Winter and the NHS

Jeremy Hunt yesterday gave a honest and detailed account of the state of the NHS and its response to winter demand. He told us just how big the increase in demand for care and treatment has been. There are 9m more visits to A and E than in 2000; He reminded us that there are 340,000 more people over 80 than in 2010, the age group needing most NHS care. He explained how more and more people go to A and E at the hospital, when quite often they do not need hospital treatment. Around one third of those who attend A and E do not need to be there but could be dealt with by a GP or other local health professional. Despite the large increase in demand, most hospitals and trusts are coping a little better than last year. A few Trusts are performing very badly, have poor records on keeping people waiting and are being placed into special measures to improve them.

The NHS has a target of no-one waiting more than four hours at A and E. Clearly if on admission the person needs urgent treatment, that is what they should get without waiting 4 hours. The NHS recruited 1600 extra doctors and 3000 more nurses this year, to help cope. Since 2010 there has been an increase of 11,400 doctors and 11,200 nurses overall. The NHS also commissioned more GP consultations for the holiday period to try to reduce the pressures on A and E. Over Christmas and over New Year 150,000 medical staff were on duty in hospitals to deal with all the cases.

Clearly we need to continue to expand the NHS to deal with extra demand. We also need to help users of the NHS understand how it is organised and how it is best to use it. All UK citizens should be registered with a GP, and should normally use the GP as the first point of call for diagnosis and possible treatment. The GP should be the gatekeeper to the hospital system. Only where someone has a bad accident or a serious looking medical condition happens suddenly should they seek direct access to the hospital via A and E. We offer free emergency provision to anyone in our country.

New migrants to the UK should seek doctor registration for the free NHS as soon as they have legally settled here. Anyone not qualifying for free treatment should be informed of their need to hold insurance or to be ready to pay for non emergency treatment should they need any whilst staying in the UK.

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151 Comments

  1. Prigger
    Posted January 10, 2017 at 5:46 am | Permalink

    “Around one third of those who attend A and E do not need to be there but could be dealt with by a GP or other local health professional. ”
    So are they asked to go to the GP immediately? That one third are only a problem if not.

    “Anyone not qualifying for free treatment should be informed of their need to hold insurance”
    They should not be here in the UK if they do not hold insurance.

  2. Leslie Singleton
    Posted January 10, 2017 at 5:48 am | Permalink

    Dear John–Why isn’t it obvious that more charging needs to be introduced, like it or lump it, especially for non emergencies? What is special about the Dentist or the Optician?

  3. Pragmatist
    Posted January 10, 2017 at 5:49 am | Permalink

    So we know the script for the Labour Party in the next PM Questions. It is the same set of scripts they use each year. Could they not be asked to take the scripts , get The Speaker to rubber stamp them as READ, then after the London New Year sales, they can get back to their Constituencies and get some useful work done.

  4. Shock
    Posted January 10, 2017 at 6:03 am | Permalink

    “Jeremy Hunt yesterday gave a honest and detailed account of the state of the NHS and its response to winter demand.”
    We get weather forecasts every fifteen minutes on the BBC and fanfares. So winter has not come as surprise. In my experience winter happens every year without fail. Giving a honest and detailed account is good. But why should there have been problems? This is but a mild winter.
    Mr Hunt has in fact been talking up the health service before and throughout the Chanting Young Doctors dispute.
    The people aged 80… they were on record of being 79, 78,77,76 75 an so on. They being 80 years old is no surprise either. Is Mr Hunt claiming 80 year olds crept up on him and fell out of some wayside secreted place and mumbled ” Thuprizzzzth Thuprizzzth ! “The ones without NHS false teeth that is.The government has had 79 years to prepare for it.

  5. ABC
    Posted January 10, 2017 at 6:19 am | Permalink

    Since so many people are going to A&E instead of their GP then why is their GP located down side-street in a old terraced house not fit for purpose where you need directions if you are not a regular user? Why is the GP not located at the front of the hospital..all of them? My hospital is on a regular bus route. My doctor (GP ) isn’t.

    Instead of seeing patients according to area, they could do them alphabetically ( it’s a state of the art system invented by Arabs I believe several hundred years ago ).
    The major problem for Mr Hunt is that it will probably take the NHS ten years and a public enquiry to understand that there are more surnames beginning with certain alphabetical letters than others. Nothing short of one of those dinky Committee Q &As in Parliament would be needed to finally sort it out.
    When this revolutionary system is started after due deliberation, in about 2090AD, if I’m still alive, I shall change my name to Mr Aardwark or better still Mr Zzxerby

  6. Shhhhh
    Posted January 10, 2017 at 6:39 am | Permalink

    No upper cash limit given by Mr Hunt. Why?

    So, whatever the medical need, whatever the number of our population, whatever the number of cars on our roads creating A&E fodder, we will just find the money? Evidently, our Chancellor is called Micawber, “Something will turn up”
    Mr Hunt did not mention children at A&E. Of course it is easier to blame eighty year olds who are most likely 99% white British. Being British we can take it (or leave it, as far as the government is concerned )

  7. Duncan
    Posted January 10, 2017 at 6:39 am | Permalink

    ‘Over Christmas and over New Year 150,000 medical staff were on duty in hospitals to deal with all the cases’

    The NHS employs just under 530K doctors and nurses. So in effect we have around 380k doctors and nurses on holiday. That is only 28% of all NHS medical staff are on duty over the festive period. So why can’t the other 72% come into work and do what they are employed to do ie assist patients?

    How many D & N are available to work over the weekends?

    Why is Sat & Sun not deemed a normal working day in the NHS?

    Why do staff unions dictate to NHS management when their members will and will not work?

    NHS staff want to work Mon-Fri (9-5). They don’t want to work nights and weekends, BH’s or over the festive period. Healthcare doesn’t operate like a shop selling products.

    If you throw into the mix the number of bank staff (agency nurses) brought into to fill so called gaps in staff numbers you can see why this nonsense about a ‘humanitarian crisis’ is nothing more than a political ploy by NHS staff vested interests to hand out the begging bowl again.

    It was a clever ploy to use the Red Cross for maximum propaganda purposes. It was also pathetic, shameless and the worst form of gutter politics and the type of nonsense we have to tolerate from a public sector that as become an employer rather than a provider of services

    The NHS as become a fat, inefficient organisation whose primary function is not the provision of medical services but the protection of employee interests. The interests of NHS employees is elevated to the front of the queue while the patient (who lacks power to impose its influence) is stamped down

    The unions run the NHS not the management. If the government wants a well run NHS then May should go to the country, secure a massive majority and ram through unprecedented reforms across all areas of union activity.

    The feminisation of the NHS is also destroying its productive base. In 20 years time the gaps in staff numbers will only get larger

    The NHS has sacrificed patient care on the altar of staff interests

  8. Mick
    Posted January 10, 2017 at 6:52 am | Permalink

    It’s funny that the NHS as got slowly worse over the past 10-15years, I wonder what the biggest cause is let me guess too many immigrants sucking the life out of it and there’s only one party to blame and that’s the Labour Party for opening the floodgates, can only hope they don’t get anywhere near to power for a very long time

  9. Ian Wragg
    Posted January 10, 2017 at 7:00 am | Permalink

    New migrants should seek GP registration asap. That will be 22 in one morning using the same address as in our practice.
    The BBC was in overdrive blaming everything except half a million immigrants annually coming here.

  10. Caterpillar
    Posted January 10, 2017 at 7:02 am | Permalink

    The NHS Choice website advises a pharmacist visit before GP since pharmacists are often available for longer and more convenient hours, without appointment and, where appropriate can treat immediately. It also states,
    “If everybody went to a pharmacist with common health problems, more time would be freed up for our GPs. This might make it easier to get a convenient appointment with your GP next time you need one.”

    This seems to indicate that there is something structurally wrong, many people struggle with getting GP appointments that they are able to attend or are early enough, leaving either the A&E or pharmacy route.

    http://www.nhs.uk/Livewell/Pharmacy/Pages/Commonconditions.aspx

    [Well done to pharmacists who often do provide a good service.]

  11. Lifelogic
    Posted January 10, 2017 at 7:03 am | Permalink

    In my experience a few years back in north London a wait of three to four hours in A&E was virtually standard. I got the impression they worked to this in order to deter people coming in. No one even looked at you to see if you needed more urgent treatment before the three hours. They also frequently got the diagnosis totally wrong even after assessment and test and scans needed were often not done due to lack of facilities (or space) out of hours or just a lack of any motivation to do the job properly.

    How can they know if, for example, a patient has chronic cholecystitis and their gall bladder is about perforate until they have examined the patient and done the relevant tests?

    The system need to be structured sensibly, currently they often do not even invoice many non entitled patients who have insurance to cover the it or would be happy to pay. So poorly run and incompetent is the organisation. They are trying to delay and defer an treatment rather than trying to serve the patient.

    It was suggested yesterday that the four hour limit should be scrapped for non urgent cases, but until you have assessed the patient you do not know which are urgent and which are not. Even after examination this may not be clear cut.

    You need a system where the hospital has an incentive to serve rather than as now an incentive to deter.

    The reason many go to A&E is also due to the difficulty in getting to see a GP as they often have a ration, put off and delay approach. It is not a lack of money it is an incompetent system that can never work efficiently as currently structured.

    Cameron’s priority in three letters the N… H….. S….. is even worse than it was when he took office, but no one has the political courage to do anything about it.

    • Lifelogic
      Posted January 10, 2017 at 7:06 am | Permalink

      Free at the point of indifference, deterring and rationing can never work. We need to charge and get rid of this dire, virtual state monopoly and make nearly everyone pay or insure. With some safely net for the few who really cannot pay.

    • Lifelogic
      Posted January 10, 2017 at 8:06 am | Permalink

      Doctors should never be able to get away with telling patients that they can only bring one issue per appointment or that they have to ring back tomorrow between 10 and 10.30 to make an appointment for the day after as they will not book you in before or after that slot.

      Imagine you solicitor, accountant or any other private professional behaving in such a way. You would fire them go to some one else. But in the NHS you cannot fire them. You get what you are given or more likely not given. This as the state has taken your money already, so their incentive is to ration, delay and deter you as much as possible. This is largely what happens.

      The solutions are:

      Give income tax and NI relief for all people who insure and companies that insure their staff. Get rid of the 12% insurance tax. Encourage more competition. Make the money follow the patient. Have more specialist centres more where all the tests and diagnosis can be done in one place on one appointment. Make sure anyone coming into the county has compulsory medical insurance. Charge something for all ambulances, gp appointments, casualty visits. Treat, but recover the money later from all but those really unable to pay, and reduce taxes in proportion.

      The NHS is also hugely over managed and over paid at the admin level and very badly managed too. Get it away from the politicians as much as possible.

  12. Barefoot and dutiful
    Posted January 10, 2017 at 7:11 am | Permalink

    “Clearly we need to continue to expand the NHS to deal with extra demand” Red China did as much under the guidance of their “Great Leader Chairman MaoTsetung” during the Cultural Revolution in the 1960s
    They were called “Barefoot Doctors” 赤脚医生; A kind of low-tech NHS 111. Except the Barefoot Doctors, taking the place of what we would call proper doctors were far into the countryside aways from mainstream medical facilities. They were however trained in some respects unlike NHS 111 services
    The Barefoot doctors answered a need. They took the strain off A&E . They were also skilled in chanting, parading, writing slogan signs and marching in demonstrations just like Best Practice in the NHS.
    Unlike the NHS, a few of them could actually do acupuncture properly leading to positive results. Paid very much less than NHS staff it must be said as to them it was a calling and not a means only for buying a time-share in the Disney Land area

  13. Money
    Posted January 10, 2017 at 7:19 am | Permalink

    Jeremy Hunt, probably the best of men,genuinely, does not sound convincing anymore.

    No news: the NHS is a bottomless money pit.

    It is the only political football the Labour Party can kick as they are a laughing stock in most areas of debate. So the NHS will get kicked. But someday there does have to be cross-party agreement on what has to be done with it.

  14. Cheshire Girl
    Posted January 10, 2017 at 7:34 am | Permalink

    I thought that Jeremy Hunt looked distinctly uncomfortable on the Ch. 4 news report last night, as well he might. He forgot to mention the ‘growing’ population, but mentioned the ‘ageing’ population. What did the Government expect, when more people are coming to the UK every year, and they havent a clue what to do about it. I dont buy the argument that because many of the immigrants are young, they wont need the services of the NHS. For a start, our Maternity services are stretched to the limit.

    Some of what he said about people going to A and E with minor ailments is probably correct, but he attempted to give the impression that most hospitals are coping well. I’m not at all sure I believe him !

  15. Ex-expat Colin
    Posted January 10, 2017 at 7:45 am | Permalink

    The delay in seeing a doctor is too long although a Nurse Practitioner (NP) should be more easily available. And the NP can call upon a doctor quickly if need be. A&E entry needs to be better controlled…so why isn’t it?

    I was surprised when Hunt said there are at least 3 children in every UK school class with mental issues? The NHS also needs to stop being an International Service and a big question lies around its specialised services. I live near Worcester (9 miles) and thanks to Blair I hear and witness the ambulances ferrying people there and back. …stupid scheme!

  16. Skippy
    Posted January 10, 2017 at 7:46 am | Permalink

    Aside from the nitty-gritty of our thoughts on areas of “industrial” activity such as the NHS, we do need to look at our society and figure out what “progress ” means.

    Are we paying more or are we paying less as individuals for goods and services? In my case, I am paying more, much more.

    Yes, but you will argue my health services buses, trains etc are all much improved from when I was young; therefore, I pay proportionately more. ( ok forget the trains and buses, they are certainly NOT improved on most counts )

    Well that is the problem. I rent a car at £9 per day and the next car I rent from you is £15 per day. I complain and you say but it is a “better” car. In my book, that is not an improvement, not progress. In my opinion, scientific progress and improvement makes the better car or the same car not just for the old £9 per day or but for £2 per day. That is progress. The other is nonsense and a sales gimmick.
    So with the NHS. It is not progress when it costs more despite all the labour-saving, cost cutting, technological advances.

    Progress should be doing the self-same things for a decreasing cost year by year. It is not happening in the NHS. Bring in innovation in drugs and procedures when you have decreased the costs of what you were doing before! I should not pay a doctor NOT to fly off and live in Australia. If he wishes to go then go! Be warned though, the Aussies have really big rabbits for jumping up and down outside hospitals and being a thorough nuisance. They work for free.

  17. Richard1
    Posted January 10, 2017 at 7:56 am | Permalink

    This would be fine if you could see a doctor 24/7, like a pharmacy. But you can’t they are closed out of hours and at weekends. There needs to be the option of private GP provision – just beginning to open up now online – to take the strain off A&E

  18. Anonymous
    Posted January 10, 2017 at 8:01 am | Permalink

    The NHS leeches £1.5bn a year in no-win-no-fee claims. Make no mistake. People are dying and suffering in discomfort on waiting lists because of this.

    It does not inspire confidence in these claims that lawyers see the space between Jeremy Kyle and Judge Rinder as prime advertising.

    Making users of the NHS sign disclaimer forms would be the lesser of two evils. Better still – get rid of no-win-no-fee, which is a blight on everything we do including the choice of London buses.

    • Anonymous
      Posted January 10, 2017 at 8:03 am | Permalink

      Make weekend drunks take a breath test and pay a surcharge if they turn up at A&E.

  19. Advancement
    Posted January 10, 2017 at 8:06 am | Permalink

    “Morrisons posts best sales rise for seven years over Christmas
    Supermarket Morrisons has posted a 2.9% rise in like-for-like sales over the nine weeks to 1 January ” Sky News

    Our media has already factored in such ostensibly good news by saying people were spending more at Christmas because hey feared prices would go up if they didn’t. I get the impression the media are Remoaners. Just a feeling.
    I watch Sky News very much NOW for fear their journalists will just suddenly upsticks and leave the programme blank and get proper worthwhile jobs in taxidermy , foul feather-plucking, and mole catching.

  20. Dave Andrews
    Posted January 10, 2017 at 8:08 am | Permalink

    Elderly care isn’t the only increase in demand on hospitals, obesity has also increased and is avoidable. It is time to stop blaming government for NHS failures and put the spotlight on the British people, who need to pursue healthy lifestyles.
    Assuming we already have the best people for the job in the NHS, where are we to draw the additional staff from? Surely it will have to be those who are lower down the list in the recruitment drive, and the applicants who are less suited to being doctors and nurses.
    We need radical thinking in healthcare, like setting up dedicated malnutrition clinics with direct access to the bank accounts of the food industry to meet their financial needs.

  21. SM
    Posted January 10, 2017 at 8:21 am | Permalink

    I speak from experience, both as a carer for friends & relatives (involving A&E on occasions) and as a former senior member/chairman of Patient Care committees.

    1. The law obliges A&E depts to care for you once you have stepped over their threshold, even if you are only suffering from an ingrowing toenail. If the legislation cannot be adjusted, then there must be a rigorously-adhered to triage system in place in EVERY hospital.

    2. Different A&E Depts have different patient-processing criteria; while a few handle matters with what most of us would consider the utmost common sense, far too many continue to process patients without regard to their wellbeing, simply because “that’s the way we do it here” – I quote directly. The NHS must insist on good practice being adopted in EVERY hospital.

    3. The Police bring the mentally-ill and the drunkards to A&E because station cells are utterly inappropriate places for them – but so are A&E Depts! This is something which can only be addressed (in co-operation with the Police and the NHS) by Parliament, but it has continually been ignored, as far as I am aware.

    4. The NHS needs to boost the availability of and access to Minor Injury Units.

  22. Lifelogic
    Posted January 10, 2017 at 8:32 am | Permalink

    Please can we have your views on the current sinister moves to try to totally destroy the free press in the UK?

    • JJE
      Posted January 10, 2017 at 12:36 pm | Permalink

      Guido Fawkes at order-order has some background to this which is compulsory reading before this appalling measure takes effect.
      Lifelogic is not exaggerating.

      • Chris
        Posted January 10, 2017 at 7:24 pm | Permalink

        There are more and more things going through Parliament, or about to, which a Conservative government should have no association with whatsoever. That of course brings one to the big question about Theresa May. I, personally, am not reassured by her at all. She is trying to keep the Conservatives on the centre ground, come what may, and she seems, sadly, in the hands of PR people. If only she could sound authentic, a true Conservative, then I might be swayed by her.

        • hefner
          Posted January 11, 2017 at 8:44 am | Permalink

          TM “is trying to keep the Conservatives on the centre ground, come what may”: where would you want to see the Conservatives going?
          What is “a true Conservative”?
          How far to the right (left?) would you like to have your Overton window?

        • Lifelogic
          Posted January 11, 2017 at 12:16 pm | Permalink

          I am not even sure it is the “centre ground”. Much of the May agenda is just bonkers interventionist & damaging socialism. Making more and more red tape and inconveniencing the productive. This while wasting money on absurd vanity projects like HS2, “lagoons”, green crap subsidies for wind and PV, biofuel imports, heating empty barns and Hinkley C.

          She is more like Ed Miliband than a proper Conservative.

  23. Mark B
    Posted January 10, 2017 at 8:37 am | Permalink

    New migrants to the UK should seek doctor registration for the free NHS as soon as they have legally settled here.

    To the UK taxpayer the NHS is only FREE at the point of service, we still have to pay for it whether we use it or not. Only those that have NOT paid in is it truly FREE as they can access it right away. And believe me, they do !

    It should be a leagl requirement that all non-EU citizens coming to the UK should have adequate medical insurance BEFORE they are allowed to enter the country. EU immigrants should have their healthcare charged to their country of origin or, the EU itself via reduction in our contributions.

    Negotiations on the terms of leaving the EU should also cover the aforementioned healthcare provisions for all EU immigrants and migrants for the entire length of their stay here.

    Fair is fair !

    • Mark B
      Posted January 10, 2017 at 8:37 am | Permalink

      Opps!

      Good morning.

  24. Andy Marlot
    Posted January 10, 2017 at 8:41 am | Permalink

    New migrants to the UK should not be eligible for free health care unless their country offers similar treatment for UK citizens. If they cannot afford care and do not qualify for free treatment why are they here? Why should we pay for them? Would they pay for us?

    • Lifelogic
      Posted January 10, 2017 at 7:11 pm | Permalink

      A condition of entry should be satisfactory medical insurance.

  25. JJE
    Posted January 10, 2017 at 8:47 am | Permalink

    I can tell you haven’t been needing to use the NHS much recently.

    • acorn
      Posted January 10, 2017 at 8:00 pm | Permalink

      The affects of seven years of Osborne Neo-liberal “austerity”, New Keynesian style, are starting to show up on the little peoples radar. Be it Prisons; Social Care; Hospitals; Mental Health facilities; Trains; Potholes. The funding cuts in public services since the 2010 general election; which have so far, been invisible to voters, are now becoming obvious in 27 million Households.

      The government, in manufactured media headlines, will claim that it is increasing funding on this that and the other; but, won’t tell you that these increases are only a fraction of what they have cut, when you weren’t looking.

      The bottom line is now, as it has been since the 2010 general election, “austerity”. A lack of government spending to replace the lack of non-government sector spending. Just be thankful that we are not in the Euro currency system where the problem is the same but multiplied by nineteen different sets of fiscal equations.

      • Narrow Shoulders
        Posted January 11, 2017 at 8:08 am | Permalink

        How much of our taxes would you have spent by government @acorn?

        I would suggest that the problems to which you allude do not reflect the amounts spent on those areas so much as how the vast sums involved are used.

  26. a-tracy
    Posted January 10, 2017 at 8:55 am | Permalink

    How many patients should each GP have registered to them based on a full-time working week? To cover holidays and sickness how many GPs are required to be shared between practices to cover these holidays, sickness, maternity etc. How many do we have in each hospital region in England? Which trusts fall short? If more GPs choose to semi-retire or work part-time do we have double the numbers of staff?

    If we’re taking so many more young, fit, working immigrants all paying their NI why is it a problem to staff up, we are told we need 300,000 to 500,000 extra workers each year to fund our old age care yet we’re seeing our services reported by The Red Cross as a humanitarian crisis.

    The renegotiated GP contract in 2004 stopped most local weekend and night cover, some extra cover was provided in Cities in walk-in centres and as add-on GP led units at A&Es but there wasn’t much extra money invested in it and local surgeries only lost £6k pa per GP to stop doing on-call, the extra clinics were insufficient and stopped many people going for treatment that needed it which put additional strain on the ambulance/paramedic services, are these units all still fully operational?

    Are the third of trusts that are struggling all in the poorest areas? Do they have the same or less spending as other trusts that are successful? Is there a bigger demand in poorer areas? The medical profession are saying frequently almost on a daily basis in the press that it’s down to funding can we transparently see the figures before the whole thing disintegrates and the rich start setting up their own A&E’s and the rest being left to die on trolleys.

    • a-tracy
      Posted January 13, 2017 at 12:13 pm | Permalink

      http://www.telegraph.co.uk/news/2017/01/13/ae-crisis-deepens-58-hospital-trusts-issuing-emergency-alerts/

      Do these trusts have the funds or wherewithal to put out a request to local GPs and other healthcare professionals to work some overtime one day at the weekend, what is Leicester’s attendance record like, is it their staff that are suffering from local flu effects and are funds available for emergency sick cover? |Can’t the local charities be asked to come into hospitals to cover emergency mental health care if it is such a big crisis.

  27. Geof Hughes
    Posted January 10, 2017 at 9:05 am | Permalink

    People go to A&E because the waiting times to see their own GP can be 4 weeks or more.

  28. Bert Young
    Posted January 10, 2017 at 9:06 am | Permalink

    The NHS does vary according to location – as does the ability to see a doctor . Fortunately where I live in South Oxfordshire our local medical practice is highly efficient and the facilities of the hospitals in Oxford are outstanding . There is no doubt that the older generation numbers have increased and do create a considerable extra burden ; equally the expanded population – from immigration and other causes , have also contributed to the load the NHS has to undertake .

    Leaving the EU ought to be a saving grace for the NHS ; some of the funds saved from the contributions we make to the EU should be diverted to the NHS ; when this happens it should also begin with a management and infrastructure overhaul . Managing an organisation the size of the NHS is no easy thing and efforts in the past to create an efficient structure have not succeeded .

    The NHS always features as one of the most significant features in any election programme so politicians need no injection to remind them of its importance . I rank the NHS in the same category as leaving the EU.

  29. alan jutson
    Posted January 10, 2017 at 9:38 am | Permalink

    “The GP should be the gatekeeper to the hospital system”

    Agreed, but the GP system is failing, here in Wokingham at the largest GP practice in Town, getting an appointment involves ringing in before 8.30am (last time I was 36th in line) having already spent 30 mins with the engaged tone trying to get through..

    The GP’s are then protected by a staff gatekeeper who wants to know your symptoms, if they feel you may need treatment, then they arrange for the Doctor to ring you back sometime during the day, who after a telephone discussion with yourself, may, may not, give you an appointment or a prescription based on a telephone consultation.

    The above may well suit some retired people, but does anyone on the way to work want to talk to the Doctor on a train, or in the office, or whilst driving ?

    Clearly the above has been put in place for a reason, and we are told there is a huge failure of people to attend arranged appointments which wastes a GP’s time, and this is the cause.
    If this is so, why not fine the people involved (unless they are a hospital case by then).

    More recently the Practice has now put in, an additional turn up and wait system for those who cannot arrange a same day appointment with a Doctor using the phone system, I have used it once and waited nearly 3 hours !
    I had paid for 2 hours parking in Town !
    Fortunately not spotted, so no fine !

    Agree it should start with GP”s, but they need to sort themselves out first, to make their own local practice service fit for purpose, otherwise its no wonder people will turn up at A&E.

  30. Know-dice
    Posted January 10, 2017 at 9:42 am | Permalink

    I think that the NHS needs to do a bit of lateral thinking around how the public access their services.

    In particular to make the GP, Out of Hours Services, Walk-in Centres & A&E acting together in a more integrated fashion.

    People go to A&E not as a last resort but because they cannot access their GP when they need to. I don’t think it is reasonable that an individual should necessarily be the one that makes the decision as to whether their health issue is minor or critical, even a simple headache could be the sign of something more serious.

    May be out of the normal 9-5 office hours, Triage at A&E could be the first port of call with Triage able to make the decision as to how to route the patient – A&E, Out of Hours, back to GP or take a couple of Paracetamol…

    A&E could have a “back office” ward to act as a buffer between A&E and the main hospital, in order to allow a patient that needs to be admitted to clear A&E quickly before being fully admitted to the main hospital.

  31. John Bucknall
    Posted January 10, 2017 at 9:53 am | Permalink

    “Free at the point of care” is utterly impossible when we insist on delivering an International Health Service. The NHS has outlived its original objectives and is doomed to failure. The same is true of the Ambulance service – one family called them out around 2,500 times last year leading to to just 10 (or so) journeys to hospital. And throwing even more money at an organisation which is so big (1.4million employees!) it is impossible to manage is insane. Charging for health services is inevitable and in my opinion would lead to significant increases in efficiency. I might even get a local hospital in my town of 400,000 people!

    • David Ashton
      Posted January 10, 2017 at 1:33 pm | Permalink

      I fully agree with your comment. Anything which is free will be abused. I believe a fee of £25 to see your GP, and £40 to visit A&E. If the GPs refers you to A&E then the total fee would be £40. There is also a problem with over prescribing. 10% of the retail price of the medicines should be charged, although a maximum cap would be needed.

      Such changes would reduce time wasters, make people think twice about demanding medicines they don’t really need, and more importantly by introducing a cost to ill health provide an incentive to follow a healthy lifestyle.

      • fedupsoutherner
        Posted January 10, 2017 at 6:10 pm | Permalink

        David Ashton.

        There is also a problem with over prescribing. 10% of the retail price of the medicines should be charged, although a maximum cap would be needed.

        Try telling that to the SNP who are quite happy for free prescriptions to be given to all for things like Ibruprofen, toothpaste etc. Utter madness. Let’s not forget the baby box being given out at the moment at a cost of millions. Surely the money could be better spent.

      • Narrow Shoulders
        Posted January 10, 2017 at 7:48 pm | Permalink

        I think the fees you mention could be refunded if you turn up, required an appointment and are eligible for taxpayer funded care.

        The fees should apply on booking the appointment. Benefit receivers have an NHS card which exempts them from prescription charges and eye test costs. These can be used at the time of booking with benefits deducted for no shows to avoid campaigners claiming the poor and vulnerable are being priced out. They will only pay if they don’t show up which seems quite reasonable to me.

        Everyone else can use a credit card and have the funds recharged. The banks and clearing houses can offer the clearing in exchange for taxpayer credit backing which they have been pleased to take.

    • Posted January 10, 2017 at 2:56 pm | Permalink

      Free at the point of care (or indeed supply of anything) rarely works anyway. They have your money already so the incentives on them are to ration, delay, put off, give you the cheapest treatment or fail to treat you at all if they possibly can.

      This is largely what happens in the NHS. It is not a health system it is a rationing system. The BBC and the Politician may claim it is the “envy of the world” or my priority in the letter the N… H… S….. but no one is copying it unless they are mad.

      One thing they should also do is to have no blame limits as to compensation (at low levels but quickly paid out). If you use the NHS you should have to sign up to these.

      If you want more compensation you take your own insurance mate that is the deal.

      This at least would cut out the parasitic ambulance chasing lawyer and all the many people in the NHS and lawyers who defend these actions. Also the time take up by medical staff and surgeons defending them.

      It would also cut out the pain for people in having years of heart rending litigation after event.

    • Lifelogic
      Posted January 10, 2017 at 3:07 pm | Permalink

      Charging is indeed inevitable and would be a good thing. The GPs and Hospitals might actually be keen to see you then rather than treating you as an expensive nuisance.

      • David Ashton
        Posted January 10, 2017 at 6:59 pm | Permalink

        Your comment about patients being a nuisance is spot on. When Blair was throwing money at the NHS about 12 years ago, the CEO of our local hospital was recruiting staff like there was no tomorrow. When the increases in funding came to a grinding halt, they had over recruited and needed to reduce costs. This was done by reducing beds, reducing elective surgery ie. reducing customers. What other business, when it gets into a tight financial situation, believes the solution is to turn away customers. This illustrates perfectly that the way we fund the NHS, and in particular, hospitals is simply crazy.

        • Lifelogic
          Posted January 11, 2017 at 8:03 pm | Permalink

          Exactly.

    • miami.mode
      Posted January 10, 2017 at 3:57 pm | Permalink

      Totally agree JB. While ever the NHS is offered for free there will be a queue for it. NHS dentistry has proved that even with charges there are waiting lists.

      There should be charges for visits to GPs and for visits and stays in hospital for everyone and, in line with the current system for NHS dentistry and optical services, the less well-off can pay a reduced rate if it has been pre-approved.

      In today’s world £20 or £30 would not be an unfair price for a visit to a GP with perhaps a reduced figure for any follow-up visits relating to the same illness.

      However, it’s all about political will.

      • David Ashton
        Posted January 11, 2017 at 6:40 pm | Permalink

        Fully agree Miami, but a higher charge has to be made for A&E otherwise folk will use that rather than their GP. Also a ‘hotel charge’ needs to be made for stays in hospital to cover food, a cost you would have to bear if you were at home. This would have the additional advantage of improving the quality of the food.

  32. alan jutson
    Posted January 10, 2017 at 10:07 am | Permalink

    “We offer free emergency provision to anyone in our Country”

    Do you not see a potential problem with this.
    No wonder we get health tourists and pregnant women arriving here. !

    “New migrants to the UK should seek Doctor registration for the free NHS as soon as they have legally settled here.”

    Do you not also see a real problem with this, given some who settle here may have elderly people as part of the family, or who maybe in dire need of some medical treatment on arrival.

    No wonder the NHS is running out of funding !

    We need a sensible cross party resolution to the above simply to protect the system.

  33. graham1946
    Posted January 10, 2017 at 10:33 am | Permalink

    Blame the elderly? Lack of planning is the real cause. The same issue as with lack of power stations. The elderly have not suddenly come down from outer space, it has been known for donkeys years that people are living longer and there is a bulge with the ‘baby boomers’ coming on. By 2030 there will be a lot more over 80’s. Will this come as a shock to the government?
    See a GP? Have you tried it Mr R?. My local town’s two surgeries have closed their lists and at the moment are offering appointments in 4 weeks time. There’s your problem – solve it, it’s what we pay you and Mr Hunt for. Don’t keep pushing the blame onto the people and the NHS. We pay, we deserve the treatment. More than enough tax is collected to do all that needs to be done already, just the political will is needed.
    Get rid of the 4 hours target time? Another government way of fiddling the figures to look better at PMQ’s and totally useless, as usual. Charge the drunks who turn up at A&E for their treatment and you’ll soon solve a good bit of that problem.

    It’s hardly surprising that with the thick end of 2 million more people here since 2010 things are getting worse and when cuts are being made to social care. The government says it is spending more, but what about per capita? Does anyone have that figure? It always seems that money is promised for the future, never for the crisis now. Health in this country is done on the cheap. Yes it’s a great deal of money, but at least 2 percent of GDP short of what most other developed economies spend, whilst we fritter billions on Hinckley, HS2, greencrap subsidies, foreign aid etc. . Time for politicians to get a grip and stop living in the la la land of Westminster. What is more important than the nation’s health? Without it, there’ll be no ‘economic miracle’.

  34. Posted January 10, 2017 at 10:34 am | Permalink

    Since when was flying into the UK from Nigeria to have a baby an emergency? This seems to be a regular event at one South London hospital and the system seems quite happy that it continues with no chance of collecting payment and, presumably, a child which presumably can claim UK citizenship.

    • JJE
      Posted January 10, 2017 at 12:38 pm | Permalink

      That citizenship by birth only works in the US and even there it’s a relic of the abolition of slavery.

    • Jagman84
      Posted January 10, 2017 at 12:45 pm | Permalink

      You will probably find that no attempt is ever made to recover the costs of the treatment. The NHS was captured by Socialism at it’s conception so any demand for recompense is considered “inhumane”. I have personally witnessed such events at my local hospitals so it is probably widespread.

      • Iain Gill
        Posted January 10, 2017 at 4:00 pm | Permalink

        A lady from the USA I know had a baby here. She actively tried to pay. She gave up eventually as it was just too hard to get them to accept her money.

        • Lifelogic
          Posted January 11, 2017 at 8:04 pm | Permalink

          Indeed typical. I was never billed for something even though I live abroad and had insurance to cover. The NHS is a sick joke.

    • Dennis
      Posted January 10, 2017 at 2:45 pm | Permalink

      “presumably, a child which presumably can claim UK citizenship.”

      No that’s been stopped now – still available in the USA for US citizenship.

      • Iain Gill
        Posted January 10, 2017 at 4:01 pm | Permalink

        True. But in practise you will never get kicked out of the country if you were born here.

        • Lifelogic
          Posted January 11, 2017 at 8:05 pm | Permalink

          Indeed, but they almost never kick anyone out.

    • Posted January 10, 2017 at 3:00 pm | Permalink

      Indeed, not that I blame the Nigerians I would probably do the same in their circumstance. They are behaving rationally given the system that prevails.

      It is the NHS that is at fault yet again.

    • Chris
      Posted January 10, 2017 at 7:26 pm | Permalink

      Until the Government itself calls time on this sort of activity then it will not cease. Up till now it has been Farage or Professor M Thomas, or a few other brave individuals, who have highlighted the disgraceful situation.

    • hefner
      Posted January 11, 2017 at 10:51 pm | Permalink

      Since Mrs T, any child born of EU parents is not British. The child will have to wait till he/she is 18 years old to be able to apply for British citizenship.

  35. Lifelogic
    Posted January 10, 2017 at 10:41 am | Permalink

    What few people seem to point out is that making people wait 4+ hours really does not save the NHS as a whole any money anyway. It can even cost more due to the need to manage the queue the irritation caused and deterioration in the condition need more interventions. If you get the system and match staffing to periodic demand correctly it costs no more to work with no queue.

    If your just brought in a small team in for a few hours (to clear the circa four hour backlog) then going forwards the existing staff should be able to continue with no queue while doing no more work than they were before with the queue.

    It is the system that is at fault and management/politicians that haven’t got a clue and do not really care much anyway. Not my money not me using the “service” or getting the value mate

    Broadly the same work has to be done in the end, be there a queue or no queue. The delays may also make the condition more serious and costly to treat in the end.

    What is really going on is a battle between GPs, casualty departments and other parts of the NHS to pointlessly push people from pillar to post. This needs tackling by making the money reward the people who actually perform rather than as now the people who deter and inconvenience best! It is the system that is broke.

    The hospitals and GPs need the right incentives. The NHS needs to take a global view and endure the right incentives exist. As of course does government in general pointless pushing from pillar to post goes on in government all over the place.

  36. ferdinand
    Posted January 10, 2017 at 10:48 am | Permalink

    Extended personal experience of these pressures over the past twelve months support two facts : far too many people are attending A&E with petty conditions needing home medication only, and far too many foreigners are visiting the country simply to benefit from the NHS. These are the two factors causing the greatest pressure. I am sure Jeremy Hunt is well aware of both but resolving them will require guts and skill. I am sure he has those qualities.

    • Lifelogic
      Posted January 10, 2017 at 3:09 pm | Permalink

      Well they might well need the medication, it might only be available on prescription and they perhaps cannot get a convenient appointment to see their GP.

      • Len
        Posted January 11, 2017 at 1:53 pm | Permalink

        Or, they cannot even register with GP who might be overwhelmed due to spending cuts and “refugees”. I have been trying for over 3 years to register with GP, unsuccessfully. Every visit to surgery to try and register I was left waiting for unacceptable lengths of time while majority of non-English speaking patients were endlessly coming and going to see the doctors.
        Being white 65 yo British I guess I am less of PC priority.
        Yes, I’m all for charging ALL non British for the use of NHS.

  37. Antisthenes
    Posted January 10, 2017 at 11:04 am | Permalink

    The NHS and it’s problems are so regularly aired it surprises me that no one with power and influence that is has opined that the service is no longer fit for purpose(probably has never been) and radically new thinking needs to brought to bear on how to address the root causes of it’s problems. Instead just patching up the same broken bits which are numerous is advocated. Whilst the blinking thinking that “it is the envy of the world”, it just needs better management and more money poured into it is the solution then reading about the problems will continue unabated until it sinks because society has run out of money to keep it afloat.

    Pin pointing the problems emanating from the poorly performing NHS is easy and so are the causes. They are that the use of resources and labour are inefficient, wasteful and the embedded culture favours the employees at the expense of the customers (patients). This has come about because it is believed it being a universal public service it can only be provided by the state which is the opposite of the truth. Coupled with legislation especially the minimum living wage and minimum qualification requirements plus a raft of others. That lead to expensive and unnecessary labour costs, lack of incentive to innovate and a monopolistic environment where the need to provide the best service is not a prerequisite to ensure it’s survival.

    As it stands as I have said earlier only money keeps it going (much of that wasted) and as even that is finite despite the left’s magic money tree it is no solution in the long run. Also as I have said before the answer is to change how health care is funded and provided. Break it’s monopoly and open it up to competition and thereby create incentives so that it uses labour and resources wisely. Make the individual more responsible in the way he/she uses the service and the medical practitioner’s work ethic be based on their productivity. By the simple expedient of the patients making a direct contribution as well as the state for their treatment and the medical practitioner income directly related to that payment.

    For those who say none of that can be done as the service would deteriorate and the less well off would suffer. I would counter that it can and is being done in other countries with the effect that the service instead of deteriorating is many times better. The less well off do not suffer as simple safeguards in the system avoids that. If we want an NHS that is fit for service we would do well to learn from others how to effect that and France probably a good place to start.

  38. Lifelogic
    Posted January 10, 2017 at 11:24 am | Permalink

    William Hague says EU workers yes. Benefits no: My terms for Brexit if I were PM in the telegraph today. One assumes he has been given the non by T May. It amounts to little more than a slight improvement on Cameron’s dire EU non-deal that he tried to con the nation with.

    It is nothing like enough we need real Brexit and real control. We need far more in the way of quality control over incoming workers. People earning low wages are a net liability to the state and lower gdp per cap, even if they are working. They also depress the wages of other. They require housing, health care, police, education for their children, roads, defence, social services ………We need to attract only certain higher skilled, higher paid or wealthy self sufficient workers.

    There should be no (racist) preference given to EU worker over any others. We need to give points for speaking english, likely earnings, no criminal records, good health, age, personal wealth, dependent relatives, relevant skills, qualification and experience. But May has ruled out “points” for some mad reason. Well let’s just call them merits instead.

  39. Graham
    Posted January 10, 2017 at 11:32 am | Permalink

    GP as gatekeeper for A&E?

    Job done then as it’s getting increasingly difficult to get an appointment. Around here the sick have to personally queue in the surgery at 0730 every morning. Don’t bother phoning it won’t work.

    Why is it not possible to book an advance appointment for non urgent afflictions surely one doctor can be put aside for this.

    • fedupsoutherner
      Posted January 10, 2017 at 1:47 pm | Permalink

      Graham

      Please let us all know the area you live in so we can avoid it like the plague.

    • hefner
      Posted January 10, 2017 at 2:10 pm | Permalink

      Such an advance booking system exists. It is called PatientAccess. There is an app you can put on your smartphone or computer (iPhone/iPad or Android). You usually get the possibility of booking an appointment with a GP within your surgery within 10 days to 3 weeks. I have used it now for three years for all of the family’s non urgent afflictions. I find it to work well.

      • Beecee
        Posted January 10, 2017 at 4:36 pm | Permalink

        It also works excellently in my area.

    • Lifelogic
      Posted January 10, 2017 at 3:03 pm | Permalink

      Because the NHS is about putting you off not about treating you. They have your money already, so patients are just a nuisance to be deterred, delayed and put off as much as possible.

      • Iain Gill
        Posted January 10, 2017 at 4:09 pm | Permalink

        Correct.

        Its the only place that gets away with putting posters up telling customers to go away.

        • Chris
          Posted January 11, 2017 at 9:17 am | Permalink

          True, IG, and quite staggering. I feel the people who run the NHS need a Trump to sort them out.

          • Lifelogic
            Posted January 11, 2017 at 8:06 pm | Permalink

            Drain the swamp as he might put it.

        • Lifelogic
          Posted January 11, 2017 at 8:43 pm | Permalink

          Indeed last time I was at Adenbrookes about A year ago (visiting a elderly relative) that was exactly the position and the parking was a rip off too.

          What they seem not to understand is that the patents and often even the doctors often cannot tell what is an emergency or not, until they investige and do relevent test and scans. Many people are even discharged only to die shortly after.

  40. Lifelogic
    Posted January 10, 2017 at 11:37 am | Permalink

    Also in the telegraph the Editorial today:- Mrs May must stand up for free speech.

    Well we shall see. She has got nearly every one of her decisions wrong so far since taking over, let’s hope she at least gets this one right.

    • bigneil
      Posted January 10, 2017 at 12:32 pm | Permalink

      Free speech is only for non-English non-white people. Anyone else can come to our country, live completely off our taxes, then get with his buddies and march down our streets ( with police protection and traffic chaos ) while calling for the slaughter of all those who aren’t of their religious persuasion. Let just one, who is not of their group, do the same – they will be arrested instantly.

    • rose
      Posted January 10, 2017 at 1:26 pm | Permalink

      At least the Justice Secretary made an attempt to defend the free press when being bullied to condemn it. (Over the High Court ruling in favour of the people who are trying to overturn the referendum and would presumably be the sort of people to use the courts to get newspapers shut down for not toeing the line.)

  41. Lifelogic
    Posted January 10, 2017 at 11:39 am | Permalink

    Corbyn seem to heading towards a cap on earning for top workers. Not a good idea. What is needed is far better shareholder control mechanisms over top pay.

    Doubtless Theresa Miliband will favour the former approach given her record so far.

    • Iain Gill
      Posted January 10, 2017 at 12:00 pm | Permalink

      With a cap on earnings many rock stars etc would simply go to another country, with a massive loss of tax revenues for this country. Corbyn is clueless.

      • Lifelogic
        Posted January 10, 2017 at 7:16 pm | Permalink

        He is indeed clueless but I am rapidly coming to the conclusion May is too. The low pay controls they seem to approve of are also hugely damaging.

      • hefner
        Posted January 11, 2017 at 11:03 pm | Permalink

        Maybe yes maybe no. Remember 1966, Taxman, George Harrison, the Beatles “it’s one for you, 19 for me”. If the Rolling Stones moved later on to the French Riviera, the Beatles stayed in Britain. Why do you think the present-day “rock stars” would all move to another country? They might simply move their assets to one of the (so often British-“sponsored”) “treasure islands” (Isle of Man, Jersey, Guernsey, or further afield Virgin Islands, Panama, …).
        I think many more than Corbyn are “clueless” here.

    • Bob
      Posted January 10, 2017 at 12:03 pm | Permalink

      @lifelogic
      If the millions of small shareholders whose investments are held in ISAs, pensions and mutual funds were given the right to vote their shares, it would likely result in far fewer obscene pay & bonus awards.

      Presently, the fat cats who run the mutual funds (who are dining & golfing buddies with the fat cats in the footsie companies) will either not vote the shares or vote with the management, which is why such large remuneration awards are possible.

      The reason the govt allow this situation to continue is because the fat cats make large donations to political parties.

    • JJE
      Posted January 10, 2017 at 12:42 pm | Permalink

      Yes including empowering those of us who hold their shares in nominee accounts to vote as applies everywhere else in the world except Eire.

    • miami.mode
      Posted January 10, 2017 at 4:11 pm | Permalink

      LL. How would the Corbyn Cap apply to the outside earnings of MPs?

    • hefner
      Posted January 10, 2017 at 5:43 pm | Permalink

      Agreed. Make remuneration committees include representatives of the entire range of shareholders (pension funds and other institutional sales but also private ones). Make the decisions of these committees enforceable and make sure they are enforced. There are too many CEOs losing money for their shareholders who still see their pay packages increase.
      Apple’s Tim Cook appears to have lost roughly 10 percent of his year’s package following (relatively) bad results in 2016.

  42. Original Richard
    Posted January 10, 2017 at 12:19 pm | Permalink

    The NHS and benefit system will collapse and become privatised/insurance based/contribution based if our leaders to not curb the current high levels of immigration.

    It is inevitable.

    With our ‘free at the point of service’ NHS we should not allow non-EU nationals to come to the UK without medical insurance, and, when we exit the EU this should also include all EU nationals from countries who do not offer our citizens ‘free at the point of service’ care in their own countries.

    Valid medical insurance can be checked by the airlines and ferries just as they do for a visa.

  43. David Tomlinson
    Posted January 10, 2017 at 12:28 pm | Permalink

    As so often, it is the quality of management which determines the quality of outputs. I’m registered at an inner London surgery in what is allegedly one of the most deprived LAs in the country.
    The great majority of patients there are either Portuguese (EU migrants since 1994) or Somali refugees.
    The surgery runs an online appointment booking service which works well for appointments 5-7 days ahead. Urgent appointments are harder – phone line opens at 0800 and you have to call repaeatedly to get through but you will within 15-20 minutes and get a same-day appointment. If a visit is not necessary you will get a timed (within a 2 hour slot) call back from a GP for a telephone consultation in the next 24 hours or so. I’ve never known it fail.
    Repeat prescriptions are available with online request and transmitted to the local pharmacy for collection.
    When I called in a couple of times before Christmas I commented on how few people were waiting. “They’re all shopping” I was told – amazing how people’s illnesses depend on alternative priorities. I happen to know that in fact many Portuguese will have been back at home in Portugal (especially the home island of many – Madeira) for an extended Christmas holiday.
    After Christmas there was so little call for appointments that the online service was offering them next day.
    My daughter is an A&E nurse. She has spent two years at a major nationally renowned trauma centre outside London. Over Christmas she temped at an equally renowned London teaching hospital. She confirmed they were desperately short of beds to move patients to out of resus and then A&E, but she said it was worsened by the poor quality of management in the London hopsital compared with what she was used to.

  44. Sue Doughty
    Posted January 10, 2017 at 12:31 pm | Permalink

    New immigrants need to register with a local surgery. And they need to be taught road sense – many are from countries where there is little or no traffic, they don’t know how to use zebra crossings and do not know about traffic lights. That would save so many ending up in A&E.

    • Len
      Posted January 11, 2017 at 2:02 pm | Permalink

      Not having them here would save lot more and give Brits better service. After all, WE are paying for NHS. We are perceived by international scroungers as treasure island with free everything they want. It MUST stop.

  45. Posted January 10, 2017 at 12:35 pm | Permalink

    Anyone who has been to A&E late at night will tell you that their worries are compounded by the huge number of drunks and their companions creating havoc. Staff and patients are intimidated and treatment is delayed. Police are reluctant to take miscreants into custody in case they harm themselves or suffer other alcohol-related effects.

    I read about one area that has set up separate centres to deal with these people, staffed by medical and police workers, freeing A&E staff to care for the genuinely sick. I would like to see a law officer in attendance too, to make sure that drunks are charged – as they used to be – with being drunk and disorderly – and expected to be in court the next day to pay fines well in excess of the cost of their treatment.

    As for foreign users of the NHS: I never go abroad without travel insurance. Could incomers not be expected to produce an insurance certificate at passport control? No insurance – no admittance. Presenting fake documentation prior to any treatment could be punished with a fine well in excess of any treatment costs.

  46. Richard1
    Posted January 10, 2017 at 12:38 pm | Permalink

    What happened to the NHS drop in centres? These were a good way of getting care for minor ailments without having to queue for weeks at a GP or block up A&E. I think the coalition must have closed them. A certain use of common sense would also be helpful. E.g. It was once reported that Andy Burnham when Health Secretary had come up with the excellent idea of charging drunks who show up to A&E. Gordon Brown apparently shot it down as it offended the religious principle of the NHS always being free no matter how culpable the user. Such an idea would have huge support in the Country and Mr Hunt needs to get bolder and more radical to knock some sense into the system.

    • Iain Gill
      Posted January 10, 2017 at 4:11 pm | Permalink

      They don’t help the clinical commissioning groups tick any boxes so they wont pay for them. You see its all about box ticking and not what is best for patients.

    • Qubus
      Posted January 10, 2017 at 6:12 pm | Permalink

      They still exist. There are several in Sheffield for example.

      • Richard1
        Posted January 11, 2017 at 2:09 pm | Permalink

        I just checked – the nearest to me is 1 hours drive away!

    • Deborah
      Posted January 11, 2017 at 1:15 pm | Permalink

      In the good old days, drunks didn’t tend to show up at A&E. Back then, drunks were arrested as drunk and disorderly and taken down the station for the night – providing an excellent deterrent.

    • Lifelogic
      Posted January 11, 2017 at 8:48 pm | Permalink

      Charging the drunks and drug addicts seems rather a good idea. At least they would have rather less money for their addictions the next weekend.

  47. Michael Wood
    Posted January 10, 2017 at 12:51 pm | Permalink

    In early November last year, on a fine autumn day, I was thinking about how fortunate I was. I am 75, in good health thankfully, and not having to take any medication.
    Also I usually get a lot of exercise, walking, by taking out my disabled daughter in her wheelchair for miles at a time, cycling and occasionally playing table tennis.

    For those of you getting bored already, please bear with me, as this is about the NHS.

    On 2nd November I went to play table tennis at a local village hall for the first time in two years – although I had been playing elsewhere also. I had only been there for about ten minutes, when I fell heavily on my right side, while trying to hit the ball hard.
    I soon realised that I wouldn’t be doing anything energetic for a long time and couldn’t get up unaided. I was driven home in my car by a friend and my wife called an ambulance. By 8pm that night I was in Bronglais Hospital, their A and E department and found out that I had cracked my hip and would need a total hip replacement.

    I had the operation 48 hours later and was out in just under a week. I cannot fault the care I received and am about to write a letter to the General Manager thanking his staff for looking after me so well.

    However, I often wonder what might have happened if I lived in a major city or suburb.

    Of course, I will never know but recent comments on blogs do suggest I may have had a ‘near miss’

  48. Posted January 10, 2017 at 12:54 pm | Permalink

    You make it all sound very easy! The chaos in the NHS over Christmas underlines the futility of allowing uncontrolled access to a service for which there is infinite demand. Those who cannot afford to pay should of course have free health treatment but there is a crying need for realism over what can be provided and this should be the subject of review leading to a reform of how the NHS is funded and this must be by those who can, contributing directly. If this is not done the system can only collapse.

  49. fedupsoutherner
    Posted January 10, 2017 at 1:52 pm | Permalink

    And then we have that idiot Corbyn telling us he is happy with the level of immigration. Has the man completely lost his marbles? Then there are the visitors who take advantage of our NHS. Having babies over here. Whatever happened to the rule you can’t travel by air over 28 weeks pregnant? All those nurses in hospitals where they are happy to treat these people are a disgrace. Our waiting times are getting longer while we treat foreigners. We pay and they take advantage and sometimes precedence over us. In some areas people are going to A&E because they cannot get appointments with their doctors. What happens if you have a lump in the breast or something similar? Are you going to be happy waiting around for weeks before even seeing your doctor? No. People just get fed up and go to the hospital. The NHS will always struggle when our population is rising at the rate it is John. A cut in immigration numbers cannot happen too soon.

  50. Healthy foreigner
    Posted January 10, 2017 at 2:09 pm | Permalink

    Why do you British need so much hospital? There must be something wrong with you!

    • Len
      Posted January 11, 2017 at 2:05 pm | Permalink

      Yeah, we allowed to many foreign scroungers in.

      • Healthy foreigner
        Posted January 12, 2017 at 1:12 am | Permalink

        So you did it for a few months then stopped it? One year? Two years? Three years? Four years? More? Too sick to have elections?

  51. Juliet
    Posted January 10, 2017 at 2:10 pm | Permalink

    NHS needs to be reform:
    – the “free at the point of care” is not sustainable with increasing population from EU migration & immigration
    – A&E should be for emergencies not extension of GP backlog

    Health Tourist Debt
    – recoup in full non-payment of treatments from EU27 countries and non-EU countries
    – emergency care insurance should apply to health tourist as it does for tourist (elderly, maternity)

    Automate Admin Roles:
    – reduce cost, waste and inefficiencies across the board
    Reduce non-medical management roles
    Embed non-medical roles in business practices:
    – diversity & inequalities doesn’t need a manager to facilitate

    Introduce migrant healthcare insurance:
    – restrict free access & treatments for migrants unless they have been resident in UK of 11 years progressing to become naturalised British Citizens

  52. At a stroke!
    Posted January 10, 2017 at 2:42 pm | Permalink

    Aspirin 75mg Gastro-resistant tablets Enteric-Coated ( 28 in the packet )
    Merely a quarter sized regular aspirin which is coated so it does not dissolve in the stomach but lower in the digestive system, avoiding stomach upsets for regular users.

    Price on the internet..anything from 75p to £3-50p. In a chemist near my doctor..”Oh!”, he said as did his female assistant ” I’m not sure if I have any..they are for heart trouble aren’t they? ” He then went into his small store room. “I have two packets left..they were for another customer but he cancelled.”Price £8.50p for two packets taped together.

    MPs and Mr Hunt should sort out the little problems in the NHS and accompanying facilities and the big problems may take care of themselves. Also get doctors to agree if aspirin is OK. They throw tantrums with one another and get quite upset about the answer about a drug which has been in regular use throughout the world for decades. In just two months the NHS advised against it then advised it was OK. ( right at the top. ).
    What a joke! And they are hazy about cannabis usage. We should stop praising the medical profession to the ceiling.

  53. Dennis
    Posted January 10, 2017 at 2:54 pm | Permalink

    Seems no one sees the extra calls on the NHS is due to overpopulation. Perhaps it is now illegal to mention it but I’m not in jail yet.

    • rose
      Posted January 10, 2017 at 6:35 pm | Permalink

      All our current problems are due to overpopulation. The situation in the NHS, the prisons, the schools, the trains, the London underground, the roads, housing, the traffic, mental health, pollution… all are symptoms of the national emergency which dare not speak its name.

      • Chris
        Posted January 11, 2017 at 9:21 am | Permalink

        Quite, and until Theresa May et al actually admit the cause of the problem then there is not a hope that the problem will be tackled properly and solved. That is why I believe we need a Trump approach to the whole issue. Of course Farage was not afraid to speak out about the real problem but, as in the US with Trump, the political elite and the media rounded on him and relentlessly smeared him and his 4 million voters.

        • Lifelogic
          Posted January 11, 2017 at 9:01 pm | Permalink

          Theresa May presided over this increase, for many years, as Home Secretary. This while pretending to be aiming for net migration in the tens of thousands. She also lied to referendum voters that they had control of UK borders while in the EU, under Schengen.

          Can she be trusted now?

      • Posted January 12, 2017 at 11:21 am | Permalink

        Well Said Rose

        I submitted a post along these lines to the Times the other day using very reasonable language asking why no politicians are prepared to stand up and tell the truth about all these problems.

        It was removed.

        QED

  54. colin Watson
    Posted January 10, 2017 at 3:27 pm | Permalink

    John

    I total agree with your post. My wife is seriously ill and we have attended A and E many times the most recent just after new year. We have just written to the CEO of the Royal Berks in Reading to say what an amazing job there are doing under considerable pressure. We have always known that on attendance we were safe, would get the appropriate help but may have to wait at times. That may be an inconvenience but only that.

    Our experience in Scotland (my home country) was in stark contrast. At A and E and being told my wife’s condition and presenting with a temperature of 103 she was made to wait an hour to be seen. Had three days in hospital with the worst food imaginable. Not to forget the ward of six ladies having no toilet paper for two days. Medical care great support appalling. Mrs Sturgeon needs to stop winging on about the EU and another vote and support the people in a very basic requirement.

    • miami.mode
      Posted January 10, 2017 at 4:24 pm | Permalink

      Colin

      …….Not to forget the ward of six ladies having no toilet paper for two days……..

      Unfortunately this reflects rather poorly on their relatives/visitors who could quite easily and fairly cheaply have provided toilet rolls, but at the same time exposes the fact that many people simply expect the state to provide everything.

      • Iain Gill
        Posted January 12, 2017 at 8:17 pm | Permalink

        Fairly high percentage of patients are far from home on their own.

  55. Mike Wilson
    Posted January 10, 2017 at 3:35 pm | Permalink

    I wonder what percentage of the NHS budget goes to paying pensions.

    And, what is the percentage of medical staff to non-medical staff?

    And the costs of the non-medical staff compared to the costs of the medical staff.

    The endless cry that the NHS is under-funded make me sick. How much more tax do people think we should pay? I already hand about half of my earnings to the government by the time I have paid income tax, national insurance, VAT, council tax, duties on fuel, car tax and other sundry taxes.

    It is high time we moved away from income tax, national insurance, VAT, council tax duties on fuel, stamp duty, inheritance tax etc. and simplified tax in one stroke by moving to a Land Value Tax. Then, the 6000 that own 70% of the land would pay 70% of the tax.

    • Qubus
      Posted January 10, 2017 at 6:32 pm | Permalink

      Yes indeed.
      JR, could you perhaps provide us with a breakdown of where all this money goes? I am fairly sure that more than 50% goes on salaries. How much goes on pensions? How much goes on PFI payments? How much goes on medicines? Why can’t a national scheme for purchase of drugs, instruments etc be organised? How much goes on re-employment of previously employed executives?
      A free health service is bottomless pit; as medical procedures
      get more sophisticated, they get more expensive, additional so, since the patients, praise be, live longer.
      I find it a disgrace that the UK, what is it the world’s fifth biggest economy, cannot produce enough medical staff, doctors and nurses, to meet our needs. importing staff from abroad merely impoverishes their country of origin.

      • rose
        Posted January 11, 2017 at 10:19 am | Permalink

        And how much on litigation?

        • rose
          Posted January 11, 2017 at 6:36 pm | Permalink

          I believe a fair number of the 6 million British people who now live in less crowded countries are doctors and nurses. I am always hearing of medical staff leaving for Canada or Australia because of the overcrowded conditions here and the resulting strain on the staff in the NHS.

    • Longinus
      Posted January 10, 2017 at 6:32 pm | Permalink

      Assistant Director of Equality and Diversity
      Job Reference: 349-COR-0663

      Employer:Central Manchester University Hospitals NHS Foundation TrustDepartment:Equality & DiversityLocation:ManchesterSalary:£46,625 – £57,640 per annum (pro rata)

      My father had to wait 4 h for an ambulance to arrive after he fell at 4 am and broke his pelvis a week ago. In severe pain the whole time.

      • Lifelogic
        Posted January 11, 2017 at 9:04 pm | Permalink

        Yeah, but I am sure he understands how vitally important diversity officers are!

    • Leo Savanttgmail.com
      Posted January 10, 2017 at 6:49 pm | Permalink

      If you are working in the UK your total tax penalty is more like 75%, which is far too high, but your suggestion, which amounts to taxing people for the land they live on, has some very nasty but presumably unintended consequences.

      If those with a low income are taxed in such a manner they could become homelessness and it seems more than a little immoral to tax people without any relationship to their ability to pay. Many own a home on land which has gone up in value, due mostly to high demand (immigration) and deliberate government policy to inflate the housing market; but this in no way ensures an ability to pay tax. With a land tax farming would also become even more unsustainable and the tendency for people to be crammed into even smaller homes would increase.

      If people have to sell their homes to pay tax, they could become homeless, costing the state even more and causing misery to the individuals. Furthermore taxing something discourages it, which is why tobacco is so highly taxed; it stands to reason that taxing wealth and assets, such as land, will discourage their ownership. There then will be more poorer people who will forever be tenants and most probably far greater expense for the state as a direct consequence.

    • Lifelogic
      Posted January 10, 2017 at 9:22 pm | Permalink

      Indeed they spend nearly 50% of GDP yet deliver almost nothing of value in the way of real public service.

  56. Iain Gill
    Posted January 10, 2017 at 3:50 pm | Permalink

    This whole approach also misses that in this country the only places capable of doing tests immediately is the local A & E.
    For example, Is you ankle badly strained or broken? Turn up at a GP and any decent GP will send you straight to the local hospital to have an X-Ray anyway. That GP consultation is a complete waste of everyone’s time, you may as well have gone direct to the only place where you get an X-Ray. So “bad accident or a serious looking medical condition” is wrong! You may only have a 10% chance of having a broken ankle, but you will never know without an X-ray, and if you are in the 10% and don’t get the correct treatment you risk being crippled for life.
    Same with many things, part of our problem is we waste too many resources on un-necessary GP appointments, and the need for their referral, when often the patient knows exactly which specialist they need to see. Got an eye injury? Pointless going to see a GP. Got an inflamed mole that maybe turning cancerous? Pointless going to see a GP. In many other countries patients can self refer, and this would cut a lot of the waste in the bureaucracy we have here.
    Trying to blame the patients for the rubbish way the NHS is setup and is incentivised is completely the wrong way to look at things.

    • Iain Gill
      Posted January 12, 2017 at 9:35 pm | Permalink

      Indeed one consultant cannot refer you directly to another specialty, they have to write to the GP and ask them to do it. A complete and utter waste of everyone’s time.

  57. Chris
    Posted January 10, 2017 at 4:28 pm | Permalink

    O/T but I have just picked up Philip Hammond’s comments as reported by the BBC, in Conservative Home newsletter. How can these be compatible with the vote to leave the EU. We voted to leave the EU meaning leaving the Single Market, as made abundantly clear by Cameron. Osborne et al. It is quite ridiculous and unacceptable that we are being kept on the end of a long string with different interpretations by different members of government of what Leaving the EU meant/means. The single market issue was one of the things that was made quite clear before/in the run up to the Referendum.

    Quote from Conshome newsletter:

    “Britain has not made any decision on whether or not to stay in the European single market after Brexit, says the UK Chancellor, Philip Hammond. The chancellor made his comments in an interview with the Irish broadcaster RTE. “We haven’t made any decision on which structures would best support our aspirations,” he said. “Whether it is being in or out of the customs union, in or out of the single market,” he added.” – BBC

    • jane4brexit
      Posted January 11, 2017 at 3:46 pm | Permalink

      You may know this already Chris but for anyone who doesn’t, if you watch PMQ’s 15th June the last one before the referendum (3rd question before end), or read the questions and answers in Hansard on that date column 1759, the PM was asked by Nigel Adams MP whether there would be a 2nd referendum and what would happen after the British people voted in the referendum.
      The answer was”… “out” means out of the eu, out of the European Single Market, out of the Council of Ministers out of all those things ……To anyone still in doubt – there are even members in the House still thinking about how to vote – I would say: if you have not made up your mind yet, if you are still uncertain, just think about that…”.
      So there is no excuse for any MP’s not to know those facts and I find it hard to believe that so many do not.

  58. Chris
    Posted January 10, 2017 at 5:06 pm | Permalink

    I agree with all of your comments. However, last time I rang up for a GP appointment I was told the first appointment I could have was in 3 weeks time. No questions were asked about what the appointment was for, nor was I told if it was something urgent I could be seen earlier. I think these sort of issues must be affecting the pressures on A&E.

    • rose
      Posted January 11, 2017 at 6:59 pm | Permalink

      When I rang I was told to ring back in a week because they weren’t making appointments more than 3 weeks ahead. In other words go away. No use remonstrating. That was the Practice Manager’s decision.

    • Chris
      Posted January 11, 2017 at 8:51 pm | Permalink

      This is a different “Chris” writing the above comment about GP appointments. Please, Mr Redwood, can you ensure that my ID cannot be used by other people. I have been registered on this site for some years as Chris, and I do not want to have posts/comments attributed to me incorrectly.

      Reply i cant stop someone using the name Chris which is a common enough name

  59. John
    Posted January 10, 2017 at 5:37 pm | Permalink

    With net migration nearing 350,000 a year and a higher birth rate from first generation migrants we can’t keep up with the increase in demand.

    What is amazing by its absence from mainstream media is that the demand is mainly from the increase in the population. The indigenous population is not increasing, they like to tell us that frequently themselves. We need to restrict number coming in.

    I am seeing more and more people who are not speaking English but have serious medical problems. For instance a 35 to 40 stone eastern European in a mobility scooter, perhaps in his 30s. What work did he come here to do? I’m seeing too many of these to think that we are not a draw for those with serious medical issues and prepared to give treatment and equipment for free.

  60. alte fritz
    Posted January 10, 2017 at 5:51 pm | Permalink

    My experience is that GPs and out of hours doctors push patients towards A & E as the easy option. Empirical evidence, I know, but real.

  61. Leo Savanttgmail.com
    Posted January 10, 2017 at 6:29 pm | Permalink

    A number of comments suggest or demand that the NHS should charge us for both hospital and GP visits. The problem is that we are already being charged, via taxation, for both our own visits and for the visits made by non UK taxpayers.

    Non UK taxpayers should be required by law to hold approved health insurance at the point of entry, if they don’t they should be offered the opportunity to buy a policy there and then. Failing that they should be denied entry. Many countries do this, including European ones such as the Republic of Macedonia, which like the UK has an overstretched national system of health care.

  62. Colin Hart
    Posted January 10, 2017 at 6:55 pm | Permalink

    I have just been listening to an item on the radio about the pressures on A&E. It seemed to be entirely about people who had taken drug overdoses or addicts threatening to do themselves in. Tells you something.

    Meanwhile my wife and I are managing our Queen’s Colds with self-medication and staying in wasting our time on the internet.

  63. Fragile Brit
    Posted January 10, 2017 at 7:48 pm | Permalink

    “You are weak, weak!” a Belorussian woman told me as my being a generic example of British.
    “You are spoilt!” an Afrikaaner/British South African woman told me as my being a generic example of British.
    “You wouldn’t stand a chance, you wouldn’t survive in Northern Ireland!” a Northern Ireland woman told me as my being a generic example of British.
    By the way, this was said to me in reality. I look like a Lib Dem in seaside shorts.

    Overseas aid should continue until they reach an adequate level of education. We don’t need the NHS as much as the foreigners employed therein maintain.

  64. leila young
    Posted January 10, 2017 at 9:45 pm | Permalink

    The country needs a visionary leader which (the PM) is most certainly NOT.

  65. 37/6
    Posted January 11, 2017 at 9:17 am | Permalink

    Why don’t young doctors want to become GPs ? Because they have to buy into a practice and run it like a business. Not good when you already have £100k student debt and can’t rent a decent flat.

    Dare I say it. Not enough boys are being trained to be doctors. They are less likely to go part time or take leave to raise children. Tactless but factually correct.

    • rose
      Posted January 11, 2017 at 6:47 pm | Permalink

      Not tactless at all. It is time we faced up to the damage to our society that compulsory careers for women are doing. In this instance, for every female GP who works part time, there will be a man in the practice providing cover. The patients soon tumble to who has accrued the necessary knowledge and experience, and, overburdened, the men eventually say to themselves, why should I put up with this? They either emigrate or retire early.

    • Lifelogic
      Posted January 11, 2017 at 9:07 pm | Permalink

      Indeed the combination of more femail students and the EU working time directive mean you need to train double the numbers of doctors, to get the same number of productive hours of work out of them.

    • Posted January 12, 2017 at 11:44 am | Permalink

      The rewards in GP practices are a postcode lottery but can be very worthwhile : One GP I know is a member of a rural practice which also operates the local pharmacy.

      His income is around £200k ! About 25% of this comes from the pharmacy.

  66. The Prangwizard
    Posted January 11, 2017 at 1:44 pm | Permalink

    I saw a piece on local tv which covered a proposal to get GPs to stop prescribing OTC drugs like Ibuprofen. The fact that they do astounded me in the first place. I dare say the patients were pleading poverty and the spineless GPs just went along with the soft option.

    The nation is being impoverished in ways like this all the time. The NHS is now expanding coverage of ‘mental illness’, the definition of that is infinitely elastic and will be another drain on resources and will be abused.

    Spineless and politicised professionals and cynical politicians will make hay. No-one will dare speak out, especially when foreigners turn up and demand treatment. They will able to do that with menaces too and claim their illness made them do it.

    We are managed by fools.

  67. a-tracy
    Posted January 11, 2017 at 4:08 pm | Permalink

    Why don’t you do an NHS recruitment drive to retired NHS workers for a short term assistance boost. I have skilled people come out of retirement for peak needs and times and quite enjoy it. Mind you my retired employees aren’t on NHS type pensions.

  68. a-tracy
    Posted January 11, 2017 at 4:59 pm | Permalink

    Simon Stephens – what is his job?
    How much did he ask for?
    How much did he get?

    Which hospital A&E’s in particular are causing a humanitarian crisis and how can the Red Cross be asked to give us specific details and evidence? When I looked it up “A humanitarian crisis (or “humanitarian disaster”) is defined as a singular event or a series of events that are threatening in terms of health, safety or well being of a community or large group of people. ” Wiki

    Pretty serious allegation.

  69. 40+40=80
    Posted January 12, 2017 at 1:26 am | Permalink

    Mr Hunt has clearly pointed out that 350,000 net returning British 80 year olds to the UK has resulted in a momentary glitch. Mrs May says 350,000 80 year olds returning for Christmas and eating too much fatty food caused the A&E a problem but to call it a “humanitarian crisis” is totally unacceptable as most victims are British and we are not human like the rest of the world.

  70. Elephant
    Posted January 12, 2017 at 1:34 am | Permalink

    Do local communities have to set up picket lines outside their local hospitals preventing immigrant entrance?

  71. Posted January 12, 2017 at 11:39 am | Permalink

    We live in East Dorset and, despite the high proportion of residents over state pension age ( a group I recently joined ), our experience with the NHS could hardly be more different from what we hear on the news.

    We can almost always get a GP appointment the same day. We have to ring in the morning and keep redialing but we do get through eventually. Routine appointments for non-urgent issues are scheduled over the following three weeks.

    One of us had a minor op as an outpatient at the Dermatology clinic recently. The appointment came through just five days after seeing the GP and was for the following week. Arriving early, the Op was carried out within an hour despite the letter suggesting we should allow three hours.

    Others we know have similar experiences. One friend is waiting for a knee replacement which she has been told will be done within three months.

    The only criticism is the antiquated communications system : Hospital appointments arrive by snail mail rather than email and it’s not possible to change them without ringing up. The hospital appointment line is open short hours and closes at lunchtime. This could so easily be fully automated.

    We are not supposed to contact our surgery by email but as we spend a lot of time abroad, I get round this be emailing the Practice Manager.

    Why can’t the NHS move the customer interface into the 21st century ?

  72. a-tracy
    Posted January 12, 2017 at 12:41 pm | Permalink

    If it’s cuts to social care funding that is causing the majority of problems in A&E and the NHS that is being reported on tv, care homes closing, day care centres closing, and these are closing because of a reduction in budget to the local councils by 25% was this spending including in our Health Care spending when comparing us to other Countries in the EU? What % of the local Councils’ budget, funded out of rates, is supposed to be put aside for social care? Or is this funding direct from Central Government. How much does Central Goverment give to Scotland, NIreland and Wales in comparison to England for this service.

  73. a-tracy
    Posted January 13, 2017 at 11:31 am | Permalink

    Perhaps we should close down half the met office!!! and put the money in the nhs.
    They have spread fear and warnings across the whole of the UK quite unnecessarily for the past two days.

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    John Redwood won a free place at Kent College, Canterbury, He graduated from Magdalen College Oxford, has a DPhil and is a fellow of All Souls College. A businessman by background, he has been a director of NM Rothschild merchant bank and chairman of a quoted industrial PLC.

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