with the excesses and exemptions increasing we decided it wasn't worth it. We can afford to self pay. Why, however, if the NHS can provide a service as good as is available privately should one if one doesn't have to? Doesn't it make sense to receive what is available free and pay for what isn't. DD recently needed some blood tests. Our local private hospital quoted £270; our GP did them for free. They were recommended by her psychiatrist to whom we had already paid about £900 plus £550 of counselling because CAMHS didn't consider her to have reached their definition of tier 3 although she was only assessed by a primary mental health worker, whatever that is. Therefore I have no difficulty picking and mixing, especially as our tax bill last year exceeded £250,000. That's an awful lot going into the system for very little return. If only the system spent money as wisely as we do.

[BeaufortBelle]

Because for a family of four when DH and I hit 50 the premiums increased to about 6,500 per annum. In the last four years we would have paid £26,000 in insurance premiums. In the last four years we have spent about £6,500 so far. My op will cost about £5,000 I think. We are rich enough to take the risk and self fund, especially with limits and excesses imposed.

[hefzi]

Titclash genuine question: if 116 billion isn't enough to do a good job, how much is? And if 1.5 million employees (see previous posts) aren't enough people to provide a good service, how many would be? You do know too, don't you, that the Tories have put more money into the NHS than Labour did? (Not a Tory, but I think this is something more important than party politics) And that their election pledge was over twice what the Labour party promised?

Having a massive NHS deficit, with such an enormous budget and payroll, is a problem: how much money is enough? How is this decided? Who decides? It's simplistic in the extreme just to say it's all the Tories - how about Labour's love for PFI hospitals, for a start? Yes, it's a nice soundbite, to blame "austerity" - but it's neither true, nor helpful.

And as for cuts to libraries, MOW etc: that's in the gift of the LA. Ours have cut these - but managed, at the same time, to take on new offices at vast expense, give all councillors double percentage point salary rises (again) an put council tax up. My parents live in an area where their council tax hasn't increased in five years - mine shoots up every year. LA's love to blame the government - but they don't want to get rid of their chauffeur-driven cars, multi-million pound junkets to Shanghai or moving to the latest plush set of offices, despite still having to pay millions every year for the lease they've broken.

[JakeyB]

Of course I know this, that's why I never once said "English government". I said your government, as the poster didn't make it clear where he/she was from. Clearly not Wales or Scotland, but could have been NI.

[hefzi]

BeaufortBelle genuinely not a goady question, but if your family are in the top 1% of earners, why on earth do you not have private health insurance? I am not a higher rate tax payer, and it's my single largest monthly expense after my rent - but I do: precisely do that I can be referred quicker than otherwise would be possible. Yes, it costs me about £800 odd a year, plus one excess, and obviously my tax share into the NHS is more than this - but a regular night in hospital costs around £1000 (to the NHS): it doesn't take much to see that a lot of people are taking a lot more out than they are contributing, and that this will have knock on effects.

I appreciate that perhaps, if you have the money to pay, perhaps it makes more sense just to cough up ad hoc - but if that's what you're doing, why on earth not tell the NHS so, as one days when one has insurance, so that you can be referred quicker?

[TitClash]

I actually support the NHS as it is, rather than paying lip service to it and then saying 'but lets just dismantle it anyway'.

Its not crumbling, or in crisis. The Tories have underfunded it, no surprises there.
We are also losing libraries, mental health services, daycare, home helps, meals on wheels and a lot of other services.

Privatisation didnt work for the trains, water companies, electricity companies et al and no one want the 'health care' system the USA are stuck with. They are now trying to move toward the European model.

[hefzi]

Jakey you do know that there is no "English government", right? It's the UK government who makes the decisions on England - Scottish, Welsh and NI MPs included

[Atenco]

When I lived in Dublin the "poor" were given medical cards that entitled you to free medical care and prescriptions. There were two problems with this.

One was that it was generally understood that GPs gave better care to their private patients. I don't know if this was a fact, but I, having a medical card, found the local GP appallingly bad, whereas all my friends who paid him privately loved him.

The other which is more serious is the cut-off point. I knew people who earned five pounds a week more than me who had to pay for everything.

As for private insurance, where do I start? One friend of my sisters has not been able to move countries in the last thirty years, because he has a pre-existing medical condition and would never be able to get insurance for it. A couple of friends of mine have had accidents that were not covered by their medical insurance because of imprudence. Another person who had a heart attack while on holiday was made to wait sixteen hours in the waiting room and not allowed to leave the hospital because they couldn't process his travel insurance.

[BeaufortBelle]

Or you go to the gp who refuses to refer to prevent a condition becoming long term and chronic and preventing the individual from working. At present I pay rafts of money in tax and the NHS has refused to provide necessary care to my family to deal with illness. But it provides free abortions, free gastric bands, free check ups just looking fir disease but not medical care when it is necessary.

As far as I'm concerned I has reached the end of the road. It isn't even as though the services it has failed to provide us with would have been provided to a poorer family. The poorer family would just have ended up with a teenager attempting suicide and dropping out of school before anything was done and a parent who had to take early retirement, probably without the means to claim an ill health pension.

The problems in the NHS trace back to Europe and working time directives, poor management most notably creeping in when the PCTs mushroomed and caused an administrative and bureacratic explosion, and the dilution of the influence of doctors 20 years ago now replaced by new consultants trained in a broken culture and without the same levels of practical experience because you can't get it if you work half the hours of previous generations of early careerists.

Happy to pay more, but the culture and attitude have to change.

[Tfoot75]

First of all the government that won an overall majority at last election don't support public spending or increasing taxes to well off people.

Secondly if they wanted to increase nhs spending, which they don't, why not just double prescription charges? The point is, the vast majority of people accessing gp services are pensioners, children, disabled or on benefits so would be exempt, so your suggestion wouldn't raise very much money at all.

Thirdly, such a system needs to be free at the point of access to have any chance at cost prevention. Ie we vaccinate, prescribe medicine, do diagnostic checks by gp to avoid admission to hospital, which costs a fortune. If you charge for gp access you just add more cost further up when more people require hospitalisation because they avoided the gp. Rather obvious.

[JakeyB]

It is utterly unfair that we pay the same tax rates but Scots and I think Welsh even if they are billionaires do not pay a penny in prescription charges. Scots don't even pay student fees. We should be a united one nation with the same rules for all. Or if the welsh want free prescriptions they pay 5% more income tax.

But the reason we are all different DeoGratis is that we are not one nation. We are four different nations in a political union. We are governed in different ways and each governing body had the right to do what it thinks best for its people.

There are also four separate NHSs (although I think the NI one is called something different). The problems described in this thread mainly relate to NHS England, but that is because of how they have chosen to use their budget. NHS Scotland and NHS Wales have decided to spend theirs differently, e.g free prescriptions, free personal care for the elderly etc. which again is their right to do. If you have a problem with other parts of the state having free prescriptions, you should be lobbying your representatives for the same, not insisting the other countries should lose them.

Similarly student fees - the Scottish government has chosen to invest its money in making further education universally available. Yours has chosen not to.

[cleaty]

We do not pay enough for healthcare, it is as simple as that.

Although I do not think viagra should be free on the NHS.

[scarednoob]

Yes. Of course it is bullshit to say that paying money is of more practical benefit than talking about how everyone else should pay more money

[Bubblesinthesummer]

Those that have a certain number of prescription each month can get the previous paid cards if they don't get free scripts.

I think it is about £12 a month.

I have being doing this for years. If I had to pay separately for each script it would cost me well over £200 every 4 weeks.