A&e visits

[pip1954]

Hi all how many people thinks is is about time people using a&e should be vetted and if it is not an accident or emergency they should be turned away and told to go to a gp a&e are under a lot of pressure from people who should not go there with minor problems ,
Well this is my view gives you a clue as it is in the name
Pip

 

[No skills]

The problem lies at the GP stage - no bugger can get an appointment inside 7 days (prolly 2 weeks on average at our gp, which actually is an improvement on recent years).

Sort the local surgeries out and excess a&e attendance will disappear.

 

[Racers]

The problem is what happens if they misdiagnose something like meningitis which can present as a cold/flu?

Pete

 

[Gary]

Hi all how many people thinks is is about time people using a&e should be vetted and if it is not an accident or emergency they should be turned away and told to go to a gp a&e are under a lot of pressure from people who should not go there with minor problems ,
Well this is my view gives you a clue as it is in the name
Pip

I wonder what the factor into their statistics we have a minor injuries unit at our local hospital which doubles as an out of hours doctors.

 

[RobinBHM]

I think Jeremy Hunt beat you to it

I heard a doctor on LBC discussing this issue, her thoughts were that yes, there a level of public visiting A&E for non emergency reasons which exacerbates the situation but it is a contributry factor, not the primary cause.

The primary cause is multi factoral, but one key problem is that social services cant and wont move patients out of hospital blocking the sytem all the way back.

On point she did make was that on average every Monday she typically sees 4 people that have a bad sore throat but no temperature, which does not need a doctors visit to identify. These patients should be, taking advise from relatives, visiting a pharmacy, looking up on the NHS website or ringing 111. Her opinion was that todays culture is not medically savvy and dont take responsibility for their own health where minor ailnents are concerned.

I think I agree, having had staff off sick with bad backs, my advise is go and visit a private physio, sports injury clinic, osteopathe. Usually though Its always, Ill get a doctors appointment first, which is a total waste of time. My wife, I have to say had the same opinion, after 3 days of being barely able to walk I finally managed to persuade her to visit a physio clinic, half hour appointment and able to walk easily again (and exercises with an exercise ball which are fantastic for lower back pain).

I have heard that disorganised people that run out of prescription medication do visit A&E and its a common occurrance

 

[t8hants]

In the last twenty years they have halved the number of beds available and there are now double the number of patients requiring them from twenty years ago.
Bed blocking was a problem when I did my nurse training thirty years ago, until there is proper post hospital care available, or a dramatic increase in beds things wont change.

 

[Phil Pascoe]

One of the district nurses that I see told me she worked in A&E prior to this job, and the last NYE she worked there was not one person she dealt with that was any other than drunk.

 

[RobinBHM]

One of the district nurses that I see told me she worked in A&E prior to this job, and the last NYE she worked there was not one person she dealt with that was any other than drunk.

And for those people the NHS should not be free at the point of entry. Travel insurance abroad does not cover for accidents whilst drunk, which foreign doctors know and wont treat anybody drunk unless they pay as the hospital wont get reinbursed by the insurers.

So in this country if you get an injury whilst drunk, get your credit card swiped at the desk first!

 

[RogerP]

One of the district nurses that I see told me she worked in A&E prior to this job, and the last NYE she worked there was not one person she dealt with that was any other than drunk.

Alcohol now costs the NHS £3.5bn per year; equal to £120 for every tax payer

https://www.alcoholconcern.org.uk/alcohol-statistics

 

[beech1948]

I think a few simple changes would cause a fast and irreversible alteration.

1) Anyone who goes to A&E and who is affected by alcohol over the drink drive limit should be charged the full cost of being there.

2) Anyone who goes with an illness that family, friends or workmates can diagnose and advise on treatment eg colds, flu etc should be charged the full costs of the visit.

3) Any time wasters..charge them the full costs.

4) IVF ( it is natures way that some people are barren) and breast enlargements ( vanity) charge full costs or refer to private medicine.

5) ???? next

Typically the costs are around £250 per visit.

The NHS should also charge all of the foreign nationals who are using our hospitals for free. Even to the extent of of each visitor having to prove eligibility.

Al

 

[beech1948]

I think a few simple changes would cause a fast and irreversible alteration.

1) Anyone who goes to A&E and who is affected by alcohol over the drink drive limit should be charged the full cost of being there.

2) Anyone who goes with an illness that family, friends or workmates can diagnose and advise on treatment eg colds, flu etc should be charged the full costs of the visit.

3) Any time wasters..charge them the full costs.

4) IVF ( it is natures way that some people are barren) and breast enlargements ( vanity) charge full costs or refer to private medicine.

5) ???? next

Typically the costs are around £250 per visit.

The NHS should also charge all of the foreign nationals who are using our hospitals for free. Even to the extent of of each visitor having to prove eligibility.

Al

 

[Phil Pascoe]

Maybe be a little careful with the alcohol - last I went to A&E I walked home from the pub in pitch darkness in a howling gale after four or five pints . This W. Cornwall ... a howling gale is not a joke. I went into my garden the same way I went out, and stood on a six by four sheet of ply that had blown in from somebody's else's garden. It was green with algae (I found out the following morning), my feet shot out from under me, I corkscrewed around and put a steel post that was on my right side through my left palm. Fortunately it didn't sever any tendons. I think it would be rather unjust if someone had decided that was alcohol related.

 

[Inoffthered]

I had a chat with a medical consultant at a christmas party who was banging on about the need for more money in the NHS.
I said that if a Uk national required medical treatment abroad there was invariably a charge to the patient and/or an additional charge to the NHS from the country providing the treatment. There was a report over christmas that the Polish health service charge to the UK for treatment to Brits in Poland was 14 times more than the charge for treatment of poles in the Uk.(I dont remember the exact amounts but it was tens of millions).
I asked what the system was within the NHS for collecting the info to allow the necessary recharges to be made. The reply was that the job of the NHS was to treat patients not to raise invoices.

I also recounted my experience while attending a cardiac clinic with my son. While waiting for him to have an ECG, a gentleman arrived with his family (and judging from the labels still attached to his suitcase, he had recently arrived at Heathrow). He went to the reception desk and asked for an ECG. The receptionist asked for his referral letter from his NHS doctor and he got quite agitated saying he had just arrived in the country. His wife dragged him away and said they'd go to A&E.

A few hours later while waiting with my son for another bunch of tests, I saw this chap being pushed in a wheelchair by an orderly on his way to have an ECG. I have absolutely no doubt that he was a health tourist.

Two isolated examples of, perhaps, why the NHS is under pressure. If the NHS trusts were allowed to keep any money re-invoiced for treating non UK nationals then maybe the challenge of funding increasing care for the elderly may not be so acute. I fully accept that the NHS should treat anyone in urgent need of attention but I dont think the NHS should be expected to solve the worlds health problems and visitors to the UK should have some form of health insurance to cover the costs of treatment or at least make a contribution to the cost of that treatment. Also the costs of treating migrants from the EU should be recharged in the same way that the UK is charged for treatment given abroad.

 

[Keithie]

I dont know much..but I know some stuff. What I know about the NHS is that if there was an easy solution then they would have sorted it by now. It cant just be money can it?

The issue is simple ...if you cant specify the problem clearly then u aint gonna have much luck by just randomly guessing at a solution!

I doubt anyone really knows what the problem with the nhs is...sadly

 

[Sheffield Tony]

I think a few simple changes would cause a fast and irreversible alteration.

1) Anyone who goes to A&E and who is affected by alcohol over the drink drive limit should be charged the full cost of being there.

2) Anyone who goes with an illness that family, friends or workmates can diagnose and advise on treatment eg colds, flu etc should be charged the full costs of the visit.

3) Any time wasters..charge them the full costs.

4) IVF ( it is natures way that some people are barren) and breast enlargements ( vanity) charge full costs or refer to private medicine.

I don't think it is that simple.

I'd think carefully about the "charge drunks" idea. So the NHS should charge people who've had a couple of drinks because their lifestyle contributed to the risk. Then what about all the other hobbies and lifestyles that put you at increased risk of a health problem ? Drug abuse ? Smoking ? Contact sports ? Horse riding ? Motorcycle riding ? Woodworking :shock: ? Idleness ?

With regard relying on self diagnosis (or by friend/family) - we also hear talk from medics about the "worried well". But then we hear that early detection of serious conditions is hampered because men especially don't present early enough. You can't have it both ways.

For IVF, there is the counterclaim that the mental health problems that arise for people who can't have the children they want outweigh the cost of the treatment. Don't know whether I believe it.

IMHO, the inefficiencies of the NHS are many, and distributed in a fine grained way throughout all the systems. Not something that can be fixed at a high level by simple rule changes. It would take an army of troubleshooters shadowing every process to find and root them out. And a lot of medics would be peed off by the experience !

I'd agree with a couple of things already said though - lack of availability and cash for social care, and poor access to GP's - especially out of hours - both must contribute to A&E overload.

 

[AJB Temple]

We have become a needy society that thinks that all health care should be free at point of delivery. With a population that is expanding and getting older this is unsustainable.
A long recession materially reduced tax take and government funds available.
Medical work is no longer a vocation and payroll costs have therefore escalated, including at GP level.
We no longer look after our old people within the family and dump them on the state in an entitled way.
Global market for drugs pushes up prices.
Doctors are by and large anti being involved in charging - they may see this as being too similar to private practice (in which case they may as well do that).

 

[transatlantic]

From what I have heard, it appears that the problem is mostly due to timewasters and irresponsible intoxicated people. I think that these people need to be detered in some way, or simply be given a bill. As pointed out, you can be a respectable member of the public, be drunk, and still have an accident, .. doesn't necessarily mean you're irresponsible. So perhaps a warning system needs to be put in place, three strikes (within some specified time period) and you're out so to speak. You'd of course always be dealt with, but after the third strike, you'd inccur the fees?

I also keep hearing about patients "pre-booking" doctors appointments just in case they become ill ... surely this is easy to spot and put a stop to? but I should think it's a very small part of the problem. I'd hope there really aren't that many idiots doing it.

 

[novocaine]

Of course, if we didn't depend on PFI to fund it in the first place and saddle the NHS trust with massively interest laden debts thus in effect reducing the amount the individual NHS trust actual has available each year (and every year the debt goes up), then maybe we wouldn't have quite such an issue, but then no one but those working in the NHS would make any money from the funding and wheres the fun in that?
1 year before he came to power a certain Mr Osbourne declared the PFI system broken and not to be used, the next year, he signed off on 61 new PFI contracts and saddled the NHS with massive debts, he then wiped his hands of it and let the NHS bare the brunt of the criticism over spiraling costs. Yet it doesn't get media coverage, why not? is it because bed shortages and failure to provide health care are more scandalous stories for the media to portray perhaps?

this is just one of the issue, there are many many more, and no matter what happens they system isn't going to be fixed overnight.

why is it we talk about being charged for health care if you are drunk? you are already charged for health care, we all are. are you going to prorata the amount paid by a drunk based on his tax and national insurance payments? if so, then the rich get better care than the poor, what a wonderful idea, if not, then the rich still get better care than the poor, distopian future isn't it.

 

[lurker]

My wife is a specialist practice nurse, she can do 90% of what a GP can do.
She daily sees patients who want a prescription for paracetamol.
Free prescriptions if you are on benefits
Next door is a Co-Op paracetamol are 30p a packet

 

[RobinBHM]

I hear that there are an increasing number of private GP clinics that offer same day appointments with early morning and evenings available. There are quite a few in London and for busy commuters I imagine the cost of the appointment is probably less than the cost of the loss of work.

I dont know what the answer is, it seems having health care free at point of delivery is not sustainable but the problem is that as soon as charges are introduced the issue of elitism crops up as it means that those that cant afford it wont go or will have to wait longer. I know private health care is available anyway, but that is currently kept separate (although you may go to the same hospital and see the same consultant, just 6 months quicker!)