Should the NHS ever charge extra?

[Jac1978]

NHS bosses have suggested charging for out of hours GP visits and for hospital meals to try and raise some much needed funds but is this the right way to go about it? Would it be better to charge those who abuse the NHS instead eg people who miss appointments or repeatedly end up in A&E drunk? Or would this be the start of privatisation when we all pay our national insurance for a completely free health service? How would you save money?

I'm in Sweden. We have to pay around £10 per doctor's visit, more if you miss it, and £8 for nurses/physios etc. We also have to pay approx £15 per night for hospital stays, although it varies from hospital to hospital. There are lots of exceptions eg children, pregnancy related appointments, routine vaccinations/screening, and once you've paid a certain amount (around £100 I think) in a year you're totally exempt for a year.

The Sweden model sounds excellent. I also think people that injury themselves whilst drunk should be charged. Nothing annoys me more than taking a sick child to A and E and having to wait while staff deal with drunken idiots. Obviously alcoholics are an exception but young guys fighting on a Saturday night are totally unacceptable.

I'd prefer to pay for missed appointments but no idea how u would do it.

In principle i would agree if it were not for the fact thatI keep on getting letters from the hospital telling me off for DNAs for appointments they have never told me about in the first place! so I would be wary of a system that penalised me for their mistakes. The hospital in question is lovely and brilliant except where paperwork is concerned where they are absolutely atrocious. DH worked there for a bit and got annoyed with the chaotic nature of the admin & management. He complained that it often made the running of his clinics nigh impossible.

Mmm interesting topic . I think maybe charging for missed appointments is something to think about . We have to wait about 2 weeks for gp appointments . It annoys me at the fact that the fortnights booked appointments won't all be kept and my DCs could have used it .

Charge missed appointments
Charge drunk relates injuries.

I quite like the sound of the Swedish model Too .

The problem is, where would it stop? First missing appointments, drunk-related injuries..smoking related diseases...obesity related diseases...addiction....OOH appointments...ambulance 'wrongly' being called out....

I don't disagree as such, just don't trust this government an inch not to take a mile.

Here in Ireland we pay ?50 approx to see our GP, and I can usually get an appointment the day I phone. We pay about ?100 per night in hospital.

All maternity care is free. I don't mind paying as you do question if you really need to see Dr. Families on low income get payment exemption

Charging for missed appointments sounds ok, but I wonder if a disproportionate number of missed appointments are MH appointments where the patient may be in no state to attend the appointment or to pick up the phone to cancel. I think a lot of consultation regarding exemptions would need to be carried out before introducing a scheme like this.

Not much point giving people hugely expensive treatment in a hugely expensive hospital bed, and neglecting the really cheap bit of their treatment: basic nutrition.

What on earth would you do with someone poor who scrimps on meals to save money in hospital? (Bear in mind illness is expensive - they're unable to be at work, may need to pay childcare, family have transport costs to see them, etc.)

The Irish system is fucking hideous and plenty of families don't take their sick children to the GP because they can't afford it.

And no, they should not start charging for OOH care to create easier profits for private contractors.

As for all the moralisers calling for the withdrawal if medical treatment for people who are injured when they've been drinking - words fail me.

I know, since we're desperate for income, we could pay for drunk injuries by increasing tax on alcohol. Including beer.

Oh, wait...

In principle I think it's a good idea but you have to keep it simple or the administrative costs will rocket. That means avoiding judgemental charges - was it the patient's fault he was injured, how much did he have to drink? Impossible.
On the other hand a nominal sum for a GP appointment and modest hotel charges for hospital stays seem reasonable.

Hospital transport is also huge drain on the NHS. Free transport is provided to and from hospital for many, many patients regardless of means.

Er, some people can't afford to stay in hotels...

I don't mean that literally.
I mean a small charge for food during overnight stays.
And as always those on benefits could be exempt or pay less.

The nhs is free to all and should stay that way ! I work in the nhs and there are many faults with the system but that it is free is not one of them! Starting charging for certain things is slippery slope to the American way ! Not enough money to be treated ? Do you really want that ?

That's a difficult question. I am a district nurse and see lots of people abusing the system. Not complying with treatment, calling us out over nothing (repeat offenders), people who could easily do their own eye drops but insist on a nurse visiting 4 times a day. BUT the worry would be that people who genuinely needed a service wouldn't use it because if the cost. There are a lot of older people who have no conscience in over using the NHS as they feel have paid in all their lives and deserve something out of it.

What about things like continence pads? The nhs spends millions on these - should this come out of an over stretched budget?

Definitely no continence pads for people who piss themselves because they are drunk.

Or people who wet themselves laughing. Fucking pay for your own humour-related wee wee accidents.

Having fun is a choice!

But people who wet themselves laughing have stress incontinence same as when you laugh & sneeze!! People with peg feeds have their feeds supplied on prescription and also those with coeliac disease are able to get food basics on prescription. Are these items medicinal? Should they be paid for by the NHS? It's hard to know where to draw the line.

Yeah, right, the out of hours service is a disgrace and has been a disgrace for a long time and they have the cheek to suggest charging for it. Jeez. NHS managers know OOH is a mess. People have died because OOH is a mess. Some providers only bother to employ one doctor to cover huge parts of the country - I think the whole of Cornwall had one out of hours doc at one point.

And wonky's right that missed appointments are often NOT the fault of the poor darn patient. MIL is getting increasingly confused and the hospital are writing to her with appointments, even though there's no chance she will understand, retain and use the information. SIL has pleaded with them to at least copy her in on appointment letters, but no joy. We just have to hope that when dh and SIL go round they manage to find any letters MIL has tucked away God knows where. (MIL gets five carer visits a day but really needs to be in a home, but the bureaucracy of SS doing assessments, hospital doing assessments and the potential home doing assessments and then finding a place is never-ending.)

My friend kept getting "naughty naughty you've missed XYZ antenatal appointment/scan" letters - even though she's had a miscarriage and ERPC in the same damned place as was sending the letters.

The admin just isn't up to this.

And I think it's wrong anyhow.

I'm not sure I understand the rationale behind paying for OOH treatment, except that many people use it who don't really need to (depending on who defines 'need', obviously - the worried first time mum? The confused elderly person? The chronically ill patient whose pharmacy didn't deliver the right quantity of pills? Have had to do that one twice). Equally many people make appointments with their GP which are unnecessary and that costs money too. So ... why is OOH different?

My surgery is being urged by the patient group, including by me, to consider penalties for repeat offenders who Do Not Attend (DNA). They are extremely reluctant to do so - I suspect for some of the reasons given above. MH and other vulnerable patients whose lives will be made worse if they feel pressurised about poor performance - and the downward spiral only increases costs on the NHS anyway. I have a feeling (although they haven't said it) that they rely on a certain percentage of DNAs to make sure they can get through the day's appointments without massively overrunning. A bit like airlines overbooking flights.

So in the traditional time-cost-quality model, if costs can't increase and (obviously) quality can't decrease, that only really leaves time. Longer waiting times in order for hospitals to do more private work? (Although god knows there's plenty of spare capacity for private work already, they're called 'weekends').

Tribpot, they may well be extremely reluctant to do so as it's probably illegal. Although the dog's breakfast health bill did originally include the outrageous ability to impose charges, I have no idea whether they made it through all the shenanigans... but I imagine any surgery trying it would find itself on the front page of the nationals very quickly.

And yy, surgeries do rely on a certain proportion of DNAs to make their workload more manageable.