What should be free on the NHS?

[tim2000s]

I've seen plenty of people pushing the "Keep the NHS free" online petition and there are regular discussions on the forum relating to testing strips for Type 2s. We all know that the NHS is hard pushed for funds and that this stems from multiple directions. There is a huge amount of data available on the NHS with a quick search.

My question is, for the NHS to remain wholly state funded, what should not be provided for free? Should Diabetics not be provided with pumps at an annual average cost of £7,000 per capita when MDI is readily available and much cheaper? Should life prolonging cancer drugs be not provided as they don't offer a reasonable return (3 months extra life for ten thousand pounds)? Should certain forms of plastic surgery that supposedly reduce mental health issues at a minimum spend of £10,000 not be free?

Where do you draw the line? I find it astonishing that in a country that supposedly has a forward thinking government and population that the idea of being able to top up for certain forms of treatment is nigh on impossible - just look at Insulin Pumps for Diabetics, where they are heavily restricted by the NHS but it is almost impossible to obtain and use one privately, even if funded by yourself.

The model is clearly not functioning correctly, but instead of the blanket "It should all be free", which makes me angry, I think we need to make some hard decisions about what should be free. e.g. Insulin for diabetics should be free. Treatments that have a clear set of evidence for saving lives, should be free. I think beyond that it becomes a lot harder, and no-one wants to make that call. Currently 18% of UK public spending goes on Healthcare, second only to Pensions. How should that be spent?

What are your views?

For some context, this is the NHS in numbers:

NHS funding

• NHS net expenditure (resource plus capital, minus depreciation) has increased from £64.173 billion in 2003/04 to £109.721bn in 2013/14. Planned expenditure for 2014/15 is £113.035bn.
• Health expenditure per capita in England has risen from £1,712 in 2008/09 to £1,912 in 2012/13.
• The NHS net surplus for the 2013/14 financial year was £722 million (£813m underspend by commissioners and a £91m net deficit for trusts and foundation trusts).

NHS staff

• In 2014 the NHS employed 150,273 doctors, 377,191 qualified nursing staff, 155,960 qualified scientific, therapeutic and technical staff and 37,078 managers.
• There were 32,467 additional doctors employed in the NHS in 2014 compared to 2004. The number has increased by an annual average of 2.5 per cent over that time.
• There were 18,432 more NHS nurses in 2014 compared to ten years earlier. The number has increased by an annual average of 0.5 per cent over that period.
• There were 5,729 more GPs and 1,688 more practice nurses employed by GPs in 2014 than ten years earlier.
• There were 12,432 more qualified allied health professionals in 2014 compared to 2004. However the number of qualified healthcare scientists has declined for each of the past five years, with the number in 2014 874 below that of 2004.
• 50.6 per cent of NHS employees are professionally qualified clinical staff. A further 26.0 per cent provide support to clinical staff in roles such as nursing assistant practitioners, nursing assistant/auxiliaries and healthcare assistants.
• An NHS Partners Network survey shows that more than 69,000 individuals are involved in providing front-line services to NHS patients among their membership. Approximately two-thirds are clinicians.
• Since 2004 the number of professionally qualified clinical staff within the NHS has risen by 12.7 per cent. This rise includes an increase in doctors of 27.6 per cent; a rise in the number of nurses of 5.1 per cent; and 8.1 per cent more qualified ambulance staff.
• Medical school intake rose from 3,749 in 1997/98 to 6,262 in 2012/13 - a rise of 67.0 per cent.

Management

• Managers and senior managers accounted for 2.67 per cent of the 1.388 million staff employed by the NHS in 2014.
• The number of managers and senior managers increased slightly in 2014, having declined in each of the previous four years. However 37,078 was the second lowest total since 2004.
• In 2008/09 the management costs of the NHS had fallen from 5.0 per cent in 1997/98 to 3.0 per cent.

NHS activity

• The NHS deals with over 1 million patients every 36 hours.
• In 2013/14 there were 64 per cent more operations completed by the NHS compared to 2003/04, with an increase from 6.712m to 11.030m.
• The total annual attendances at Accident & Emergency departments was 21.779m in 2013/14, 32 per cent higher than a decade earlier (16.517m).
• The 95 per cent standard to see patients within 4 hours of arrival at Accident & Emergency departments was achieved in 21 weeks during 2014.
• There were 15.462m total hospital admissions in 2013/14, 32 per cent more than a decade earlier (11.699m).
• The total number of outpatient attendances in 2013/14 was 82.060m, an increase of 8.8 per cent on the previous year (75.456m).
• In the year to September 2014, 418,661 NHS patients chose independent providers for their elective inpatient care. There were 688,977 referrals made by GPs to independent providers for outpatient care during the same period.
• There were 1.747m people in contact with specialist mental health services in 2013/14. 105,270 (6.0 per cent) spent time in hospital.
• There were 21.706m outpatient and community contacts arranged for mental health service users in 2013/14.
• 53,176 people were detained for more than 72 hours under the Mental Health Act in 2013/14.
• 75.60 per cent of Red 1 ambulance calls were responded to within eight minutes in 2013/14.
• There has been an 18.5 per cent increase in emergency incidents between 2007/08 and 2012/13, reaching 6.89m in the latter year.
• At the end of January 2015, there were 2.920 million patients on the waiting list for treatment. 216,791 (7.4 per cent) had been waiting for longer than 18 weeks, compared to 189,612 (6.5 per cent) at the same point in 2014.
• Over the past three years the number of patients waiting longer than a year for treatment has declined from 5,898 in January 2012 to 441 in January 2015.
• In the same period, the number waiting in excess of 26 weeks has declined from 70,059 to 67,205 (although that is second highest number in that period).
• 88.7 per cent of people with admitted pathways (adjusted) were treated within 18 weeks of referral in January 2015, compared to 90.4 per cent a year earlier.
• 95.0 per cent of people with non-admitted pathways were treated or discharged within 18 weeks of referral in January 2015, compared to 96.3 per cent a year earlier.
• At the end of January 2015, 766,414 patients were on the waiting list for a diagnostic test. Of these, 2.4 per cent had been waiting in excess of six weeks.

Health and population

• Life expectancy for UK men in 2010-12: 78.9 years.
• Life expectancy for UK women in 2010-12: 82.7 years
• The UK population is projected to increase from an estimated 63.7 million in mid-2012 to 67.13 million by 2020 and 71.04 million by 2030.
• The UK population is expected to continue ageing, with the average age rising from 39.7 in 2012 to 42.8 by 2037.
• The number of people aged 65 and over is projected to increase from 10.84m in 2012 to 17.79m by 2037. As part of this growth, the number of over-85s is estimated to more than double from 1.44 million in 2012 to 3.64 million by 2037.
• The number of people of State Pension Age (SPA) in the UK exceeded the number of children for the first time in 2007 and by 2012 the disparity had reached 0.5 million. However the ONS currently projects that this situation will have reversed by 2018, with 0.3 million more children than those at SPA.
• There are an estimated 3.2 million people with diabetes in the UK (2013). This is predicted to reach 4 million by 2025.
• In England the proportion of men classified as obese increased from 13.2 per cent in 1993 to 26.0 per cent in 2013 (peak of 26.2 in 2010), and from 16.4 per cent to 23.8 per cent for women over the same timescale (peak of 26.1 in 2010).

Data sourced from: http://www.nhsconfed.org/resources/key-statistics-on-the-nhs , http://www.kingsfund.org.uk/about-us and http://www.ukpublicspending.co.uk/

 

[KateA]

I believe the NHS should be free and the appropriate treatment should be available to all patients.
What I do not agree with is companies and individuals making huge profits from NHS services.
Interesting that you mention pension costs being higher than NHS costs. Our current government protects pension spending but then adds it onto the benefits figure to beat the most vulnerable people in our society with.
I should be revising for exams so haven't studied the figures you quoted but will do so once my exam week is over. It would be helpful if you could reference your sources please.

 

[dannyw]

Good question Tim and not an easy one to respond without fear of upsetting a few lol !
My personal opinion is that there are many people that chase a pump just because they want one and with a bit more effort and education could manage on MDI. There are also some that genuinely need one that cannot get one. I think there are more in the first category though. I also think too many children have them for fear of them not coping with needles, kids are pretty resilient.
I'm a T1 and get all my prescriptions free but hand on heart, should I ? OK, the diabetes meds etc should be but if i get an ear infection or similar, should the meds be free ? I'm not sure. I would rather not get blanket meds and see more T2's get BG meters & strips.
Obviously if the money was there, I'd love to see everyone get pumps and all T2's get free meds and others get surgery that may not be life threatening but more cosmetic but the money isn't there and tough choices need to be made. These are just my thoughts and are not evidence based in any way.

 

[Engineer88]

Honestly I think the NHS could be SMARTER with its money before we look at making cuts. For example bank nurses and such, they pay much more per hour for a bank nurse than they would a non bank nurse but that isnt considered because hey dont have 'headcount'. I now try and minimise my px apart from insulin strips and thyroxine. Its rare i get gluten free goods for instance. I think we could also reduce money there a bit but please dont batter me too much for that.

 

[CollieBoy]

Honestly I think the NHS could be SMARTER with its money before we look at making cuts. For example bank nurses and such, they pay much more per hour for a bank nurse than they would a non bank nurse but that isnt considered because hey dont have 'headcount'.

Perhaps if the NHS set up THEIR OWN staff banks. Couldn't be less cost effective, could it? On second thoughts ...

 

[Engineer88]

Perhaps if the NHS set up THEIR OWN staff banks. Couldn't be less cost effective, could it? On second thoughts ...

I am talking about their own! external ones are even worse. (Mum was a nurse hence insider info)

 

[Sid Bonkers]

Perhaps if the NHS set up THEIR OWN staff banks. Couldn't be less cost effective, could it? On second thoughts ...

They do have their own bank staff, my wife is a medical secretary and as well as doing her own job she works extra hours for the trusts bank, she is paid her regular hours by the hospital trust and her overtime by the hospital trusts staff bank and gets two separate pay slips from two different employers.

The bank employs all kinds of staff both secretarial and front line medical staff.

The biggest problem the trust she works for is that our hospital was built under the PFI and the company who built it charges an outragous amount of rent to the hospital trust plus all maintenance has to be carried out by the PFI company, my wife had to get a combination lock fitted to the office door and the cast to supply and fit the lock and maintain it for 10 years was £16,000 yes £16k to fit a door lock!!

That is the scandal of PFI's

http://en.wikipedia.org/wiki/Private_finance_initiative

http://www.theguardian.com/society/2012/jun/26/nhs-trust-debt-tory

 

[Engineer88]

Agree Sid,

 

[JANROU]

I would happily pay for prescriptions that are not related to diabetes.

 

[lovinglife]

I would happily pay for prescriptions that are not related to diabetes.

Totally agree, I have been on long term meds for asmtha and psoriasis- paid for them both for 35 years, now get them free because of diabetes meds, I often think it's not right, but at the same time I don't work because I am full time carer to my son for the princely sum of £62ish a week no other income so I am appreciative that I now get this.

 

[Fallgal]

I am an American citizen, living in the UK now for nearly five years (due for citizenship later in the year). When I first came as a visitor, it was for two months. During that time, I had to go to the doctor. I was not charged, despite asking the receptionist and the doctor I saw to please charge me something, as I had no right to use the NHS as a visitor without paying. They flat out refused to charge me anything, stating that the NHS was free to everyone. I knew this was NOT true, and told them so, but they acted like I was a 'crazy American' because I *wanted* to be charged.

When I went to apply for my first visa, the application instructed me to disclose any time I used the NHS as a visitor without paying. I was further advised that if I admitted to that, that my visa would be delayed, and possibly denied (I later found out it was only if you owed them in excess of £1,000.). Even though I only had one appointment, I went back to the surgery and again asked for a bill. I was told they had no way in their system to bill me. I was then advised by an immigration pro to get a letter from the practice manager stating that they refused to charge me, which I did get, so I was not penalized by immigration.

My first visa (as the fiancee of a British citizen) entitled me to completely free use of the NHS, from the moment I stepped off the plane in Manchester. Why??? Although I was allowed to use it, I didn't, until long after we married and I truly needed to. I simply felt guilty. My 2nd visa allowed me to work, and being self-employed, I started paying my contributions. I then felt at least I was contributing and felt easier about using the NHS. Two years later I had to have two surgeries (and plastic surgery) for skin cancer. A year after that I was diagnosed with T2 and all that entails, and have frequent podiatrist appointments. I also have IBS.

I have found out quite recently that they are charging new (*non-EU*) immigrants around £200 per year (charged with their visas to be handed over from the Home Office to the NHS) until they receive permanent resident status. (I am speaking of non-EU, non-Commonwealth citizens only; I don't know the rules for the others.) This will not affect me, but I in all honestly would have felt better being charged this from the get-go. The immigration boards would slay me, but I have never thought it was fair that immigrants have use of the NHS the same way tax-paying citizens do!! Why on earth would they allow this? And why on earth doesn't the NHS charge/know how to charge/have a system of charging non-residents? Think of the money saved!! I am not talking about A&E or life-saving situations. But surely all the rest should be chargeable. Think of the money saved over the years that could have been used for a plethora of services for residents! I have heard in the past a *very few* amount of immigrants being charged, mainly in London where of course there is a much bigger immigrant population than here in my pokey town.

This may not be the sort of response the OP was looking for but I think it is a valid point. The NHS needs to charge people who are not supposed to be using their services free of charge!

 

[Kat100]

For me its free health care for all on the NHS ... With medication to ...

There is a lot of waste I feel in the NHS as to where money is wasted ....

 

[AndBreathe]

I am an American citizen, living in the UK now for nearly five years (due for citizenship later in the year). When I first came as a visitor, it was for two months. During that time, I had to go to the doctor. I was not charged, despite asking the receptionist and the doctor I saw to please charge me something, as I had no right to use the NHS as a visitor without paying. They flat out refused to charge me anything, stating that the NHS was free to everyone. I knew this was NOT true, and told them so, but they acted like I was a 'crazy American' because I *wanted* to be charged.

When I went to apply for my first visa, the application instructed me to disclose any time I used the NHS as a visitor without paying. I was further advised that if I admitted to that, that my visa would be delayed, and possibly denied (I later found out it was only if you owed them in excess of £1,000.). Even though I only had one appointment, I went back to the surgery and again asked for a bill. I was told they had no way in their system to bill me. I was then advised by an immigration pro to get a letter from the practice manager stating that they refused to charge me, which I did get, so I was not penalized by immigration.

My first visa (as the fiancee of a British citizen) entitled me to completely free use of the NHS, from the moment I stepped off the plane in Manchester. Why??? Although I was allowed to use it, I didn't, until long after we married and I truly needed to. I simply felt guilty. My 2nd visa allowed me to work, and being self-employed, I started paying my contributions. I then felt at least I was contributing and felt easier about using the NHS. Two years later I had to have two surgeries (and plastic surgery) for skin cancer. A year after that I was diagnosed with T2 and all that entails, and have frequent podiatrist appointments. I also have IBS.

I have found out quite recently that they are charging new (*non-EU*) immigrants around £200 per year (charged with their visas to be handed over from the Home Office to the NHS) until they receive permanent resident status. (I am speaking of non-EU, non-Commonwealth citizens only; I don't know the rules for the others.) This will not affect me, but I in all honestly would have felt better being charged this from the get-go. The immigration boards would slay me, but I have never thought it was fair that immigrants have use of the NHS the same way tax-paying citizens do!! Why on earth would they allow this? And why on earth doesn't the NHS charge/know how to charge/have a system of charging non-residents? Think of the money saved!! I am not talking about A&E or life-saving situations. But surely all the rest should be chargeable. Think of the money saved over the years that could have been used for a plethora of services for residents! I have heard in the past a *very few* amount of immigrants being charged, mainly in London where of course there is a much bigger immigrant population than here in my pokey town.

This may not be the sort of response the OP was looking for but I think it is a valid point. The NHS needs to charge people who are not supposed to be using their services free of charge!

An excellent, and heartening response @fallgall.

I spend part of my time somewhere where there is nothing like the NHS, and it's astonishing when folks go off-island for several weeks how many are going away for medical treatment, in more sympathetic countries. UK isn't the post popular destination, as I understand it; Canada seems to be favoured by many. Interestingly Canada's system is broadly modelled on ours here, and it is in a similarly stretched predicament, with some Canadians - even living in cities - not able to register with a doctor. They have to go to a sort of walk-in centre where they are treated piecemeal and transaction ally, with little consideration to continuity of care. Many of the locals here have relatives in both Canada and UK! And you can bet your bottom dollar they all have both UK and Canadian postal addresses, which seems to mean their eligibility is simply never questioned.

There are some incredibly unfair situations out there, all over the world.

Personally, I'll steer away from commenting on non-diabetes related prescription charges, as I don't qualify, and would hate to be considered to be showing sour grapes. But, I do just wish there was some sort of mechanism whereby we could top up on the NHS system, rather than have such a two-tier NHS/Private system as we have now. A relevant example here, though, would be the treatment of pumps where a patient doesn't qualify via the NHS, but might be able to self fund, or for topping up on some drugs charges. I also wish there was a more honest, and open, dialogue is situations like testing for diabetics. Why does the apparent dogma persist that it's such a bad idea, when really the main problem is cost. Why not just treat we adult patients as such and support our self funding positively and with grace? I just don't quite get that bit.

We are so incredibly lucky to have the safety net we have.

 

[tim2000s]

@Fallgal, @AndBreathe, thanks for your contributions. They both make very valid points.

I don't want to see a privatised NHS, but neither can it continue as it is. When first conceived the breadth and depth of treatments on offer was far smaller than it is now and I think people have an irrational view that all of these should be available to all without considering the consequences.

I also note that we never seem to get an adult debate on the topic because no-one in government is willing to utter the words "we can't afford it as it is now".

I too would like to see some form of optional top up available, if only to release pressure on existing funds.

 

[catherinecherub]

Here is where a lot of the money goes.

http://www.telegraph.co.uk/news/hea...lion-in-pay-rises-despite-funding-crisis.html

Nearly 50 hospital bosses pocketed more than £400,000 last year despite standards of care slipping, the figures showed.

Some were found to have played the system by ‘retiring’ for a day, then returning to their posts full-time, allowing them to claim a huge pension lump sum early.

Others were reported to have avoided tax on their earnings by channelling their salaries through private companies.

Professor Sir Brian Jarman, a senior Government health adviser, called for a public inquiry, saying bosses were manipulating the system.

Would you expect to get toothpaste on prescription? If you are exempt from prescription charges then this is ludicrous, you can buy your own like everyone else has to. The same goes for sunscreen and vitamin tablets.

http://www.theguardian.com/society/...-sun-cream-at-cost-of-millions-figures-reveal