Should the NHS charge for such things?

Rosie51

Dentists do usually charge for missed appointments as do many other services. I'm concerned about charging for missed hospital appointments, the problem is some letters giving hospital appointments are turning up after the date of the appointment. I know this is probably not the case for most but it is becoming an increasing problem.
I wanted to cancel a GP appointment a few months ago. I telephoned the surgery and was in a long queue, after 30 minutes hanging on I rang off and drove to the surgery to cancel in person. The receptionist said they normally only take cancellations by phone 🙄

It isn't always straightforward to cancel particularly hospital appointments if they're not on the main Trust outpatient system. Given the money wasted, an easier way of cancelling has got to be cost-effective.
A couple of years ago it took me 5 phonecalls to 3 different numbers to cancel an outpatient apointment. If you're cancelling because you or partner has been taken ill, that's not practicable.
Also some "no shows" used to be because the patient was an inpatient & had to be on the ward for rounds, or was in imaging.I'd like to think the IT systems highlight when that's the case now, as they're not "no shows".

MissAdventure

Because france has essentially private Healthcare
They also stay i touch with pafients after an op, send them to convalesce, give regular check up appointments, send in district nurses.
Why can't the uk do those things?

France spends more than us as a % of GDP and per capita. I don’t think it’s accurate to call it ‘essentially private health care’ as the main system is organised by the state with compulsory contributions with people topping up with mutuelles many if which are run by the unions.

Those who advocate charging for food supplied in hospital obviously havnt spent time in Southend Hospital. 😱

Witzend

They also have to pay for GP and A&E visits...

Norway has a similar system of charging for GP appointments - and appointments with consultants and specialists etc.

However it's important to point out that there is a limit to these payments - in both Sweden and Norway.

There has to be a ceiling - otherwise patients who are chronically ill, or who have complex medical needs would be unfairly penalised as their appointments are likely to be more numerous.

The limit applies to everyone. When it's reached, you still pay, but are refunded - I believe it's a more economical 'admin' method.

The charge for consultant/specialist appointments vary, when I was in Norway, it could be anything between around £9 (equivalent) up to about £23 - but that charge is also added to your 'ceiling' - the more appointments you have, the quicker you reach it! Again, when I lived there, the ceiling was about £100 (+/-). So no-one ever pays more than that £100.

Surprisingly, if your consultant or specialist keeps you waiting for more than half-an-hour for your appointment - the charge is refunded to you! Not sure whether they still have this policy today. post-pandemic.

Per-capita funding is far higher in Norway than here in the UK. And across the board, wages are significantly higher too - a £9 or £10 GP fee that might cripple a low-paid worker here would not be the norm in Norway.

Hmm, things working relatively well in my city. Not perfect all the time of course but atm:

One letter, well in time, unless it's a very quick/emergency appointment. Lots of text reminders. Clear reminders on letters and texts with either contact phone number or online space to change an appointment.

This true for hearing: eyes? (oncology but OK), and today a yes a 6 month wait for orthotics but I got nearly 50 mins with a very skilled person, really through and polite.

(What I do noice with great sadness in this rush of recent appointments is the number of people of our ages who haven't taken good care for themselves....Diet... exercise... It impacts on so very much 🥲.)

My dentist is very clear about not only missed but late appointments (I was seven minutes late last year - sent away with a flea in my ear!). No excuses accepted. Notch up three and they take you off the list!!

I never get any text or emails about any appointments despite me advising them if my phone no etc many times. We don’t have an app in Scotland, either, so it’s either snail mail or phone calls. You still have to phone for blood test results - I phoned mid-afternoon, hoping it would be quieter and avoiding clogging the line first thing for people needing appointments. I was still 29th in the queue!!

Thanks for the description of the Norwegian system Dickins. My worry would be that this might still cause some people not to see a doctor when they need to but, balancing that I do think we should have a system that makes us more aware of what the costs of our treatment/s actually are.

I also think we have to be careful about pushing people with no access to technology, or the knowledge to use it, into a system that depends on it.

theworriedwell

mokryna

In France you have to pay for meals, full price, even if it is a yogurt, three meals a day.
I also have to pay missed appointments for specialist.
But people are texted/ messaged a week in advance as well as days before hand asking if they would like to cancel free of charge, so there is no excuse.

If I didn’t have someone overnight in the same house/flat where I was sleep after a GA, I would have to pay for the night in the hospital because I was well enough to leave.

I think this would also stop bed blocking as AC have to pay for a level of parents’ care, depending on income, however, parents cannot disinherit children.

What happens if you can't pay? I'm guessing people aren't left to starve.

We have never been charged for food in hospitals in France and DH spent many weeks there in recent years. That includes the local hospital, the University Hospital and various Cliniques.
Do you not have top-up insurance?

Please don't suggest it -a lot of people are suffering enough as it is .

DaisyAnneReturns

Thanks for the description of the Norwegian system Dickins. My worry would be that this might still cause some people not to see a doctor when they need to but, balancing that I do think we should have a system that makes us more aware of what the costs of our treatment/s actually are.

I also think we have to be careful about pushing people with no access to technology, or the knowledge to use it, into a system that depends on it.

My worry would be that this might still cause some people not to see a doctor when they need to...

The Norwegian health system has safety nets for people who cannot pay the upfront fee - no-one is turned away from essential care.

If you don't have a penny to your name at the moment you need to see a doctor - you can request an invoice, to be paid within 14 days.

Anyone who cannot afford a basic necessity - and that includes medical fees, can walk into their local Labour & Welfare office for immediate coverage of the fee.

Children under the age of 16 do not pay, neither do pregnant women, all the consultations related to the pregnancy are free.

When I first moved to Norway I, too, was curious about the possibility of a person not being able to pay and I asked one of the girls I worked with if she'd known anyone who'd experienced this, and she hadn't. As said, the average worker has higher purchasing power than here in the UK, and that includes from jobs in retail and hospitality

Norway was very clever by investing its North Sea Oil in a way that it could reap the benefits for centuries, which shows now health and pensions.

They seem to do social democracy very well Dickens. I was interested to learn when they set it up having a small hope that they learned from our mistakes. Not a bit of it! This is it's history:

Norway established its universal healthcare system in stages. The first public health boards were formed in 1860, and mandatory health insurance for employees began in 1909. This system evolved into a universal, mandatory right for all citizens in 1956, eventually integrating into the comprehensive National Insurance Scheme.

I do wonder why we haven't learned more from them.

It’s a balance really. Norwegian citizens earn higher wages, but they also pay higher tax contributions towards healthcare.
In return for that, I like their idea of a cap on the amount you pay for treatment before it becomes free.

Norway has the same ring up at 8.30 for an appointment system that we do.
Dickens you may know the answer to this.
Do they sometimes have to wait longer than 3 weeks for an appointment like we do once they get through?

Whenever we ask about health care or old age care either from family members living in Europe or even the guide on a coach trip in Portugal, their first comments are about how much tax they are required to contribute.
Successive governments might see that as a way to go here, but I worry that higher taxes would still not get me a quick appointment.

Ive beem told that in France the appointment system is slowly becoming less efficient than it used to be.

I have had no problems, yet. I go online and pick a date and a time the suits me with the doctor I want to see. If I want someone very quick and isn’t available I, of course pick another in the same surgery.
Of course with specialists you know that there is a three month wait if they are popular but I know I live in an area that is not deserted others are less fortunate.
However, I do know that if a patient lives on an island eg Corsica or one of the Domtoms, France pays for the airfare and in one case a person to accompany them. Well, that was twenty years ago and I don’t know if it still happens

My OP was referring to GP appts., not hospital ditto. I do agree that many such missed appts. are the fault of hopeless NHS admin.

My dh was once sent to the wrong centre for a small day-surgery procedure. It was a good half hour away from where he should have been sent, so that was an appt. wasted through no fault of his own.

Then a BiL was sent a letter about his oncology appt. to an address he’d left over 12 years previously! Other letters had been addressed correctly - they just hadn’t deleted his old one.

Luckily the new owners of the house forwarded it, just in time.

A major peeve of mine (don’t know whether it’s changed) was appt. letters being sent to my mother with (diagnosed) dementia, when she’d only hide them or throw them away, and certainly wouldn’t make a note of date and time!

I asked them repeatedly to send a copy to me or my brother as well - this was before we’d managed to activate her old style P of A - since otherwise the appt. would certainly be wasted.

Oh, not, they couldn’t do that, because of ‘patient confidentiality’.
Zero common sense!!

I never thought Iwould do a 'think about the poor' post but in this case I will.

Not everyone who doesn't turn up for an appointment could have cancelled. Older less mentally acute people, not with dementia but not as sharp as they were can easily forget appointments, have difficulty sorting out transport or have last minute problems. So can harrassed mothers with small children.

Not to mention appointments where no one has told the patient about it, we have suffered those. By the time you have sorted out why people did not cancel, whether their excuse is valid, not to mention whether they can afford it. The money raised will have been used up

The same with paying for meals. What will we have, bedside means testing? In countries where people pay they usually have a medical system which contains an element of compulsory insurance and meals paid for in hospital can be claimed back on insurance.

Rosie51 is right some benefits are withdrawn if you are in hospital for more than a few weeks. I know longer have all the detail at my finger tips as I did once, but benefits are withdrawn.

As Rosie also says a vacant house does not mean reduced costs. Setting aside where someone is part of a household and there are other people in the house. An empty house, if it is to be returned to, needs to be kept heated. Damp and decay uickly does damage.

Have you ever had to deal with a wardrobe of clothes turned into a solid block by mildew? I have. I had a relation, who could well afford heating bills, but didn't feel the cold, so even in winter, no heating was on. This was the result.

Council tax will also need paying, house insurance nd many other bills continue whether you are away from home for any reason, not just in hospital.

Tuliptree

MissAdventure

Because france has essentially private Healthcare
They also stay i touch with pafients after an op, send them to convalesce, give regular check up appointments, send in district nurses.
Why can't the uk do those things?

France spends more than us as a % of GDP and per capita. I don’t think it’s accurate to call it ‘essentially private health care’ as the main system is organised by the state with compulsory contributions with people topping up with mutuelles many if which are run by the unions.

The health care in France is essentially state funded, with top-up insurance for those who can afford it. The top-up insurance providers cannot discriminate against those with existing conditions. If your income is below the threshold the funding is 100%. If you have a a long term condition or a serious illness such as cancer then it is 100%. It is a good, socialist system, of which we had extensive experience in our twenty years there.

My DH has recently tried to cancel appointments with our local hospital with no success. He's now on the receiving end of a telling off.

We have to pay for a lot of medical things. You have to be on a government pension and not worked or not been paid much to get free stuff. We just accept it. It is usually subsidised, not quite as bad as the USA. I don’t know how the UK manages to afford their NHS, we couldn’t. You are lucky.

I agree with a charge for missing appointments in principal but how could a person prove that they hadn't received an appointment letter which does seem to be something that happens quite a lot nowadays. Appointments could be notified via text but then some would say they don't have a mobile phone.
I also think a co-pay for visiting a GP (as in the US) is a good idea with exemptions for children's appts etc. I would happily pay this even on a voluntary basis ( that is of course if I could actually get a face to face apt with a GP).

I’m concerned about the cost of missed appointments, too. Perhaps lodging a certain amount of money (a tenner perhaps?) with a practice that will be withheld for a missed appointment might work? Calling on the day you receive late notification may absolve you…not perfect but better than nothing.

When mu daughter was having chemo, it was imperative thay she didn't go along with a cold, cough, and thay kind of thing.

We spent all morning trying to cancel her appoinent.
No reply, no reply, no reply, whichever way we tried.
Appointment time loomed, so we got in the car and drove to the chemo unit, and i went in to explain.
I got a real ear bashing, and was again given the number we'd been trying all morning, as well as a telling off to pass on to my girl telling her she had no business driving there.

With what I've seen on the tv, people that come out of the night clubs drunk in the early hours and get into fights and end up in hospital with injuries should be made to pay for treatment.