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.

Yes, as an NHS clinical lead, I know this! 'On costs' are about 20% of salary on average, so my figures were based on £40,000 average salary with £10,000 of on costs added.

Just wouldn't get offered another appointment until paid it, rather than 'miss an appointment, get sent another, miss that one, get sent another, round and round'

How would it ruin the dr-patient relationship? That relationship is based on mutual trust and mutual respect. If someone doesn't show up, they aren't showing much respect.

I mainly work in NHS but have done a bit of private work, and anecdotally have found a much more respectful and collaborative approach from patients in private practice. I can be honest with them as not tied by NHS rules, and they are honest with me as to not do so would be a waste of their time and money.

There is no concrete evidence as it hasn't been tried. What the article actually said was that it wouldn't work to raise revenue as costs of administration would be same as the fines, not that it wouldn't change the number of missed appointments

What is your suggestion to reduce DNA's?

We already send appointment letters, reminder texts, our admin team make reminder calls to patients who are highlighted as needing them due to health/social need. We do home visits for those who report to be unable to leave home to get to clinic (but when we arrive are sometimes not home!). We offer locality based clinics so people don't need to travel far. We give our patients our work mobile numbers so can text us directly to cancel/rebook. What else would you suggest we do to reduce DNA's?

@Bushmillsbabe

What would i do?

As happens in our local trust, 1st failure, letter, 2nd failure, removal from list....Unless convincing reason given.

My FiL was told quite bluntly, if he misses the next one, he will have to go back to his GP to be referred in again..... (he had cancelled but that info was not passed on)
You re solution of blackmailing the patient into paying a large fine, would mean poorer people would just not pay and miss out on essential treatment, i don't really understand how you can't see that?

Enforcement? are you saying an elderly lady, who misses her bus, should be fined? and if you let that go, well, its a get out of jail free card for everyone else......

At the end of the day, a consultant appointment usually means you ve something quite seriously wrong with you & you ve probably waited a long time to get that appointment, there will, usually, be v good reason not to turn up.

Private practice is totally different, a consultation will be around £150 to £200 (self pay) and with insurance, failure to turn up can mean having your policy revoked.

People with PHI won't be using public or hospital transport either.

The hairdresser charges if you miss an appointment with less than 24 hours notice. I have been asked for a per capita deposit by card to guarantee a restaurant booking. Of course, it is a different service, but that different?

That makes no sense. If someone fails to turn up - deny them care by removing from the list - that's the solution? Surely that's worse than a fine in terms of health outcomes?

And then gp uses their valuable time to see patient and refer in again, they miss their appointment, back to gp and round and round we go. This process wasting thousands in gp, admin and consultant time, and meanwhile the wait list gets longer and longer?

I work in the NHS. I use the NHS. There are huge issues which throwing money at it won't solve. It wasn't built for the complexity and level of need we are seeing now, and without radical change, it won't survive. Which is incredibly sad, I have stayed in the NHS when I could easily earn double elsewhere, because I believe in equal access to care, especially as I work in paediatrics, where the care the child gets is largely dependent on the parents. But myself and my team are demoralised, not by our pay (which is pretty decent at £50,000 a year for qualified staff with a few years experience) not by our working conditions (7 weeks annual leave, pension and maternity pay). But by the way we are treated by patients, who are rude, abusive, think Google knows more, don't turn up, arrive late, don't follow our advice and then blame us for them not improving. It's not a money problem, it's an attitude problem

@Bushmillsbabe Well, i never actually said that did i? might help to read the post first before commenting.........as i said...it wouldn't be a first "offence" off the list system..... imho if someone willfully misses two appointments, they wont bother going back through the GP system again, they have prob got better.

Your solution, a £100 fine, would just punish poorer but still ill people & as i said how would you find out if they never turned up for a appointment due to a public transport failure or couldn't be bothered? spend hours investigating if a person had a genuine reason or not?

Would you fine an elderly person whose transport didn't arrive? someone with memory issues? someone who became seriously ill on the day or a faller?

Plus, once again, you ve no evidence that fining would work..... the links up thread suggest otherwise.
New methods of working should always be evidence lead.

How on earth do you think patients hit with a £100 fine are going to improve their attitude towards you? do people like traffic wardens?

Who are "people"? Because the rich don't like to pay Tax and always have ways to avoid paying taxes.

The reality is that no system will work perfectly for everyone. But is it fair that 80% of the population have to endure a poor level of healthcare because it might be harder for low income people to comply with penalties for missing appointments?

If charging £5 to visit your GP or £10 for A&E cuts missed appointments, reduces spurious visits and improves waiting times, that helps everyone. Including people on minimum wage who don't have 9 hours to visit A&E.

People who work in the NHS say it's not working. Simply sticking with the current system so certain groups aren't potentially discriminated against isn't the answer. The French and German systems presumably work round this.

Most of Europe has mutual-type health insurance cover, the cost of which is about €250 pp per month, or €350 for a pensioner couple. But in most of Europe, the state pension is higher -- from about €1200 in France to €3000 in Belgium and Luxembourg, other countries between the extremes.

The UK's state pension is considerably lower because of NI contributions towards past generations' health and retirement benefits. So the next question would be: "If we expect everyone to contribute to their health costs, how much is the state pension going to increase? And is it worth doing?"

It costs far more to pay to have things done privately, especially if you’re self funding as insurance companies pay a lot less. DD needed major spinal surgery - private quotes were £50k, meanwhile it cost the NHS around £25k to do it.

Sorry, my mistake, its waste 2 appointments,then back to gp re referred and then waste another 2. We theoretically have that system, rarely implement it due to being paediatrics, but where we do, they pretty much always get re referred, then same cycle starts again. Do you have experience of managing an NHS team, to know the amount which get re referred?

You ask how would we find out? - the child's parents would call us to let us know :-) We know our families well, and which ones try their absolute hardest to attend on time but are occasionally limited by factors outside their control, and those that just can't be bothered. Where children aren't brought we contact social services to see if anything we should know about which prevents families from attending.

On the topic of reading posts - I clearly stated earlier on thread that we don't count late as a dna - as long as they call and let us know running late. We dont count getting sick on the day, again as long as they call us. If they are very sick and in hospital, again the system lets us know automatically and not counted. Where there are complex situations like parents also have a disability and struggle to get to us, we offer a home visit, or we call day before to check in with them that still able to come.

So what else (apart from the cyclical DNA - discharge- re refer) do you suggest we do to improve attendance?

At the end of the day, if staff are demoralised, and leave the nhs due to the way patients treat them, no one wins, most of all the vunerable people you mention. The more well off will go private, its those living in poverty which will lose out the most.

On a wider view I think it is interesting to see why ideologically Hunt is seeking to reduce NI to zero and effectively abolish it.

Now ostensibly he pitches this to voters as reducing tax but in reality with the fiscal drag on tax thresholds this will make very little difference to take home pay.

What I think he is trying to do is to separate the linkage between access to social benefits such as NHS and importantly state pension and NI contributions.

Many people still think that paying NI is like paying into a private pension and that somehow that is your state pension pot. In reality the NI you pay today pays for today's pensioners and you just have to hope that when you retire there is still a universal state pension. To means test state pensions would be viewed by many as stealing or taking away "your contributions into your state pension pot".

However if NI is effectively abolished and state pension and NHS is paid for out of general taxation then there is no "personal state pension pot" (not that there is anyway but the perception of one) and there is no "personal health insurance" of the NHS. Thereby opening the door for means testing the right of universal access to both.

@Bushmillsbabe Without proper evidence on the effects of fines, implementing that sort of change could well have severe knock on effects for the poorest in society.

Here is a summary from the BDA on charges for DNA's

Charging for missed appointments has two major benefits: to reimburse the practice for any financial loss; and to discourage future non-attendance
However, it has been suggested that fining patients for missed appointments leads to breakdown of the patient-practitioner relationship, particularly where patients who have diligently attended appointments previously have missed an appointment due to unforeseeable circumstances

Like i said up thread, 90% attendance, bearing in mind the demographic of many patients, is probably as good as it gets, assuming text and letter reminders are used & the threat of having to be re referred, which i think for the genuine DNA is probably quite a good incentive not to do it again, obviously for an elderly patient, with cognitive impairment, this wouldn't be used.

@1dayatatime Yes pretty much agree with all you've written.

I'd add that it also puts a policy divide between Lab and Con too, perhaps Starmer needs to remind him that the Tories wanted to put UP NI just 3 years ago....

@Alexandra2001

leads to breakdown of the patient-practitioner relationship

Is there a patient-practitioner relationship anymore at all?

I've not seen the same GP twice for about 20 years. It's always someone different. Out GP surgery has 9 "partner" GPs mentioned in the "meet the team" section of their website, many of whom have been there years - I know most of them by name, but only ever seen 1 of them and that was only once. They all seem impossible to book an appointment with and the one partner I did see was an "urgent" on the day appointment about a decade ago.

Same with nurses. I have T2 diabetes which was diagnosed about 25 years ago. At first, I saw the same practice nurse for around 3/4 years at a time so there was a bit of continuity. Now, for maybe the last 15-16 years, it's literally someone different every year, often a HCA who just takes blood, fills in an online questionnaire and checks my feet. The website says they have three diabetes specialist nurses, but I've never seen nor spoken to any of them.

I think the "patient-practitioner relationship" broke down 10-20 years ago, certainly in our GP practice.

@Alexandra2001

To be honest Labour are being handed a poisoned chalice when they get elected anyway.

With debt at a ridiculous all time high, weak economic growth, public services suffering and tax at a 70 year high we are all screwed either way.

What are you on about? It was a jokey comment about where our taxes go. Absolutely hilarious, I know...

'But no, I don't think corruption in government is a product of high taxation. Give yourself a little shake, and stop frothing at the mouth, in the nicest possible way.

The relationship is more than seeing the same medic, its about being respectful, doing what they tell you to do.... even attending future appointments!!

@1dayatatime We aren't taxed that much compared to European countries.
At some point, IF we want better public services and roads etc, we'll have to pay for them.

imho what the Tories are doing by handing out tax cuts, funded by public service cuts in the future, that they wont have to implement, is criminal behaviour.
They are deliberately screwing over the british public, hoping that it will hamstring the Labour Government, allowing them back in at the following GE.

I think I recall that you cycle in Europe @Alexandra2001 from another thread, but British road maintenance is a disgrace. However, I also remember driving in Spain 35 years ago, and the EU investment that has gone into the Iberian road network and building the bridges to connect all the small towns has been immense. Because the UK built all those links so long ago - between Victoria and Elizabeth - it's been a maintenance issue. Which costs very nearly as much, but doesn't unlock any new value/advantage.

Sorry, off topic, but loosely related. The UK, as one of the first industrialised nations, built everything in the Victorian era, Brunel, Bazalgette, etc and thought the advantage would last forever. We're still using that legacy and it's become threadbare. But now, there are no capitalist barons (who paid for it back then, with joint stock companies) content to take a 40 year view.

We do indeed! well remembered!

My DD is home atm, she was asking why the road to the village is now little more than a track "was it always like this?" she asked

i replied "No, when i was growing up, this lane would be tarred and gritted every summer, then every 2 summers, probably hasn't been done in 15 poss 20 years....." and it shows, its now too dangerous to cycle down on anything less than a mtb.

French and Spanish minor roads also link towns and villages, these roads are 100s of years old, tarmacked over the last 100 or so BUT maintained as we used too do.
(Not talking about some of the EU funded main roads, funnily enough the A30 nr me, is being dualled, part funded by the EU)

We were in the Pyrenees last summer, road mtce teams were fixing damage to the road surface & quickly, they carried their own wheeled traffic lights, when they stopped for lunch or went home in the evenings, traffic lights put back in the van.... how different are we!!! close the road & lights provided by a 3rd party.

The UK has stopped preventative mtce, be it roads, hospitals, schools etc & as every homeowner knows, this ends up costing more in the long run.

What i'd like to know is where has the money gone that used to be used for mtce? along with the billions supposedly saved because of Austerity.

@1dayatatime that's interesting about NI.

I looked in to how it actually works, a few years ago.

I was helping colleagues in a pension dispute and as an Economics teacher, thought I should know.

I was surprised (although hardly shocked) to find it's essentially a government slush fund that doesn't actually have to be spent on the NHS at all.

Charging anyone for anything is going take a lot more admin and management, not less.

Imagine how many exceptions there'd be!

NHS = Too many bosses.

I'm just wondering how many people commenting about whether charging would or wouldn't work are actually NHS staff/managers? And same for comments about too many managers? And that nurses etc are low paid?

There are many narratives spun by the press about

• how poorly paid qualified NHS staff are - in context, an NHS band 7 (more than 5 years experience) physio, OT, nurse is paid £50,000 outside London, £57,000 in London as a basic, with extra for working night shifts or weekends. With 8 weeks a year holiday (Inc BH's) and good pension and maternity pay. Not a fortune, but well above national average salary, and with good benefits
• 'too many managers' The NHS actually has fewer managers than many comparable size organisations. The bigger problem is that many managers are clinical staff with no actual training on how to manage, and are in the role either because they were pushed into doing temporarily and ended up stuck there, or because there are few other options for advancing career clinically. They don't really have the training in effective people management, so it's very pot luck whether you get a good manager who drives improvements, or one which just ticks boxes and allow poor quality staff to continue in roles not suited for
• that NHS funding is dropping - its not, it's higher than its ever been.

There are so many popular narratives around the NHS, that people are not aware of the real issues. 5 of my team have left in past year and moved in private practice. 2 was due to lack of opportunity to progress, 3 due to stress caused by patient behaviour. None due to salary or workload. Team is well funded and wait list under 2 weeks for urgent and 6 for non urgent.

So the narrative that just throwing money at NHS is the answer isn't correct. There are structural issues and patient behaviour challenges which are deep rooted and nothing will improve until these are tackled.

@Bushmillsbabe How many band 7s are there? and you should really know that at B7 many roles are no longer clinical.

Agree on not enough managers etc.

Funding? in real terms, facing cuts, its only "higher than ever" due to v high inflation and Covid measures.

Who has actually said (on here) Throw money at the NHS ? no one.

Money always has to be targeted and long term, really pisses me me off when i hear sunak saying "we gave the NHS x amount for winter pressures.." so fucking what??? the NHS needs a constant stream of targeted funds across many years, to address winter pressures, which right now are also spring summer and autumn ones.

2 weeks Urgent, 6 weeks non urgent - You work in the private sector, its also Anecdotal, your team isn't the NHS as a whole, nor is it representative.

the NHS isn't even achieving that in Cancer Care - read the recent report by the Health Ombudsman..

@Alexandra2001 the NHS works for anyone who would qualify for a job in it on intellectual terms. It is too complicated for most people who are slower of thought, which is at least 49% of the population. Those people need handholding through the basics. DP, who is decidedly not among the intellectually challenged, has solved the issue by delegating the management of it to me. I grasp quite a lot of the science in medicine, because it was a topic I had to be on top of during work years.

I agree with you in your frustrations and I really fear any future in which anyone not a digital native can't cope. That said, my mum (89) and dad (90) still get by although neither look at their phones unless they make a noise.