View Full Version : NHS - Drunk A&E patients should pay!
http://www.bbc.co.uk/news/uk-scotland-12428765
"Anyone who has been abusing alcohol and can't stand on their feet and is admitted to hospital at the weekend should pay towards their treatment."
On the back of recent threads about the NHS, treatments, causes and patients: Discuss...
I don't think it's a good idea.
Where do you draw the line? Only drunk people? Only at the weekend? What about smokers? What about people who have car accidents through speeding or careless driving? Mountaineers?
The assaults and trouble caused by drunks in A+E is a different matter, and I think perhaps tougher punishments are needed. Using them as a smoke screen for making savings is wrong though.
What are they basing the amount someone has drunk on...one or two glasses of wine or a bucketload of alcopops?
What about someone who has had one glass of wine and has tripped and broken an ankle in their high heels (they cant stand up or walk)?
Blazing Sporrans
11-Feb-11, 14:48
Purely as Devil's Advocate, why not use the same standard that is used for Drunk & Disorderly?
Purely as Devil's Advocate, why not use the same standard that is used for Drunk & Disorderly?
That's a reasonable suggestion but I don't see how you would implement it.
To be guilty of being drunk and disorderly you have to be proven guilty in a court of law. Innocent until proven guilty is a fundamental human right in our society and I don't see that changing anytime soon.
I don't think it is workable. British Society sees it as their fundamental right (probably duty in some cases) to get as blootered as they want, as often as they want, and for a reasonable price as well. Most see themselves as moderate drinkers and say that "the few" spoil it for the "sensible" drinkers. The figure from the article Phill links to:-
"The Scottish government said alcohol misuse cost Scotland £3.56bn a year - about £900 for every adult."
will register with very few readers.
ShelleyCowie
11-Feb-11, 16:38
Do they mean like if your so unfit to walk that you need taken to A&E to have your stomach pumped?! If your so legless and unable to talk there is also the slight chance that person might have had their drink spiked and would just be put down to being legless. Trust me, i have been there!
So many areas to cover im not sure how it could be implemented.
Blazing Sporrans
11-Feb-11, 16:38
That's a reasonable suggestion but I don't see how you would implement it.
To be guilty of being drunk and disorderly you have to be proven guilty in a court of law. Innocent until proven guilty is a fundamental human right in our society and I don't see that changing anytime soon.
Looked into this a wee bit and it seems I made an error. It's Drunk & Disorderly in England and Drunk & Incapable in Scotland;
Drunk & Incapable
Source: Civic Government (Scotland) Act 1982, Section 50
Offence: (sub-sections)
Any person who, while not in the care or protection of a suitable person, is, in a public place, drunk and incapable of taking care of himself shall be guilty of an offence, and liable on summary conviction, to a fine not exceeding £50.
Any person who is drunk in a public place while in charge of a child under the age of 10 shall be guilty of an offence and liable on summary conviction, to a fine not exceeding £50.
And it also seems you can accept a fixed penalty ticket (not sure how much the fine is) which means you don't have to go to court and have a conviction for the offence. So if it's not necessary to go to court, why can't hospital security staff (for example) be given the power to do the same? Purely as Devil's Advocate again.... :)
The figure from the article Phill links to:-
"The Scottish government said alcohol misuse cost Scotland £3.56bn a year - about £900 for every adult."
will register with very few readers.
Yes, but the £267M figure for alcohol related healthcare is about 7.5% of that total cost.
I wouldn't deny that the drinking culture and associated problems need to be adressed, but I couldn't agree that making drinkers pay for healthcare after a drunken injury is a way of tackling it.
It's a nice idea in principle, the implementation is another matter.
I suppose it brings round the question of taking out personal insurance, which I agree with for sports injuries including those sustained as a result of participation in extreme sports such as climbing and kayaking as well as run of the mill sports such as football, rugby and cycling.
And it also seems you can accept a fixed penalty ticket (not sure how much the fine is) which means you don't have to go to court and have a conviction for the offence. So if it's not necessary to go to court, why can't hospital security staff (for example) be given the power to do the same? Purely as Devil's Advocate again.... :)
Yes, you can accept a fixed penalty and admit guilt, but you are also entitled to deny the charge and have your case heard in a court of law.
How could you enforce that?
NURSE: "You're drunk, do you admit that and agree to pay for the cost of resetting that leg you broke?"
PATIENT: "No I don't"
NURSE: "Well then we'll have to wait until you've been to court before fixing you."
I just can't see it working.
I suppose it brings round the question of taking out personal insurance, which I agree with for sports injuries including those sustained as a result of participation in extreme sports such as climbing and kayaking as well as run of the mill sports such as football, rugby and cycling.
I don't necessarily disagree, but again, where do you draw the line?
What constitutes an activity requiring insurance? Making people pay for the privilege of kicking a football could hardly be seen as promoting the health of the nation. What about joggers? Or dog walkers? Do you demand everybody has insurance if they leave the house?
The thing to remember here is that everybody pays national insurance already, it's not a free service from the government but something we all pay for.
"Healthcare for all" is not a policy we can expect to change anytime soon.
Blazing Sporrans
11-Feb-11, 16:56
Another possibly valid concept Red. I'm not suggesting for a minute that these insurances should cover the full cost of treatment; anything that assists NHS budgets though is surely worth looking into. Maybe a requirement for insurance might prevent the 'casual' hillwalker going out woefully under-prepared and possibly prevent needless tragedies like this occurring
http://www.google.com/hostednews/ukpress/article/ALeqM5hoYkJcc0k6WV7cmaG0XJBXWrLXsQ?docId=N05822212 97027695922A
Again I acknowledge that it would be extremely difficult to implement but if organised clubs took up the idea, then as Tesco tells us.... Every little helps!!
Blazing Sporrans
11-Feb-11, 17:03
Yes, you can accept a fixed penalty and admit guilt, but you are also entitled to deny the charge and have your case heard in a court of law.
How could you enforce that?
NURSE: "You're drunk, do you admit that and agree to pay for the cost of resetting that leg you broke?"
PATIENT: "No I don't"
NURSE: "Well then we'll have to wait until you've been to court before fixing you."
I just can't see it working.
That's a slightly obtuse take on the situation isn't it? Nobody's saying they have to be forced to pay for the treatment beforehand. If there are witnesses there (and the perfect environment for a quick blood/alcohol analysis) then take your chances and go to court afterwards. I bet there wouldn't be many takers if the medical staff had a blood/alcohol reading...
I don't necessarily disagree, but again, where do you draw the line?
What constitutes an activity requiring insurance? Making people pay for the privilege of kicking a football could hardly be seen as promoting the health of the nation. What about joggers? Or dog walkers? Do you demand everybody has insurance if they leave the house?
The thing to remember here is that everybody pays national insurance already, it's not a free service from the government but something we all pay for.
"Healthcare for all" is not a policy we can expect to change anytime soon.
I used to play a lot of sports when I was younger: hockey, rugby, climbing, kayaking and as a result I knew that I was placing myself in a position where I was more likely to require the services of the NHS than say the average dog walker.
I took out personal insurance that covered the cost of private medical care and also covered me if I was off work as they had already told me that due to the outside activities I was involved with, if I was injured they would not honour 'sick pay'. I have seen a few really nasty accidents where people have been off work for months/years because of sporting injuries.
I think that it's the responsible thing to do.
Accidents do happen, it's inevitable, however there are certain things which we all do in life which do have more risk associated with them. I think that people with injuries caused as a direct result of those activities should be required to pay for treatment and not place unfair demands on an already over-stretched system.
That's a slightly obtuse take on the situation isn't it? Nobody's saying they have to be forced to pay for the treatment beforehand. If there are witnesses there (and the perfect environment for a quick blood/alcohol analysis) then take your chances and go to court afterwards. I bet there wouldn't be many takers if the medical staff had a blood/alcohol reading...
I don't think I'm being obtuse, just offering a questioning attitude.
The problem then would be the time spent by healthcare proffesionals acting as witnesses in the court.
If somebody was facing a bill of hundreds, or even thousands of pounds I would think they may well take their chance in the court. It might relieve costs in healthcare only to raise them in the justice sector.
Blood alcohol levels may be useful in determining a legal level for driving for example, but in the case of "drunk and incapable" it is more down to the individuals ability to handle their drink than actual alcohol levels. I know people who can't walk after 6 pints and others who'll still be more than capable of looking after themselves after double that amount.
Also, would it therefore be made compulsory to have a blood test when recieving treatment?
Back to my previous point, people pay their national insurance and everyone is entitled to healthcare because of that. Removing it from those taking part in a perfectly legal pastime whilst still offering healthcare to drug addicts, for example, would be wrong in my opinion.
Accidents do happen, it's inevitable, however there are certain things which we all do in life which do have more risk associated with them. I think that people with injuries caused as a direct result of those activities should be required to pay for treatment and not place unfair demands on an already over-stretched system.
Yes, but again, where do you draw the line?
Driving for example? Hundreds of people are injured everyday doing that. More than those injured hillwalking I would imagine.
I can see the validity of the points being made but not how to address them.
If there's not enough money in the system to pay for the services we expect, raising national insurance for all is a fair option. And, I imagine, a lot more likely than the introduction of selective healthcare.
Like road tax and roads, NI has little correlation to what is spent on the Health Service.
Yes, but again, where do you draw the line?
Driving for example? Hundreds of people are injured everyday doing that. More than those injured hillwalking I would imagine.
I can see the validity of the points being made but not how to address them.
If there's not enough money in the system to pay for the services we expect, raising national insurance for all is a fair option. And, I imagine, a lot more likely than the introduction of selective healthcare.
Use the same scale that insurance companies use. If you were to buy holiday insurance you pay one price, but if you want to go skiing or do other sports on holiday then you pay more premium because you are more likely to have an accident, surely that is based upon statistics.
Is it necessarily fair that everyone is penalised for the actions of a few... (actually that could be said of more than just this thread... but that is another discussion :) )
Knowing the insurance industry, and I do, the only group that would be insurable against drunken accidents would be teatotallers. :lol:
Use the same scale that insurance companies use. If you were to buy holiday insurance you pay one price, but if you want to go skiing or do other sports on holiday then you pay more premium because you are more likely to have an accident, surely that is based upon statistics.
Is it necessarily fair that everyone is penalised for the actions of a few... (actually that could be said of more than just this thread... but that is another discussion :) )
Again, that goes against the principle of free healthcare for all, paid for by national insurance. I just don't see that happening.
Like road tax and roads, NI has little correlation to what is spent on the Health Service.
True, but regardless of what you pay, you are paying for your healthcare.
Duncansby
11-Feb-11, 17:38
Use the same scale that insurance companies use. If you were to buy holiday insurance you pay one price, but if you want to go skiing or do other sports on holiday then you pay more premium because you are more likely to have an accident, surely that is based upon statistics.
Is it necessarily fair that everyone is penalised for the actions of a few... (actually that could be said of more than just this thread... but that is another discussion :) )
However, those who regularly take part in sports are generally more healthy than those who don't do any form of physical exercise. Therefore, in this insurance scenario will couch potatoes have a higher premium?
Blazing Sporrans
11-Feb-11, 17:49
I don't think I'm being obtuse, just offering a questioning attitude
I think that the example offered is obtuse, sorry if that offends, but nobody ever suggested withholding healthcare until an agreement was received in advance to pay. I also subsequently suggested that the care recipient need not pay the cost of treatment in full but a percentage would possibly suffice as a deterrent from irresponsible behaviour. Even a first time warning with a threat to bill for future similar indiscretions requiring treatment might help an already overburdened NHS.
The problem then would be the time spent by healthcare professionals acting as witnesses in the court.
That's why I suggested hospital security taking care of the issue.
Blood alcohol levels may be useful in determining a legal level for driving for example, but in the case of "drunk and incapable" it is more down to the individuals ability to handle their drink than actual alcohol levels. I know people who can't walk after 6 pints and others who'll still be more than capable of looking after themselves after double that amount.
So if they can cope with the amount of alcohol consumed then they are not incapable by definition, I'd have thought and less likely to sustain injury etc through the level of their impairment. I'm only suggesting that blood/alcohol levels could be taken as proof where impairment is already apparent. If blood/alcohol levels are low, then that might suggest some other contributing factor, but for the sake of simplicity, I'm confining the argument to alcohol in the meantime.
Also, would it therefore be made compulsory to have a blood test when recieving treatment?
If the level of sobriety is in question then why not? Do you cost the system £900 per year through alcohol excess and if not why argue in favour of those who do? It certainly angers me to think that money I would not begrudge the NHS for people truly in need of medical care goes towards what might be considered to be an unnecessary burden on a fantastic NHS facility.
Back to my previous point, people pay their national insurance and everyone is entitled to healthcare because of that. Removing it from those taking part in a perfectly legal pastime whilst still offering healthcare to drug addicts, for example, would be wrong in my opinion.
A different argument from the original topic but as I've stated above, I make my NI contributions willingly because I'm a big believer in the principles on the NHS and also social responsibility. People who abuse the system through self inflicted idiocy should pay something extra...
I make my NI contributions willingly because I'm a big believer in the principles on the NHS...
Your viewpoint would appear to infer otherwise.
From the NHS website, there are 3 core principles:
http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx
That it meet the needs of everyone
That it be free at the point of delivery
That it be based on clinical need, not ability to pay
I would say your opinions go completely against the first 2 and arguablly against the third.
I think anyone who thinks that these principles, that have been around for 60 years, are going to change anytime soon is quite deluded. Even if they are, from the original post, the chairperson of a group as high profile and as influencial as the Scotland Patients Association.
canadagirl
11-Feb-11, 18:31
And just how would they get these irresponsible drinkers to pay up? I suspect it would cost more to chase down the money than what it already costs. :confused
Bit of clarity:
If you are violent or abusive to NHS staff, you may be refused NHS hospital treatment, or given a verbal or written warning before treatment is withheld or withdrawn. Violent or abusive behaviour could include verbal abuse, threats, violence, drug or alcohol abuse in hospital, and destruction of property.
Each NHS trust can decide which types of behaviour could lead to treatment being withheld or withdrawn and how such policies are implemented. However, treatment cannot be withdrawn for more than twelve months.
If you are violent or abusive to NHS staff and have severe mental health problems or are suffering life-threatening conditions, you will not be denied treatment.
http://www.adviceguide.org.uk/index/your_family/health/nhs_patients_rights.htm
Bit of clarity:
If you are violent or abusive to NHS staff, you may be refused NHS hospital treatment, or given a verbal or written warning before treatment is withheld or withdrawn. Violent or abusive behaviour could include verbal abuse, threats, violence, drug or alcohol abuse in hospital, and destruction of property.
Each NHS trust can decide which types of behaviour could lead to treatment being withheld or withdrawn and how such policies are implemented. However, treatment cannot be withdrawn for more than twelve months.
If you are violent or abusive to NHS staff and have severe mental health problems or are suffering life-threatening conditions, you will not be denied treatment.
http://www.adviceguide.org.uk/index/your_family/health/nhs_patients_rights.htm
True and, in my opinion, quite correct.
But being abusive to staff is very different to turning up at A+E merry after a bottle of wine with a broken ankle.
Two totally different scenarios even if alcohol is involved in both.
Blazing Sporrans
11-Feb-11, 18:45
Your viewpoint would appear to infer otherwise.
I can't help how you choose to (mis)interpret what I write, however with family members still working within frontline healthcare I can assure you that I am 100% behind the principles of the NHS, I'd just prefer to see funds for treatment going to those who have not drunken themselves into a stuporous state of their own volition. And having said that, I just phoned the Police HQ in Inverness at Burnett Road to enquire what happens with catatonic drunks (told them it was for research) to be told that they are taken to hospital for overnight observations. Now is it just me, or is that a burden the NHS doesn't need?
From the NHS website, there are 3 core principles:
http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx
That it meet the needs of everyone
That it be free at the point of delivery
That it be based on clinical need, not ability to pay
So if it's really 'free', why are NHS allowed to claim some £200+ million pounds annually under the Road Traffic (NHS charges) Act 1999, where the NHS can recover charges from a negligent driver's insurer? Using your same argument, perhaps we should campaign to stop this nonsense...
I think anyone who thinks that these principles, that have been around for 60 years, are going to change anytime soon is quite deluded. Even if they are, from the original post, the chairperson of a group as influential as the Scotland Patients Association.
So let's not even discuss or consider the possibility of change and wait for our betters to tell us when change should come about; now THAT is bound to work... ho hum
I can't help how you choose to (mis)interpret what I write,
What you have written goes against at least 2 of the 3 core principles of the NHS.
Do you not agree with that?
I really don't think I've misinterpreted anything.
So if it's really 'free', why are NHS allowed to claim some £200+ million pounds annually under the Road Traffic (NHS charges) Act 1999, where the NHS can recover charges from a negligent driver's insurer? Using your same argument, perhaps we should campaign to stop this nonsense...
I see your point, but it is not "free", it is "free at the point of delivery" and prepaid through national insurance.
So let's not even discuss or consider the possibility of change and wait for our betters to tell us when change should come about; now THAT is bound to work... ho hum
Who's suggesting that? I've engaged in this debate considering the possibility for the last couple of hours!
The "I think" at the start of the sentence makes it quite clear that it is MY OPINION these proposals will not go through. But the proof of the pudding will be in the taste. Lets wait and see what happens when the all powerfull Scottish Patients Association casts its influence in the coming weeks.
My bet is nothing............
Blazing Sporrans
11-Feb-11, 19:01
And let's not forget the Emergency Workers (Scotland) Act 2005 which was brought about, in part, to safeguard Ambulance Staff, Doctors and Nurses from alcohol induced abuse and threats. Ask anyone in frontline healthcare if they have ever been threatened or intimidated by a drunken patient and I wonder how many negative responses you'll get? I know my brother, sister and sister-in-law can all speak to being regularly terrorised within the A&E department by various drunks.
Blazing Sporrans
11-Feb-11, 19:09
I really don't think I've misinterpreted anything.
I can steadfastly assure you that you have, but we'll obviously have to agree to disagree on that point.
I see your point, but it is not "free", it is "free at the point of delivery" and prepaid through national insurance.
But if the NHS still recoups it's costs or partial costs from motor insurance companies as a result of traffic accidents, then where is the difference in suggesting that drunken people contribute towards the financial outlay of the treatment required by them? Is that not a case of double standards within your argument?
I can steadfastly assure you that you have, but we'll obviously have to agree to disagree on that point.
Why agree to disagree?
If you can tell me, honestly, how your viewpoint matches these principles, the 3 core values of the NHS:
That it meet the needs of everyone
That it be free at the point of delivery
That it be based on clinical need, not ability to pay
then surely we can agree?
I don't think you can. I think you believe in your own interpretation of the values of the NHS, not those stated by the organisation itself.
But if the NHS still recoups it's costs or partial costs from motor insurance companies as a result of traffic accidents, then where is the difference in suggesting that drunken people contribute towards the financial outlay of the treatment required by them? Is that not a case of double standards within your argument?
Where did I say that I support that?
If you read my earlier posts I stated that I was against using personal insurances to pay for NHS healthcare, not just in driving but elsewhere.
So, I would ask you to reassess your view that I hold double standards, at least on this point.
And as for your point about drunken abuse of staff, I agree that it is unacceptable. I have not said anything to infer otherwise. But that shouldn't stop any non-abusive people getting free treatment, whether under the influence or not.
What about these two senarios..
A young lad out for a night out who is drinking more than he should but is with his pals,one of the others is mouthing off and the poor bloke is standing in the wrong place gets glassed, not his fault, will he have too pay for treatment?
Or the young lassie who has her drink spiked and is totally freaking out and lashing out..she had only 2 drinks and someone slipped drugs in her 2nd for a laugh!
Who will police who has to pay?
Blazing Sporrans
11-Feb-11, 22:05
Seriously annoyed.... wrote a lengthy discourse in reply and when I tried to post it, found I'd been automatically logged out and lost the lot!!! Grrrrrrr.....
Seriously annoyed.... wrote a lengthy discourse in reply and when I tried to post it, found I'd been automatically logged out and lost the lot!!! Grrrrrrr.....
Not quite the same, but I got caught out the other day; wrote a long PM, tried to send it - seems the other's box was full and my PM disappeared (I expect I did something wrong)
orkneycadian
11-Feb-11, 23:57
From the NHS website, there are 3 core principles:
http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx
That it meet the needs of everyone
That it be free at the point of delivery
That it be based on clinical need, not ability to pay
These princinples don't apply to NHS dentistry. Here in Orkney like so many places;
It does not meet the needs of everyone (it hardly meets the needs of anyone!)
It is not free at the point of delivery, even if you are lucky enough to be seen
Clinical need goes out the window. If you need it, "go private and be forced to pay for it!"
If NHS can so blatantly disregard their core principles when it comes to dentistry, they should have no qualms about doing the same with A&E!
http://www.bbc.co.uk/news/uk-scotland-12428765
"Anyone who has been abusing alcohol and can't stand on their feet and is admitted to hospital at the weekend should pay towards their treatment."
On the back of recent threads about the NHS, treatments, causes and patients: Discuss...
IMO it wouldn't work.
The suggestion would go against the grain of the main principles of the NHS in Scotland. Here's a shortened version :-
The NHS provides a comprehensive service, available to all
Access to its services is based on clinical need not an individual's ability to pay
The NHS aspires to high standards of excellence and professionalism
NHS services must reflect the needs and preferences of patients, their families and their carers
The NHS works across organisational boundaries with other organisations in the interests of patients, communities and the wider population
The NHS is committed to providing the best value for taxpayers' money, making the most effective and fair use of finite resources
The NHS is accountable to the public, communities and patients that it serves
Here's the full link :-
http://www.scotland.gov.uk/News/Releases/2008/07/03160736
Perhaps re-education is the key.
That's a reasonable suggestion but I don't see how you would implement it.
To be guilty of being drunk and disorderly you have to be proven guilty in a court of law. Innocent until proven guilty is a fundamental human right in our society and I don't see that changing anytime soon.
I do agree with you point about the difficulty in implementing it but perhaps it should apply to repeat offenders.
I do disagree with your comment about innocent until proven guilty that was thrown out years ago with the speed ...sorry safety cameras...where you are guilty without being shown any evidence, and if you don't plead guilty you will face even greater fines.
A colleague of my husband lived a double life- Monday to Friday he was sober and respectable. however at weekends he was suicidal and drank until he knocked himself out (he was a divorce, and his grown up children and ex wives cut him out of their lives) When he drank he was obnoxious and terribly accidnet prone. One weekend A&E turned him away (they had been dealing with a horrific accident, and they sent him outside to cool off until they had space to deal with him. He tucked himself up into a corner of the car park, and choked to death on his own vomit.
we went to the funeral, and while everyone felt guilty about his death, the handful of mourners agreed that this in fact was what he'd been trying to do for years- and the kindest thing was to let him get on with it
http://www.bbc.co.uk/news/uk-scotland-12428765
"Anyone who has been abusing alcohol and can't stand on their feet and is admitted to hospital at the weekend should pay towards their treatment."
On the back of recent threads about the NHS, treatments, causes and patients: Discuss...
No argument about it, they should pay - however, if I had my way I would not even let them over the A and E doorstep until sober.
Powered by vBulletin® Copyright © 2024 vBulletin Solutions, Inc. All rights reserved.