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.

That was beautifully put - i dont know many people who would want to live like that at all. I certainly do not want to and, i am guessing, anyone on this thread.

The answer is a properly funded and managed NHS. This can only be achieved through higher taxation but no party will commit to that because it may cost them votes. The NHS is being run down with impossible year on year financial targets. Eventually the government will turn round and say that the NHS cannot meet targets, its failing, we will privatise it. Say hello to a system similar to the US because that is certainly where we are headed.

eleven, there will be a thread in 20 years time saying 'why cant we have our NHS back?'

www.kingsfund.org.uk/blog/2016/01/how-does-nhs-spending-compare-health-spending-internationally

How about we match other countries, and just allocate more money to the NHS?

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

That's exactly the point, isn't it, and the same goes for charging to see the GP and so on. I imagine many would be willing to pay if they really could be sure the additional money would make a difference and be spent properly rather than disappearing down yet another financial black hole

The irony, of course, is that if the vast amounts allocated already had been spent wisely, extra money probably wouldn't be need - or at least nothing like as much

That's a dreadful idea OP. It's like something out of a Margaret Atwood novel.

On the issue or health tourism I would charge the airlines who carry people into the UK who then go on to use the NHS.

In effect the NHS already makes these decisions, just that the quaity of life margin is a bit higher than that. I was refused IVF with PGD for a chromosomal abnormality (not explicitly refused, but I was let know that my application for funding probably wouldn't be a priority) because I let it be known that if I got pregnant I would have CVS and abortion if the baby turned out to be affected. The cost of the IVF was only worth it if it was to avoid me having a baby that would need lots of expensive care, so since I was willing to have an abortion there was nothing to lose in letting me continue to conceive naturally and have abortion/miscarriage every time it went wrong (the odds of it going wrong were 2/3).

I'm sure there's already tons of examples of people being refused expensive cancer treatments and stuff too, it's a reality.

I think as a society we (you - I live in Germany, thank Christ) need to decide what you want to spend your money on. I think that paying doctors and scientists to work their magic and let people live longer, do more and feel better (to borrow a phrase from a famous pharma company) is a fucking awesome use of our wealth, far better than smartphones and big cars. Course you need a socialist government, and you buggers keep voting Tory.

How would it 'save' the NHS? It would take it away from some of its most vulnerable users.

Yeah, it would perhaps retain some of the bureaucratic structures of the NHS, but it would make it a completely different thing. It'd be a system similarly to that of the US, where if you can't afford healthcare, you just don't get any.

It'd be like if you tried to save democracy by establishing a dictatorship. You could still call it a democracy, but it would not be one anymore.

I think we have to be very, very careful with the assumption that all older people have lives riddled with sickness that aren't worth living. The OP's post mentioned people over 70. Now I know several people in their 70s that have an extremely high quality of life, with no or only minor illness. The proportion who continue to have that high quality of life in their 80s starts to decline, but I still know some in their 80s and 90s who are by no means living the incontinent, bed-bound nightmare described here. Older age now lasts a VERY long time, and it would be a mistake to treat the years after 65 as if there is no change to people's health!

This is where we have to start looking at the connection between NHS care and social care for the older population. The lack of funding for the latter, in particular, is causing problems for the former and if we could just be honest about this and decide how we want to fund care needs that are often progressive, we could really make some progress. One of the conversations that needs to be had is to what extent we use private housing equity to fund it (and how we provide equitably for those who don't have such resources). I also think there are BIG questions about the ethics of having so many private providers. I personally feel that here, as elsewhere in the health sector, there is a conflict of interests between healthcare and the profit motive. But I also recognise this is a battle I am unlikely to win in the current, despairing climate.

Good point toomuchtooold. And we are stuck with the Torres for want of a credible/viable opposition. 😳

eleven, there will be a thread in 20 years time saying 'why cant we have our NHS back?'

Yep, I think you're right!

Wow. So people pay into a system their entire lives and then suddenly at 70, sorry, we deem to you old to have treatment?

The NHS needs totally restructured, but it can't be the NHS under any of the terms you're all posing, it can be a NATIONAL health service if it excludes certain groups.

Ulimtarely it's either make it a much more basic service for everyone, and cutting out mass amounts of management, or, it becomes another service where it's not free at the point of contact, like paying for GP appointimmets, neiether great options, but I do think excluding certain groups is descrinimation and singleing out the old is even more curel!

It'd be a system similarly to that of the US, where if you can't afford healthcare, you just don't get any

Please keep in mind that the US system is not the only alternative!
(not specifically at Vestal, several others did post something similar)

A lot of other countries have a system in between, where there is free healthcare for people who can't afford it, but you can also pay to be seen quicker / by your doctor of choice / have a treatment that is not deemed as essential...

Just saying, scaring people by saying it is the NHS or a US system is wrong.

I would not mind paying more tax if I knew it was going to what I deem to be the critical priorities of the NHS. Saving people's lives, ensuring that people who crtically need care get it, paying our nurses and ambulence workers a decent and proportionate wage for the work they do.

However I think what others are saying is that its not just about the funding. It would be interesting to understand for example in Germany if its so much better, how you make doctors appointments and if these ar e free of charge also if there is pressure on the hospitals.

Ultimately no matter how much money you put in it, because of demographics and new medical advanced NHS is a bottomless pit so some sort of official guidelines or reform needs to be done in tandem with funding reviews.

Chickydoo - I'd support charging for missed appointments (how long does it take to cancel?) but if you charged for actual appointments then that would mean those who are really poor would put off going to the doctors (and maybe put off taking their kids) which is not really what we'd want as a society I'd think.

Having just read the first post I am . What a horrible horrible idea. I don't see why the elderly are less deserving of treatment than somebody half their age when actually they are the ones who have paid the most into the system because they have been around for the longest. So when they are at their most vulnerable we basically leave them to rot? You realise you will be 70 one day OP, it may not seem like such a reasonable idea by then.

magic I didn't say it was reasonable. Not at all.

But where do we draw the line?

So a person who has potantially paid their tax and NI for 50 odd years is no longer entitled to treatment, whereas a person who has received benefits for nearly all of their lives gets treatment without ever having paid a penny??

Only read first page, but shouldn't we be judged by how we care for the weakest and most vulnerable in our society, nor the strongest? I'm sure some wise person said that.

rookie I don't know about Germany, but in France (from what I remember) you can choose to see the doctor (or specialist) you want.
The state will reimburse you around 80% (100 if long term illness, limited resources,...) up to an amount of X, and you can choose to have private insurance to reimburse the difference.
So you can choose a doctor who asks for X or less, or you can ask for a more expensive one and pay the difference (or have it paid by your insurance).

You also have to do the equivalent of registering with a GP surgery, but no catchment areas or surgeries "not accepting new patients". You can still go see other GPs but there will be a fee. Obvs, as in the UK, you can change where you are registered if needed.

Hospitals are similar than here IME.

Private health is way less expensive than in the UK.

Not technically "free at point of contact" but getting there, as the 80% reimbursement from the state gets directly paid to the doctor most of the time, and the insurance part is also more and more directly paid. TBH I don't understand why this "free at POC" means so much, as long as you get your money back shortly after...

We draw the line at foreign people using the service and people who have never contributed. We privatise various parts of it. This has no effect on the healthcare received, just charge W H Smith for floor space in a hospital. Stop doctors prescribing medicines on free prescriptions when the medicines cost less than a £5.

Doesn't N.I.C.E. decide how much new drugs add to the quality life verses cost before they decide if its worth allowing them?

This could be applied to every NHS operation/treatment. That would help us get better value for money. We just cant keep being all things to all people.

Charging for Gp appointments etc again hits the most vulnerable - the poor, the elderly, children, those with medical conditions and disabilities - the hardest. A terrible idea. Also if people put off going because of cost, the condition they have may end up being more expensive to treat.

I do feel meds shouldn't be free if you can afford to pay
My mums friend hoards meds....boxes and boxes full.
She brags about it.
Makes me 😤

Course you need a socialist government, and you buggers keep voting Tory.

Well said ^