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?

[Namechanger2015]

Is there a reason gp surgeries and hospitals don't have donation boxes by the entrances?

I recently had a 3-day stay at a children's ward with my daughter and the staff and facilities were amazing. I felt quite guilty leaving without contributing a penny. I did ask a nurse and she said that donation boxes are seen as begging and therefore not allowed. But I'm sure those who could afford to would gladly drop a tenner in a box on their way out.

The NHS is incredible and I think enforcing payments for services is a very slippery slope. But there should be an easy straightforward way to contribute if you want to. It can't all be about charity hikes and 5k fun runs.

I would love to see a voluntary donations box at every st the door of every healthcare provider.

[Eastpoint]

I recently visited a refugee service and one of the areas in which they assist their clients is understanding services such as the NHS. Some of their clients mistakenly believe that if they need to see a doctor they should just call 999 and get an ambulance to take them to hospital. I assume they are telling me the truth when they say this.

[Hamishandthefoxes]

The trouble is that if there is s charge for gp visits, a huge number of people will go to a&e. Charging for A&e would immediately destroy the concept of a free at the point of use NHS.

There either needs to be an additional hypothecated tax of compulsory insurance. Otherwise a&e will crumble under the strain more than it is.

[willowsummers]

The issue with blithely stating that 'they can afford it' ('they', presumably, being those who earn over a certain amount and no adjustment made for personal circumstances) is that it quickly leads to resentment between the haves and have nots. It adds to the sense of general disparity between those who work and have to pay for essentials and those who do not.

Unless the charge is brought in for everybody - which I imagine most of us would be against - it would not make people feel for the most part happy to be saving a crumbling NHS but bitter that again, working and contributing to the economy in some way is something they have to pay for.

[scarednoob]

I have wondered about this, but in all honesty I don't think it would work - slippery slope and it will create a lot more admin. Plus it would only be scratching the surface. Eg I'm a higher rate tax payer and have been lucky to be v healthy; I never went to the gp (other than for smears) for years. I definitely put in way more than I took out, which I was happy about.

But when I had DD and had reduced movement plus GD, I was in for daily monitoring. Then 3 weeks on the ward and a 5am c -section. Not covered by my private health insurance. So that one incident would have swallowed up what I've put in over the last 20 years and then some. And I was just one person having all that; hundreds of women passed through my ward during the 3 weeks I was stuck on it. It made me really appreciate the incredible value of the nhs in a way that I just hadn't appreciated before, because I hadn't needed to. We must preserve it; it's incredible.

I think the cuts are in the wrong places; i suspect there are some middle management roles that might be surplus. And I know this will be unpopular, but what about tourists/visitors/people who haven't lived here and paid tax for a certain number of years having to pay for treatments, perhaps with travel insurance requirements or something? The case of this lady was of course extreme:

//www.metro.co.uk/2015/08/29/this-mum-had-quintuplets-but-not-everyones-happy-she-didnt-pay-the-nhs-145000-5366373/

but I had DD in a Central London hospital, and I overheard numerous ladies chatting with nurses and midwives who were only in the uk temporarily and going home when the babies were here, so I do think there is an element of health tourism, which I had previously dismissed as daily fail bollocks. And when my friend twisted her ankle when we were in France, she had to pay upfront. It's not ideal but something has to change as the nhs is unaffordable in its current state, and that might be one way to trim some of the costs.

Of course in an ideal world, everyone and every company would pay their fair share of tax, but until we get a government that can do that without stopping investment here, we have to look at outgoings as well as income IMHO.

[Inertia]

I completely disagree, and you are being completely unreasonable.

The entire point of the NHS is that it is free at the point of service. We've seen what happens when this government decides that universal benefits are no longer universal- the qualifying criteria become increasingly restrictive.

The people who would suffer most with a charging system would be those with chronic health conditions and disabilities, or children whose parents have had to give up work to manage the long-term medical problems of the child.

A nominal charge, and the associated means testing system, would cost money to process. This means that either the patient is paying for bureaucracy, or the NHS spends money on means- testing/invoicing systems which could be spent on patient care. An income tax increase and accompanying increase in health budgets would be by far the most efficient way to raise funds- by definition, those who could afford more would pay more.

But this government is determined to privatise the NHS, especially as so many of them would personally benefit financially - it terrifies me , frankly, that we have this incredible healthcare system that we take so much for granted that we're in danger of it being dismantled before our eyes.

If you personally want to pay, then private healthcare is available.

[Mistigri]

ruby the Australian health service ranks as pretty good on most international comparisons (though overall slightly below the UK) - but you also spend about 10% more per capita than the UK does, for a health service that is inaccessible for part of the population ...

The biggest consumers of GP services are the elderly and those with chronic conditions; these are also the people least able to pay. The report linked below has a graph showing how the average number of primary care consultations a year has changed in the last two decades: it's risen slightly for people of working age, but has massively increased for people over 65 (on a per person basis; this doesn't take into account the increase in the total number of elderly people in the population).

It's not completely clear why this is, but an increase in the number of elderly people living with multiple chronic conditions is part of the story.

www.rcgp.org.uk/~/media/Files/Policy/A-Z-policy/The-2022-GP-Compendium-of-Evidence.ashx

[sashh]

Go have a look at the history of the NHS - particularly at the start when doctors and government were totally unprepared for the number of people needing medical attention but who had been suffering for years.

Look at vaccination rates in the US - when children start school they are vaccinated, but often parents spend years saving for jabs that in the UK are given much earlier.

[Rubygillis]

In australia once you have been to the GP a certain number of times in the year (maybe 4) you reach a threshold and after that all healthcare is free, so people with chronic conditions don't pay - not did I for anything the year I had my babies.

You also don't pay for children.

But it is different - we do pay a lot more tax.

[Nottodaythankyouorever]

Because most triage people are idiots

Any other untrue sweeping generalisations you want to throw around cats

[Rubygillis]

But I would disagree that it is inaccessible to anyone (although am prepared to be corrected) because of the threshold.

[BeaufortBelle]

On balance I agree with an upfront charge and indeed a complete reorganisation of the NHS. In the last six months:

My DD has been refused a CAMHS intervention when she was escalating (no alternative but private and both CAMHS and GP told us to sort it out ourselves and google therapists)

My DD had some NHS blood tests that were "unusual" GP refused to refer for additional tests because they were just within the norm. DD diagnosed privately with a life threatening and serious medical condition.

I had an accident and a&e staff refused to find me a seat when I couldn't lower myself into their little chairs or stand any longer. My back was broken.

Recent experiences lead me to conclude the NHS is no longer fit for purpose. Fortunately we have quite a lot of money but if that was not the case my DD would by now be in a dreadful state mentally and physically and would have suffered probably permanent detriment to her future. I'm off to see a specialist today at a private hospital because my GP refused to refer me for further investigations whilst offering to sign me off work for four weeks. I took two.

As far as I can see the NHS is no longer fit fir purpose and certainly does not exist for the benefit of the patient. The fact we are supposed to be grateful for something so disgraceful is beyond me. There is no way I am prepared to pay more tax for this shambles and it's incredible that people in the NHS think standards are good enough when they simply are not. We have never abused it. When we needed it, it wasn't there. Ifcwe didn't have money, I honestly don't know where we would be.

[iPaid]

NHS free at the point of use now and always.

[SmallGreenBouncyBall]

having received apalling 'care', outright dangerous delays and mis diagnosis, I don't think abolishing (or massively reorganising) the nhs would a bad thing.

[HumptyDumptyHadaHardTime]

On balance I agree with an upfront charge

So you want people that may not be able to afford it to pay but you aren't prepared to pay more on taxes even though as you admit, you have the money.

I am sorry for what you have been through but also private isn't always best.

[LazyDaysAndTuesdays]

having received apalling 'care', outright dangerous delays and mis diagnosis, I don't think abolishing (or massively reorganising) the nhs would a bad thing.

I have had misdiagnosis and a condition made worse privately. Just because something is paid for it doesn't always mean better.

[lostinyonkers]

But Beaufort, what would happen to all the people without money if there was no NHS?

I think there should be some education on the NHS to try and stop entitled arses swanning in to their GP surgery for an appointment and demanding a free prescription for paracetamol, which they could have picked up at the supermarket for 19p (am in Scotland so all prescriptions are free). So they have taken up an appt, and are costing the NHS £'s for a tablet which they could have picked up in 5 minutes at the Tesco's they pass on the way to the surgery. Pharmacist friend despairs over the amount of waste he comes across - literally bins full of unopened packets of pills/dressings etc.

Our surgery has just started to post stats on the missed appointments every month and there have never been fewer than 8 a day, in quite a small practice.

I do however think (and so do most of our GPs), that there should be some kind of OOH GP service, say until 10pm and on weekends.

[OhShutUpThomas]

This is a ridiculous idea, and a good start down the slippery slope to losing the NHS.

[BillSykesDog]

Because most triage people are idiots......I refuse to speak to them now. I know my condition, I know what I need. I don't need some unqualified jobsworth telling me to call back later.

And therein lies the problem. They're not 'unqualified idiots', triage is done by senior doctors or GPs themselves normally these days. But people are resistant to even the most basic triage to identify emergencies. Everybody thinks they are the one special person it shouldn't apply to. Which is why the system is falling apart.

[LazyDaysAndTuesdays]

Because most triage people are idiots......I refuse to speak to them now. I know my condition, I know what I need. I don't need some unqualified jobsworth telling me to call back later.

Actually they are highly qualified Thecatsmeow but don't let ther truth get in the way

[TheCatsMeow]

At mine they're just receptionists

[WidowWadman]

A token amount wouldn't stop the worried well seeing their GPs or attend A&E when they don't need to, but may very well stop or delay people who need healthcare from going, making things worse for them and more costly for the NHS.

[NeedACleverNN]

Whoever said that we need to be fined if we miss an appointment, well in that case the doctors need to find a way for people to cancel them easier.

I needed to cancel an appointment and after an hour of ringing, I still couldn't get through. By then I had missed it anyway. That wasn't my fault. I had tried to cancel but as the phone lines were engaged I couldn't get through

[Mrscog]

I think a way of donating would be the best way forward - collection boxes or something. I love our GP surgery, it's excellent and I'd happily throw in my loose change when I'm there, likewise when I had my DS's I wanted to donate to the wards but I didn't just because it would have involved writing a cheque and sending it in - if I could have done cash/text message donation etc it would have been done there and then.

[BeaufortBelle]

Let's be clear, I would pay more tax for a modernised, restructured service. Whilst those in the NHS continue to tell me how marvellous it and do not acknowledge its shortcomings I will not willingly pay more tax to fund its failings. The NHS seems to get more like Little Britain every day. DD's bill is presently just under £4,000. I have no faith left in our local NHS services to transfer her care back to them. Mine today will come to whatever an MRI and Xray costs, with probably some treatment for one condition which needs to be changed but the NHS refuses to do this because the drug interraction isn't great enough or I'm just outside the NICE criteria which doesn't take into account the benefit of me staying at work.

Some acknowledgement of the failings and idiocies from within would be good but until those running it understand this isn't good enough there is no point in giving it more money. The money will just be wasted.