Free at the point of delivery

Bradford GP

Probably the most heart-warming post on the site for me today. As an inner city/suburban GP I am demoralised by the multi-generational dependency on the health service for the most trivial of complaints. Add to this the linked burden of incapacity benefit (or ESA) dependency. Most of our long-term unemployed learnt that being on long-term sick pays better and requires less 'work' than unemployment benefit (and are educated in this fact by jobcentre employees). This is such a problem that my receptionists have suggested having a separate appointment system just for repeat sick notes! As long as governments choose to hide the true burden of joblessness this isn't going to go away. This is another reason that we are swamped with 16-30 yr olds in surgeries around the country.

SUSAN HILL

BRADFORD GP Thank you. I regularly speak to a broad cross-section of NHS workers, mainly but not all doctors, and I like to get my information right. Pace the commenter above, I do not write before I think and I ask for information before I write. I`m pleased if your experience confirms at least some of what I have said - though of course not pleased that this is the way things are.

SUSAN HILL

My comment refers in part to one which has now been removed.

luke

Apologies if my comment somehow caused objection.

John Edwards

I am glad to see you "like to get your information right".

Two questions:
Can you identify precisely which layers of NHS management you would remove?

Can you please share with us the evidence on which you base your statement about the extent of health tourism in the NHS?

SUSAN HILL

Luke, it was not that you disagreed but the way you expressed your disagreement. There is a campaign afoot to raise the tone of comments on CH so that good manners are more to the fore than unpleasantness. Everyone should be able to take disagreement.
John EDWARDS. The middle layers of management... the managers within a hospital who manage other managers, or manage small areas - e.g. the operating theatre rota - but are answerable to other managers, and so on up. Every large organisation has to be managed but the bureaucracy has got out of hand both in hospitals and in PCTs.
Evidence of health tourism comes from DOH statistics. Though perhaps 'tourism' is the wrong word.

SUSAN HILL

Further to this. PLease see Daily Telegraph. October 3rd. Michael Fallon MP on It's Time to Slay the Bureaucratic MOnster ruining the NHS.
Very informative and with facts and figures.

Fergus Pickering

Of course I don't live in a big city, but I just love my GP, bless her, and the operation I had to remove a cataract in my eye was carried out by somebody from the sub-continent who was courteous and obviously efficient, since I can now see more clearly out of that eye than I have been able to for twenty five years. Now they are doing their best to stop me dropping dead from an irregular heart-beat(no, I don't understand, either) and so far so good. My daughter works for the NHS as an Occupational Therapist. She deals with mad people and drug addicts (the categories overlap), and doesn't seem at all demoralised. She enjoys a job which allows full rein to her natural cheerful bossiness. She is also, by all accounts, veryb good at it. Mind you I know there is resentment over Dover way at immigrants coming over to avail themselves of free health care in the way you describe. But they tend not to get as far as Canterbury where I live or Tunbridge Wells where my daughter works.

Augustus

My mother was a matron in St.Thomas's London before WW2, and my aunt was a sister in a Dover general hospital both before and during the war. By all the accounts I heard from both of them up until the 1970s, the standards and quality of the nursing profession were a lot better in their day.
As far as operations are concerned, I have had them in both NHS and private hospitals.
With the right consultant the standards are
the same, I would say.

Nevertheless, other countries in Europe (I don't know about all of them, but I do know about Holland) manage their systems better than we do. Why? simply because the governments don't have a monopoly of either funding, or a say in how the systems are managed and run. It's nothing to do with commercial privatization (as in British Leyland or British Steel) but because of the social and fiscal agenda of requiring employer and employee particpation funding by means of seperate social taxes which are bundled to include both old-age retirement benefits as well as sickness benefits. In effect the government gets to form a partnership with insurance professionals whilst the funding is compulsorily taken care of by the community. That way the most efficient and democratic system is put in place. This must be so because, apart from dental and a few minor plastic surgeries, no private healthcare as Britain knows it exists.

Bunnykins

Off the topic slightly, but I feel the following matter needs clarifying......"There is a campaign afoot to raise the tone of comments on CH so that good manners are more to the fore than unpleasantness." - and so saying, someone's comment was removed. Sue, I had read that comment before its removal and although it wasn't particularly nice, it hardly warranted removal. That's a very censorious approach and will certainly diminish the level of humour currently enjoyed on the Speccie blogs. Should we assume that you are going to spike any comment that hurts your feelings from now on? I think we should be told!

Kevyn Bodman

Should we consider the possibility that 'free at the point of delivery' is the cause of the abuse of the system you mention?

Associate use with payment in the mind of the patient and you'll get fewer snifflers attending GPs' surgeries.

Having said that you don't want to discourage people from attending when early diagnosis can be helpful.

And in the event of a serious accident or illness you want immediate treatment without the medical professionals looking to the accountants.

The problems of the provision of health care and services in the UK are not an easy set of problems to solve;I suggest that the best way currently available is compulsory private insurance,rather like the compulsion of motor insurance.

I'm not entirely happy about the idea of compulsion, but can't think of a better alternative,starting from where we are now.

Sam ARMSTRONG

My stepdad's tumour was caused by him constantly having his mobile phone clamped to his ear trying to run his business. It was a tumour the size of an orange right above his left ear. Is he one of these terrible 'people' that distort your utopian vision? Is he?

Barbara

Has a retired nurse I felt not all of your comments rang true but nevertheless I like what I read. My husband has received four operations in the last 15 months and had wonderful treatment, fast and done well. The longest he waited was 18 weeks between each operation. The wards were clean, meals eatable, and overall well done! I can see changes from when I nursed, and one thing in particular is the access to foreigners who are receiving treatment who should be paying for it. This alone costs this country over three million per year. We pay when we go abroad why not them? The faciities and treatments should be only for British citizens who have paid taxes and foreigners should only have access when they have paid into the system over time, say 6 years. We cannot, and should not, be a benevolant country anymore, we just cannot afford it. Like you say people should also look to pharmcy's for light treatments they are just has effective. Good article well done.

Beer Moth

Sam ARMSTRONG

Get a grip.

Hayden

When you give something away for free then demand tends to exceed supply. Simple economics.

If people had to pay for their flippant usage of their healthcare, they would think twice about their behaviour.

John Edwards

Thank you for replying to my previous comment. By "health tourism" I mean anyone who uses NHS services who is not entitled to free healthcare on the NHS.

I did hear an interview some time ago with a middle manager in a hospital trust who was employed specifically to check the credentials of patients and who succeeded in saving the trust quite a lot of money.

I suspect that this best practice is not widespread across the NHS and the problem goes undetected. I was therefore surprised that the DH published statistics on "health tourism". Can you tell me where to find these statistics(date, source etc) I appreciate they might be called something else

John Edwards

I have just looked at the Micael Fallon article. The most interesting reference is to "350 commissioning staff". I wonder how many of these would exist were it not for the internal market reforms in the NHS in England, pioneered of course by the previous Conservative government and continued by Labour.

While on the subject of cutting bureaucracy Private Eye had an interesting piece on the £1.565m paid by a hospital trust to the management consultants McKinseys to advise them on how to reduce costs.

Snowman

The NHS is but a replica of a communist societal model, and as such it will implode.

jose garcia

well the answer is what amarica has, private health service,

there is choice and competition for the providers, and it comes with most of the jobs.

for drunks, abusers , time wasters, etc ,

simple , just charge for it.

just lisen to the howl of the marxita socialists goverment paid pressure groups if you mention this, a sure way to know you are right

Verity

Two things: 1. Any non-EU foreigner landing at a British airport or port should have to show papers demonstrating that they have a current health insurance policy. No insurance, no admittance. Just as there are those machines that allow you to take out a life insurance policy just before a flight, there should be machines in the Immigration area where those who have been negligent can purchase short-term (for the length of their stay) health insurance. The airlines themselves will soon begin to insist on seeing health insurance papers at check-in to save themselves the cost of having to return those travelers who tried to wheedle their way out of buying any.

2. Optional surgery should not be an option, I don’t care how many psychiatrists and social workers a patient can get to swear that not getting surgery will make them suicidal. Providing “sex change operations” (or the absurd “gender reassignment” to give it its politically correct term – an American invention) – although there is no such thing in real life; one cannot alter one’s DNA – should be done privately, if at all. The same with breast enhancement procedures (except in the case of cancer surgery), and gastric bands and all that other crapola should be to their own account.