We need to start charging for NHS services

[Fragmentedbrain]

£15 for the GP
£20 for A&E
NHS routes to paid-for fast track treatment
Options to pay for nicer rooms

We need to stop putting working people on disability benefits for want of a functioning health service it's barbaric

Some many missed appointments are caused by NHS inefficiency, so what happens there? I wouldn't pay a fine if it was no fault of my own. I've been warned more than once about missing appointments that I phoned to cancel with plenty of notice

Last year I took a day off work to go to a hospital apt that I didn't need , it had been booked on an automatic system and not been cancelled when I didn't have the initial procedure that "triggered" it...

My DH (works. For the NHS) says this

Criticising the NHS feels like it's almost unpatriotic and so prevents people from actually saying it's not fit for purpose in many cases

Yes it saves lives, people on this thread I'm sure will owe their lives to the NHS and it staff

But that doesn't mean it should be protected as is at all costs.

Er, we do @hattie43 Even International students on a UK Student Visa typically pay a healthcare surcharge (IHS) of £776 per year.

Except charging means that there would be pressure on GPS to not go back on a previous diagnosis. So someone who hasn't got the right diagnosis is even less likely to get the right one. GPs would end up spending more money dealing with complaints and claims for additional costs.

https://www.health.org.uk/features-and-opinion/blogs/why-charging-for-health-care-isn-t-a-credible-fix-for-our-nhs-crisis

https://www.kingsfund.org.uk/insight-and-analysis/long-reads/nhs-crisis-evaluating-radical-alternatives

the latter is a really interesting breakdown of a variety of options and makes it clear what a complex problem it is.

Yeah sorry I may not have been clear enough. I meant guidelines would need to be put in place to ensure patients are NOT charged when returning due to previous misdiagnosis etc.

I don't see an issue with a contribution system like we have for dentists. People who need financial assistance still get it. It might help reduce time wasting and increase the coffers slightly. If you paid when booking and only got a refund if cancelled more than 24 hours in advance I think most people would think twice.

I supposedly missed an appointment. It was a phone call and not in person which I did actually take.

I once cancelled a GP appointment. I got a reminder about it on the day. I spoke to the receptionist and said that I already asked (when I came in a few days previously) to cancel it

I agree with this. I've had a similar conversation with DH. He's adamant that GP appointments should charge £5 each and just will not understand that there are many people that just can't afford it. It's infuriating and a sign of privilege that he's never been in a position to be watching every single penny.

There should be a missed appointment fine, or a points based system where you get fined if you miss a certain amount.

There are definitely areas that could be monetised to bring in some more cash, but anyone that knows anyone that works in the NHS also knows there are plenty of places that money is wasted because of how it is organised.

I know of someone that was in a high banding. She got made redundant from the NHS but then they re-employed her as a contractor on a higher rate. All because one budget line had more capacity than the other. Overall it cost the NHS more.

I am sure many different options along these lines have been considered by previous governments since the NHS was founded and that they haven’t been implemented either because of political ideology (possible) or lack of funds (more likely) or probably a bit of both (most likely).

If you’re genuinely concerned about this, there is so much to unpick and tease out and consider here. I’d suggest writing to your MP about this, as that’s something constructive and positive that may result in some change. I know it can feel like you’re banging your head against a brick wall when you want to see a change in politics, but it may pay off. Or maybe you could see if there’s a way you can contribute your views to your local NHS trust?

Finally, I know your OP is brief and probably written in the heat of the moment, but the fast-track treatment option is a completely different kettle of fish to the nicer rooms option. The NHS is built first and foremost to consider clinical need, and is struggling to manage this well due to lack of resources/funding/many other factors, and they will focus on meeting this need first before turning to more ‘cosmetic’ things like nice rooms.

System like Nz - if you’re on a low income or have a chronic illness (eg asthma) or disease (like cancer) or disability (eg blind) : free doctors appointments. Everyone else pays. It works.

No. Because even two parent working families are struggling with the everyday cost of living. They would not qualify for any exemptions, but paying for NHS care would be a massive burden on families already unable to cope. Those most unable to pay would be hit hardest.

Successive governments have massively fucked up to get us in this state but forcing people to pay even more for basic essential services is not the answer.

The big flaw in your plan however is that people in genuine need might not go to the doctors.

During Covid, there were a lot of people with serious issues who never went to hospital or called an ambulance because they didn’t want to be a ‘bother’ while the NHS was apparently overwhelmed. I was one of them! I had a very fast heartbeat for 24 hours and didn’t want to see a doctor for the same reasons, but was eventually persuaded to go to A&E. I was seen immediately and treated - it’s good that I went.

On paper it sounds good but in principle I think it’ll create a whole host of other problems.

They spend more per capita too.

Really?

Then you are lucky not to know of mothers who go hungry so their child can eat, because they have no money for three days.

Start with non attendance, GP appts same rules apply for prescriptions. Chronic conditions with exemptions.

Because there are so many exemptions for prescription charges, our pharmacist said the NHS would make more money if everyone (no exceptions) paid £1 per prescription. And rather than charging for DNAs, there could be a booking fee refunded when you turn up.

I get it’s hard but what’s the alternative, to basically not get to see a doctor- which is what happens for many people now or they get palmed off on to different health care professionals as only the most ‘severe’ cases get to see the actual doctor.

Me and my husband have no children and no UC, we are not high earners. We make about £56k between us both a year. With the COL every penny is accounted for and I would probably just put off seeing a Dr if I had to pay. We have very little in the way of luxuries so where do I cut back? We finished the month (I got paid today) with £5.64 in our bank. i have paid NI every single month for over 30 years surely I should be getting something for that chunk that comes off my wages? If they do this they will need to reduce NI. As people are paying twice in that scenario.

the whole NHS needs an overhaul, my mother was in a ward taking up a bed for 8 weeks to get a scan. They told us the quickest way to get a scan was by her being there. She has dementia and became very confused and frightened and upset. It must have cost a fair amount to keep her in there. We could have had her at home and taken her for her scan. As she was so confused they had to restrain her for the scan.

You do realise there are people with painful gum disease whose teeth are falling out but cannot get treatment as they cannot afford private dental care? The Dentist system is not working.

It's a very recent introduction though. Foreigners have been taking advantage of the NHS for years, coming to London for free treatment. Foreign holiday makers are still surprised when they are not charged for treatment here, even though they are quite happy to pay.

Its all water under the bridge now, but we should have started doing this years ago.

paragraphs from the Kings Fund -

“Second, in the long term, there is no evidencethat suggests any specific funding models routinely delivers a better health care systemthan any other. In fact, what tends to differentiate performance of health systems is the level of investment rather than underlying model of funding. This would suggest that a lengthy, costly and disruptive transition to social insurance is unlikely to deliver significant improvements in and of itself, without a corresponding increase in investment.

Third, self-pay and expanding charges would have ramifications for health inequalities for those unable to afford them and would also be unlikely to reduce pressure on the NHS. Furthermore, those who delay or avoid care due to cost could increase demand for expensive treatments, and this could also result in poorer health outcomes. All the different models still need a tax-funded safety net, and if this is not adequately funded and resourced there will be implications for health inequalities.
Finally, in the short term, there are significant challenges facing the NHS that these alternatives do not help to tackle. None of the alternatives proposed above would in and of themselves increase the capacity of the health care sector and so there would be no meaningful impact on improving access or reducing the backlogs of care more quickly. They would not result in more beds, diagnostics equipment, or improvements in the state of NHS buildings. Neither would they overcome the significant workforce challenges in the NHS, which require action to boost recruitment and retain existing staff. Likewise, to improve health outcomes requires action on both the quality of health care and also societal action on the wider determinants of health, which these alternatives do not guarantee.
England needs to improve both health and care delivery and health outcomes. Doing this requires additional investment particularly on capital (buildings and equipment), fundamental changes to social care funding and provision, a comprehensive approach to improving the wider determinants of health and governments adopting a long-term perspective to avoid repeating the mistakes of the past on issues such as workforce planning. None of the ‘radical’ alternative models would be an immediate or targeted solution to the challenges facing the NHS. In fact, each would bring their own drawbacks as well as benefits and introducing any of these would bring significant disruption. Tackling the challenges is better done through improving our current health care system rather than jumping ‘out of the frying pan and into the fire’.”

There isn’t an easy answer and the social insurance model (which I am very interested in) will require more not less government investment.
That’s not a reason to look into it - but we should be wary of anyone selling it as an easy answer.

My friend had a good suggestion of mandatory social insurance, I don't know much about it but apparently it's the model in a number of European countries. So you pay something towards your care, and the NHS would be getting money from insurance payouts, not just tax.

I need to learn more about it and genuinely curious if anyone knows and could say reasons for or against it.

I think the huge issue with the NHS at the moment is the actual proportion of the population that is tax-paying and working-age is slim compared to the rest. We have private medical insurance for me, DH and our baby - friend survived cancer at a young age so we budget to prioritise it.

People do get to see a doctor now, its just not as quick as anyone would want. Under the proposed system there would be people who literally could not see a doctor due to cost.

I think you should be charged for missed appointments.