To wonder if perhaps the answer is just to stop paying?

[Resurgam2016]

Listening to the radio the other day and there was a South African lady who was having kidney dialysis in the UK because she couldn't afford it in her home country. Apparently in SA they don't fund this treatment for the over 65's. There just isn't the money. She was a medical tourist but that is another issue entirely.

So what if we contemplated something similar to help 'save' the NHS? No treatment for life limiting conditions over, say 70 years. No treatment for conditions that are not life saving (so fertility treatment or breast rebuilding for example). Making people (or their relatives) pay for all but the medical care they receive (so food etc.). It's a horrible thought but maybe the answer?

FYI I have a chronic illness so might well be 'caught' under these new rules. I'm just wondering if it is 'acceptable' in SA why we don't debate it here.

The problem with any reforms are that there's only so much future proofing you can do when governments are constantly changing goalposts every 4 years, back tracking, worrying about short term goals and reelection.

I am all for an extra 1 or 2p in the £1 towards the NHS but how long until this is eaten up by more cuts?

We need a Minister for the Future like they have in some Scandinavian countries to ensure that policies and reforms are all consistent with and conducive to where we need to be in 10, 20 years time.

So as a type 1 diabetic when I hit 70 I'd just die a slow painful death? Or would we legalise euthanasia? Because that would be the option id choose in that scenario.

Sounds rather horrific to me. Instead of Care Homes are we going to have regional centres for the ill. If they don't score enough points they get moved to the wing of doom, where you only get water, as why waste food on people condemned to die. No heating either, if you're not going to get better, you'll either starve to death, freeze to death or die from your health issues.

I'm sure we covered something similar in history classes at school what were they called again.

I would suggest that parents & schools advocated young adults get private medical insurance so they received faster care. Or anyone that doesn't have pre-existing issues.

To save money in A&E have a triage nurse on reception who asks, 'Have you been in an accident?' No! 'Do you feel that your life is in imminent danger?

No! 'Call NHS 111 and ask to see a GP. Should they not feel it's required please don't decide to turn up here'

Yes! 'What are your symptoms and why do you think it is classed as an emergency?'

Ok sounds harsh, but I'm sure it would have an impact. Or if it was that the person felt it was an emergency, symptoms would be taken, then their vitals taken by a nurse practitioner who spoke through the symptoms to decide if you need treatment at hospital.

They triage people now, but I don't think they tell people to go home, it's not an emergency. I would maybe extend it to broken fingers, toes, unless a bad break. As little can be done.

No treatment for conditions that are not life saving (so fertility treatment or breast rebuilding for example).

Excellent idea.

So the NHS will no longer need to deal with broken bones, arthritis, anything to do with eye sight or hearing, stomach problems, eczema, repairing birth injuries, mental health (until the person has attempted suicide, at least) , endometriosis, thyroid problems.

Basically, the NHS will treat heart attacks, cancer and victims of serious accidents. So it will only need a tiny budget.

Great idea.

We do this anyway - NICE looks at treatments and assess the cost per QALY (quality adjusted life years). Treatments over a certain cost are not available on the NHS.
There are lots of limits on infertility treatment, hip replacements etc.
Any service which is free at the point of use will be over-used, so education/fee charging for time wasting should be looked at.

If you were anywhere close to that age yourself, you would realise what a horrific prospect it is to do that. It's easy to suggest things that don't affect you directly. What if we said that the NHS should stop funding IVF instead- no exceptions? I bet there would be plenty of Mnetters who would not be happy with that, because it would affect them directly.

The whole 'we can't afford it' is bull. We are one of the richest nations in the world. Of course we can afford it- we just have a government who does not prioritise healthcare and want to move to a privatised system ASAP.

Also South Africa is NOT a country that anyone should try to emulate.

Wait, isn't this the plot of Logan's Run?

With ref to endometriosis, I've not had treatment in years, whilst yes it is painful, I don't think there's a need for repeated ops, unless it was pre TTC. I say this as someone whose insides are obliterated with endo & adhesions.

I think in order to ascertain what can be done, we need to look at how tax & NI is spent in a bit of detail. So each constituency could have a breakdown of what the money has gone towards. I'm sure we would find areas where money could be saved, without stopping/refusing benefits, healthcare, care services.

I'd be interested to know the costs p.a. of using locum and bank staff to plug gaps caused by reductions in permanent staffing rates, staff retention issues and sickness due to stress. Particularly in relationship to how more permanent staff would have cost over the same period.
My suspicions are that there's a saving right there.

They already assess whether an operation is in an elderly patient's best interest. (And presumably the same for any patient.)

When my grandfather got thrombosis they could have amputated his leg. But the doctors tLked to us about the chances of him surviving the op (less than 50%), the level of pain afterwards (high), his current quality of life (close to non existent), his quality of life post op (no better and possibly worse if that was possible) and we all agreed that it wasn't in his best interests. Grandad couldn't take part in the conversation as he had severe Alzheimer's by then and couldn't talk at all but the doctor still explained it all to him in case he could understand.

When granny was 92 and got a stomach blockage again the same discussion was had. In this case granny's life was still pretty good (she was still lecturing on Jane Austen at the WI). Apparently they tested granny's soundness of mind by asking her who the Prime Minister was. Granny pretended to think for a minute before explaining it was Gordon Brown and explaining to the doctor all 15 ways why she didn't approve of him and how when she was a Labour councillor things were done properly. She then started on her 15 point plan for improving the NHS. She got her op. (Probably because the doctor ran screaming down the corridor shouting "anaesatist - put her under! Please! Now! Anything for quiet!)

I think we need a massive overhaul of the NHS. We all know cases of excessive waste & people rinsing the system. Higher taxation though?? Struggling with that bit. At present, someone on say £75k hands over more than a third of their salary over as it is.

Oh and removing the NHS from politics and running it with long term stable planning rather than chopping and changing with ideology. A board of governments with a budget and a mix of business and medical experience (not cronies) get to set direction etc. Fewer trusts.

A better tax system and economic policies all round. One that provides better education (for the continually changing technological world we live in), more and better jobs, the chance of economic security and provision for all those who who need it. And the most difficult of all, find people to become our representatives who have moral courage, experience of the real world, and carry out their responsibilities. I speak as a longtime Labour Party member, and now ex-member, trade union rep (TSSA), one-horse business owner (successful, tax paying), disabled retired person. Make JM Keynes compulsory study in schools. Read Mark Blyth's Austerity: The History of a Dangerous Idea for why.

I'm 70 in two months, from a typical traditional working class family, and bloody grateful I was born when I was. I had the best of this country's times, and retired before the worst hit. I really, honestly, don't know how we can give our young people hope for any kind of future. At my urging, my DDs and DS have applied for, and received, citizenship of EU countries. Despite being in the Eurozone, which is bound for collapse anyway (see above mentioned book), they're much more likely to have more economic security where they are than they are here. Theresa May and Philip Hammond want to make this country an off-shore tax haven? WTF? It's already the money-laundering centre of the world. Many of my foreign friends (my tertiary education was in Germany) wonder why we made a fuss about the Panama papers when we do all that stuff ourselves. They thought we were completely hypocritical about it.

Introduce a partly insurance funded NHS, this would take two generations to be fair, so people could grow up in the knowledge that there will come a time when they'll have to fund their health care more directly than happens now. All the above, and more, need to happen before we can do this. It's necessary.

End of rant.

Given that at 54 I haven't yet used the NHS for anything much other than childbirth, I would be pretty annoyed if when I need something I am told I am too old especially given that I can't retire until I am 67.

Hmm, work your arse off and pay taxes until you retire at 65+, to have less than five years of free medical care before you're simply left to 'expire'?
Yikes.

allchattedout, I totally agree and I live here, in SA! We only have hospital cover here, and buy any prescriptions over the counter.
That particular woman can't afford private health care in SA, she has lived with her family in the UK for a while now, and frankly, if she get deported back to SA, she will be dead within a fortnight, and that is sadly often the plight of poor South Africans, black and white, as most government hospitals are dire.

Lucky old East Germany. They let the old and sick, especially the ones who could not work, go across the Wall where the West Germans would house them and look after them, and the East Germans could give their homes to people who were still useful. The OP has had to find a more drastic way of achieving the same saving.

It has often been mooted on here and on the TV , radio phone ins too, about limiting IVF treatment - it is a postcode lottery as it is and watered down a lot over the years i am led to believe. If it is completely removed from the NHS and only offered to privately paying people, this would cause absolute uproar.
Plymonth, i can see it happening. A cut off point would be introduced, but we wouldnt know anything about it until we are in the situation of needing help ourselves - brought in by stealth. I agree that the NHS needs an overhaul, but what is good and what is bad to target? the government doesnt seem to care at all and there are reports on the news every night now about how over stretched they are and underfunded now. It is depressing and makes me wonder about our future.

Read Dr Philip Hammond's books, he did a brilliant lecture at the Edinburgh Festival last year, which was funny, sad, informative and lively, with a huge amount of NHS staff in the audience.

(Haven't rtft yet)

This reminds me of an episode of 90s TV show Dinosaurs - not sure if it was popular in the U.K. at all: when dinos turns a certain age (might even be 70), they must perform the dinosaur ritual of throwing them off a cliff into a tar pit so they're not a burden to society.

To me, the cut off suggestion reads just like this, we're throwing our elderly in a tar pit. Are we ok with that?

Many people have paid above and beyond their N.I contribution of 30 years which is what you need to qualify for a state pension, I personally have paid 41 years worth, but at the age of 62 still have to work another four years to qualify for a pension, these contributions are paid by many who never reach retirement age, where are all of these overpaid contributions going, so I finally get my pension aged 66 but four years later am denied medical treatment because I'm too old.

Dangerous thinking, this. Firstly, who decides? Would there be breast augmentation for those who have had mastectomies? We already hear of people dying because certain drugs are not available in certain areas. We've recently had the bright idea that those needing hip/ knee replacements might not get them unless the pain is so utterably unbearable that they cannot move. Really? OP, how might you feel if it were youre mum/dad/relative? It's a slippery slope. After that, might we think "no life extending surgery for the profoundly disabled?"

I was a nurse for many many years and there genuinely were times when we might look at a very frail, very elderly patient and think "why not just make her comfortable and stop with the drains/antibiotics whatever". And then....they'd get well and be discharged. 😊

I do think we should pay more taxes; I do think we need more money for social care to help alleviate bed blocking and I do think we need to be firm, very firm re: overseas travellers. People visiting the U.K. who are involved in an accident/have a life threatening deterioration in a known condition must be treated but those highlighted recently in the BBC series Hospital were staggering.

ExplodedCloud has it - remove the NHS from politics and set up a board run by experienced business people, administrators and medics.

AND raise taxes by 2p which has also been suggested up thread by many posters.

Chase up all tax dodgers and make them pay or restrict their access to services.

While I do feel that in recent years, the NHS has tried to do too much for far too many (tattoo removal, boob jobs & fertility treatment for instance), cutting off much needed, life saving treatment for elderly people or premature babies is not the answer.

and stop putting @ in front of everyone's name.

Apologies if this sounds harsh, but I'm in elderly care and I do think that, quite often, peoples lives are prolonged just for the sake of it. These extremely old, frail and sick people are often in pain and suffering, but it's quite usual to keep them going with repeated doses of antibiotics - every few weeks - when the illnesses they have mean that they are terminally ill anyway. Many of them also have dementia and have no quality of life. They are literally lying in a bed being fed and changed and experiencing goodness knows what levels of pain and/or discomfort. They cannot swallow usual diet and can only take liquidised foods and nutritional supplements. They often aspirate (foods/liquids end up going into the windpipe) which then leads to chest infection. It is a miserable existence for anybody to have to endure.

I really think that, as a society, we need to examine just what we want out of our old age and whether it is wise to prolong life just for the sake of it. From the 25 years experience I have had, I believe that quality over quantity should be the aim.

Also, if the government are intent on depriving vast swathes of the population healthcare, they really need to give us a choice of whether we actually want to live with pain, chronic illness and disability and legalise assisted dying. I'd rather check out quickly if I came down with something that the NHS are unable to treat or even help. The government can't condemn us to a horrific old age without giving us the choice to reject that and do something about it. Not everyone wants to spend what they have on their social care needs and would rather leave it to their children.

Please don't think I'm being uncaring or horrible by having these views. Virtually all of my colleagues feel the same way. What goes on behind closed doors within care homes or in home care is frequently quite awful and not something that anybody would want for themselves or their relatives. Please be under no illusion that any of these places are actually good, they're adequate at best. The public have no idea