Monday, 7 November 2011

Is It Time To Charge For Accident And Emergency Visits?

Fortunately I've seldom had to visit an NHS A&E department.  Most of the time it's been to accompany friends or family, but a recent chat with someone who works in an A & E department opened my eyes.

Although the video seems absurd it's far nearer the truth than stated by many NHS trusts.  Apart for the odd 'local' turning up with an ailment which could be easily dealt with by their GP.  They're given short shrift.

However, in this area there is an influx of eastern Europeans who come to pick the berries for which it is famous. The local people no longer want to do this seasonal work so thankfully eastern Europeans ensure the harvests are completed.  They work for the minimal wage and often have accommodation included in their 'package'.  Most are students who can go home at the end of the berry harvest and complete their studies, knowing their earnings in Scotland will provide a cushion against expenses.

But these workers, who are essential to the berry producers, clog up the local A & E on a daily basis.  Although most are given information about our medical services when they enter this country, few feel the necessity to register with a GP and therefore my local hospital, for many months, is clogged by locally welcome workers and their medical problems.

My last experience of an A & E department - it was this year -  was accompanying a friend who had fallen.  She'd hit her head yet it was not until early the next morning she phoned me and mentioned her problems. We set off immediately to the local A & E where there was a long queue and when I asked why, I was told that many patients were unable to speak English and regularly used the department as a GP surgery. Let's not mention the amount of taxpayers money spent on translating services.

Is it time to charge for treatment in an A & E department here in the UK?  In Ireland there is a cost to attending a GP or A & E.  I don't suggest that we should introduce a fee for consulting a GP, but to nip along to the local A & E with a minor ailment is surely unacceptable. Charging those who misuse the service may reduce the amount of time-wasters.


Joe Public said...

Our local hospital charges for most visits to A & E.

The revenue stream comes via the parking charges, which are exorbitant.

Dick Puddlecote said...

No. Unless there are refunds to NI contributions of course.

If we have a comprehensive NHS which one can't opt out of, then provision should be comprehensive. If it is piecemeal, scrap it and allow individuals to choose their own provider.

Hey! I didn't set the system up, politicians did. If they change the rules, they can stop demanding money with menaces, ta very much.

Sir Henry Morgan said...


No, you're NOT in there to save lives - you're in there to relieve suffering. You know as well as I do that it's impossible to "save" a life, only postpone the arrival of death ... and of course to relieve suffering.

We ALL die. Every living organism that has EVER appeared on this planet has died.

Do people really believe this NHS supplied rubbish?

Mad Morgan

subrosa said...

Right enough Joe, although only a few hospitals here charge car parking. The SG can't opt out of the contracts.

subrosa said...

Good point Dick. I wonder, with the slow privatisation of the NHS in England, if charging will be on the cards this decade though. Wouldn't surprise me.

subrosa said...

Another good point Henry. Many thanks.

Doug Daniel said...

I would think A & E departments suffer far more inconvenience and cost from young middle-class drunken Scots at the weekend than from low-paid Eastern European berry pickers who aren't sure how to fill in whatever paperwork needs to be done in order to be seen by a doctor. I've also known my fair share of people who made numerous trips to the A & E department as children because their parents left them entirely to their own devices and they ended up with broken legs, arms etc. They were all Scots. Not to mention all the namby-pamby people who waste the time of GPs by going to them with a bad cold or a sprained wrist.

Would it not be better to focus on these timewasters, clogging up the system through their own stupid, avoidable misdeeds (much like the women in the video), rather than expecting low-paid, overworked berry pickers to pay, just because they don't understand how our NHS works?

Or maybe they've tried getting a GP appointment, but made the fatal error of not phoning for an appointment at 8:30am precisely and got told, as I recently did with a particularly sore throat, that there no appointments available for three weeks (by which time my tonsillitis - which is what it turned out to be when I eventually got an appointment - would have cured itself, even without anti-biotics). So they've gone to the A & E instead since they can't wait that long and nobody has told them that you only get same day appointments if you phone at 8:30am.

I know you're acknowledging immigrants play a vital part in our local food produce industry, but it still sounds like a bit of a moan against immigrants. I think we Scots are the real problem.

subrosa said...

Doug, my local A & E in Perth doesn't have too much of a problem with weekend drunks I'm told.

The eastern Europeans are all informed, in their relevant languages, by many agencies that they must register with a GP, yet most ignore the request and like the immediacy of the A & E department. They do understand how the NHS works, believe me, or they wouldn't be queuing up each weekday. At weekends it's quiet I'm told. The foreign students who come here are very well cared for regarding their rights and healthcare. Local employers ensure they're given detailed written information in their own language and the local library also has a whole section allocated to the various eastern European languages. Perhaps that's why they fit in with the local communities.

I'm not knocking immigrants but showing they know how to 'play the system'. As for others who rush to A & E with the slightest problem my suggestion is that they be charged.

Here I can phone the GP anytime between 8am and 9am and get an appointment that day. I live in a rural area but know that the service in cities can leave much to be desired.

Disenfranchised of Buckingham said...

My experience is the same as Doug. Ring at 8:30 precisely and I can see the useless doctor. Otherwise wait at least 2 weeks to see my doctor.

The reason A & E is "misused" is it provides a walk in service at the time people want to use it.

The problem with the NHS is they want organise us, the customer, to work their way not organise themselves to work at our convenience.

Anon said...

Recently I visited someone in hospital.

It struck me that:

1. The hospital food is very poor quality.

Almost all patients could afford to contribute £5 per day to improve the quality of the food.

2. The hospital staff told me that the hospital cannot afford to have more than one doctor on duty at the hospital at weekends!

I would suggest sacking half the administrators and spending the money on employing more doctors at weekends.

And, almost all patients could afford paying £5 per day to cover the cost of extra doctors.

3. Most doctors and administrators are now paid too much. I would suggest a strict limit on how much any one doctor or administrator is paid.

- Aangirfan

subrosa said...

The doctors at my surgery have a rota for who takes 'emergency' patients DoB.

As far as I know nobody is ever turned away from my local A & E. The lines between accident and emergency are blurred nowadays and true emergencies are not receiving the instant attention they deserve. When my mother had a stroke she was left for 2 hours lying alone in a side room. It was only hours later, when she was on a ward, that I was told about the diagnosis.

I would support walk-in centres in hospitals as long as those who are in desperate need are given priority.

subrosa said...

Good suggestions Aangirfan. When I was in hospital a few years ago patients were encouraged to ask their visitors to bring food. One man brought his wife a fish supper every night.

Would the food improve if £5 contributions were made? I doubt it really. That money would be better spent by families bringing soups etc.

pa_broon74 said...

I don't really know why people go to see a GP, you're better off googling your symptons then telling the GP what is and asking for the medication.

Hospital A&E, fortunately not much experience there, last time I went I thought, or rather my Dad thought I was having a heart attack; it was tendonitis in my arm.

The immigrant thing is emotive but it is an issue in all areas of local services inc schools, hospitals and GP's. There are areas of Edinburgh that suffer from chronic over-crowding, the polish folk don't mind sharing space (we Scot's are far to discerning ;-) You have two and three bedroom flats with three or four people to room, slum landlords really are alive and working in Edinburgh, I used to live next door to one on Broughton Street then again in Pilrig.

One other thing of which I am guilty. My Dad is occasionally put into hospital, the Dr will come out and say he needs to go in, he'll phone and book transport either for that or the following day. I now dial 999 because its quicker and still technically an emergency (because the Dr ordered it.) The paramedics don't mind and it saves my dad having to sit for minimum 6 hrs for an ambulance because they can't specify a time even to one or two hours.

I'm not going to go into how crap GP's can be. Had recent issues which I might blog about, could be cathartic, (I was quite angry.)

subrosa said...

I have to admit I do that pa_broon but the GPS don't like you to arrive with a wad of evidence of your ailment.

The immigrant issue here at A & E is different to the one affecting other services. To us there's a distinct difference between a GP surgery and A & E. The local foreign workers here know that too but they also know their ailments will get immediate attention at A & E.

I had an email earlier which mentioned the writer's A & E send all minor ailments back to GPs but it doesn't happen locally here.

Auch it's possibly a generation thing with me. I was taught A & E was for those who were seriously in need of medical care.

Do blog about it. Look forward to it.

Apogee said...

Charging for A&E will make no difference, except to make us poorer.
And we will experience the American system of your credit card being checked before you are! Do you really want that?
Because you must realise with our ability to take PC to extremes, and the inevitable jobsworths, it will inevitably happen!

subrosa said...

You have a point Apogee. My thought was that charging would deter those with trivial ailments. Perhaps not.

Brian said...

Before the NHS most hospitals had a member of staff called the Almoner whose job was to extract money from those who could afford treatment to subsidise the costs of poorer patients. Many Trade Unions and Friendly Societies ran medical insurance schemes for a penny or tuppence a week. All this before the NHS and the Big Society

subrosa said...

Brian, I'd forgotten about Almoners. They were also helpful in liaising with home nursing services if I remember, such as district nurses. I'd also forgotten about the effectiveness of trade unions to help their members. No longer sadly.

Brian said...

Rosie, This website here gives a splendid overview of the history of the NHS. Contrary to myth, there never was a Golden Age for the NHS as demand for its services has always exceeded supply. But, like democracy, it's the least worst option. Perhaps a rebranding to Our Health Service might help, although as many people no longer look after their own property properly, what hope is there for them to care about wasting NHS resources?

subrosa said...

Brian, how kind of you to post that link. It's now firmly in my Evernote and will be read regularly I'm sure.

Many thanks.

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