Missed NHS appointments - to fine or not to fine?

[Paul Waine]

The £600 million will be made up from the what the Trusts have missed out in claiming for seeing the patient.

Depending on the specialty of the appointment and whether it was a new or follow up appointment would determine the cost.
A new attendance to urology would generate a tariff of around £142, a new to respiratory £208. Followups for these are £54 & £94.

It’s also worth noting that these are national tariffs so unless Trusts have local agreements with the CCGs are the same for everybody (although each Trust does have an uplift for Market Forces Factor).

Also need to point out that some clinics overbooked, to hopefully allow for that however that creates issue if nobody DNAs

Thanks for this info, Wilks. So the £600 million is the opportunity costs of missed appointments? But, the £600 million stays in the CCGs funds and will be paid to the Trusts when the patient terms up for the re-scheduled appointment? Meanwhile, I guess, the Trusts have to pay their staff who were ready to fulfil the appointment? Do a few DNAs ("did not attend," I assume) give the staff a little less work when this happens, one less patient to see on that day?

[dsr]

Why don't they utilise the phone and call him and say, ok Mr x, we have several options available, which would you prefer! Rather than arbitraly sending a date that might not be suitable.

We have had the same issue with my wife who is a stroke survivor, they send appointment dates out according to their schedule with no consultation of whether it is a suitable appointment....

Ok, she can make that appointment, can you provide transport...no, well it's not suitable due to other commitments....

The way Airedale do it - my mother was due a cataract operation on her second eye, and the appointment they sent out was for when she was on a pre-booked holiday. Their letters include a request that you ring and confirm the date and time are suitable.

So, I rang and said the time was not suitable, and they got out the diary and immediately rebooked for the following week. Easy peasy. No reason why they can't all do this, at least for minor operations. And if it's major operations, then the patient can cancel the holiday.

[Paul Waine]

It's free, that's why.
As such many people will use it and complain about it when they could easily afford to go private.

Hi Sidney, I guess the individual will argue that they've paid their taxes, so they have the right to use the NHS....

However, maybe you are on to something, perhaps health insurance is the way to go for all of us. Perhaps we could all pay health insurance - based on our income/ability to pay. Perhaps the governments (politicians) role is to ensure that everyone can get good standard of health care, regulate the health insurance providers, regulate the health care providers, ensure that doctors, nurses, hospitals, A&Es all provide a certain standard. And, ensure that those that aren't working, can't afford to pay for their own health insurance and covered by those who can afford to pay a little extra. But, get politics out of ownership of hospitals, employment of nurses, doctors and administrators.

The NHS is bust. It's survived 70 years - but no other country has copied the NHS model. What does that tell us?

[Sidney1st]

You can't mention health insurance without the Labour supporters having a fit.

Take the politics out of the NHS, run it in a more efficient and productive manner and then see what happens.
Until then, it won't change for the better.

[bfcjg]

Re fining for non attendances I think the people who don't turn up in the main are people who couldnt be bothered so they wont pay anyway. To raise cash there should be no free prescriptions, there should be a sliding scale even down to kids paying at least £1 the unemployed £2 pensioners a fiver etc etc, that way you would at least think do I need it, can I get my medicine cheaper from Asda etc.

[Paul Waine]

[quote="dsr"]The way Airedale do it - my mother was due a cataract operation on her second eye, and the appointment they sent out was for when she was on a pre-booked holiday. Their letters include a request that you ring and confirm the date and time are suitable.

So, I rang and said the time was not suitable, and they got out the diary and immediately rebooked for the following week. Easy peasy. No reason why they can't all do this, at least for minor operations. And if it's major operations, then the patient can cancel the holiday.[/quote

So, I had an appointment booked with consultant, but needed to have a series of tests before hand. When I'd waited several weeks to get the appointment for the tests the date offered was in the middle of the holiday I'd booked (connected with friends' 50th wedding celebrations). My first thought was to try and change my holiday, which luckily I was able to do.

So, I kept the appointment for the tests - and then my appointment with the consultant was cancelled! When I asked why, I was told he was "on holiday" - I later learnt he'd left the Trust. Of course, I asked for a new appointment with the consultant. The hospital appointments team "couldn't help." They suggested I ring the consultant's secretary. No joy: I was asked "why are you calling here?" I finally got a new appointment with a different consultant - more than 3 months later.

[Sidney1st]

Re fining for non attendances I think the people who don't turn up in the main are people who couldnt be bothered so they wont pay anyway. To raise cash there should be no free prescriptions, there should be a sliding scale even down to kids paying at least £1 the unemployed £2 pensioners a fiver etc etc, that way you would at least think do I need it, can I get my medicine cheaper from Asda etc.

What about prescriptions for life long illnesses

[Roosterbooster]

I don't agree, my friend is a a top leader in internet security worldwide, why can't the NHS give him options of times and dates???

They gave him a date. And another. Then another. He can always go private if he doesn’t like it

[Roosterbooster]

The £600 million will be made up from the what the Trusts have missed out in claiming for seeing the patient.

Depending on the specialty of the appointment and whether it was a new or follow up appointment would determine the cost.
A new attendance to urology would generate a tariff of around £142, a new to respiratory £208. Followups for these are £54 & £94.

It’s also worth noting that these are national tariffs so unless Trusts have local agreements with the CCGs are the same for everybody (although each Trust does have an uplift for Market Forces Factor).

Also need to point out that some clinics overbooked, to hopefully allow for that however that creates issue if nobody DNAs

But this £600m is still government money. The trust might get some extra, but the overall money available for the NHS doesn’t change

[wilks_bfc]

Thanks for this info, Wilks. So the £600 million is the opportunity costs of missed appointments? But, the £600 million stays in the CCGs funds and will be paid to the Trusts when the patient terms up for the re-scheduled appointment? Meanwhile, I guess, the Trusts have to pay their staff who were ready to fulfil the appointment? Do a few DNAs ("did not attend," I assume) give the staff a little less work when this happens, one less patient to see on that day?

Wouldn’t say gives them less work
A clinic may have 10 slots. They may know that they have on average a 20% DNA rate so book 12 to try & compenstate that.
They may still have 2 that DNA or they may have all 12 that turn up.
Some services will try and contact the patient to find why they. DNA. Sometimes it will be they “forgot”. More often then not they’ll say they now feel “better” & didn’t want to waste the doctors time

[Inchy]

So the younger people don't worry about the political football until they or someone they care about needs the NHS in an emergency?

That would be the same generation who believe that it was better under Labour I suspect.

Hope your dad's ok.

I do care about the NHS because I work in it and I have used it before. I am 30 so not that young, certainly not an 18 year old who loves Corbyn.

IMO and from my experience the NHS was better under Labour

[wilks_bfc]

But this £600m is still government money. The trust might get some extra, but the overall money available for the NHS doesn’t change

No it doesn’t but who has that money does.

The government don’t pay the hospitals, they pay the CCGs that then contract & pay the hospitals for services.
In theory it is/should be cost per case but if due to demand the Trusts are seeing over the contracted activity, then this raises questions from the CCG, thinking that Trusts are standing on the roundabout directing passing trade in

[Sidney1st]

I do care about the NHS because I work in it and I have used it before. I am 30 so not that young, certainly not an 18 year old who loves Corbyn.

IMO and from my experience the NHS was better under Labour

I know you work there.

As Lancaster has excellently pointed out, Labour threw money at it regardless and people thought that was great but it didn't resolve the issues with it as a whole, but people didn't worry about that until the Tories came along and asked the NHS as a whole to justify it's spending.

[HatfieldClaret]

Throwing money at the NHS won't help on its own. It needs a radical shake up.

Poor administration, badly managed and organised and (some) ridiculously demanding patients, and relatives who don't want the parents home as it costs too much or too much trouble and pretend they care.

And as for appointment dates being inconvenient.... are you ill or not ? Get re-referred by the GP when you are ready.

[Inchy]

You can't mention health insurance without the Labour supporters having a fit.

Take the politics out of the NHS, run it in a more efficient and productive manner and then see what happens.
Until then, it won't change for the better.

Here my fit.


As soon as you make a healthcare system for profit it will encounter problems. Has there been any improvement to other government run services which are now privatised?

The problem is if you set the standard for private hospitals the same as the NHS (e.g. waiting times) how will a private hospital improve this and make a profit? If they don't then what?

Say virgin care take over the whole NHS and the politicians set the standard that all elective surgery should only have a 4 month waiting list. What happens if they don't meet that? They get fined? What if they continually don't meet it? They get fined. Will their profits take a hit? No because there are share holders to care for. What if its to difficult and Virgin Care threaten walk away because the standards expected are too high?



There is a lot of money to make out of healthcare and a lot of money to be made out of having an unwell population. Why would there be any public health if that drops profits?

That might sound tin hat but how many people got rich by going to war in Iraq? If corporations can make money they will at all costs

[Inchy]

I know you work there.

As Lancaster has excellently pointed out, Labour threw money at it regardless and people thought that was great but it didn't resolve the issues with it as a whole, but people didn't worry about that until the Tories came along and asked the NHS as a whole to justify it's spending.

I am not saying labour was perfect but the NHS was better under labour. Waiting times are up, registered staffing levels are down, people are being nursed on corridors. That's all got far worse

[Sidney1st]

I am not saying labour was perfect but the NHS was better under labour. Waiting times are up, registered staffing levels are down, people are being nursed on corridors. That's all got far worse

Could that be due to some financial cuts/restrictions and the need to justify where their money has gone?

The Public sector are well known for over spending on all sorts of things, so maybe this has happened to the NHS and now they're having to re-jig everything around and be more efficient?.

Closing, or partially closing, smaller hospitals to make larger 'super' ones hasn't helped the matter and that was part of a Labour initiative I recall.

[starting_11]

Just wondering why missed appointments cost so much money when you go to the docs 10 mins after it opens and you're left waiting for half an hour?


Surely they're a good thing?

[Sidney1st]

Here my fit.


As soon as you make a healthcare system for profit it will encounter problems. Has there been any improvement to other government run services which are now privatised?

The problem is if you set the standard for private hospitals the same as the NHS (e.g. waiting times) how will a private hospital improve this and make a profit? If they don't then what?

Say virgin care take over the whole NHS and the politicians set the standard that all elective surgery should only have a 4 month waiting list. What happens if they don't meet that? They get fined? What if they continually don't meet it? They get fined. Will their profits take a hit? No because there are share holders to care for. What if its to difficult and Virgin Care threaten walk away because the standards expected are too high?



There is a lot of money to make out of healthcare and a lot of money to be made out of having an unwell population. Why would there be any public health if that drops profits?

That might sound tin hat but how many people got rich by going to war in Iraq? If corporations can make money they will at all costs

All very good points.

Out of interest do you think a non-public sector organisation could run the NHS in a more efficient and productive manner, whilst also making it better overall?

[Inchy]

Yes possibly, but they would struggle to make a decent profit if they had to meet the same or better standards.

As has been previously mentioned, although the NHS is not a world leader anymore it is still one of the most cost effective.

[dsr]

And as for appointment dates being inconvenient.... are you ill or not ? Get re-referred by the GP when you are ready.

That's all right if you have money to burn and the cost of a holiday is petty cash. Not many of us are in that position. If a cataract operation can be put off for a week at no inconvenience to the hospital, then why shouldn't it be?

[Sidney1st]

Yes possibly, but they would struggle to make a decent profit if they had to meet the same or better standards.

As has been previously mentioned, although the NHS is not a world leader anymore it is still one of the most cost effective.

Why would they struggle to make a profit?
If they can make it more efficient and productive then a profit will be made.
Standards can be met when things are more efficient.

The public also need to take a look at themselves, but that's already been discussed.

[Sidney1st]

That's all right if you have money to burn and the cost of a holiday is petty cash. Not many of us are in that position. If a cataract operation can be put off for a week at no inconvenience to the hospital, then why shouldn't it be?

So you want the hospital to plan around your holidays?

[Inchy]

Why would they struggle to make a profit?
If they can make it more efficient and productive then a profit will be made.
Standards can be met when things are more efficient.

The public also need to take a look at themselves, but that's already been discussed.

Well that depends on how its privatised. If we all pay for insurances apart from pensioners or people not working then why would pensioners or those not working stop abusing it if it doesn't cost them anything? Also why would a private company want to stop them abusing it if they are getting paid anyway?

Although undoubtedly money is wasted the NHS is still very cost effective when compared to other healthcare systems.

Personally I would recentralise a lot of it to stop the disjointed thinking. I wouldn't remove money from a budget if profit is made (which is what is currently done and why CSUs panic spend near april). I would also make it easier to sack people for sickness and incompetence

[Paul Waine]

Here my fit.


As soon as you make a healthcare system for profit it will encounter problems. Has there been any improvement to other government run services which are now privatised?

The problem is if you set the standard for private hospitals the same as the NHS (e.g. waiting times) how will a private hospital improve this and make a profit? If they don't then what?

Say virgin care take over the whole NHS and the politicians set the standard that all elective surgery should only have a 4 month waiting list. What happens if they don't meet that? They get fined? What if they continually don't meet it? They get fined. Will their profits take a hit? No because there are share holders to care for. What if its to difficult and Virgin Care threaten walk away because the standards expected are too high?

There is a lot of money to make out of healthcare and a lot of money to be made out of having an unwell population. Why would there be any public health if that drops profits?

That might sound tin hat but how many people got rich by going to war in Iraq? If corporations can make money they will at all costs

Hi Inchy, I've experienced the insurance based health care in Netherlands. I've heard other Europeans speak well of their insurance based health care systems (and puzzle over how the UK runs the NHS). I've met Brits who've used health care system in Spain. None of these systems is "free at the point of care" and funded by taxpayers. They are all better than the NHS.

All healthcare systems are "for profit." The GPs make profits from the NHS - how do you think one is reported to earn £700,000? The consultants profit from the NHS - they split their time between NHS and private practice. And, if we run a successful national health care system we all "profit."

I suggest we shouldn't confuse the providers of the health care from the health care system. If we had an insurance based system, then we would have multiple providers - and why wouldn't we? There's enough need, particularly at this time of the year, to fill several "NHS type systems."

The way the NHS manages health care at present is to ration it - that's what's happening with all these cancelled ops.

There's no way any single provider would "take over the whole NHS." We don't like monopolies. But, it seems the only monopoly we are allowed to have is the state funded NHS. Sort out that everyone, and I do mean everyone, can afford to pay for their health care and open up the supply side to multiple providers.

BTW: Don't worry about "shareholders" - if they invest in a company that isn't successful they lose their money. There are no "guaranteed profits" anywhere.

[Inchy]

I was using Virgin care as an example but I understand it would never be taken over by a single provider. Does Spain offer universal care free at the point of use? What if you cannot afford insurance?

Perhaps the NHS budget should be given to a private company for a large trust like Manchester and see how they get on. If it works then that's the way to go.

[dsr]

So you want the hospital to plan around your holidays?

Yes. If it is vital to the smooth running of the hospital that my hypothetical minor but necessary operation must take place on a particular date, then I will cancel my holiday to accommodate them. But why would it be? They do cataract operations every week of the year. There's no reason to give ultimatums saying it must be this date or else.

[houseboy]

£10 nowhere near enough. The NHS would need to employ thousands of people to implement, manage, data collect, blah, blah, blah.

Make it £50.

And for self inflicted (drink related) dickage, all treatment to be paid for.

We have lost sight of why the NHS and the welfare state were introduced. Bloody hell, we are sending people for boob jobs because small saggy tits makes em unhappy!!!

I’m sure there will be people who start skriking about “quality of life” and all that, but this sort of shite is crippling it.

There will also be those who suggest (for example) smokers with lung cancer should pay also, but this I believe needs some thinking about.

Anyway, yeah - fine em.

To charge people for treatment, even 'self-inflicted', goes against the whole ethos of the NHS. It becomes problematic also when you start to draw the line, what is 'self-inflicted'? Lung cancer is one of course but then lot's of none smokers get it and most smokers don't. Drink related issues? Is it when you fall over? Many people fall over sober. What if you are in a car accident, is it your own fault if you were in the car? The whole 'self-inflicted' thing is impossible to work because there are too many grey areas. Besides the whole point of the NHS is 'free at the point of treatment'.
I agree about cosmetic surgery not being available for vanity reasons although some, people who are disfigured due to some accident or illness for example, should still qualify. There are many ways the NHS could save money but I don't think charging or fining is the answer. Rationalising the salaries of the senior managers could be one way, even though it would only save a relatively small amount. Cutting down on waste (which apparently is appallingly high) could be another.
One other thing regarding A&E waiting times (I haven't been in years so this might happen but I don't think it does - forgive me if I'm wrong) but why don't they have a small team of people at the entrance (say 2/3 people - qualified in some way of course) who would see everyone as they enter the building (it is very rare other than in mass emergencies that they are queuing to get in) to assess them and simply turn them away if they have a none emergency illness (such as a bad cold - yes it happens). If A&E's are so busy with these people stopping real emergencies surely this would be worth trying. It surely wouldn't be too difficult if someone turns up with a sore throat or a painful toe to say sorry, that is simply not an emergency, go and see your GP (although that in itself is another issue).

[Inchy]

To charge people for treatment, even 'self-inflicted', goes against the whole ethos of the NHS. It becomes problematic also when you start to draw the line, what is 'self-inflicted'? Lung cancer is one of course but then lot's of none smokers get it and most smokers don't. Drink related issues? Is it when you fall over? Many people fall over sober. What if you are in a car accident, is it your own fault if you were in the car? The whole 'self-inflicted' thing is impossible to work because there are too many grey areas. Besides the whole point of the NHS is 'free at the point of treatment'.
I agree about cosmetic surgery not being available for vanity reasons although some, people who are disfigured due to some accident or illness for example, should still qualify. There are many ways the NHS could save money but I don't think charging or fining is the answer. Rationalising the salaries of the senior managers could be one way, even though it would only save a relatively small amount. Cutting down on waste (which apparently is appallingly high) could be another.
One other thing regarding A&E waiting times (I haven't been in years so this might happen but I don't think it does - forgive me if I'm wrong) but why don't they have a small team of people at the entrance (say 2/3 people - qualified in some way of course) who would see everyone as they enter the building (it is very rare other than in mass emergencies that they are queuing to get in) to assess them and simply turn them away if they have a none emergency illness (such as a bad cold - yes it happens). If A&E's are so busy with these people stopping real emergencies surely this would be worth trying. It surely wouldn't be too difficult if someone turns up with a sore throat or a painful toe to say sorry, that is simply not an emergency, go and see your GP (although that in itself is another issue).

I think some trusts are now using an A and E consultant to triage patients at the door. So for example if you have man flu but no other comorbidities you will be told to go home

[aggi]

All very good points.

Out of interest do you think a non-public sector organisation could run the NHS in a more efficient and productive manner, whilst also making it better overall?

On private healthcare (which I'm not necessarily opposed to) this is an interesting watch re: dialysis in America, the exploitation of healthcare for profit and the costs per patient compared to other nations https://www.youtube.com/watch?v=yw_nqzVfxFQ" onclick="window.open(this.href);return false;

[Paul Waine]

I was using Virgin care as an example but I understand it would never be taken over by a single provider. Does Spain offer universal care free at the point of use? What if you cannot afford insurance?

Perhaps the NHS budget should be given to a private company for a large trust like Manchester and see how they get on. If it works then that's the way to go.

Hi Inchy, I don't know how it works in Spain. In Netherlands, people in work are required to have approved health insurance for themselves and their family. The policy includes a deductible amount that you are required to pay yourself each year - only amounts above this deductible are claimed on insurance. The insurance premium also includes an amount that contributes to paying for insurance for those not in work/on benefits. I don't know details about pensioners. I assume that those on good pensions also have to but their own health insurance.

The model that operated in Netherlands, and I believe most other European countries, is that several GPs and Hospitals can offer services in the same area. So, it wouldn't be a single private company setting up to provide all the services in a single area, but several health care providers. Patients get to choose which GP they want to see, they don't sign-up to just one GP or another. When A&E (erste hulp) is required, you choose where to go. Similarly, you get the chance to pick the hospital that is best for you.

[Paul Waine]

To charge people for treatment, even 'self-inflicted', goes against the whole ethos of the NHS. It becomes problematic also when you start to draw the line, what is 'self-inflicted'? Lung cancer is one of course but then lot's of none smokers get it and most smokers don't. Drink related issues? Is it when you fall over? Many people fall over sober. What if you are in a car accident, is it your own fault if you were in the car? The whole 'self-inflicted' thing is impossible to work because there are too many grey areas. Besides the whole point of the NHS is 'free at the point of treatment'.
I agree about cosmetic surgery not being available for vanity reasons although some, people who are disfigured due to some accident or illness for example, should still qualify. There are many ways the NHS could save money but I don't think charging or fining is the answer. Rationalising the salaries of the senior managers could be one way, even though it would only save a relatively small amount. Cutting down on waste (which apparently is appallingly high) could be another.
One other thing regarding A&E waiting times (I haven't been in years so this might happen but I don't think it does - forgive me if I'm wrong) but why don't they have a small team of people at the entrance (say 2/3 people - qualified in some way of course) who would see everyone as they enter the building (it is very rare other than in mass emergencies that they are queuing to get in) to assess them and simply turn them away if they have a none emergency illness (such as a bad cold - yes it happens). If A&E's are so busy with these people stopping real emergencies surely this would be worth trying. It surely wouldn't be too difficult if someone turns up with a sore throat or a painful toe to say sorry, that is simply not an emergency, go and see your GP (although that in itself is another issue).

Hi houseboy, the whole point is that "free at the point of treatment" is what is wrong with the NHS. Provide people with the means to pay for treatment, but ensure that they understand that there is the need to pay for treatment and all of the cost issues with the NHS can be solved.

I'm going skiing in a couple of weeks, 64, had a heart attack two years ago. I expect my health insurance will be expensive, but that's what "self-inflicted" means.

A&E does work like you say, but they people who ask the questions are at the reception desk. Fortunately for me, if they think you might have had a heart attack (I didn't, I just felt "unwell") then you jump straight to the front of the queue how ever many hours other people may be waiting. The NHS is great when they know that "time is critical."

[UpTheBeehole]

Hi houseboy, the whole point is that "free at the point of treatment" is what is wrong with the NHS.

No, that is everything that is right with the NHS.

But we all know you're a free market libertarian, and we all know what they'd like to do with the NHS

[Paul Waine]

No, that is everything that is right with the NHS.

But we all know you're a free market libertarian, and we all know what they'd like to do with the NHS

Just telling it like it is, UTB, and as I have observed myself from (1) the time I lived in Netherlands and (2) direct experience of NHS over the past 2 years.

Why would anyone want the people living in the UK to have an inferior health service?

[Sidney1st]

No, that is everything that is right with the NHS.

But we all know you're a free market libertarian, and we all know what they'd like to do with the NHS

It's a good system when it works, but it's taken advantage of by members of the population who are either to stupid or lazy to deal with minor issues themselves.
It's also taken advantage of by people who clearly want appointments moved around their holiday's

It wastes a hideous amount of money though and it needs to stop.
Labour is happy to throw more money at it, Tories are happy to chop it all back, so there needs to be a middle ground somewhere but politicians would rather kick it around instead of dealing with it.

[Rick_Muller]

Hi Inchy, I don't know how it works in Spain. In Netherlands, people in work are required to have approved health insurance for themselves and their family. The policy includes a deductible amount that you are required to pay yourself each year - only amounts above this deductible are claimed on insurance. The insurance premium also includes an amount that contributes to paying for insurance for those not in work/on benefits. I don't know details about pensioners. I assume that those on good pensions also have to but their own health insurance.

The model that operated in Netherlands, and I believe most other European countries, is that several GPs and Hospitals can offer services in the same area. So, it wouldn't be a single private company setting up to provide all the services in a single area, but several health care providers. Patients get to choose which GP they want to see, they don't sign-up to just one GP or another. When A&E (erste hulp) is required, you choose where to go. Similarly, you get the chance to pick the hospital that is best for you.

Paul, I am curious about those people, like myself, who have lifelong illnesses. In the UK getting private healthcare for me is almost impossible, the quotes I receive if I include a request to cover my illness are extortionate and I have been refused quotes to cover it - and at best very expensive if I exclude the illness because I am seen as an at risk patient. At the moment, I receive adequate care from the NHS and I have a rough idea that my 8 weekly chemotherapy infusions cost in the region of £2000/session for the medication alone (big pharma charging extortionate rates for licenced drugs for massive profits is another argument).

Do you have any examples of how this is covered in the Netherlands and Spain, and how would you propose I get my medical care if the NHS is scrapped and services are privatised? Understand that because I receive the medical care that I do, that I am still able to be a full member of society and I pay my taxes because I can remain employed - without the care I receive from the NHS, this is likely to not be the case and I would end up on benefits and a likely recluse not contributing to society at all.

For those who would welcome privitised Healthcare - go online and get a quote, see how much it actually will cost you and be careful you dont have any existing medical conditions because your premiums will increase significantly - they are businesses that want to profit for shareholders, they wont give a sh!t about you.

[Rick_Muller]

By the way, one of big biggest bugbears about the NHS at the moment is that I get asked to rate the service by SMS after every appointment - is this a precursor to going private and promoting competition? As far as I know, the treatment I receive is from my local hospital only and I cannot change where I go so why ask if I would recommend the service to a friend or family!

[DavidEyresLeftFoot]

Looks like we've had the full house of much repeated myths about the NHS......

- "scroungers are happy for other people to pay for them" - how does everyone think insurance works? I pay my car insurance every year despite the fact that I've never had a crash. The NHS works on pooled risk. You pay in during the healthy times knowing if you get sick you've got cover. And unlike an insurance scheme you can't be excluded if you've had previous illness. It's the fairest and most equitable way. Nobody has to worry about going bankrupt over medical bills.

- "the NHS is an inefficient black pit of money"
In 2015 the NHS underwent the Nicholson Review where it attained 20 billion pounds of efficiency savings. Its chief said at the time that this was not repeatable, yet this government is trying to screw even more out of the health service. Productivity in the NHS has been around 2% over the course of the last parliament, far outstripping any other sector of the economy.
Spending on healthcare isn't a black hole. Economists believe that every pound spent on healthcare results in £4 worth of economic activity

The reason there's such a jam in the hospital sector currently is a complete lack of slack in the system. Hospitals should aim to run at around 85% bed capacity - to allow enough slack to absorb fluctuations in demand. The NHS has for the last few years has been running at bed capacity of above 95%. We've had a reduction of 15000 beds over the last parliament. The result is absolutely predictable...that a winter surge of flu and norovirus brings the whole system crashing to a halt. It's nothing to do with how hospitals are organising themselves, it's meddling from the top that's caused an absolutely predictable crisis.

The fact is that we spend around £2400 per person per year to cover all our health needs. Compare that to the Germans who spend around £4000.

Let's all be distracted by stories of people missing appointments, immigrants coming over for treatment and greedy staff. The real reason is a lack of beds, a lack of staff and a lack of investment - all of which are fixable if there is a will to do so.

[Paul Waine]

Paul, I am curious about those people, like myself, who have lifelong illnesses. In the UK getting private healthcare for me is almost impossible, the quotes I receive if I include a request to cover my illness are extortionate and I have been refused quotes to cover it - and at best very expensive if I exclude the illness because I am seen as an at risk patient. At the moment, I receive adequate care from the NHS and I have a rough idea that my 8 weekly chemotherapy infusions cost in the region of £2000/session for the medication alone (big pharma charging extortionate rates for licenced drugs for massive profits is another argument).

Do you have any examples of how this is covered in the Netherlands and Spain, and how would you propose I get my medical care if the NHS is scrapped and services are privatised? Understand that because I receive the medical care that I do, that I am still able to be a full member of society and I pay my taxes because I can remain employed - without the care I receive from the NHS, this is likely to not be the case and I would end up on benefits and a likely recluse not contributing to society at all.

For those who would welcome privitised Healthcare - go online and get a quote, see how much it actually will cost you and be careful you dont have any existing medical conditions because your premiums will increase significantly - they are businesses that want to profit for shareholders, they wont give a sh!t about you.

Hi Rick, I admit I don't have direct knowledge of how people with long term health needs are looked after in Netherlands or Spain. What I do know is that Netherlands is a "very caring" society - and I'm sure their system ensures that everyone can get the health care they need. I mentioned that my health insurance, while I was living in Netherlands, was both required by law and included a contribution to pay for the health insurance of those that couldn't pay themselves. I'd expect that my extra contribution also covered those with frequent/high cost needs.

I think there's a massive difference between health insurance in the UK and health insurance in countries that require everyone, by law, to have health insurance. I know with my coronary heart disease - even though my consultant has said I'm fit to go skiing - that I will be charged a lot to get health insurance for skiing. Health insurers in the UK are concerned that they will be asked to provide insurance cover for everyone with health issues - but people without health issues will not sign up. So, they need to exclude pre-existing conditions or price accordingly. In countries where everyone has to have health insurance these "adverse selections" don't apply, so their health insurance premiums will be more reasonable. And, don't forget if we were all required to have health insurance by law, then the taxes we pay should be lower (I want to say "would be lower" - but you know what governments are like).

[Paul Waine]

Looks like we've had the full house of much repeated myths about the NHS......

- "scroungers are happy for other people to pay for them" - how does everyone think insurance works? I pay my car insurance every year despite the fact that I've never had a crash. The NHS works on pooled risk. You pay in during the healthy times knowing if you get sick you've got cover. And unlike an insurance scheme you can't be excluded if you've had previous illness. It's the fairest and most equitable way. Nobody has to worry about going bankrupt over medical bills.

- "the NHS is an inefficient black pit of money"
In 2015 the NHS underwent the Nicholson Review where it attained 20 billion pounds of efficiency savings. Its chief said at the time that this was not repeatable, yet this government is trying to screw even more out of the health service. Productivity in the NHS has been around 2% over the course of the last parliament, far outstripping any other sector of the economy.
Spending on healthcare isn't a black hole. Economists believe that every pound spent on healthcare results in £4 worth of economic activity

The reason there's such a jam in the hospital sector currently is a complete lack of slack in the system. Hospitals should aim to run at around 85% bed capacity - to allow enough slack to absorb fluctuations in demand. The NHS has for the last few years has been running at bed capacity of above 95%. We've had a reduction of 15000 beds over the last parliament. The result is absolutely predictable...that a winter surge of flu and norovirus brings the whole system crashing to a halt. It's nothing to do with how hospitals are organising themselves, it's meddling from the top that's caused an absolutely predictable crisis.

The fact is that we spend around £2400 per person per year to cover all our health needs. Compare that to the Germans who spend around £4000.

Let's all be distracted by stories of people missing appointments, immigrants coming over for treatment and greedy staff. The real reason is a lack of beds, a lack of staff and a lack of investment - all of which are fixable if there is a will to do so.

Hi DELF, we might argue that we only got the "full house" when you added your post.

Why "shut the debate down?" Is the NHS "sacrosanct" so that it cannot be discussed? We know it has it's shortcomings?

See my post on other countries that operate compulsory health insurance schemes. Why do those "caring societies" chose that approach? No one is excluded through previous illnesses. No one goes bankrupt over medical bills. (The UK is one of many countries in Europe. The choice is not between the NHS in the UK and the health insurance system in USA).

You mention Germany spending £4,000 per head compared with UK at £2,400. Germany operates compulsory health insurance. Maybe we should take a look at how it works and consider it as a possible way to fix health care the UK. (Do you also have health spend figures for Netherlands ad Spain)?

[UpTheBeehole]

You mention Germany spending £4,000 per head compared with UK at £2,400. Germany operates compulsory health insurance. Maybe we should take a look at how it works and consider it as a possible way to fix health care the UK. (Do you also have health spend figures for Netherlands ad Spain)?

Why would we look to adopt a system which is two thirds more expensive?

[Sidney1st]

Looks like we've had the full house of much repeated myths about the NHS......

- "scroungers are happy for other people to pay for them" - how does everyone think insurance works? I pay my car insurance every year despite the fact that I've never had a crash. The NHS works on pooled risk. You pay in during the healthy times knowing if you get sick you've got cover. And unlike an insurance scheme you can't be excluded if you've had previous illness. It's the fairest and most equitable way. Nobody has to worry about going bankrupt over medical bills.

- "the NHS is an inefficient black pit of money"
In 2015 the NHS underwent the Nicholson Review where it attained 20 billion pounds of efficiency savings. Its chief said at the time that this was not repeatable, yet this government is trying to screw even more out of the health service. Productivity in the NHS has been around 2% over the course of the last parliament, far outstripping any other sector of the economy.
Spending on healthcare isn't a black hole. Economists believe that every pound spent on healthcare results in £4 worth of economic activity

The reason there's such a jam in the hospital sector currently is a complete lack of slack in the system. Hospitals should aim to run at around 85% bed capacity - to allow enough slack to absorb fluctuations in demand. The NHS has for the last few years has been running at bed capacity of above 95%. We've had a reduction of 15000 beds over the last parliament. The result is absolutely predictable...that a winter surge of flu and norovirus brings the whole system crashing to a halt. It's nothing to do with how hospitals are organising themselves, it's meddling from the top that's caused an absolutely predictable crisis.

The fact is that we spend around £2400 per person per year to cover all our health needs. Compare that to the Germans who spend around £4000.

Let's all be distracted by stories of people missing appointments, immigrants coming over for treatment and greedy staff. The real reason is a lack of beds, a lack of staff and a lack of investment - all of which are fixable if there is a will to do so.

So years of financal waste and mismanagement by successive Labour and Tory governments can be ignored then?

Surge of Winter Flu?
The last place you should be going is the hospital unless you're an elderly person, or suffering with things like Asthma etc and even then flu jabs should be helping reducing the number of people getting it.
I suppose we could make the flu jab compulsory for everyone instead?

It isn't about being distracted, it's about fixing all the smaller issues that rollover into bigger ones but some people seem to want to ignore these things.

You mention a reduction of beds over the last parliment, meanwhile previous governments partially or fully closed other hospitals which has also contributed to this shortage but don't worry about mentioning that.

Several people on here have stated that control of the NHS needs to be taken away from Politicians who use it for point scoring and it needs to be ran in a manner that is in the middle of Tory cuts and Labour giddly pouring money into it.

[Sidney1st]

Why would we look to adopt a system which is two thirds more expensive?

Is it a better system overall though?
I've no personal experience but if it has less of the issues the NHS has...

[Inchy]

So years of financal waste and mismanagement by successive Labour and Tory governments can be ignored then?

Surge of Winter Flu?
The last place you should be going is the hospital unless you're an elderly person, or suffering with things like Asthma etc and even then flu jabs should be helping reducing the number of people getting it.
I suppose we could make the flu jab compulsory for everyone instead?

It isn't about being distracted, it's about fixing all the smaller issues that rollover into bigger ones but some people seem to want to ignore these things.

You mention a reduction of beds over the last parliment, meanwhile previous governments partially or fully closed other hospitals which has also contributed to this shortage but don't worry about mentioning that.

Several people on here have stated that control of the NHS needs to be taken away from Politicians who use it for point scoring and it needs to be ran in a manner that is in the middle of Tory cuts and Labour giddly pouring money into it.

He is right about winter flu. The reason for the current crisis is largely because the elderly or those with comorbidities are suffering from flu.

The flu vaccine is always made months before they are sure what strain of flu it will be. Basically they guess because they have to. Once the flu is here its too late to manufacture the volume needed before the outbreak. The vaccine worked last year but it doesn't seem that way this year. The vast majority of wards in my trust have more than 3 elderly patients who should be on elderly wards but are not because there are no beds. That has a knock on.

Closing A and E departments isn't necessarily a bad thing either. Before Burnley General closed both Blackburn and Burnley had A and E departments which didn't have all the specialists in the same place. That's a nightmare particularly in poly-trauma. Now go to Blackburn no matter what is wrong the speciality is there. Tories reducing beds and staffing is the issue, not closing A and E departments.

[Sidney1st]

So partially or fully closing hospitals, thus reducing bed availability isn't an issue?
Ok then....
If you're saying it's better that all the special services are in bigger 'super' hospitals then why didn't they leave smaller hospitals open etc to cope with the extra demands for beds?
If the main treatment can be given at the super hospital, surely recuperation could be done at a more local hospital, thus freeing up a bed?

They've even spoken about asking people with spare rooms to rent them out to hospitals/NHS so that people can recover outside of the hospital but still not be alone etc, which is just a bizarre idea.

I didn't realise that about the vaccines though, so I stand corrected on that one.

[Inchy]

I understand that when they opened BRI's new bit it was with enough beds to cover any closed at Burnley. Maybe they should have kept them for intermediate care but keeping acute beds open when all the specialists are down the motorway would have been pointless. They should have made more beds available at Blackburn.

I think most of Burnley General is outpatient stuff now other than the maternity wards

[jdrobbo]

With regards to actually collecting fines, I would say that the fine should be paid on arrival for a future appointment, be it one week later or five years later.

Don't pay, don't see a NHS Doctor.

[Paul Waine]

Why would we look to adopt a system which is two thirds more expensive?

Maybe we will get a health service that is two thirds better? But, let's take a look at the costs in some of the other European health care systems - and their health outcomes. That's always worth a consideration.

[Sidney1st]

Maybe we will get a health service that is two thirds better? But, let's take a look at the costs in some of the other European health care systems - and their health outcomes. That's always worth a consideration.

http://www.bbc.co.uk/news/health-38899811" onclick="window.open(this.href);return false;

worth a read.

[Paul Waine]

He is right about winter flu. The reason for the current crisis is largely because the elderly or those with comorbidities are suffering from flu.

The flu vaccine is always made months before they are sure what strain of flu it will be. Basically they guess because they have to. Once the flu is here its too late to manufacture the volume needed before the outbreak. The vaccine worked last year but it doesn't seem that way this year. The vast majority of wards in my trust have more than 3 elderly patients who should be on elderly wards but are not because there are no beds. That has a knock on.

Closing A and E departments isn't necessarily a bad thing either. Before Burnley General closed both Blackburn and Burnley had A and E departments which didn't have all the specialists in the same place. That's a nightmare particularly in poly-trauma. Now go to Blackburn no matter what is wrong the speciality is there. Tories reducing beds and staffing is the issue, not closing A and E departments.

I read recently that the flu jab doesn't work for the over 75s. Work is going on to create a better "universal" flu vaccination - using a different medical approach - that will protect against all strains. Be a year or two (or more) before this new flu "jab" will be available, but we won't need a new one every year.