We are all very much aware that our country is in a difficult financial position which we are all affected by in one way or another. Yes we all make our national insurance contributions (or have done/will do again in the future) and will all probably have different ideas on priorities but we have to accept that the government will make cut backs in all areas including the NHS. Therefore funding is limited and as such certain treatments will be cut to allow for others to carry on.

So my question is this: If you were in charge of NHS spending, what would you make available and where would you make your cuts? Are there any treatments that you think should be available that aren't now, are there any treatments that you disagree with being NHS funded?

My OH went to the docs yesterday to be refered for a vasectomy, he was told by his doctor that it's a good job he came now as the government will be withdrawing funding for vasectomys but as long as he registered before April 1st he is fine. I had no idea this was happening so I'm relieved he has been as there is no way we could have afforded it this year. Now whilst I agree that this is a non essential treatment I also think that providing women with years of contraception (pill, coil, injections, implants, condoms) as well as morning after pills, terminations or ante natal/post natal care must cost A LOT more than what amounts to a simple outpatient procedure.

I completely disagree with the 'post code lottery' system where depending what area of the country you live in determines which treatments are and aren't available. We all pay NI at the sames rates so we should all have the same level of services available to us.

IVF varies depending on where you live. You could be entitled to between 0-3 attempts on the NHS. This might be controversial on a baby forum but I think it should be restricted to 1 attempt across the board. As a mother I understand the 'need' for a woman to be a mother and I remind myself daily of how lucky I am that I conceive easily and have two beautiful, healthy and happy babies. I can't imagine the heartache of struggling to conceive naturally. However when it's a choice between funding potentialy life saving cancer treatments or IVF with a success rate of around 33% then unfortunately I would choose the cancer treatment everytime.

Another potentially controversial subject is treatments for drug abuse - including cigarette and alcohol related illness. I firmly believe that if you choose to polute your body which foreign chemicals which you know can and will cause harm, illness and death then you should forfeight your right to NHS treatment for any resultant damage. If you can afford to abuse your body with drugs then you should be able to afford a private health insurance policy to cover any damage.

These are just a few topics for discussion and I welcome different opinions so please don't think these are personal digs at people. We all have loved ones who have required different treatments for whatever reason so certain things are close to our hearts.

xx

I was given a questionnaire last time I went to my GP and it asked this question. I let rip on it lol.

My biggest cost saving point was that the right arm needs to speak to the left. Proceedures need to be streamlined to prevent repetition. And why on earth they need to send letters and invite people to an appointment only to tell them there is nothing wrong or we just need to refer you to so and so etc is beyond me. A simple phone call with standard data protection questions would be more than efficient. It would take the consultant an eighth of the time, save everyone having to take time off work and the costs of travelling to the hospital. There would be less need for waiting rooms, seating etc

I 110% agree with you on this;

"Another potentially controversial subject is treatments for drug abuse
- including cigarette and alcohol related illness. I firmly believe
that if you choose to polute your body which foreign chemicals which you
know can and will cause harm, illness and death then
you should forfeight your right to NHS treatment for any resultant
damage. If you can afford to abuse your body with drugs then you should
be able to afford a private health insurance policy to cover any damage."

And I told them too!

I don't live anywhere that even has NHS so for me looking in it all seems like a huge luxury! It costs me £30 to see a doctor as an example...

Anyway, if I was in charge of the NHS I would put in place a system based on peoples earnings that would determine the level of "fees" they should pay, probably only for doctors visits as a start. I think most people should be able to contribute something to their personal health. Be it only £1 for a doctors visist for example. Why should people earning over 100k get free healthcare? They should pay more.

Then that would make more money to continue providing services for free and they wouldn't need to make ridiculous custs that will end up affecting the people that need the help the most.

Agree about the drug abusers, I was a smoker and I would never expect to get free care for a lung disease that I had given myself. But how far do you go with this - what if an alocholic had an accident... do they not get helped because they got themselves drunk knowing it is dangerous... not sure where you would draw the line on that.

I would try to change the referral system... I dont really understand it but if you have something wrong with your kids do you see your GP... if its serious they will refer you to a pediatrician? I think you should be able to go straight to a pediatrician without wasting the doctors time.

I know what you mean about drawing the line Jade - it's a difficult one but I was more meaning drug related illness so in the case of an alcoholic - diseased liver/kidney etc. I think an accident is an accident - drunk or not and is something that would require immediate attention and therefore be open to all. However if there was a shortage of money to treat liver disease for example then the alcholoics should be at the bottom of the pile as far as I'm concerned. As for liver transplants - anybody who has contributed to the damage to their own organ should not be entitled to do the same to someone elses. I have a donor card and I would honestly turn in my grave if I new my liver had gone to an ex/addict instead of some poor unfortunate person/child who was ill through no fault of their own.

I have to disagree with income based NI contributions too. We are all entitled to the same level of care and should therefore pay the same ammount in. Tbh if I was earning over £100k we would go private anyway (most people probably would) so would still be paying NI but not taking out of the system which I think is fair.

xx

My oh is a high earner and pays a huge amount of tax so why should we pay to go private?

The whole idea of the NHS as set out in its 1948 charter is free health care at the point of access from cradle to grave. Whilst this is simply not feasible in this day of age i disagree with income related fees. People earning over 100K a year already pay 50% tax and NI so why should they then be forced to fork out extortionate doctors fees to prop up those in the benefits system (i earn nowhere near 100k btw lol) and thats not offensive to people on benefits im simply saying why hit higher tax payers with a huge double whammy, tbh though if i had the money id have private health insurance anyway. I think if you are looking at a system like that you are actually discussing scrapping the NHS in favour of an american health insurance system.

I think the main things that need to be changed are not actually clinical and choosing one health problem over another. I think there should be a simpler management structure and less administration. Case in point: In my dept we have band 5 staff nurses, band 6 senior staff nurses (we are an anomaly caused by banding changes and being phased out) and band six sisters. There are then band 7 senior sisters, TWO matrons, a deputy general manager and a general manager - for ONE directorate. The matrons AND the managers have PAs ad secretaries. Are you hionestly telling me that above band 7 we need another 3 tiers of management? Id phase at least one of those out and probably halve the amount of 7s we have (i think we have 8 band 7 senior sisters, 5 band 6s and 5 band 6 staff nurses). The money ca then be redistributed into more clinical staff to enable higher quality care at the point of access, with support and training and probably leave some left to plough back into patient care. Thats before i even started on the admin streamlining.

I cant comment on what I think should be scrapped/kept as I think everyones views are different depending on their own personal circumstances. Eg in your case you rationalise that a vasectomy should be provided as its cheaper than long term contraceptives/maternity care if a baby results... but then a smoker determined to quit would say they should be provided with nicotine patches as thats cheaper than them needing lung surgery in 20 years time.

I see your point over making priorities though. If I knew that Caitlin wasnt receiving Cancer drugs that would save her life because the woman across the road was on her 3rd attempt at IVF I cant deny Id feel upset/angry.

I think the NHS should provide the same service for all regardless of postcode/income etc. I can see how it seems unfair that people that can afford to pay for a service themselves are in a way taking away resources from those who cant... but then it has to be acknowledged that without tax payers the system wouldnt exist.

In NI we all get free perscriptions. I think that could be scrapped actually. Up until 1-2 years ago it was only under 16s and those on low incomes that got them free, everyone else paid about £7 an item (those with certain medical conditions could get a cert that they also got meds free or paid a one year fee). Quite oten a dr would be honest & say if you could get something cheaper over the counter and recommend that to avoid paying script fee. Id say people coped paying a fee for 20 years before and we could go back to paying again.

Another waste of money is patient surveys, not the actual survey but the way they carry them out. I was selected randomly to do one recently and with Caitlin being ill/me being lazy I kept forgeting to do it. They sent me the form out 3x at first class postage. I know its not much but things like that all add up.

Tbh Snoops I don't necesarily think Vasectomy should be free as in my eyes it is a non essential treatment but when I thought about the alternatives they just seemed much more expensive in the long run. Smokers are provided with free patches to help quit too but by my own reasoning I don't think they should be or lung surgery for that matter. If they chose to do damage to themselves then they should put into place an insurance policy to cover future repair jobs.

I completely agree with Mario on streamlining the management structure and with Lisa and Snoops on the administration side of things.

Pen - I agree you shouldn't have to pay for private health care when you put so much into the system. I think however if I was earning in excess of 100k I would go private for certain things just to avoid waiting lists etc (coz I'm impatient ).

xx

I used 100k just as a rough figure.. but ok what about the reeaaaally rich people... ones that pay the inland revenue a flat fee of 30k to NOT have to pay any other tax.... who knows how much they are earning.. they shouldn't be allowed to use the NHS or they should contribute towards it if they do. I'm not talking abuot people paying a huge amount but if it helped funding for the NHS wouldn't everyone rather contribute a little towards it?

Or do you think that perhaps an american style insurance system would be better? or perhaps better for people earning over a certain amout?

30% of my salary goes to the tax man and 12% to social security but I dont use the free healthcare we can get I go private... but I think that's because Ive heard horror stories about the general hospital here and even the doctors here tell people not to go there :/ (nothing to with UK system though I think thats fab for the most part!)

I don't think we need to change the system we have - I think the NHS is a brilliant service, it could just be managed better.

I don't think anybody who pays the tax man 30k a year should have any qualms about using the service - they pay more than most so surely that makes them more entitled than anyone to use the service without having to pay private. But like I say - chances are anybody earning that ammount would go private through choice anyway. If we had an american system we would all pay a similar premium regardless of our earnings.

xx

tbh I havent really thought about this in depth. All i want to say is that it is a shame that the nhs is in the state its in and also an insult to the memory of its founder Aneurin Bevan ("Aneurin Bevan" is my local health board as he was from this area). What he had in mind back then was free health treatment for all regardless of circumstances and background. If he could see the state of the nhs today, which in my view is caused by mis-management and like Rot said "top heavy" he would certainly be turning in his grave.

I understand that times have changed but the basic principle of the nhs has been forgotten about and its run too much like a "business" these days. Hence, people are not getting the treatment they REALLY need because some department in another health board has to hit their figures for waiting lists/patient turnover time so that they get the funding for the next few years etc etc

It's all arse backwards !!!

As a higher rate tax payer I already pay a disproportionate amount towards the NHS compared to the national average contribution and I object to the suggestion that I shouldn't be entitled to use the service because I work hard and earn a lot (and it is hard work and determination that means I do this not that I am 'lucky').

I also cost the NHS very little because I have private health cover should I need hospital treatment and since I choose to take care of my body and mind I am less likely to need medical care.

I am also a believer that the main problem with the NHS, as with most public bodies, is that they are poorly run and managed and vast sums of money are wasted. Aside from the ridiculously laden management structures and poor budgetary control there are no doubt millions of pounds wasted each year on the annual dash to spend any remaining budgets to avoid reductions in budget for the following year, as is the case in most public sector organisations.

My day job is as a buyer and even from the outside I can see endless possibilities to reduce the cost of supplies into the NHS through better procurement, contract management and greater collaboration between NHS trusts. I can almost guarantee that neighbouring trusts will be paying different prices for the same product or service possibly from the same supplier.

Goddammit i just typed a huge post and pressed the f*cking back button. Will come back to this later

I completely agree with everything you have said Gill!

Lol Mario - I hate it when that happens, problem is I don't learn and do it quite often - look forward to your input later.

xx

Right ive taken a deep breath to start over. I wanted to play devils advocate on the smoking theme for a moment. Im a non smoker but do have another take on this. I partially agree with the argument that smoking related illness is a self induced condition and shud it be treated but there are other aspects to be considered.

My husband smoked for years. Now putting aside for a moment the fact that due to the taxation on cigarettes he put money into the NHS from his smoking he disliked it, even more so once chicky chick came along and tried to quit over and over again. He tried hypnotherapy, patches, lozenges, inhalators, gum, cold turkey, you name it he tried it and we both paid privately for it and he failed every single time and was a friggin pain in the ass each and every time. Eventually when he discussed it again i couldnt face it and told him to go to his doctor. They put him on champix a tablet for quitting. He pays prescriptions so didnt exactly get it free-he did get it subsidised but still paid .50 a fortnight for 3 months, had to be chacked every fortight to ensure he wasnt cheating through breath testing and has now been smoke free for 5 months and never wants to do it again. I honestly believe if he hadnt had this option through the nhs would have still been smoking.

On the flip side i have a colleague who is morbidly obese. Im a size 20 and shes gotta have 6 stone on me. She had a gastric band fitted on the nhs which IIRC is something like £20k and a year later has only managed to lose 2 stone-why?-cos she cheats. She still makes poor dietary choices, she has reduced capacity to eat but what she does eat is calorific and unhealthy and over time the pouch created by the band has stretched so she can eat more and as a consequence isnt losing the weight so she has basically had a hugely expensive treatment and pissed it up the wall.

So who is the bigger burden on the NHS? My husband who yes had treatment for a self inflicted condition but went in with grit and determination and achieved what he set out to do and long term is healthier and less likely to need treatment for health conditions, or my colleague who took the opportunity she was given and said f*ck it and in the future is now at continued risk for diabetes and heart disease and requiring extensive healthcare input in the future. Im heavily overweight and intend to address this once Awens born but i dont intend to seek NHS treatment, i got orlistat on prescriotion once and ended up deciding it wasnt for me so i refuse to waste further tax payers resources on my weight issues because its no ones fault but my own that im the size i am as i have poor impulse control and make poor dietary choices. I can only hope i succeed this time round in losing weight and keeping it off to set my girls a good example.

So id say i think theres still an argument for subsidised quit smoking treatments but for people who arent willing to even try and end up with smoking related disease i think then theres an argument for making them input into their own care. And same with obesity related disease, alcohol related illness etc-give people a chance to have treatment by all means on the NHS if they are willing as it does save money long term but if they fritter it aay then sorry but sod em.

Couldn't agree more Gill.

Imagine the uproar if one of us said that the people on the lowest tax band should only be entitled to a bit of NHS and those on benefits who do not pay tax.... Well they are not entitled to to anything!

This would never be said as the NHS is for us all whether you pay 30k tax or are on benefits, this is what makes it so great and the envy ofmany other nations.

Mario, as an ex smoker I'm inclined to agree that the smokers/drinkers and high tax payees are keeping the nhs afloat. Feck! There'd be a lot less tax paid if everyone quit.

But yes, it does need sorting out.

It's such a complex issue isn't!

I have to say that I'm in favour of a one strike and you're out approach to all things self inflicted, be it obessity, drug/alcohol/smoking related or anything else where people need to help themselves. They need to be forced into taking responsibility for their own actions and life choices. If they are given free treatment once then piss it up the wall like your friend then tough tits that's their own fault and they can either live with the consequences or pay out for private treatment.

yup basically where iwas heading with tht lisa x

totally agree Lisa and Rot.

Once thing that confuddles me though (probs because I havent looked into it) How the blooming heck can the Welsh Assembly afford to give everyone in Wales free prescriptions??? Dont get me wrong its fabulous for us but even a £1 a script would put extra money in the pot. I have 3 repeat scripts every month !!! I think im going to research this actually because it is bothering me. Where is the money coming from to pay the pharmaceuticals ???? x

Can I just clarify to everyone that I would be classed a high tax payer too so this isn't in any way a dig at people who earn more money using the NHS or anything like that!

anywya, on the smoking thing I agree with mario you should be given help to try and quit but not over and over again. I think someone like your colleague should have to try and pay back what she's cost the NHS!