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?

Why do you NEED that? Why do you think it's acceptable to have that when some people can't afford a basic standard of living?

Yes, lets implement communism. When people who've spent ten years training to be GP's have a national median income of 21K to look forward to, there will be such a rush of people wanting the jobs that all problems of appointment availability in primary care will vanish immediately.

Or maybe the people who think other peoples earnings should be allocated to them should just go and do the jobs the highly paid people do? After all, if there's nothing different about them that makes them deserving of being paid more, then there's nothing to stop you being them?

I believe some things should be charged for, regardless of whether someone is "poor" (whatever that is) or not:

1. Missed doctors appointments
2. Missed hospital/consultants appointments
3. anyone drunk in a and e
4. fertility treatment

5 cosmetic surgery for anything other than accident

1. all holiday vaccinations
2. any bariatric treatments
3. anyone not a UK citizen before they receive treatment, not after when you are chasing up someone who has left the country.
4. gender reassignment

the NHS in its current model is completely unsustainable. I already pay for the service as a net tax payer. and before anyone says one of the points above is unreasonable for whatever reason I have had to use the service under at least 2 of the headings that I would no longer want to see funded.

we cant keep asking for the nhs to do more and more, for less money to more people. we just cant. it needs a radical rethink and reshape as it is no longer fit for purpose.

The start of a very slippery slope IMO and IME

I don't think anyone was arguing for a communist state theoretician, merely that some elements of the distribution of wealth are unfair, and could be fixed. And fwiw, I don't want anyone else's salary for myself - I'm perfectly comfortable ta! I could easily double my salary for very little extra effort but prefer doing a job I love.

mummy, it is interesting that at least one of your list is a medical problem which is not the fault of the person needing treatment. But you've missed off many treatments which are the responsibility of the person involved (eg any injury while drunk or playing rugby).

hefzi, there's an aging population to take in to account too. People (on the whole) need more medical care as they get older. And raw data on new staff isn't that helpful. Does it take in to account those leaving as well (ie are they net figures) and are they all full time, or is part of that down to an increase in part time working? Finally, as we keep finding new ways to treat illnesses which used to be untreatable there is an associated cost with the additional treatments.

The biggest problem with the NHS is that it is successful. It keeps people alive and then they need more treatment!

The NHS dental service already charges people - it's 18.80 for a basic exam with scale and polish. That goes up to 51.30 for fillings and root canal treatment. As an adult you have to show proof of free entitlement in order to not pay the fee e.g. you get DLA or jobseeker's allowance. I don't see why this shouldn't be applied more generally in the NHS, particularly with GP visits. Surgery and the like should always be free though, in my opinion

Problem is dentists don't deal with life threatening illnesses.

People don't go to the dentist even when in pain, if they can't afford to.

If someone doesn't go to the GP because they can't afford to it could lead to serious issues or even death.

Also a quick point. You also don't automatically get free dental care if on DLA or PIP.

I completely disagree, no one chooses to be ill and require seeing their GP or going to hospital. Yes, promiscuous behaviour is personal choice but that doesn't mean the person chose to get an STD and should pay for it. Yes, drinking so much you are sick is personal choice but that doesn't mean that person should be made to pay A and E bills. No one chooses to get ill, and no one should pay for healthcare.

For many people who suffer from 'self inflicted' conditions, they are taking the first step by seeing a healthcare professional. Why should they be punished for trying to get better, by having to pay for it? It'd just mean more people not going to the GP or whatever, which would make things a lot worse

I guess there's an objection to paying more tax whilst the NHS system is as inefficient as it is. There's probably enough funding to pay for everyone to have lifesaving/ life improving medical treatment, but so much money is squandered. Reform would be needed before tax hikes could be sold to taxpayers, I suspect.

France's system seems sensible at face value.

100% agree with mummymeister's list.

Just common sense really.

Theoretician I'm a socialist not a communist. I don't think everyone should get a flat rate. But the redistribution here is awful and some professions are horrifically underpaid.

It's immoral to have someone earning 200k when there ate people using food banks

I don't think anyone was arguing for a communist state theoretician, merely that some elements of the distribution of wealth are unfair, and could be fixed. And fwiw, I don't want anyone else's salary for myself - I'm perfectly comfortable ta! I could easily double my salary for very little extra effort but prefer doing a job I love.

So how do you suppose this 'redistribution' should happen then?

Jessica they are net figures - so after retirees etc and calculated at 1.0 apparently (so a 0.5 contract counts as half a person): if you include the non-working population, it's something like 1 in every 45 people works for the NHS (so actually, a much lower rate once you've taken children etc out) It's not just people living longer: that's a trend across the developed world, for one thing - and actually, the NHS doesn't have the best outcomes, overall in certain areas, in the developed world (for example, in cancer. The figures don't include services that are contracted out - like security or cleaning - or agency nurses.

There are still only 65 odd million people in the UK - including children etc- and 1.5 of those work for the NHS: we should have a totally phenomenal service and outcomes at those ratios. And yet we don't. So what exactly is going on? And I don't think it can all be cost of drugs - after all, isn't that exactly what NICE is set up for?

So something else is going on here: is it over-staffing in the wrong areas? General inefficiencies? Woeful mismanagement of budgets? When there's a problem, the solution isn't just to chuck money at it: you need to identify the problem, resolve it - and then see if it needs further money.

I don't work in the NHS, so I don't know what the problems are on the inside - and they probably aren't the ones it seems from the outside (poor balance to management/front-line staff for example): but when over £116 billion is nowhere near enough, there needs to be a real overhaul of the system.

It was in the papers last week that an NHS operation is cancelled every 10 minutes because patients haven't followed their doctor's/surgeon's instructions prior to the procedure: that's over 50 000 per year. That has a cost. Missed (and not cancelled) appointments have a cost. Long-term sick leave as a result of stress has a cost. Perhaps it's a combination of lots of little things like this - or perhaps there's a bigger, structural failing. Perhaps it's just that we are all taking out more than we put in - whether because of an increasing population or an aging population. But it certainly needs to be proven before taxes are further increased to pay the costs. You wouldn't go to a mechanic, and he tells you that the problem with you car is that you need to spend more money on it to get it to run better - and then hand over a blank cheque without receiving further details: you'd want this proving to you. It's the same with the NHS (in this case - but applies to anything in the public sector really) - it needs to be shown what the problem is, so that it can be fixed.

shut higher taxes and better public services. I could write a super long post but I dunno if you'd be interested?

Basic first aid in all schools would be an amazing start
I have NEVER had a call about a child/toddler/baby that's been burnt/scalded where anyone has thought to use cool water on it
Really simple stuff - if blood is spurting out, press on it, if someones having a fit, don't jam your fingers in their mouth
999 gets used because it's free - when people have no credit, they ring

Basic first aid in all schools would be an amazing start

Yes it would

On the other hand I went to the GP. One of my medications gives me severe pain but I need it. So the pain isn't controlled with codeine. They wouldn't offer an alternative but gave me 28 codeine tablets (dose of 1 or 2 X 3 a day) so that's what 4 days worth? And it's not on repeat. So in 4 days when I still have the pain (as I will for the rest of my life), I have to get another appointment to get another 4 days worth of a tablet that doesn't control the pain
I mean... That's insane

I have three illnesses that require frequent gps visits ( one life threatening) how much do you think that would cost me?
I never asked to be ill. I hate it, it's ruined my life.
I have missed two doctors app before in my life.
Why? One because my counselling app that was supposed to only take 30mins took an hour and 20, and when a family member had a crash and i hadto get there.
Thankfully my surgery know idon't miss apps without a valid reason.

Cosemetic surgery, so if someone was born with facial disfigurement they shouldn't be entitled to help?
Or such bad skin condition they are severely depressed?

I ended up not going to the dentist for ages because i couldn't affod it!

What really boils my piss about how IMPOSSIBLE it is to get a GP appointment (because they are all gone at 8.57 am which is the first time you get an actual position in the caller queue as opposed to just an engaged tone, when the line opens at 8.30) is that when you DO finally get one (only open for this time next week, so you definitely have to miss a meeting at work to get to one as you have no way of arranging it around your work) - when you DO finally go, the conversation goes like this:

Patient: could you look at this please?
Dr: hm. How long has it been like that?
Patient: about 8 weeks.
Dr: what have you tried?
Patient: I ignored it for a week, then I tried e45 / ibuprofen / canasten / sudafed for a few weeks, then I went to the pharmacist and got a stronger painkiller / topical treatment, then no improvement, so now here I am to see you.
Dr: ok. I'd like to try you on ibuprofen / E45 for a bit... then if it hasn't worked in 5 to 7 days, I'd like to see you again.
Patient: but I did that. for a few weeks. That's why I'm here. Can't you prescribe x?
Dr: well yes I can but I need to see that isn't responding first.

Quite often, this INSANE multiplication of appointments (do they not believe you? Why do they do this?) is taking place under a poster that says DO NOT WASTE APPOINTMENTS.

So you're back to square one with the phone business, the missing important meetings etc....

I would love it if you could see drs near your work, instead of having to be near home. I miss a whole morning or afternoon practically, whatever time the appointment is, because I commute.

hefzi, I'm pretty sceptical about survival rates. I'll see if I can find the death rates because they are (often) more telling.

£116 billion for 65 million people is loads. Is that just gps and hospitals, or does it include care homes?

I have absolutely no problem with charging people for missed appointments.

kali110 - I have no problem paying for all of your treatments. you didn't ask to be have them. I wouldn't for one minute suggest not treating someone who has a life limiting or life threatening condition or who is involved in an accident. that is absolutely what the NHS should be for.

I do have a problem with tattoo removal - you paid to get it done, you pay to get it undone.

go to an a and e on Saturday night and count the sheer number of people who are there through drink. they should be charged. end of. they have enough money to pay for the alcohol to get themselves in that state.

infertility - I suffered it. I paid for the treatment. not having children isn't life limiting or life threatening.

anyone who calls an emergency service for a completely stupid reason like run out of condoms or cant turn the gas off. bloody charge them the call out fee.

we cannot pay any more money into the NHS. we really cannot. if it were a business it would have gone under years ago. we just keep piling on more and more treatments for more and more things.

I would probably add sports injury to my list as well now that that has been suggested.

we need to go back to the first principles of the nhs. treatment for life limiting and life threatening. we also need to recognise that there are a lot of lazy people out there who take no care of themselves. they never self treat and go to the doctors at the drop of a hat.

HowBadIsThisPlease yes i love your post!!

If you can't turn the gas off ( say an oap) that would be an emergency...
I'm not talking tattoo removal, i agreethere, but skin conditions such as severe scars, or scars that have ben left from acne.
It can be soul destroying.

howbadisthisplease the reason this happens is because 99 times out of 100 the person presenting in front of the doctor is not like you - nowhere near in fact. they haven't tried self medicating at all. they haven't shown the slightest interest in sorting it out themselves. they have just thought "ohhh get myself to the doctors with this"

so who can blame the doctor when almost everyone she/he sees falls in to the "I cant be arsed to sort this out myself" category.

when someone like you walks in, they just cant quite believe it.

we are really lucky with our GP. my eldest dc has heart disease. they don't see us at the surgery from one year to the next. however, if I call and say DC has to be seen now they know I will have tried to sort it out first and that I see them as they should be seen as the last resort. I get DC seen immediately.

same as the hospital. I sat in casualty with 2 bones broken. also there was someone who had conjunctivitis (mildly) a man who was constipated who it turned out had only not been for 2 days, hardly an emergency, a teenage girl with a cough who wanted something to help her sleep and several drunks needing stitches. not what the NHS was really set up for.

kali110 - cant turn the gas off call a bloody plumber of your neighbour or your friend or your family. not a blue light service. that is bonkers. I said life limiting or life threatening. each condition would be a judgement call.

we have to get away from the view that the NHS pays for everything. it shouldn't we cant afford it.