Friday 4 April 2014

NHS: patient fines.

A former Labour health minister has suggested people in England pay a £10 monthly membership charge to use NHS services.

This question came up at Question time. Almost no one on panel or in audience agreed with it. rightly too. An Extra £120 from every adult in the UK is some tax! But many did agree that something should be done.

Charging for appointments was immediately out. Free at the point of use and all that. {Why don't we care that we pay to see a dentist? We hand them cash and don't even think about it.}
But the idea of fining people seemed quite popular.  Not the A&E drunks and druggies or 50 fags a day heart failures and the fat to walk types.  More the inconsiderate. The  people who don't attend an appointment. The people who don't finish their course of prescriptions. calling an ambulance for a splinter and such. 

On appointments 3 times missed to be a fine was suggested. 3 times seems absurdly generous considering 99% of the nation, including children, have a mobile. Its only a call to say can't attend. Maybe a text/email line would help? 
The reality is it often takes two weeks to get an appointment by which time a % of people feel better and have forgotten all about it. 

But it is an easy one to implement. Appointments are recorded already. A second data file to record who hasn't attended wouldn't be hard to add. And a £10 fine or exclusion not too onerous for anyone.
Remember, its not for cancelling an appointment but for not turning up and telling anyone. And schools fine parents £80 for taking a term time holiday. The council will slap £120 if you accidentally put glass in the tin recycling box.  Its £60 for 3mph over the speed limit.That is to encourage responsibility, so government says.

£10 a sinner won't raise any money. maybe make it two tenners? And all the £10's can go into a staff Xmas bonus fund to make sure that the receptionists collect them. It would set a precedent. For the courts. For social worker visits. Local authority repair works.. .

 And the NHS is the most expensive thing we have in this country. Shouldn't we at least try and make people respect it a little more?


Scan said...

You lot have come out with some bonkers ideas this week; what have you been smoking? :)

The thing with the NHS is that (apart from major or life-threatening cases) it's a totally incompetent and dysfunctional organisation and the phrase "people in glass houses..." comes to mind.

I've been in the NHS system for a year and at every turn they themselves have cancelled appointments after I've turned up; not booked appointments they've told me they have; changed appointments without telling me; lost all my files when they have managed to get appointments right...and that's just off the top of my head.

If you're going to fine patients you also have to fine hospitals and give those fines to the patients they've messed about.

Christie Malry said...

On this £10 fee thing:

(1) Someone is brought to A&E bleeding and unconscious. They haven't paid their £10 fee. What do you do?

(2) Someone is brought to A&E bleeding and unconscious. They don't have any ID so you're unclear whether they're paid their £10 fee. What do you do?

(3) How quickly can you sign up for NHS services after paying your fee? Can you dip in and out without consequence? Can you opt out having received treatment for a long term ailment?

Roderick said...

As usual our myopic leaders ignore best practice elsewhere to keep up the pretence that the NHS is the envy of the world.

The remedy for a huge part of the wastage endemic (sic) in the NHS is to impose a charge for a doctor's appointment. That will make the time-wasters think twice, while everyone else will benefit from a faster response. It need not add to the user's cost: in France for example this charge is usually recoverable via insurance.

visc said...

You would have to make sure its not a fine ...

"That all grants and promises of fines and forfeitures of particular persons before conviction are illegal and void."

Blue Eyes said...

To get an appointment relatively recently I was forced to complain. My GP friend says that regular users of the system learn how to game it and irregular users get a worse service as a result.

Charge £20 for a GP appointment. First prescription includee free. Fine people £50 for mis-using A&E / ambulance services. Admittedly there will always be people who refuse to pay the fine but charges might put off many offenders.

Bill Quango MP said...

I must be in some other NHS world, Scan. I've been to the specialist this morning. I was given a range of appointments to choose from. I saw the doc within 5 minutes of appointment time. That's the fifth one I've had in the last two months, all on or nearly on time and most local. I thought it was pretty good.
Mind you, as the local Mp who pushed through one of the last hospital projects under the spend-what-U-like brown years, I have a local-local hospital and 2 surgeries.

Christie- A&E and any emergency would be excluded. Who decides what is emergency? the receptionists, who already decide.

personally i wonder how much of a big deal these non appointments really are? Some doctors say 10-15% of their day is waiting for people who never come. But I'm sure the GPs know this and use the time to write up notes, have a break etc.

Roderick:Sounds good.But the backlash would be awful. people don't want to pay for a 'free' service that they already pay for.

visc:Dentists will charge their patients if they don't show up. Charge them if they don't and if they do show up. So the mechanism exists.

BE: Those dumb ambulance and police and fire calls bug me. I'd like to address those. By a fixed penalty fine. Again, backlash would be huge. 1st child that dies as mum didn't call an ambulance after a head injury and government falls!

I, personally, had a bill for an ambulance once.

I was a passenger on a motorcycle that was hit by a car. I had minor head injury and was rushed to hospital. Saw two or three doctors and two or three specialists {I had concussion so maybe it was only one} The motorcycle driver had two broken legs and was seen by no one for 6 hours and was on a trolley in the corridor in agony. And they did his legs wrong and had to rebrake them later.

Both he and i got a bill for the ambulance after police determined crash was motorcycle's fault. That was £25 in 1985. A Thatcher health dept policy.

I got off when I said I wasn't driving and the driver got off when he told them to stick it, as how else could he get to hospital from the middle of the road with two broken legs.

i think the whole charging thing was dropped shortly after.

Blue Eyes said...

Well clearly we cannot trust people not to be thick. In which case why not simply abolish all freedoms and responsibilities and declare a British Soviet.

Weekend Yachtsman said...

£10 to make an appointment.

Returned when you turn up on time at the right place.


lilith said...

I rang up to cancel a GP appointment..the receptionist's tone was one of incredulity.."you want to CANCEL an appointment?!" I guess people normally don't bother and the gaps let the GP catch up.

lilith said...

I like that idea Weekend

lilith said...

Bill I think they may still charge anyone for their medical care who is involved in a road accident, although not pedestrians or cyclists!. Reason being "car insurance pays".

Bill Quango MP said...

BE: people can't be trusted with anything. Plain paper fag packets and a sugar tax and reduced holes in salt cellars etc..etc..etc..Sigh.

WY: _ Almost cracked it. But the specifics? Pay when you make the appointment? On a card? And refunded after? Going to be difficult. not impossible. But harder than it sounds.

Lilith. I can believe that. I agree those gaps are probably built into the day and the whole appointment thing is not really that much of a problem.
When i used to do interviewing we never scheduled lunch. There would always be a few no shows sometimes allowing a double bonus long munchtime.

dearieme said...

"An Extra £120 from every adult in the UK is some tax!"

If it replaced the £145 BBC poll tax people would probably stump up. Especially if it bought you, say, an "NHS passport" which foreign freeloaders wouldn't have.

Sebastian Weetabix said...

My sister is a paramedic. They have quite regular 'customers' who have figured out how to game the system. For example, one old codger in a rural village, about 12 miles from the nearest town: he doesn't have a car, a taxi is about £15 each way and buses are rare, so when he wants to go to town he dials 999 and tells them he has chest pain. The protocol means he gets one ASAP, no questions asked. So within 15 minutes he is collected and whisked to the town hospital. He then declares he is feeling better and discharges himself and off he goes shopping and socialising using the £15 he saved in the pub. He does this at least twice a week, every week. And they cannot refuse him under the rules, due to the magic code words "chest pain".

It isn't just appointments that get wasted. I vote £20 for an appointment and £30 for an ambulance.

Electro-Kevin said...

Weekend drunks should definitely be charged for services.

That would not only deter NHS wastage but also make people drink more responsibly.

andrew said...

it will cost something like £30 to collect the £10. bad idea.

you have a basic choice of putting up with people who game the system and all the good and bad things the nhs offers that we pay through taxation

or a fee based system.

K said...

If you want to get a GP appointment within 2-3 hours you should phone at 8-9am. In my experience there's always a free spot at 10-11am on the same day. So if you're self employed or whatever it's always super easy to get an appointment. Makes you wonder if surgeries should be open from say noon-8pm or something like that (you could make the same argument for many services).

Failing that, if you just need a new inhaler or whatever, try and blag a prescription over the phone. Again, in my experience, GP's know things like the "asthma nurse" stuff is bullshit and will easily give out repeat prescriptions if you've been on the same medication for 10+ years (hence why inhalers can now be bought over the counter even if you hear a lot of complaint from "nurses").

As someone who has been on the same medications since I was about 6-10 years old I don't understand why they make me jump through hoops to get the same medication that I'm obviously not allergic to and know how to use. Attempts at liberalisation (e.g. asthma inhalers) are always objected to even though they make sense.

I reckon we probably need to be able to buy as much over the counter as Americans do. But keep the ban on advertising as that only seems to turn people into hypochondriacs. The amount of drug advertising on US TV is astonishing.

K said...

I've got to say that I object vehemently to any "pay per appointment" scheme.

What about those of us who are forced to make appointments to get the same old medication since repeat prescriptions expire? What about people who have to go once a week for blood tests?

I'm sure we all know someone (usually a woman) who goes to the GP for a mild cough but other problems need to be solved first.

My main problem is that the "system" doesn't seem to trust me and wants me to always come back for more. Charging me for such would be outrageous. They put creams etc on the prescription that are cheaper to buy over the counter. Always check with the pharmacist what medications you can buy without prescription as they will usually be cheaper.

Jim said...

Any 'charging for missed appointments/irresponsible behaviour' concept will fall foul of the usual problem with anything related to anti-social behaviour - namely those the fines are imposed on will always be the basically law abiding who make a mistake, while the brazen repeat offenders get off scot free because those in charge of the system can't be bothered to try and chase the underclasses for their fines.

Remember that all State systems are run for the benefit of those running the system first and foremost, and only tangentially for the stated purpose. Thus the middle class mum who calls an ambulance for her kid who turns out not to need one will get a fine, while the Eastern European who repeatedly pretends to be unconscious in the street in order to get taken to a hospital so they can ingest the alcohol based hand gel found there (a known phenomenon in the NHS these days) will be ignored, because chasing him for his fines will be hard work, and what State employee wants that?

The only solution to NHS woes is a complete destruction of the current system and its replacement with one that treats people as adults not children, rewards the responsible, and penalises the irresponsible.