People would be happy to pay more tax if it went directly to the NHS

[Blackcats7]

I think people would be happy to pay more tax if it was guaranteed to go to the NHS.

@Kosenrufugirl

"We have a lot of people mostly women working long hours in insecure jobs just to keep their family heads above water. These women aren't going to get time off work in the middle of the day and they won't be able to afford a fee. So they will just go without medical care"

I totally agree and I especially agree it is mostly women working long hours in insecure jobs just to keep their family heads above water whilst juggling child care as well.

But alot comes down to what the fee is to access medical care and I really don't think it has to be a lot to manage demand- say £5.

For these women and men they can either take time off work and not get paid for it plus risk their employment or pay say £5 for an evening appointment or just go without medical care. Currently they are forced to go with the latter and I am sure many would choose to pay £5 in order to avoid losing a day's wage at say £80!

I think it shows a lack of understanding from posters who counter that well if it's an emergency then you'll find the time. That might be the case if you are in a safe salaried employment contract but alot of people (mostly women) are not. Also the majority of the time you don't even know if it's an emergency or important or not - yes if I have broken my leg I know I need to go to A&E but if I have a persistent cough should I get it checked out (probably should) or not.

@Bushmillsbabe
@Papyrophile

Both sensible suggestions which no doubt will both get criticised.

Yes in an ideal world you could get appointments when you wanted to and yes there wouldn't be people who didn't show up or think everything is free.

But the reality is not the case and unless the government spent so much more money on the NHS so that it crippled other budgets like education, this is never going to change.

Why was it the norm before 2010? What’s changed so radically in 14 years?

Reasons why someone might not show for a doctor's appointment: they're careless; they're in the early stages of dementia; they live in a rural area and are reliant on public transport which doesn't show up; they're on MH medication that has a severe impact on their ability to wake up in the morning; they have learning and developmental difficulties or substance abuse problems that make them chaotic.

Many of these people will already be living in severe poverty. You've now created a situation which will be a barrier to them accessing the medical care they so desperately need.

The thing that the NHS has actually been more successful at than most other systems of healthcare is addressing chronic health needs of the poorest and most marginalised people in society. The system you suggest would be the most harmful to this group, who probably make up the bulk of 'no shows' as they're some of the heaviest users of NHS services.

But I think policy changes that push the most marginalised people over the edge, in social & economic terms have been a feature of the past 14 years. We're hardened to the idea that it's ok to make life worse for the most vulnerable if there are benefits from doing so for the majority of ordinary people.

I friend who works in an inner city paediatric eye clinic, ie kids where the GP is concerned about their eyesight including babies, says that the no show rate is around 50%. These are important appointments. Factors that make a difference are things like half term when entire families will turn up. Yes, dementia etc will be factors but not valuing a free service is one.

I fully take on your point. But

• being careless is no excuse
• if public transport doesn't come, and someone is a bit late, we dont mark this as a DNA as long as they call and let us know
• medication - if struggle to get up then book an afternoon appointment
• dementia - there would be a note on system which would flag this and additional reminders and support to attend appointment, messages also sent to carers, family members with patients consent. If less wastes appointments, there may be capacity for home visits for the most vunerable people who are unable to get to GP's, who are also loosing out in the current system

This is not a new concept. You book an NHS dentist, if you don't show up, you pay or get removed from their practice. They have very low dna rates.

It's precisely because of vunerable people who face massive delays in accessing care, that we need systems to prevent it being abused. Less wasted appointments means better care for all

Working in nhs, I see very little correlation between DNA's and poverty. We have families living in horrendous situations who consistently bring children and actively engage, and some 'middle class' (hate that term) families who feel entitled to abuse us and the system as they 'pay their taxes'. A person's level of accountability isn't defined by their income, but by their intrinsic values. For those living with mental health difficulties we have advocates to support and try to engage, and again we get good results with the right support.

... and yet other European countries manage this.

How much should be spent on healthcare and social care is a political decision.

After WW2, the NHS was founded on the principle that there would be healthcare available to all, free at the point of access. This replaced a system under which decent healthcare was only available to those who could afford it, with the resulting poor health and shorter life expectency of those not able to afford it.

The same happened in most other European countries. Although the funding and delivery of healthcare differed from the UK NHS model, the principle was the same - what previously was only available to those who could pay should be available to everyone.

Over the years, and particularly in the recent 14 years, the UK government has engaged in a systematic dismantling of the NHS, claiming that there is no money to pay for the required investment and deflecting the blame on "NHS managers", the "worried well", the people who fail to turn up for appointments, immigrants and the usual scapegoats rather than looking at their own incompetence and mismanagement. The have not privatised the NHS as they know that this would be political suicide - instead they have neglected it to a point where they have driven those who can afford it (and many who can't) into the surgeries of their chums and donors in the private sector, to be fleeced at every turn.

Yes - people could pay for appointments, or for private insurance. But what if they can't? It doesn't matter whether it is £5 or £500 - if people don't have it their health will suffer - just as it will suffer if they have to spend time worried about what would happen should they ever get ill or have an accident.

And for those advocating private insurance, remember that these companies will use every trick in the book to exclude those who they don't deem to be "profitable." They will demand to see your family history - so if your father died of cancer and your mother has dementia and osteoporosis, they'll either decline to insure you or set the premiums so high that you can't afford them. And then you're back in the queue with everyone else.

Political ideology prevents the NHS from charging for anything themselves.

A lot of people would pay for more convenient appointments, shorter waiting times, "nicer" hospital room, more convenient place of appointments, etc., but the political dogma won't allow for anyone to have "better" service, so everyone has to put up with the same (often crap) service.

Take NHS hearing aids. You're basically given what you're given, no choices, no option under the NHS for enhanced aids, such as bluetooth, etc. (yes I know some trusts now offer Bluetooth ones but most don't). So if you want something better, you go private and the private provider makes a shedload of profit. Why can't the NHS provide a "chargeable" option for a better hearing aid and then they could benefit from the charge and profit??

Same with standing/upright MRI scanners. Not available under the NHS, so you have to suffer the horizontal tube which a lot of people can't tolerate, and some can tolerate with sedation. If you want an upright (open) one, it's basically £1,000 privately. Again, why doesn't the NHS offer a "paid for" upgrade to the standing one for people who struggle with the horizontal/closed one.

There's so many ways that the NHS could actually make money by offering enhanced options/services to their own patients, but politics makes it impossible so those people will pay private providers instead. Makes no sense unless you're a political ideologist who wants everyone equal!

We have similar in dental and optician services (privatised) where you can pay fixed amounts (or zero if eligible) for the bog standard treatments, but can pay extra if you want something better, i.e. white filling instead of grey or a higher spec of glasses frames. But hospitals and other services under direct NHS control aren't allowed to offer that kind of choice.

Again, why doesn't the NHS offer a "paid for" upgrade to the standing one for people who struggle with the horizontal/closed one.

Because MRI scanners cost millions which is why the NHS doesn’t buy the more expensive version. I have no problem with fully paying for healthcare over and above NHS standard if I want it. I most definitely have a problem with a two tier NHS subsidising my privilege.

The private firms have obviously decided that the investment produces a large enough payback. If a private firm can do it, why can't the NHS do it and make a profit to re-invest in other NHS services? It's just political dogma holding it back.

Why would the "NHS be subsidising my privilege"? Who said anything about the NHS providing it at cost price or below cost? My point is that the NHS could charge over cost and make a profit itself, and then use that profit for reinvestment within the NHS. If I have to pay £1,000 for an open MRI scan, why can't I pay say £900 to the NHS, so I get it cheaper and the NHS still make a profit of significant quantum to reinvest, rather than the whole profit going to some billionaire private healthcare owner??

And for those advocating private insurance, remember that these companies will use every trick in the book to exclude those who they don't deem to be "profitable." They will demand to see your family history - so if your father died of cancer and your mother has dementia and osteoporosis, they'll either decline to insure you or set the premiums so high that you can't afford them.
Yep. And try getting affordable insurance with a chronic health condition.
That’s the thing with insurance companies- they are happy to cover people for a low cost when there’s little chance of them having to pay out. It’s also not exactly ideal to have finance companies deciding what the acceptable medical treatment for patients, based on cost rather than efficacy.

why can't I pay say £900 to the NHS

Because the NHS hasn’t got open scanners because it can’t afford them.

Neither were sensible ideas, they were stupid ones.

Firstly, over 1.3m people don't even have a bank account, let alone a debit card and what about younger people who wish to see a GP without their parents knowing?

Secondly, if GPs are working 8:30 till 6 providing their normal surgery hours, who is going to be providing the weekend and evening surgeries? or shouldn't GPs and surgery staff have any free time?

Start training more GPs, fund more MIU's especially ones that have an x-ray facility and fund NHS dentistry, so people aren't doing their own teeth work and queuing for AE and GPs for pain relief.

Honestly, its unbelievable that the answer to a clogged up primary care service is to force sick people to pay.

"Who said anything about the NHS providing it at cost price or below cost? My point is that the NHS could charge over cost and make a profit itself, and then use that profit for reinvestment within the NHS"

All of this completely ignores the fact that as there aren't enough clinical staff, a burgeoning profit making diagnostic service for private patients within the NHS would inevitably reduce access for sicker non-paying patients.

It would also result in queue jumping for well off patients returning to the NHS for treatment following an expedited paid for diagnostic service.

@Alexandra2001 ,

I think small copayments would be really good, to be honest.

They would have to be means tested but, if we can do that for free prescriptions, I am sure we could extend this to the rest of healthcare.

A small copayment of, say, £10, would discourage time wasters, raise significant money and also change (in a positive way) the relationship between the GP and patient. Too often, I think, the fact the GP feels that they are ‘free’ allows them to have a very condescending attitude to their patients (not all, of course, but I have experienced it many times).

For general purposes, we raise money both by taxing income and consumption, and provide allowances for those who can’t afford to pay. I think we need to consider this in health too. It is pretty much how it works across a lot of Europe.

All of that happens with the current private system, which poaches NHS staff and enables patients to "queue jump" back to the NHS clutching their CD and written report of the private MRI scan. Just like patients who see their same consultant privately to queue jump!!

There's clearly a demand, and that demand is currently being met by billionaire, often foreign, hedge funds etc. Why can't the NHS be allowed to benefit from that demand?

It's not as if private healthcare is banned. It's here, it's been here a few decades and is growing, yet the NHS is losing, potentially, billions of revenue because it's not allowed to broaden its services accordingly and tap into all that money.

@Alexandra2001

"Honestly, its unbelievable that the answer to a clogged up primary care service is to force sick people to pay"

The alternative which we now have to a clogged up primary care service is to force sick people to queue or simply not go to their doctors until the condition has got much worse.

Of course it all depends on how much people have to pay but I genuinely believe that a small fee for a GP appointment would reduce missed appointments as it has done with NHS dentistry or opticians appointments.

No. Any extra I pay will go towards private medical insurance which, in my experience, has been priceless.

Yes, there’s a demand for private healthcare and the NHS, which is already way over capacity, is not the right provider for it. The staff who work in the private healthcare sector are usually NHS employees who work private shifts to supplement their income. My cataract surgery was done by a full time NHS surgeon whose private practice is carried out in his own time. All that happens if NHS resources are used for private work is that the queues get even longer.

@Alexandra2001 I don't disagree with training more GPs, although currently there's an outrageous % of young doctors who can't get training places because the numbers are capped: over 20%. More MIUs is a good idea too. NHS dentistry has been shrinking since I returned from the USA in 1985, so that is very unlikely to happen, although in principle, it's a good idea.

One piece of anecdata to relate illustrating that DNAs are a massive problem. DH pitched up to the local hospital 18 months ago for a day case procedure to correct an atrial flutter. (He has a 15 year history of cardiac issues, so we are regulars.) Of the six patients on the list that day, TWO turned up, so a 15-strong team of the surgeon, the IT support crew, the crash team and all the nurses were left hanging around. Everyone on that list had been contacted by letter six weeks earlier, then triaged by phone during the previous week, right down to a text reminder the day before.

That's a 60% no-show rate. If that does not indicate a lack of respect for other people's time and taxes, then I don't know where you'd draw the line.

Oh yes NHS dentistry, what a success story!

In Devon and Cornwall, there is a 4 year wait, just to get on the NHS waiting list to see an NHS dentist.

After your comment on dentistry, i'm starting to think you re actually not posting in good faith.

The alternative to your idea is to provide suitable primary care and MIU to relive AE pressures.

Of course a properly funded adult social care service would prevent people from being stuck in hospital..... and enable people stuck in AE to move to the ward... NI was supposed to raised by almost 2% to fund this...... what happened to that plan?!?!?

@Jumpingthruhoops ,

Private insurance seems like a panacea when you are basically young and healthy.

As you get older the premiums go up exponentially into the thousands or even tens of thousands per annum. In addition, some put premiums up every year if your have an ‘expensive’ disease like cancer. There was an article in the paper the other day about a cancer patient whose premiums went up from a couple of thousand to £80,000 over the course of treatment.

Private medicine is also unavailable for real emergencies.

Finally, private treatment has few multi disciplinary teams, so if you are not quite sure of what is wrong, you have to go from consultant to consultant excluding things.

A lot of people my age or older, including me, use private medicine when they feel they need to but don’t insure, paying in full. We reckon over time it will be cheaper which, statistically it definitely will, although it is far riskier.

No, I want the big companies who avoid millions in taxes to pay their tax! I pay enough whilst billionaires sit on their growing piles of profit

This.

the whole thing is a complete fucking shambles and I would deeply resent paying a single penny more towards it until its systemic problems are seriously looked at and addressed.

If this is not done it's just throwing good money after bad.

@Papyrophile People don't want to become GPs, as it seen as a high stress job.

I can only speak anecdotally, my FiL has needed many hospital appointments for circulation issues, these have been on-going for the last 3 years, i ve attended with him around 20 appointments, we hear the names called out and yes there is on occasion a DNA but its a rarity, he also has regular 8week appointments to the eye infirmary, again super rare to have a DNA.

What has been annoying though is when an appointment has clashed with an in hospital stay, its been very hard to cancel the out patient one, you phone but it doesn't get through to the appointments team and he has got a letter telling him "if you don't attend again and you'll be off the list"

what we do now is physically go to the out patient dept and tell them.....