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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

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

250 replies

Resurgam2016 · 09/02/2017 09:34

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.

OP posts:
GirlsonFilm · 09/02/2017 14:06

I think that the only way that NHS services can be improved at the moment is increased taxation (however the Tories have pledged not to do this).

Our expectation of the NHS has increased hugely since its inception and we simply cannot provide the service that patients want, however we could provide them with the service that they need. Patients expect to see "their" GP at a time convenient for them for anything they wish, in particular things which could be solved by a visit to the pharmacy or could be seen by a nurse or nurse practitioner.

Patients don't realise that if GP practices do go to 8-8 seven days per week the doctors and nurses will simply be more thinly spread across the extended opening hours which will result in less choice (appointment at 6:45pm on a Sunday anyone?).

Patient education is required in both of these areas, we could reduce the number of patients attending GPs practice simply by stopping prescribing drugs which can also be bought over the counter (and we would reduce the NHS drugs bill if patients had to buy the items themselves, rather than paying the pharmacies a dispensing fee and the cost of the medicine). Patients need to recognise that GPS are not the expert in all areas; pharmacists know more about drugs and reactions to them, nurses with a disease speciality have a more indepth knowledge of the disease than GPs eg Diabetes, COPD.

The government has allocated extra training places for GPs, however we cannot fill the ones we currently have and current trainee GPs are planning to go abroad as soon as they have finished their training, so more places will not provide more GPs in the UK. The number of university applications for nursing degrees has decreased by 10% since the bursary was removed (and EU applicants are choosing not to come after Brexit).

I fear for the NHS and I think we will regret our choices in the not to distant future when the NHS can only provide the basics and private medicine is required to access a wider choice of services.

shovetheholly · 09/02/2017 14:07

I am horrified, just horrified, at the dehumanization of older people in this thread and in wider society. It is NOT on at all - it's discrimination - and it seems to be a growing problem.

The way we should fund the NHS is to have a proper goddamn tax system that can ensure that more money is put into it. That includes some way of taxing assets for those older people with huge amounts of savings.

Those who want to privatise the health service and sell it off want to convince you that this is impossible. It absolutely isn't. We have operated as a country with far higher rates of tax in the past, and we can do so again. It's time for those who have more than they need to pay for those who haven't been so fortunate. Sickness can hit anyone at any time, and offering a safety net against that was a central rationale for the NHS in the first place.

(Note: this is not a politics of envy. DH and I are not a basic rate tax household, so we would end up paying more).

YouHadMeAtCake · 09/02/2017 14:19

YABU and ridiculous. Stop paying for all those people that have for years and years paid into the NHS you mean?

I agree with lastnight

I'd rather stop or limit/means test the treatment of conditions caused by:Obesity,Smoking,Drinking,Heath tourism and drugs.

When I lived in the UK, I didn't fully appreciate the NHS. Now where I live the healthcare is excellent BUT very very expensive.

I read that they are cracking down on health tourists as they should and should have done way before now. I am sick of seeing people that haven't paid a penny into the service using it when those entitled are denied or have to wait for treatment.

VirgilsStaff · 09/02/2017 14:28

Ageism is a MN thing shovetheholly - it's lots of younger women who don't look beyond their own noses, most of the time. I've not seen it on other web fora to the shocking degree one sees it here.

I hope they all become little old ladies. Because the alternative is worse.

Puzzledandpissedoff · 09/02/2017 14:36

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

I completely agree, and have seen this happen twice myself; both times I've gently suggested that it might not be for the best, but have been told "it's classed as curable so we have to do it". This is undeniably a difficult and emotive subject, but surely it can't be denied that just because something can be done doesn't mean that it necessarily should be

I'm also not convinced that more money would help, at least until the system is thoroughly reformed and proper accountability put in place. From bitter experience I'd suggest that a huge influx of money would most likely be prioritized as follows: a new and lavish number of managers to decide how it should be spent / immediate pay increases for all those under these managers to keep them on side / lengthy training in how to spend effectively / focus groups convened to decide who needs it most / visits to other countries (usually exotic) to observe how others do it, etc, etc, etc.

And what's missing from the list? Yes that's right - any real attention to the needs of frontline services Hmm

SaucyJack · 09/02/2017 14:40

"I hope they all become little old ladies. Because the alternative is worse."

That's a matter of opinion.

There's not much worse for all concerned than dementia.

Eliza22 · 09/02/2017 14:41

India & Chine still receive development aid.

icai.independent.gov.uk/

The80sweregreat · 09/02/2017 14:42

It is already happening - my dh was told ' lose weight , the NHS wont treat you if you became very ill' by a doctor - fair enough, he is now trying to lose weight and exercise etc, but he also pays a fair amount of tax too..
As i said up thread, i do know someone whose dad cant have an operation because of his weight - she admitted that he wont do anything about it and he is just going to become worse. she is worried , but she isnt living with him and you can only tell people so much - they will not listen or do anything if they dont want to. So it is creeping in. Soon there may well be a cut off point of 70 - after that your on your own. Non essential medicine will end - IVF may well be private only, prescribtion payments looked at , paying to see your GP up front, being turned away from A and E even if its genuine. I hate to be a prophet of doom,but i can see all of this happening slowly. The government could put the price of alcohol up to 100 a bottle? ban the making of cigarettes, stop the shops selling any food that isnt deemed healthy ( wouldnt be much to buy would there?) a lot of places would go out of business, but we would all gain wouldnt we? Who would do any of this? of course nobody would. there are not many answers and too many questions!

5moreminutes · 09/02/2017 14:44

The holier than though shock and horror about "those who have paid into it all their lives" is such nonsense of course - those who have never worked/ never done paid work in their lives (or only done a token couple of years between school and marriage/ Parenthood) become elderly too ...

It's actually nothing to do with having paid in and simply about human rights and equality isn't it?

Which makes excluding certain groups inhuman, whether it's on grounds of age or anything else...

If it's about who's paid the most then best go straight to a health insurance system with some kind of retrospective credit based on prior national insurance payments or tax records...

But it isn't about that really.

SomethingBorrowed · 09/02/2017 14:46

mothertruck3r Interesting idea re health tourism... Only downside I can see is that it could mean that the financial aid for a country is mostly used by the people who have enough money to travel to the UK.

I don't agree with your last post though, someone with a high value house probably already paid a high stamp duty, high council tax... not sure why having a high value house would mean you have to pay more towards the NHS.
Maybe an alternative would be to mean test the exempted pensioners. So children/pregnant/non-rich pensioners would still get everything for free, rich pensioners wouldn't.

shovetheholly · 09/02/2017 14:52

saucy - I am sure Virgil meant healthy little old ladies! She's very nice, you know.

I do agree about dementia. Though in my family it's my aunt who has it - and she was only in her 50s when she got it. It's a horrible disease and sadly not just one of older age. I do believe its much rarer in younger age groups though.

the 80s - I absolutely support free healthcare at the point of delivery for everyone, regardless of age, behaviour, whatever. However, I do believe that the weight concerns are often about the ability of the person to tolerate and recover from surgery? I.e. they are not about rationing the service, but about the wellbeing of the person because the last thing anyone wants is a death on or shortly after the operating table. Sad However, I'm not a doctor so I could be wrong!

SomethingBorrowed · 09/02/2017 14:56

5moreminutes You are right. But someone who is paying a highest rate of tax and using the NHS maybe 1-2 a year for a basic GP appointment will feel that a tax raise is unfair.
I don't agree with it, but I am sure a lot of people feel this way, which is why it would be politically dangerous to simply increase the taxes. Or they would have to make cuts as well.

Badders123 · 09/02/2017 14:58

My mum smoked for decades.
She now has PVD, copd and heart issues.
She stopped smoking after my dad dropped dead in front of us....
It took THAT to make her stop
She worked from 14 to 60 (when she had to retire through ill health)
Up to 4 years ago she hadnt really used the NHS much, my dad not at all really.
Whilst I am angry at her smoking and not looking after herself, should she be denied life saving meds or treatment in that basis?
The reality is we are headed for a privatised NHS. This means that those who smoke, drink, or are obese will have to pay more to get covered and statistically the groups mentioned are the poorest.
What's the answer?

Lostwithinthehills · 09/02/2017 14:58

over, say 70 years

Last week I saw reports that people in their twenties and thirties should anticipate working until they are 74. As working lives are steadily extended our concept of 'old age pensioner' is going to have to change. In my youth women who were 60 years and one day old were OAPs, today's youth will still be facing 14 years at work once they reach 60.

The80sweregreat · 09/02/2017 14:59

shove, i do agree with you , my friend is annoyed at her dad for not taking advice, she has told him why they have said he needs to lose the weight. However, i bet around 20 odd years ago they would have just operated on him. Thats the difference, it seems to be ' do this and that and you will be fine' but what happens when you do all they say , your the right BMI, then it will be some other reason.. its a bit of a conspiracy theory of mine, but i just think its to curb numbers myself. I can see all sides to this argument though.

LastnightaDJ · 09/02/2017 15:00

The answer is for people to start understanding that actions have consequences and for attitudes to problematic behaviours to start changing. Personal responsibility is important.

The80sweregreat · 09/02/2017 15:03

So we all take really good advice, we all live forever , then become ill through something that isnt weight, lifestyle related. They will say then, oh your over 70 now, did you not read the terms and conditions? Private healthcare is going to come in and its so sad, we will all miss it when the current system has gone. Its very depressing.

Badders123 · 09/02/2017 15:05

I would not treat the following on the NHS;
IVF
Bariatric surgery
Cosmetic surgery done for purely cosmetic reasons
ANY surgery that's done for the sake of it or to placate a pain in the arse patient...a friend of my mums just had her bunion on done on the NHS. She can well afford to pay. Why did she get it done? She couldnt wear her nice summer sandals. She was in no pain, and there was no clinical need for the surgery. Her dr referred her to stop her taking up an appt every week re her bunion.
I would also charge patients who DNA
I used to run clinics when I worked in the NHS. You could guarantee that on bank holidays and near Xmas people just wouldn't show up.
They don't care...why would they?
They will just get another appt!
Some very difficult discussions need to be had re the NHS
Shame no political party is willing to start it.

HerOtherHalf · 09/02/2017 15:06

It's all a ploy to divert attention away from government incompetence. Whenever the NHS/education or other public services are failing to deliver we conveniently get a raft of stories fed to the media suggesting the blame lies with health tourists/immigrants/benefit scroungers/fake disability claimants/overweight people/smokers etc etc.

From what I understand, the total cost lost to health tourists is insignificant in relation to overall NHS spending. So, as annoying as health tourists might be in principle, they are not the cause of the problems with the NHS nor will combating them result in a noticeable improvement. Also consider the implications of implementing an effective system to combat it. Aside form the cost of said system, do you really want to have to produce photo ID and 3 recent utility bills every time you visit your GP or hospital?

helpimitchy · 09/02/2017 15:07

"I hope they all become little old ladies. Because the alternative is worse."

There are worse things than death, I can absolutely assure you of that.

Imagine being bedbound 24/7, totally dependant on care staff for your every need. You're in chronic and disabling pain, but you can't express yourself adequately due to confusion or dementia. You've perhaps had a stroke and can't communicate even if you're not demented though. Staff come in and try to keep you clean and fed, but they don't have the time to see to the little things and even more important stuff is overlooked on a regular basis because they're so busy, or perhaps just don't notice. You're stuck in front of a tv with some dreadful programme blaring out, or perhaps the staff have put the radio on to give them something to listen to - it's loud and is playing some screechy Beyoncé number.

You're cold, but you can't tell anybody. You hate juice, but you can't tell anyone, so take to spitting it out to avoid swallowing it. You're thirsty, but not given an alternative drink because the staff think you're not thirsty.

They get you ready for a shower or bath and you have to be hoisted into a shower chair. It's cold and the staff don't realise or care that your limbs hurt when they're moved or when you're cold. You're naked and vulnerable as the staff chat amongst themselves about their recent night out or the short staffing problems they currently have in the home.

Mealtime consists of food you either can't eat (chewy meat, salad or crisps) or that tastes of not much and is just gooey in texture. The staff have to add thickener to your drinks so that it's safer to swallow and doesn't trickle into your windpipe and cause you to cough and splutter.

Somebody tries to get you to take medicines four times a day, but you feel nauseous and can't tell anyone, so you try to spit them out. The nurse thinks you're being awkward and has them prescribed in liquid form so they can be easier to get down.

You need the loo, but the staff are too busy to take you, so you end up sitting on a wet incontinence pad. You develop a uti, but can't tell anyone that you need the loo every five minutes and it stings. The uti takes a hold and you feel sick, you smell strange, your back hurts and you get a temperature.

Your relatives visit infrequently and you have no one to advocate for you. You're frightened, lonely, bored, in discomfort and pain, stuck in front of tv. You get diarrhoea or constipation. Your skin becomes sore or itchy and there's nothing you can do about it.

This is your reality day after day, month after month, sometimes for several years.

This is the reality for thousands and thousands of elderly people throughout the uk right now. This is what we have to look forward to. Sure, most older people can express themselves and make some choices, but many can't, and their ability to control their own environment decreases the older and sicker they become.

Badders123 · 09/02/2017 15:07

It's 0.25% of the NHS budget apparently

rookiemere · 09/02/2017 15:13

I do feel that some sort of tiered system is the way to go.

Someone up-thread was poo-pooing the idea that anyone would want a 6.45pm Sunday evening appointment. Well my DH is a contractor so yes he'd love an appointment if required outside standard hours and happily ( well he'd grumble a bit) pay for it. As would I. So if you are prepared to have a standard service during normal working hours with no pick of time, then FOC as normal, but if you want to pay more then you can choose the time and extra money goes back into the service. It's two tiered but then the system is effectively two tiered already. I have endometriosis and am fortunate enough to have private medical insurance through my work. I've thanked the higher powers for that many times as it enabled me to get the treatment I needed to allow me to continue in employment without having so much sickness that I got fired.

Unfortunately the current pressure on doctor's surgeries is pushing the problem into A&E. My DM ( ex doctor) cheerfully advises all her elderly neighbours to exaggerate their symptoms in order to get an ambulance to take them to A&E as they are unable to get doctors appointments in a reasonable time frame. Now in some cases perhaps it's warranted, but more often than not it isn't. I wonder how much more a visit to A&E costs the NHS versus a doctors appointment and if so can they invest more into GP practices.

Puzzledandpissedoff · 09/02/2017 15:13

Beautifully put, helpimitchy, if that's not the wrong word in the circumstances. Hard to read perhaps, but true nevertheless

The80sweregreat · 09/02/2017 15:15

I can see charges to see your GP coming in, as you do for the dentist.
My dh bought a bike he gave the salesman his NI number and all kinds of information came up about him - showing ID such a driving licence should be easy enough to police i suppose, although i bet a few receptionists might disagree with me! I would willingly pay £10 to see my doctor as they are very good, but its implementing these things which is hard to do and would need to be means tested too i suppose. Its just becomes another admin duty to carry out.

Chickydoo · 09/02/2017 15:17

I think we need to be sensible.
Charge for some services.
£10.00 per GP appointment
£5.00 per missed GP appointment.

£10.00 per X-ray
£5.00 per blood test

NHS Dentists charge for services like X-rays & fillings, so why not hospitals and doctors.
Also a charge for breast screening and smear tests.
If we all paid a little bit, it would take the pressure off surely???

Everyone knows the NHS is in trouble, yes we could pay more tax, but would it go to where it is really needed?

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