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?

*I'm fascinated by this idea that seems to have taken hold that the NHS is "crumbling" and "can't hold on"

My understanding is that, comparatively, judged globally, it is very cheap and efficient for what it does, and does it well.

Where does this emotive insistence that "it just can't last" come from?

Please, ask yourselves. What figures, information, that this is a bad way to run things, do you have?

If any. Is this just vague empty "PHPHPHWHH WE CAN'T GO ON LIKE THIS" nonsense that has no data?

I am really interested in this*

Me too. I think there are some people out there who really can't get their head around the idea that it doesn't make some kind of financial profit for shareholders.

Scots pay more tax per head

They take out a heck of a lot more per head.

bubble I've worked out what TheCatsMeow is, a goady fucker. Best ignored.

If the NHS was working well then we wouldn't be regularly reading on here, on MN not in the daily fail, that the following was happening:

• people turning up for appointments on time and waiting many hours to be seen. *people unable to see a doctor for days even though they called as soon as the phones opened.
• people waiting months to see specialists.
• people waiting months for hip/knee replacements
• old people fundamentally not ill and well enough to be discharged in hospital beds for months on end.
• more and more money being paid in for less and less of a service.
• huge unsustainable debt in most hospital trusts and this ever increasing.

you cant solve a problem in business, any problem, by just throwing more money at it. The NHS is a business. it provides a service and it employs people to do this.

you have to look at why the system isn't working and start from the ground up, not carry on tinkering at the edges.

when the NHS was set up it was to deal with life threatening and life changing illnesses. not tattoo removal, fertility treatment, cosmetic surgery, gender reassignment, people who call emergency services for condoms.

mrsmorton one could be goady in return and point out that the "selfish money driven ones" whose contributions pay for things are actually more practical use to society than those with lofty ideals about it all, including how to spend other people's income. But that wouldn't be very nice on a Saturday morning now, would it?!

You're being very restrained noob

I try...

I'm not a goady fucker, I just dislike some people's attitudes.

And sacred your point is bullshit, it's the old "business is better than arts" just in a slightly different form. Without people pushing for change, working in underpaid jobs, perusing cultural endeavours society would fall apart

I'm not a goady fucker, I just dislike some people's attitudes.

As others probably dislike yours. All fair and all that

For years and years I thought the fact that my need for levothyroxine meant that I got other prescriptions free was nuts too. And it was when all I needed was a whisper of HRT or a course of antibiotics every seven years.

And then I developed osteoporosis most likely because a GP failed to diagnose graves disease for about five years in my 20s. In the last few months I've needed the following prescriptions:

Risedronate x 2
Adcal x 2
HRT x 3
Cocodamol x 2
Omeprazole x 2
naproxen x 2
laxatives x 1
Levothyroxine x 2

That totals £128. Likely to need many of those meds for years to come too although if the omeprazole is long term I'll need bisphosphonates via an effusion because it stops the latter working. I might not have osteoporosis had the graves been diagnosed. I might not have a wedge fracture of my spine if I hadn't got the osteoporosis. I therefore no longer think the free prescription issue is nuts.

Yes, I could easily afford those prescriptions but why should I when my family as top 1% earners and tax payers already pays shedloads into the NHS which sadly has not provided us with too great a service in the last six months.

No treatment via CAMHS for dd so we have paid for that in spite of what we have already contributed.

GP didn't want to refer my back problem under the NHS so privately I've had a consultation, further Xrays and an MRI and advised I need a surgical procedure to help rebuild a vertebrae. Needs doing within 8 weeks of the break to be really effective but GP didn't want to contemplate referring until at least 10 weeks after so never mind developing chronic long term back problems. So that's another several thousand out of my pocket as well as the NHS contributions.

I have no doubt I'll end up paying for the effusions and rheumatology referrals too.

So, you see I really don't accept that I should pay extra on top of what I already pay for a service that appears to be non existent. If I don't get my problem treated it is likely that I might not be able to work until retirement and the NHS misses out on further tax contributions from me.

The NHS has not served my family well at all in the last six months. My trip to a&e met with a bunch of jobsworths (the doctors were absolutely fine btw) but the reception staff were monumentally rude to all they dealt with and the nurse I dealt with was the ultimate jobsworth. Both refused to help me find a suitable seat with a broken back and told me to stand and wait if I couldn't sit in the low metal chairs provided.

The only positive I can think of if I had been sent a further bill for that visit to a&e is that I would been delighted to return the invoice with a letter of complaint directly to the chief executive.

I thought the aim of the NHS was equal access for all. Charging those who pay the most more is hardly equal.

Current bill for necessary treatment not available via the NHS to ensure members of my family fulfil their potential and continue contributing is I think about £12,000. If people like us are prevented from contributing because we are not optimally treated to keep us working then that will result in a totally and permanently fucked NHS.

And finally, as a society we spend millions training nurses. We should be insisting that nurses continue to do what they were trained to do and that is to nurse. They weren't trained to manage and they don't make good managers - ask some doctors. They needs to be back on the wards, working and nursing. Personally when I do use the NHS I generally find that I get an exceptionally good service from the doctors I come across. I do not get an exceptionally good service from the nurses or from the administration I deal with. Invariably they are uncaring and have a air of doing the patient a favour. Too often their actual role and training is opaque and it is very hard to work out if one is dealing with a nurse or a healthcare assistant. It is never clear. It is not good enough.

Not of course, and they're allowed to

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.

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

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.

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.

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.

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.

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.

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

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.

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?

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.

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.

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.