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.

South Africa?
Not a country I aspire to in any shape or form whatever. Politics, health care, transport, education.

I agree with Resurgam2016 - we simply cannot continue with the NHS in it's current format as so much has changed since it's instigation.

Aging population, much more sophisticated (and expensive) medical treatments, treatments that could be regarded as non-essential. All these are factors.

It also seems to me that the NHS seems to be measured on the wrong things.

My parents put in a complaint because when my DF was rushed into A&E a few years ago, he took longer to be seen than it said on his medical notes. My DM who worked in the medical profession was very angry about this and put in a formal complaint resulting in a formal investigation.

All fair enough, but actually I suspect what happened is that the medical staff had to make an assessment based on his symptoms and prioritised accordingly. Sadly for him this meant a long wait in a corridor in less than ideal circumstances, but ultimately he was seen and received good care once admitted and his condition was not life threatening.

As they were measured on how many patients were admitted within 4 hrs or whatever, they then lied to hit their targets. Whereas the reality is that perhaps it was appropriate given the number of patients and staff that he had to wait for longer.

I'm probably not expressing myself well, but I hope you understand what I mean. We - the public - seem to expect this gold-plated service from the NHS and for many reasons they cannot deliver this. Perhaps it's time to start being more honest about a realistic level of service from the NHS.

I guess one thing is raising the free prescription age alongside raising the state pension age (or indeed making them a means tested benefit). There are also the benefits for the under 18s that perhaps should also be means tested, free prescriptions, free eye tests, free dental appointments, vouchers towards glasses, starting the process of means testing them might be a starting point to saving money.

I pay enough bloody tax! It needs to stop being spent on shite and tax/work avoiders (rich and poor) and maybe there would be a bit left for the NHS.

Those are good points Quartz.

As someone on a decent wage, I honestly don't mind paying for prescriptions and find it kind of odd that I don't. Yesterday I was at my doctors and needed some pain management, he prescribed something strong and was also going to write paracetamol on the tab, but I told him not to bother because I could buy the generic brand at the chemist for 25p.

Also find it odd that pharmacies hand out free skin care lotions etc. for DCs. My friend (who is also fairly well off) was gleeful about making sure she got these when her DCs were younger, rather than paying for them. Fair enough I suppose, why not when it's free, but seemed an odd decision to provide for free to all for a service with limited funding.

Means testing isn't fair even in its current format quartz. There are working people who have very low incomes and have to pay for dental care / prescriptions whereas people on benefits don't have to pay for those things despite the fact that both parties might have the same disposable income (due to housing benefit and council tax benefit etc). I really wouldn't want to see means testing introduced for children. It could mean some children going without dental treatment / prescriptions / glasses etc as their parents would have to decide to fund those things or feed their children (as they often have to do with themselves).

I am shocked that some regions are
Still handing out paracetamol on prescription. My CCG made the decision years back to not provide paracetamol on prescription.

Exactly it would not bother me to have to pay for stuff for my children. My daughter got glasses I spent £40, the NHS put £40 towards it. I could have paid £80. Same is true for free prescriptions, dentist appointments etc when pregnant should be means tested as well.

RedAndYellowStripe
Hence the fact this government has already said it was reducing the amount spent per person on the NHS. When the situation is already described as a humanitarian crisis.

How very true. Well said!

There will be no ‘fix’ when it is intentionally being run down.

Birdsgottaf1y
“I liked through the 80's, were a Tory Government had everyone convinced that we could no longer afford to run the country.”

Umm… You can’t afford to run the country. Not without colossal reforms which no political party will ever make now. (not that there are any viable political parties)

It’s forty years at least since UK politicians cared about real people, ie: the man and woman ‘in the street’.

Haven’t you noticed the crumbling of ALL public services in the UK over many many years?

Those in work are paying more and more for less and less. And now that slippery slope has been greased some more by Brexit.

Forget the Health Service. That’s being Americanised right now. You’ll be begging for euthanasia.

I take your point sixi so perhaps the thing to do is introduce means testing at a higher level so say anyone who is a higher rate taxpayer doesn't get them for free.

I suppose it might be too hard to regulate though.

Even if you means test it at higher rate taxpayers it could still be problematic. A single parent higher rate taxpayer (I assume you are talking about the £40k earning bracket?) living in the costly south east might not have much disposable income especially if they are paying for childcare. We have already taken child benefit from some higher rate tax payers and to take free medical stuff from their kids on top will be a real kick in the teeth.
I am not a higher rate tax payer but I do understand why they sometimes feel like the squeezed middle. It's like saying thatvhheyblibebtjemthat pay their higher rate taxes to enable low earners / people on benefits to get free stuff for their kids but they have to pay for the same stuff themselves. It would just be another divide and rule policy.

I don't think the solution is to raise taxes.

I would do

• a fee for missed appointment, by asking for a deposit when you register to your surgery, which will then be used as deposit until you miss one appointment without a valid reason. Then you would have to pay a new deposit to be able to make an appointment.
• a £1 prescription fee for people currently exempt from the prescription fee. I believe this has been done in other countries, the idea was that psychologically you value something less if it is free. Maybe a £1 charge to see the GP as well (for everybody).

Prescriptions for gluten free food is just wrong.

rookie I don't think saying a high rate taxpayer is the way to go either. What about when you only have one working parent who is a HR taxpayer and next door you have two BR taxpayers. Their combined household income could be more + they would also receive child benefit. I agree with means tested benefits, but I believe they should be based on household income and not individual.

I agree about the gluten free food prescriptions somethingborrowed and I say that as someone who has to buy gluten and dairy free food for two children (can't get prescriptions as they have life threatening allergy rather tHan coeliac). Gluten free food is widely available now and of people can't afford he additional expense they don't have to eat gluten free foods as plenty of foods are naturally gluten free and cheaply available (rice, potatoes, fruit, veg etc).

^^obviously they have to eat gluten free foods if they have a medical condition but what I mean is they don't actually need gluten free bread, flour, pasta etc as other foods are naturally gluten free.

Stopping free prescriptions, free glasses etc for children will disproportionately effect those with chronically sick or disabled children. I don't agree with that.

en.wikipedia.org/wiki/Liverpool_Care_Pathway_for_the_Dying_Patient

Sadly I don't think there is a solution to the current problem that will satisfy everyone.

Some hard decisions have to be made, be that a direct increase in taxation, a reduction in services - which is happening by default at the minute or some sort of charge at point of use for those who can (on paper) afford it.

Yes we might have to pay some more now, but unless we do I really can't see how the NHS will be sustainable whenever I'm a pensioner in 20+ years and the population distribution is even more skewed towards the elderly when it's creaking at the seams right now.

A solution that has the biggest impact on the most vulnerable is wrong.

The answer is to subtract the money that health tourists cost from the overseas aid given to their country. So for example deduct the costs for Nigerian (or whatever country) health tourists from the money given to Nigeria in foreign aid.

spikeyball morally wrong?

You could argue that denying a tourist treatment (without which they might die) is also morally wrong. I know the NHS don't actually do this yet but its going that way

Human life is sacred so not sustaining it is morally wrong?

What about quality of life? How do we define that? Is it less wrong to let someone die because they will spend their days in pain? Or more wrong?

I think that if it were about removing gluten free products from prescription or charging more for glasses they'd probably have done it by now.

I think it is a much bigger discussion.

Something they tried a 10€ fee (but payable maximum once per quarter so it didn't mount up for those needing regular appointments) for adults in Germany but scrapped it because it was just an administrative burden and not achieving anything.

Here you pay state health insurance of between 14-15% of your income, which is paid by the government for those on very low incomes and healthcare is free at the point of use - so a lot like the NHS but better funded. The system is under strain here too but IME of both systems it is under a lot less strain - you always get a GP apt on the day and never wait more than a few weeks for non urgent specialists or other treatment.

Or put capital gains tax on everyone's homes and fix the council tax system so that those with higher value homes pay more, so that those that have made huge amounts of tax free gains pay back into the system and coincidentally most of those that have made huge amounts from their houses rising in value are the older generation who tend to use the NHS more. It would be unfair to tax minimum wage and middle income workers more as they pay enough tax (and NI) and are only just coping with none of the perks that pensioners get and have gotten.

They should also get more aggressive over tax avoidance by multinationals and the very rich but seeing as the Government are part of this group, it is unlikely that will happen.

fix the council tax system so that those with higher value homes pay more,

They already do this in the council tax banding system.

Absolutely recouping unpaid tax from the top 1% and from very large corporations, and closing tax loop holes used by those of "high net worth" and multinational corporations would bring in huge sums, and perhaps avoid the need to raise taxes or cut spending in other areas...