NHS should charge people

[Brideandpredjudice]

AIBU to think that people should be charged a fee for wasting the time and resources of the NHS and to think this might help with some of the current problems?

I was just reading a thread where someone had purposely done something that they shouldn't have done before their appointment, which meant it couldn't go ahead. Why do people think this is okay?

We can't continue to have a free health service if it's misused like this and perhaps the only way to deter people would be with a fine. No idea if or how this would work in actuality and how they would police genuine mistakes from accidents, but it's so infuriating. They should at least be pushed back to the bottom of the queue.

I recently had to pay for an appointment because the waiting list was over 12 months. I wonder how much shorter it would be without all the missed appointments etc.

The argument is always who would collect the money. What about the poor, no fuck the poor what about those on income related benefits? Take dentists, nhs dentists. If you are on gateway benefits, treatment is free, you would expect those on benefits to have excellent teeth, money not being an issue. However that does not seem to be the case.

Dentists have no issue collecting payments, enforcing no show fees and the like.

we are told dental checks can pick up other more serious conditions not just tooth decay, but there are no fears about costs and finding here.

off topic it is incredible there is not an accessible and transferable (within the profession) of dental records like there is for gp records, particularly for identification purposes.

@ BambinaJAS how can you say people don't understand basic demographics facts when you are not even using the correct one to back up your weak argument, people age 65 are WORKING age not pension age so they will be still paying NI pension age when people stop paying NI is 66 (at the moment) so it's YOU who need to get the correct demographic facts

Me and my husband had a loosely similar conversation the other night, we were watching an old 999 what's your emergency, and it followed paramedics around as they were dealing with binge drinkers, and there were absolutely loads of them, who had got in such a state and fallen over, or got into fights or punched windows and needed medical attention.....I feel like those people should have a fixed fee to pay maybe?

I think our NHS is incredible, and we are so lucky to have it, but I do think we have taken it for granted in terms of taking care of our own health, such as binge drinking, smoking and recreational drug use, even maybe morbid obesity? I know lots of people won't agree, but I do think something needs to be in place to make us in charge of our own health.

In theory yes, in practice the cost of doing so, the frivolous appeals because many people don't accept personal responsibility, or the belief it should work two ways (please let me know of a doctor's appointment ever on time, for example) will mean it will never happen.

If it was I would start with binge drinkers.

Should the parents who are wrongly advised have set payouts? Recently a four month old was declared brain stem dead, they went to remove ventilation and she started breathing on her own. It's going through court now because the doctors still want to remove life support. They've said that they've never seen a case like it, but haven't said that they got it wrong, which they did. The payouts for the mother and baby deaths because of culture, ethos within maternity care would bankrupt the NHS. It's got to be a two way street.

I've worked in welfare rights and no longer are people who are disabled, especially those who have mental health issues and aren't NT getting any support or disability benefits, so vulnerable people would suffer if this came in. Nearly everyone I know has had missed appointment letters for relatives who have died. Yet if you phone the department they tell you that the system is updated automatically and there's no need to cancel. Labour has a fully coated manifesto, we can afford the NHS. We just have a government who won't fund service. Stop believing the propaganda.

Paying a relatively small amount for visits to GP and A&E happens in a lot of countries, including Sweden, where healthcare is said to be considerably better than in the U.K.
I can’t see it ever happening though. Any party of whatever colour that tried to introduce would presumably know that the other major party would vow to remove it, thereby ensuring a landslide at the next election.

When do any of them really think of what’s best for the country, rather than what’s going to keep them in power?

I do think people who end up in A&E purely because they’re drunk, should be fined for wasting NHS time.

People in the UK don't all get the same standard of treatment - those with the means to navigate the system, pay to get into the first layer quicker or who have the freedom and the money to waste hours and days to access health care do better. (As you have done yourself) How is that different from people paying for extra insurance in the US?

You worry about calling ambulances? Urgent cases here are waiting not just a few hours but many. Patients in their 80s and 90s left lying in the rain and cold for several hours, dependent on the good will of passers by or neighbours to try and keep them warm whilst waiting (and this was happening before the pandemic, its just more widespread now).

You hope that PP upthread's dire appointment experiences were unusual? To me it sounded absolutely typical. Have you never tried playing appointment roulette with the many NHS fiefdoms? Every system is different and they don't communicate. If you are really lucky you get the details of the appointment before its happened and they have a record of it when you arrive.

Its equally likely the appointment arrives after the date, for the one week you asked them to avoid, or they have lost the record and don't have your details. You take a day off for an appointment at time X, the call happens at a random time when you are on the loo - tough luck. Down the snake you go.

I recently received a text for an appointment I hadn’t made (a very common problem with clinics which issue appointments rather than allow you to make them) - text came end of business day, lines closed. Spent two hours of my own time next morning trying to get through and then gave up.
There are hundreds of different appointment systems all setting their own rules and processes - there is no “one” NHS” and we should stop pretending there is.

Some of this is down to budgets but not all of it by a long chalk. A lot of it is bad business practices fragmented across thousands of little organisations all reinventing the wheel and often its bad procurement management. Our spend per head on health is not delivering the outcomes that Europeans get, with state backed and regulated health insurance models and hasn’t done for some years. And that isn't counting the huge number of patient hours wasted trying to navigate the process and waiting around for appointments. Patient time is assumed to be valueless.
It has also always been largely privatised, especially in primary care - that was forced by the doctors’ unions as the price of supporting the system.

The choice is not between a wonderful NHS and a dire US insurance system and people should stop pretending it is.
The model which was groundbreaking in the 50s is now out of date and has been improved on by most of our European neighbours who deliver more patient focused care at lower cost and seem to be better at enabling their professionals to get on with the job rather than leaving them buried in paperwork and using antiquated systems.

Whilst I agree something needs changing, I think charging with the present state of the NHS is unworkable.

@swg1 raises excellent points, that I too have faced. Only this week... my daughter has a long term health condition. Appointment was at Hospital A at 4:30pm, Consultant running late (not unusual, she has an unpredictable condition, so this is often the case). We wait for two hours and the dr finally sees us at just after 6pm, and we're eventually finish an hour and a bit later and given two prescriptions to pick up.

Being an unpredictable condition, we're told to take our daughter to Eye casualty at hospital B the next day, and that the Dr will send a referral. Referral doesn't get through, so we spend approx 2 hours battling the nurses to try and get seen with one nurse saying to us, she couldn't see anything wrong with my daughter, followed by "has anyone actually looked in her eyes", "even if the referral does come through there's no free appointments until at least 6pm" and "are you still here?" Eventually seen, and my daughter does indeed have the new condition the DR at the first hospital thought she had, and so she's given a third prescription etc. This week alone, we have spent £15 in car parking fees, easily another £10 in petrol (both hospitals about an hour from my house). We're okay, we can afford that, but when my daughter grows up, I doubt she'll ever be able to work full time - too many hospital appointments, so when you add on the costs of prescriptions, fees for missed appointments would be just too much.

I don't think the NHS can really charge for missed appointments until...

• you can choose an appointment you can actually make. Already I have had to go part time to make some, on others, my DH has to take time off work

• they reliably inform you of all appointments, and not last minute or even after the scheduled appointment (have had both!)

• they manage to have the different hospitals / Dr systems talking to each other.... several times I've now turned up for an appointment the other hospital knew nothing about, or were not able to open a letter on my daughter's file to see what treatment was needed.

• they manage to run their appointments on time and do not double book them.

Because as it stands, it will be the chronically ill who are already juggling lots of appointments who will be adversely affected by this.

Now you're just being silly.

I do think a bit of creative thinking on behalf of the NHS could avoid a lot of this. We're currently juggling 4 appointments in 3 different hospitals.

If they developed the NHS app so that it uploaded all your hospital appointments so they were all in one place, the date adds to your calendar (like it does when you buy tickets). This might actually help people to remember all their different appointments. Might be easier to implement rather than fines, and lead to a more efficient system!

Fully agree. OH has cancer needing long term chemotherapy tablets. The scheduling of the 4 weekly blood tests for the drugs and the 6 weekly blood tests for the infusions, coupled with a 4 weekly consultant's appointment (which must be between the blood test and issue of the prescription), and actually picking up the drugs from the pharmacy on the day before the monthly cycle starts (can't pick up any earlier, can't pick up later as the cycle HAS to start on the right day). Just organising all that is a bloody nightmare as it's all different places, different appointment clerks, none of whom will liaise directly with eachother. He's lucky he's pretty fit, healthy and mentally competent to arrange it all - heaven help people who are struggling with the chemo treatment and can't "manage" themselves.

Of course anyone earning enough to pay income tax on their pensions/investment earnings should also pay National Insurance, especially as its (currently) been hiked to pay for NHS/Social Care, two things the elderly need more than most.

Are we really saying that someone with 30 or 40k in pensions and/or a buy to let property, should be able to avoid NI but a care worker on 18k has to pay it?

Yes I think that is what people are saying.

Plus have you heard the howls of outrage and "it's not fair" when said pensioners die and their kid has to pay some inheritance tax on the hundreds of thousands pounds they just inherited. Much better the care worker stumps up.

The "I've paid NIC all my life" brigade also need to recognise that NIC was historically a pretty low percentage. It's only the last 20 years or so with regular increases that it's reached it's current high levels. The current rate is roughly double what it was in the 1970's!

So, yes, today's pensioners may have paid some NIC all their working lives, but not as much as today's workers are forced to pay!

Literally giving the tories ideas.
How do you make sure implementing costs to use the NHS doesn't hit those who are disabled or literally on the bones of their arses? Because both of those demographics are about to become a lot wider thanks to the cost of living crisis.

www.bbc.co.uk/news/business-62674301 - 'Lives at risk' without more help on energy bills

www.nhsconfed.org/long-reads/could-energy-crisis-cause-public-health-emergency - Could the energy crisis cause a public health emergency? Ask the NHS confederation

Where will the money come from if people can't afford to live now?

Add to that some hospitals are on interruptible tariffs. Just coz no one is talking about it, don't mean it ain't a thing.

I guess loved ones could be strong armed into putting a few bob in the meter.

I work as a counsellor for the NHS in an area where we have a large waiting list. The amount of people that don’t turn up for their sessions and don’t let us know they no longer want the sessions is astronomical. It really boils my piss when there are other people waiting and could have started their therapy with me. I’m sure if there was some kind of cost or cancellation fee people would bother to let us know they were no longer going to attend.

Bambina, go and wag your finger at someone else

Exactly KenD, no one can complain of poor services if they are wealthy but don't want to contribute.

IHT is very generous, valuations will always be 20%+ lower than if you were valuing for a sale too.

NIC have remained pretty steady since the early 80s, they were 6.5% when I started work in 1971 and were 13% when I stopped working in 2017. In those 46 years my NI and taxes contributed to the pensions of two generations. I continue to pay tax and will for the rest of my life, which might be another 20 years.

I’m more than happy to pay my way and would also be happy to pay some form of additional tax into a ringfenced social care fund. If you want pensioners to pay NIC then the explicit link between contributions and pensions will logically need to be removed. By the way, I don’t give a shit if my estate has to pay IHT - which it probably will. After all, I’ll be dead.

We need to shift the funding to a joint insurance model, like France - employers must provide some and a lot of people "top up". There is private and public provision but all paid for through insurance, as I understand it.
Apparently provision is much better. It would be a massive overhaul though.

What safeguards are there, in introducing an insurance based system, for those with pre-existing conditions?

Would you have a cap on what is paid for?

i think it would be too much of a huge change to move to insurance based system - with not much clinical effect (especially in the short term).

what we can do is move to the insurance model for social care AND have a compulsory contributions-based pension (a bit like the LISA but you can take money out for social care rather than just to buy a house).

The trouble with employer based insurance is that the majority of medical care is needed by non working people (because generally people who are ill are more likely to be elderly and/or unable to work).

Is this about the thread where someone ate a whole meal right before a procedure? If so, totally understand your anger over that one.

If the NHS were to start charging/fining people, they would have to be really careful. It would be awful if people were charged for genuine mistakes or circumstances that are out of their control. There are some people who are already too scared to go to hospital in case they are wasting NHS time. The introduction of fines could make that worse.