Forum menu
yes effectively they do mitsui - in that under EU rules we have resciprocal arrangements so that UK nationals get free local healthcare in the EU same as EU nationals get free healthcare in the UK
Non eu nationals in the uk have to pay for all except emergency treatment
The issue of health tourism is a non issue made up by "newspapers" - don't believe it.
Still don't let the truth get in the way of good old fashioned xenophobia
Onzadog - where are you?
Surely one of the STW dentists can sort you out sooner? (I reckon same going rate as LBS workshop - choc hobnobs as payment...)
Although there seem to be quite a few 'internet' dentists on here who'd prob have a go in their shed....
Are you calling me xenophobic TJ??
I had a patient living in Italy try to get prescriptions for expensive bowel maintenance stuff (paraplegic) and another who lived and worked in Dubai "willing to take travel back to the uk for appointments " so yes. Rarely, people do.
Because the one you thing the NHS does that no other system does, is cover everyone.
Entitlement to NHS treatment is based on residency, not citizenship. Seems fair. You live here, you get to use it.
Edit
ceepers +1
There is a very strong case for introducing an insurance mix into the healthcare of the UK, in a similar fashion to France, as unfortunately, one of the unforeseen side affects of free at the point of delivery means that no value is placed on the service.
The example of 'I'd pay 0.5% of my salary to help fund it' as above, illustrates my point. Its also why we have a lot of regulars, visiting the GP for minor irritations and fat people.
If we had to pay for our healthcare, we might, just might, start to take some personal responsibility for our health.
If we had to pay for our healthcare, we might, just might, start to take some personal responsibility for our health.
Don't Americans pay for their healthcare and manage to be one of the unhealthiest countries in the world?
Hardly a convincing argument for introducing insurance into the UK health system
Where will that come from ?
Maybe the answer is on the side of a bus.
I took my Dad into hospital on Sunday night as his pacemaker had stopped working, within an hour he'd been triaged, bloods taken, seen by a Dr, Xrayed on this way to the ward. Tuesday morning he had it replaced and then home in the afternoon.
How is that second rate service?
If we had to pay for our healthcare, we might, just might, start to take some personal responsibility for our health.
That's great if you can afford to pay for it but still missing the rather large point that not all health issues are down to personal responsibility.
If you were on minimum wage and you suddenly became ill with something you couldn't have done anything to avoid you may, just may, change your opinion on this one.
slackalice - MemberIf we had to pay for our healthcare, we might, just might, start to take some personal responsibility for our health.
Yup, I'm a perfect example- being a type 1 diabetic is potentially financially crushing if you live somewhere without free healthcare or you don't have insurance, or full insurance. Even leaving aside doctor's time my consumables would be something around $7000 per annum in the US. If I lived there, I'd surely have taken greater responsibility and avoided developing this autoimmune disease at 7 years old.
(meanwhile type 2 diabetes is mostly due to lifestyle choices, and is far more common in the USA than it is here)
whilst some of that is true, slackalice makes a good point.
In my experience more of those who receive their treatment free value it less than those who pay for it. They are also more likely to miss appointments wasting valuable clinical time which impacts the cost and availability of service for all and those who get treatment free are frequently more unreasonably demanding in their expectations than those that pay.
Obviously broad strokes and just one area of healthcare but I have seen a lot of patients in the last 20 years!
It depends what the healthcare system is trying to achieve surely?
Maximum benefit for all and minimal variation in health between the haves and have-nots or maximum benefit for those who are deemed deserving and can contribute the most, sod the rest.
I'd suggest reading the health gap by Michael Marmot to understand why systems that provide the most universal coverage produce the best results for the population. We should be looking at Sweden not the US for inspiration. A 15 year old man in the US has less chance of reaching 60 than those of 49 other countries despite the US spending around three times as much on health care as most of its peers.
Anecdotally, sometimes you have good experiences sometimes bad.
My perception was changed when I moved to a different Doctor's Practice. Went from thinking it was all rubbish to all good.
Overall perception is that it is good I guess. And there are lots of worse examples.
I think theres an element of trying to square the circle here.
I'm sure everyone agrees that a universal healthcare system for all that is free at the point of service is an ideal that we would all want. The difficulty is how to pay for it.
The reality is that providing the standard of universal healthcare that everyone expects costs more than the amount of money going in to the system right now (& I agree theres probably a nlot of waste and unnecessary tiers of management at present)
Something has to give, either the funding must go up (significantly) which involves people paying more either through tax or in individual contribution.
Or the level/ breadth of service provided must be cut to match the level of funding available.
Fundamentally (in my view) that's the decision. You pay your money and take your choice as they say.....
Certainly at the moment things aren't working universally because the breadth of what is provided and the standard of the provision that's expected actually costs more than the available money and something has to give. Dentistry is a good small example of this
...meanwhile type 2 diabetes is mostly due to lifestyle choices, and is far more common in the USA than it is here.
While it's pretty well proven that being overweight and lazy increases your risk it's not necessarily true the other way round that having Type 2 means you are overweight and lazy.
I was even asked by my GP why I'd gone for a test as I didn't look like the typical shape, as soon as I explained family history I got the test.
Personally I don't give a sh!t about Type, if I can convince someone to avoid developing it then all the better as it's a sh!t condition regardless of Type.
Type also doesn't dictate how well you look after yourself, plenty of Type 1 people can be a drain on the NHS. Poorly controlled diabetes is just as bad if you're Type 1 or Type 2.
It's bad enough that the media want to blame us for everything without other diabetic people being dicks about it.
yes effectively they do mitsui - in that under EU rules we have resciprocal arrangements so that UK nationals get free local healthcare in the EU same as EU nationals get free healthcare in the UKNon eu nationals in the uk have to pay for all except emergency treatment
Which is why Spain is getting pissed off with all the elderly Brits retiring to the Costas, they cost far more than the younger (and generally healthy) workers moving to London to work as waiters...
I pay my taxes in Spain and I'd be quite happy to see this reciprocal deal get axed - it won't do the NHS any good but it might help out the Spanish health system.
Fixing healthcare provision in the UK is actually quite easy.
Scrap Trident 2, then invest the money in health education, prevention and outdoor activities for kids, so the next generation grow up stronger, fitter, healthier and better able to look after themselves.
It's not difficult.
Oh, wait, some idiots down south still living in the last century think we NEED Trident.....
The entire cradle to grave cost of Trident over the 40 year or so lifespan is not much more than one year of the NHS budget - which isn't enough as it is.
We could shut down everything, military, police, benefits, pensions, education etc. and it wouldn't be enough to sustainably fund the NHS. That's the problem.
Oh, wait, some idiots down south still living in the last century think we NEED Trident.....
Is that the S of Scotland?
That's the problem with defense. You never know what you are going to NEED. It's only in the last few years we've purged our armed forces from their cold war focussed equipment 20 years after the end of the cold war.
The problem with Nukes is that once you've got rid of them you're not getting them back. They're not like a crate of hand grenades. You need a whole industry maintaining them and once you've lost that you've lost your capability. Trident is cheap. Very cheap compared to other government departments or even other weapon systems. It's a stupid notion to suggest getting rid of it will save you enough funds to make a difference to anything. There is nothing to gain from getting rid of Trident and potentially everything to lose.
We need to save the NHS but in order to do this we need to move the debate on from the current stalemate its been at for as long as I can remember. Constantly blaming Maggie for anything is not doing that.
The problem with Nukes is that once you've got rid of them you're not getting them back.
Good.
Constantly blaming Maggie for [s]anything[/s] everything is not doing that.
Yes but TBF she did privatise the NHS, so it is all her fault and her's alone
Didn't Maggie say there's no such thing as society?
You can't improve health without paying attention to society. So yeah, Maggie and her descendants have a lot to answer for. The Tory party's pursuit of austerity is harmful to health as it is widening health inequity in our society.
Priorities all wrong.
She did but not in the way her detractors suggest
Bloody good advice in the end - those who chose to misunderstand it/misrepresent it ended up the losers. More fool them.
Didn't Maggie say there's no such thing as society?
"I think we've been through a period where too many people have been given to understand that if they have a problem, it's the government's job to cope with it. 'I have a problem, I'll get a grant.' 'I'm homeless, the government must house me.' They're casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It's our duty to look after ourselves and then, also to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There's no such thing as entitlement, unless someone has first met an obligation."
That statement just shows how someone at the advantaged end of the social gradient views the behaviour of others, without wanting to understand the causes of the causes of the behaviour that they are viewing as irresponsible. Walk a mile in their shoes etc.
It's one thing to talk about rights and responsibilities when you're a successful person in a society that treats you well, it's another thing altogether when you've come from the other end of the spectrum.
I prefer this one from Bobbie Kennedy:
"Too much and for too long, we seemed to have surrendered personal excellence and community values in the mere accumulation of material things. Our Gross National Product, now, is over $800 billion dollars a year, but that Gross National Product - if we judge the United States of America by that - that Gross National Product counts air pollution and cigarette advertising, and ambulances to clear our highways of carnage. It counts special locks for our doors and the jails for the people who break them. It counts the destruction of the redwood and the loss of our natural wonder in chaotic sprawl. It counts napalm and counts nuclear warheads and armored cars for the police to fight the riots in our cities. It counts Whitman's rifle and Speck's knife, and the television programs which glorify violence in order to sell toys to our children. Yet the gross national product does not allow for the health of our children, the quality of their education or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages, the intelligence of our public debate or the integrity of our public officials. It measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country, it measures everything in short, except that which makes life worthwhile. And it can tell us everything about America except why we are proud that we are Americans."
Docrobster, are you saying that any of the points that she made in that paragraph are actually incorrect?
Of course morally it's "correct" to state that there are obligations on individuals. I just think it's missing the bigger picture. As I said, the causes of the causes. "I don't care if you grew up in care because your dad went to prison for killing your mum when she tried to stop him raping your sister, you can Bally well fill out this form whether you learned to read or not..." I, Daniel Blake is not far from the truth.
As a GP trainer one of the tutorials I give to trainees is how to deal with people suffering from what we refer to as "shit life syndrome". When you've seen it a few thousand times you tend to want more from the politicians.
There is plenty of evidence out there that providing good universal social support structures- education, health, policing, and yes even benefits leads to a society with less inequality. But as the Kennedy speech points out, if you are only interested in GDP you will not reap these benefits. E.g. Reliance on the financial sector might be good for the old GDP but it's not good for society.
Which is why Spain is getting pissed off with all the elderly Brits retiring to the Costas, they cost far more than the younger (and generally healthy) workers moving to London to work as waiters...
They are entitled to charge the UK and do, likewise we can charge Spain for the treatment of Spaniard but don't to the same degree.
[url= http://news.sky.com/story/nhs-scandal-as-uk-pays-millions-to-eu-10189381 ]Article here[/url]
No further comment ninfan?
I took my Dad into hospital on Sunday night as his pacemaker had stopped working, within an hour he'd been triaged, bloods taken, seen by a Dr, Xrayed on this way to the ward. Tuesday morning he had it replaced and then home in the afternoon.How is that second rate service?
Drac the NHS is pretty good at stuff that may kill you. We should expect it to be so. What is very poor at are so many of the other genuine health needs with which it can't cope as imo it has the wrong organisation and a spend which is 30% too low.
TJ health tourism is somewhere between £110m-£280m as per the fullfact link, you may argue in a budget of £130bn that's a small amount but it's not a "non-issue". A French system of a health id card (Carte Vital) or you pay in full would sort most of that pretty quickly.
And how much would it cost to set up and administer a card vital scheme?
I work for the NHS and was sent this today in an email. It's by Roy Lilley, the NHS commentator. Apologies for the long post!
[i]We are where we are.
It matters not how we got here.
What matters is; what happens next.
We can't change the past; the banking crisis, quantitive easing, panicky politicians, austerity economics. We are where we are.
We can't turn back the clock. We are in the NHS, not a Tardis.
How we got here doesn't matter any more. It might matter at the next election... get your own back. But, now, we are where we are.
What matters is; what happens next.
We could be like the King's Fund and make wholly unjustified imputations that the NHS is working on the future in secret.
We could rubbish STPs. We could run around like the Captain Mainwarings at NHS Providers, crying 'doom'.
We could hammer the MPs who voted for austerity politics and we should, at every opportunity.
More productively, we have to focus on what happens next. What could happen next?
The NHS has the mother-of-all-winters and collapses under its own weight. The system could silt-up with yer granny, two-to-a-bed, marooned in hosptial because social care is bankrupt.
The renegade rump of the BMA malcontents could go back on strike, the RCN could ballot for industrial action over nursing assistants, bursaries, no proper pay increment since Florence was a lad in short trousers and GPs could follow through on their threat to resign on-mass.
Or, we could realise; what matters is what we make happen, next.
One thing we do know is; planning for next year and the year after has been moved forward. How we come at this cycle will define us.
We could say there's not enough money. What shall we cut? Or, we could say; how do we look at funding in the round to try and make what we've got, go around.
I see no role for commissioning. I see every point in coalitions of providers, syndicating resources, pooling the cash-in-flow around long-term conditions. I see redesigning patient flows which might sweat the health-pound and take some heat out of the system.
Vertical integration; recognising patient journeys that are seamless might just be better for them and cheaper for us. Social care, primary care, community care, secondary care, out of hours care. Who cares? Patients don't but protective professions do.
We are where we are... but this is not the first time the NHS has been in a tight spot.
In post war, austerity Britain it took political courage to nationalise the health infrastructure, fight the doctor's union and deliver the NHS; taking from the shoulders of working people, the worry and anxiety of accident, illness, maternity and disease.
It defined our nation; became recognised as the best health system in the world, formed the centre piece of global attention for our-Olympics and because of its significance in our national life, became the focus of lies from the chisellers and shysters of Brexit.
In the years since the NHS was born it has been used and manipulated by malevolent MPs, messed about by politicians, kept short of cash, complained about and complimented. It has made a mess, created innovations; achieved some notable firsts and played its part in helping us to live longer and better lives.
None of that happened on its own. It happened because men and women just like you, working in and around the NHS made it happen.
Now it is our turn. We have a crisis to deal with; just as those who went before us recognised they had to solve their problems if there was to be an NHS to hand on.
We have to solve our problems and hand over the NHS, safely, to the next generation.
Sharing solutions. Turning sterile meetings into melting pots of ideas into action, finding out what good looks like and doing it. Being open to better and best practice and demonstrating the NHS isn't just a bottomless pit for the Treasury to throw money into.
We will come through this tough time. We will get better at doing better.
We are where we are; together we can deal with it.[/i]
I agree with much of it but in particular this....
[i]I see no role for commissioning. I see every point in coalitions of providers, syndicating resources, pooling the cash-in-flow around long-term conditions. I see redesigning patient flows which might sweat the health-pound and take some heat out of the system.
Vertical integration; recognising patient journeys that are seamless might just be better for them and cheaper for us. Social care, primary care, community care, secondary care, out of hours care. Who cares? Patients don't but protective professions do.[/i]
The attempt to introduce internal competition and local GP commissioning has been a disaster IMO. Services are so fragmented and I think the only way for the NHS to improve is for these organisational and political barriers to be broken down completely. In my area of Pharmacy the problems are clear. We have pharmacy teams at the acute trust where I used to work, the community trust where I now work, and with the CCGs supporting primary care. None of these teams are fully staffed and people just move between them. It's largely the same pool of staff. We all know each other but we work almost completely separately. There's duplication of roles. The acute get aggrieved becuase they do the bulk of the training and then lose staff to the community or CCGs. The acute and community get aggrieved becuase the CCGs should only commission but in some cases provide services from direct employees and blur the lines. It's a mess and the organisational divisions are the biggest barrier to better outcomes without doubt. We need to be one pan-organisational team, with one central commissioner. We need to co-ordinate, remove duplication, remove the barriers, so we can follow the patients care throughout their treatment pathway. More can can be delivered out of hospitals. Virtual wards in the community. It can all be done and done much better but not without co-ordination of provision and commissioning the way it is now, will simply not allow it. That is what has to change.
Docrobster, are you saying that any of the points that she made in that paragraph are actually incorrect?
It's an ideology not a fact. An inconsistent one too. Maybe she should have recited this to Buckingham Palace.