BS: NHS treating drunks

Subject: RE: BS: NHS treating drunks
From: GUEST,Eliza
Date: 22 Jan 12 - 05:54 PM

But Stower, many many people indulge moderately in both those things without causing any problems healthwise. Is it fair to penalise them along with those who over-indulge?

Subject: RE: BS: NHS treating drunks
From: Stower
Date: 22 Jan 12 - 12:30 PM

Since alcohol and tobacco comsumption are legal, then if the government are *really* serious about the costs of drunks and smokers on the NHS tax bill, then they should surely look at the legislation which allows people to lawfully engage in these activities?

Who would support such a change in the law?

Subject: RE: BS: NHS treating drunks
From: GUEST,Ian Mather sans cookie cos on hols
Date: 22 Jan 12 - 07:03 AM

Don

The figures are to within a couple of percent NAO figures and having chaired a board spending a representative chunk of it, where budgeting is based on public health input of need, I'm not sure it's a debating point, just a raw fact with no spin.

What is management cost? How do you split it? Hospital doctors are paid in sessions, some of which are admin based. So 10% of doctor salary are part of your bureaucratic management. In year one of our trust, our director of public health had his salary classed as clinical. The Treasury changed the rules and come year two, his salary was based as management, despite still spending the vast majority of it as a consultant.

When GPs were asked to help run The NHS, ( not the new health bill but the PCTs which originally were GP led in decision making) if you had a GP spending a day a week being a clinical decision making lead, you lost 20% of his clinical time and advanced management overhead by 20% of his time, all of which goes into the figures you allude to.

Let the doctors and nurses run things? Yes, it sounds good and is good. But less clinical time means more management time, you can't have it both ways. NHS trusts are beginning to crumble and patient care is starting to be compromised because back room functions are falling victim to the cuts. It sounds great to get rid of clip board merchants but that process, despite successive ministers wanting to take the credit, has been going on for some time and many unnecessary tasks are long gone, so now the cuts to meet the £20B savings are starting to affect patient care.

£100Billion is a lot of money to administer, and there is a point where not enough people managing it is as wasteful as too many.

Trevor, rereading my comments, I accept I went for the jugular and that isn't always my way. I apologise for that. That said, NHS funding does not rely on perpetuation of life compromising purchases such as tobacco or alcohol, nor indeed poor dietary food. The figures (available on Royal College of Public Health website) show the small increase in Treasury receipts is dwarfed by the huge increase in problems.

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 21 Jan 12 - 07:46 PM

""30% of the entire NHS budget is spent on treating smoking related illness? Really? I'd be very interested in seeing the figures for that, if you can point me to where you got them.""

I too would like to see the credible source for this, given the official figures which suggest that half, or more, of the budget disappears into funding bureaucratic management, rather than patient care.

DonT.

Subject: RE: BS: NHS treating drunks
From: Trevor Thomas
Date: 20 Jan 12 - 10:04 AM

Ian Mather, I hope the bit where I said "Everyone should be treated free at the point of delivery, without fear or favour" was clear enough.

That includes smokers, drinkers, the obese, the elderly, everyone who needs treatment. That's what we've got the NHS for.

Yes I know the NHS is a tax based system, which is why I was talking about tax. In addition to the normal tax that everyone else pays, smokers and drinkers also pay a very percantage high tax on the tobacco and alcohol. Sorry if this was unclear.

30% of the entire NHS budget is spent on treating smoking related illness? Really? I'd be very interested in seeing the figures for that, if you can point me to where you got them.

Apologies if I expressed myself somewhat clumsily. Someone has raised the suggestion that if someone sustains an injury as a result of alcohol, they should pay for the treatment. My point was that they already pay for it.

Subject: RE: BS: NHS treating drunks
From: Musket
Date: 20 Jan 12 - 08:53 AM

Perhaps Trevor Thomas should make it clear what he is talking about?

The rest of us are talking about The NHS, which is a tax based system. It is and never was, incidentally, subject to National Insurance contributions for its existence.

What Mr Thomas is describing is an insurance based healthcare where you "try to get out what you put in."

Sorry, but I treat your comments with utter contempt. Even if we did ignore the moral principles versus the "me , me, me" of your post, then it still holds that revenue from tobacco would account for less than 1% of The NHS budget, whereas smoking related illness consumes over 30% of the NHS budget.

Incidentally, that is getting lower as more smokers get around to dying and the rest of us live longer, developing ailments which years ago would not have developed as we would have been already dead.

Glad you will be ahead on the deal. Also be glad that the NHS will look after you without judging you.

Subject: RE: BS: NHS treating drunks
From: Trevor Thomas
Date: 20 Jan 12 - 07:48 AM

We've already paid for it, thanks. Do you imagine all people who drink are not taxpayers? Or pay no National Insurance?

But more than this, people who drink pay more tax than people who don't. As well as the usual income tax and NI, they pay a significant amount of tax on every unit of alcohol that they buy.

Same with smokers – far more revenue is collected in tax on tobacco than is spent treating smoking related illness. I strongly suspect the same is true of alcohol. Millions of pounds of tax are raised every day on alcohol sales. The more people drink, the more tax they pay.

Those of us who smoke and drink have already paid more than enough tax to cover an A and E visit, should they need one. Indeed, we probably help subsidise the healthcare of the abstinent.
In addition, we'll die younger, saving the 'taxpayer' a bundle on all the multiple treatments that the elderly often receive.

And I'm perfectly happy with this arrangement. Everyone should be treated free at the point of delivery, without fear or favour.

I'd be happy to stump up the £200 if I landed in A&E - so long as I never had to pay another penny in tax on cigs and booze. I reckon I'd be ahead on the deal.

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 19 Jan 12 - 02:07 PM

""Not meanwhile, but immediately, the police should be required to enter premises check the situation and close them down for the night, if they are found to be serving drunks.

Prosecution would then follow and possible suspension or revocation of licences ensue.

Those powers already exist under existing law.

BTW, I am also of the opinion that the administration of those licences should be removed from Councils and returned to the magistrates, a system which worked very well for many years.

Don T.

Subject: RE: BS: NHS treating drunks
From: Backwoodsman
Date: 19 Jan 12 - 11:16 AM

A very good reason for ending the sale of cheap booze in supermarkets.

Subject: RE: BS: NHS treating drunks
From: GUEST,Patsy
Date: 19 Jan 12 - 07:57 AM

Most of the comments I hear from young people is that the prices in city clubs are extortionate, that plus entrance costs and the taxi fare home makes a very costly night so tend to drink at home or a friends house before going out on the town later. If that is the case it would be difficult to monitor how much alcohol has been consumed by the time the clubs close.

Subject: RE: BS: NHS treating drunks
From: GUEST,Eliza
Date: 19 Jan 12 - 07:00 AM

Sorry, peregrina, I didn't realise you were being ironic. I am a bit thick sometimes! But I've heard that raising the prices of drink has been mooted by the Government, and also of foods which might be 'bad' for us, the Nanny State in action again, so the irony could even become reality. I believe that reducing the hours of alcohol buying, in supermarkets, pubs and clubs may help, especially in preventing late-night boozing. It's while making their way home in the early hours that many drunkards get into trouble. If all this happened before, say, 1am, the streets could be quiet much earlier. I often wonder how these ypung drunks get up for work the next morning, as the drunkeness goes on all week, not just at weekends. They must be in work or they couldn't afford to buy the drink in the first place.

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 18 Jan 12 - 11:40 PM

I certainly don't disagree with this last point, Don.

Meanwhile, however ...

~M~

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 18 Jan 12 - 05:42 PM

Significantly reducing the number of drinkers arriving in A&E would, I think, put the question of charging to bed once and for all.

A better way to go surely.

Don T.

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 18 Jan 12 - 05:34 PM

""(There IS a law which forbids serving alcohol to an already intoxicated person, but I wonder if this is ever adhered to?) How do more civilised countries manage to keep their drunks down to a minimum?""

This is the major difference between the "Local", and the large Town Pubs and Nightclubs.

The landlord of a local pub is usually very aware of the level of sobriety of his clients, and rather good (so I've observed) at deciding when they've had enough and tactfully sending them on their way still capable if somewhat unsteady. These houses also still tend to turn out at 11.30 or thereabouts.

Large pubs and nightclubs serve large numbers of clients, using multiple staff, none of whom can possibly monitor the drinking of any one person, leading to a degree of unawareness of overindulgence. It is those venues which disgorge multiple disorderly, incapable, or violent drunks onto the streets in the early hours.

It would be logical to support the local and curb the activities of the others, but the exact opposite is happening and the responsible landlords are the ones gong out of business.

I believe that the tied pub system should be banned, and local landlords should be allowed to purchase wherever they wish, which would enable them to compete by using cash and carry trade outlets.

Rentals charged by the freeholders (where the licensee rents the premises) should be subject to review by rent tribunals, since the pub is also the landlord's home.

Lastly, the extension of opening hours which has had the opposite of the effect foreseen by the Blair/Brown government should be rescinded as a failure.

That might put some sanity back into the situation. At least it would change the activities of the proportion of clients who have only left the local for the larger venues because they can drink for several hours more.

Maybe we might move back towards the days when binge drinking was the domain of Holidaymakers abroad, and basically lasted for two weeks per year.

Don T.

Subject: RE: BS: NHS treating drunks
From: peregrina
Date: 18 Jan 12 - 04:06 PM

It was meant in irony, Eliza! I've agreed with your posts here.

Subject: RE: BS: NHS treating drunks
From: GUEST,Eliza
Date: 18 Jan 12 - 03:59 PM

Such a Tax would penalise unfairly well-behaved people who like a drink now and then but can't afford to pay even more for it. I wonder if limiting the hours of opening of clubs, pubs etc, ie revoking the open-ended Licensing Laws is the only answer. I don't myself see why people should be stravaging about the streets at three in the morning. People might then go home at, say one o'clock. The Police could then be stood down much earlier. (There IS a law which forbids serving alcohol to an already intoxicated person, but I wonder if this is ever adhered to?) How do more civilised countries manage to keep their drunks down to a minimum?

Subject: RE: BS: NHS treating drunks
From: peregrina
Date: 18 Jan 12 - 02:31 PM

Apart from the betrayal of principle (and decency) that this proposal would entail, the administrative infrastructure for the judgements, billing, bill collection, disputes, and so on would be exceedingly costly. If you really want to go down this route, put a special tax on all the drink, food, goods, and activities that lead to emergencies, *(&^, even a tax on DIY supplies if you are going to take this to its logical conclusion. A modest proposal.

Subject: RE: BS: NHS treating drunks
From: GUEST,Bluesman
Date: 18 Jan 12 - 02:23 PM

Public house and Night club owners in some areas are set to be charged for police time, due to the high number of weekend call outs. That makes sense to me.

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 18 Jan 12 - 01:56 PM

I didn't say I could instantly tell anything, Don, did I? I am not called upon to do so. But do you really think that the experienced receptionists, doctors, nurses, consultants at A&E, followed up by the almoners and welfare assistants, would not be able to tell the difference? It doesn't have to be an 'instant' decision, does it? No-one is talking about demanding payment upfront; but simply of billing certain beneficiaries who, if such a system is agreed, would not qualify for free treatment. If you are not patronising, you are being wilfully contrary, Don. You are not a fool, and you know you are being so.

I realise that we disagree as to the main question as to whether treatment should be paid for in any circumstances. We can agree to differ on that. But there is no need to continue to adduce such fatuities to support your side of this matter, on which I can see two possible reasonable stances even if you can't.

~M~

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 18 Jan 12 - 01:27 PM

Hardly patronising to point out the arrogance of believing that you could instantly tell an alcoholic from a binge drinker, something even a consultant in the field wouldn't claim to do on the strength of a visit to A&E, not that such a consultant is likely to be found in A&E at pub closing time.

Even when the difference could be diagnosed (after a series of visits and consultation), a demand for payment would be absolutely opposed to the ideals of those who created the NHS and the Welfare State.

Don T.

Subject: RE: BS: NHS treating drunks
From: GUEST,Willie
Date: 18 Jan 12 - 11:59 AM

100

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 18 Jan 12 - 11:01 AM

Patronise away, Don. It is clearly what turns you on.

Like the binge-drinking adolescents, you only do it to annoy, because you know it teases.

Hope it keeps fine for you.

〠☺〠☺〠

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 16 Jan 12 - 07:25 PM

""Of course, there will be a large number of occasions where the patient & the person causing the injury are the same.""


Strangely enough, I've been there, and I can assure you that it is indeed the other party who gets the bill in RTA cases.

I was very surprised when a pedestrian, running for a bus in the rain smashed into my car and went straight over the roof. The police car driver immediately behind me confirmed my speed at 25 mph, having had to brake hard himself to avoid hitting the pedestrian, and was witness to the fact that I was in no way to blame.

I had to pay the emergency treatment fee through my insurance company, so I believe that there cannot be many cases such as you suggest.

Don T.

Don T.

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 16 Jan 12 - 07:15 PM

""Do you really think I don't know about alcoholism or dependency, which are clinical misfortunes; or their difference from wilful teenage binge-drinking to shock & annoy the bourgeois society of their elders,""

Mike, you should perhaps apply for the job of informing hard pressed A&E staff as to the diagnosis of each and every patient who arrives suffering either from self inflicted alcohol poisoning, or injury sustained therefrom, or from the effects of alcoholism which can strike young or old.

Since you are such a convinced diagnostician, you might be quite chastened by the likely response from the real professionals. It should at the least be educational.

Don T.

Subject: RE: BS: NHS treating drunks
From: Nigel Parsons
Date: 16 Jan 12 - 12:35 PM

Just a minor correction:
The payment that insurance companies make toward emergency treatment of road traffic accidents is totally irrelevant to this topic, since it is always paid in the first instance, not by the patient but by the person causing the injury, whether or no that person is culpable.

Of course, there will be a large number of occasions where the patient & the person causing the injury are the same.

Break your leg on holiday abroad and you need to rely on holiday insurance to cover your hospital costs. Do so while drunk and they may refuse to pay up.
Why shouldn't we have similar access to services over here?

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 16 Jan 12 - 12:19 PM

... and Don, why must you always be so patronising? Do you really think I don't know about alcoholism or dependency, which are clinical misfortunes; or their difference from wilful teenage binge-drinking to shock & annoy the bourgeois society of their elders, like those nieces that Eliza is so concerned about ~ whose occasional resultant physical misfortunes to my mind can be laid firmly at the self-indulgent participants' own wilful door?

~M~

Subject: RE: BS: NHS treating drunks
From: Musket
Date: 16 Jan 12 - 12:16 PM

So many posts to this thread, perhaps now is the time to invoke Godwin's Law?

So.. when we pick and choose the worthy versus the unworthy patients, and judge them as they crawl through A&E..

Why don't we have two doors? A fast track for fair haired true Aryan stock and a door leading to a long queue for all the untermench?

Assuming you want to pay for the untermench to be treated?

Did I spell that right? Probably not.

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 16 Jan 12 - 11:49 AM

I don't know what you mean, Don, by "Thanks but no thanks". I haven't offered you anything. I have simply expressed an opinion about one particular phenomenon or situation. You are perfectly entitled to disagree, but I don't see where 'No thanks' comes into it.

& DMcG:I know what I mean, & believe myself to have to have expressed it coherently. What anyone else may extrapolate from extending my argument according to their own tastes is no responsibility of mine.

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 16 Jan 12 - 11:31 AM

""whatever anyone else might have contributed to the thread, that is not what I personally am talking about - or interested in,""

OK, so dealing with your personal interest, are you one of the benighted and ill informed who have not yet heard of two clinical states which pertain to drunken behaviour, namely "Alcohol Dependency" and "Alcoholism">

These are not euphemisms for binge happy hedonism. They are in fact very unhappy states, difficult for the sufferer to deal with.

How do you propose that A&E staff diagnose youthful (or for that matter middle aged) self inflicted excess, as opposed to involuntary acoholism, or dependency?

The payment that insurance companies make toward emergency treatment of road traffic accidents is totally irrelevant to this topic, since it is always paid in the first instance, not by the patient but by the person causing the injury, whether or no that person is culpable.

Having removed your only example of payment, we are left with a system which is unequivocally opposed to payment for treatment at the point of need.

It is the same (and rightly so) for every UK citizen from the highest to the lowest.

Any relaxation of that system opens the door to a flood of changes which would do, in the fullness of time, exactly what you and others accuse the government of doing.

Start with drunks, and somebody will ask "Why not smokers, fat people, criminals, gang members, drug dealers etc. etc"...........and in the long run "Why not everybody"?   These things never stop after the first move

Thank you Mike, but no thanks. I don't want any part of dismantling the Welfare State.

Don T.

Subject: RE: BS: NHS treating drunks
From: DMcG
Date: 16 Jan 12 - 09:08 AM

To clarify: I agree with your statement that obesity and the effects of smoking are not 'one off events', but there are many other incidents that are one off where the injured person is culpable which might be candidates for such charging.

Subject: RE: BS: NHS treating drunks
From: DMcG
Date: 16 Jan 12 - 08:56 AM

I understand your wish to focus on the main topic, MtheGM, but I'm not sure it is really possible to separate things out like that. If you argue that drunks should pay something for treatments, and give a certain rationale, then you can't help implying that other treatments may also be candidates for charging if the same or a similar rationale applies, whether you want to make that implication or not. Certainly, when the powers-that-be look at ways of funding things, if they find the public accept one set of charges it makes it much easier for them to argue for another that is similar. Equally, I can see a rational argument for no charge, or the full charge, but anything in between is a pretty arbitrary choice depending on what seems right at the time, and is therefore liable to be revised as circumstances change.

Subject: RE: BS: NHS treating drunks
From: GUEST,Patsy
Date: 16 Jan 12 - 05:43 AM

There is a difference between an alcoholic who of course needs help and someone who has got it completely wrong mostly because of inexperience or immaturity with alchohol. I am not holier than thou and can remember trying a flagon of cider when I was 15 with a few young friends there were no alchopops back then thank goodness who knows what state I would have been in, cider was about the easiest to get and to swallow at that time, beers were far too bitter and too heavy to carry around. My worst memory of that night was the room constantly spinning not being able to get any sleep and then being very very unwell followed by getting a lecture from my mother. A few years later I found out the folly of drinking on an empty stomach, mixing the wrong drinks together or drinking them too quickly. The difference for young people now is that eccessive drinking on the streets or in foreign holiday resorts are more frequently captured on camera than it was then, any drunken disturbance only got about a few lines in the local paper of gazette.

The dilemma now is who is to say that most of the girls are genuinely 18 or even that their parents have knowledge where they are so for reasons like that it would be impractical to charge all drunk people or to refuse admission. But I still think that if a drunk assaults a nurse or another patient in a vicious way to cause injury a charge should go to the hospital or to the person hurt. Being drunk is not an excuse to be violent.

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 16 Jan 12 - 03:09 AM

I think the distinction should be made, that the effects of smoking, obesity, &c, are long-term: the results of many years of indulgence in a habit or lifestyle, the ultimate possible consequences of which the sufferer has opted not to take account of at the outset.

What we are discussing here is the unfortunate results of a single incident: one day's, or evening's, over-indulgence in alcohol leading to an accident which has landed the drinker in hospital for treatment, the responsibility for payment for which is what we are discussing.

It seems to me that the drifts to smoking & obesity, in contradistinction to the clear title of the thread, have muddied the issue, and this needs to be taken into account in considering the matter.

~M~

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 15 Jan 12 - 04:29 PM

At the time you started smoking, Don, as when I did, the effects were not known, and it was regarded as a bit eccentric not to smoke; or it was, in any event, a sort of social expectation. But young people today do know; & if there is one thing I really find depressing it's seeing a young person smoke, because they do know.

However: drunks [look above at the title] are the subject of this thread. They are the only people I have addressed my remarks & opinions to. Anyone trying to distract me or catch me out by going on about smokers, obesity, whatever, is simply an irrelevant, time-wasting pisser-down-the-wind, because, whatever anyone else might have contributed to the thread, that is not what I personally am talking about - or interested in, within this thread's context, anyhow; and have no opinion to express at present about those conditions or activities.

~M~

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 15 Jan 12 - 02:53 PM

""Nobody has suggested the full cost should be recovered; only that some charge should be made. I think that a fairly significant charge to someone treated for a self-induced condition of this sort might be, say, £75; roughly 7½ bottles of vodka, I make that.""

I started smoking at the age of twelve, at a time when smoking was considered a manly pastime and nobody was aware of the deleterious effects.

I continued to smoke for 53 years, giving it up five years ago.

As a direct result, I have passed beyond COPD into the early stages of emphysema.

You might say that my condition is self inflicted, so Mike, what would you say the NHS should be able to demand from this reckless fool in payment for the treatment he will need for the rest of his life. Go on, tell me what you think should be taken from my pension to pay for my delinquency?

BTW, don't forget that I contributed a chunk of MY earnings to the treatment of other drunks and smokers, so shouldn't I get a discount?

Don T.

Subject: RE: BS: NHS treating drunks
From: GUEST,Eliza
Date: 14 Jan 12 - 02:27 PM

I take your point, MtheGM about my nieces. But I don't think stinging them for money or any other type of fee system would address the fundamental urge to drink in excess. Something else is going on among our youth than a wilful and deliberate binge-drinking attitude. These young people are not functioning mentally or emotionally as they should. It's almost as if they're trying to blot out something. Alcoholism and binge drinking aren't easy to explain or treat. Making the drunks pay for treatment won't prevent further abuse will it? The Law doesn't seem to be able to solve this, so perhaps therapy or counselling might. I have paid Income Tax and NI contributions all my life, and I quite see how angry it makes one to have to fund this problem, but I will always stand firm on 'treatment for all' under the NHS.

Subject: RE: BS: NHS treating drunks
From: GUEST,Ian Mather sans cookie
Date: 14 Jan 12 - 02:13 PM

Treat without fear or favour. Fully behind that principle.

Just something to slip in though. How do contributors feel about recovering costs?

The NHS has for a number of years been encouraged to claim road traffic accident costs from insurance companies for emergency treatment and, where they are savvy enough to make the connection, ongoing elective costs that emanated from the accident.

Obviously, not at the cost to the patient but is charging the insurance company a step nearer or something entirely different?

Views appreciated.

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 14 Jan 12 - 12:36 PM

..."therapy, counselling, medication" ~~ oh, diddums, the poor little dears. According to what you say above, Eliza, this formula hasn't had much result with the nieces you are so concerned about, has it? And who is to pay for it, eh? Buggered if I can see why you & I should be expected to.

~M~

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 14 Jan 12 - 12:30 PM

Nobody has suggested the full cost should be recovered; only that some charge should be made. I think that a fairly significant charge to someone treated for a self-induced condition of this sort might be, say, £75; roughly 7½ bottles of vodka, I make that. This should act as a reasonable symbolic deterrent to self-injury due to binge drinking, recover some of the cost, and make the point required as to the inadvisability of putting oneself outside the automatically free at point of use system by one's own idiotic actions. I still say that anyone who can get that legless with vodka at nearly £10 a bottle can afford to be charged at such a rate.

~M~

Subject: RE: BS: NHS treating drunks
From: Backwoodsman
Date: 14 Jan 12 - 12:26 PM

Exactly Eliza.
QED.

Subject: RE: BS: NHS treating drunks
From: GUEST,Eliza
Date: 14 Jan 12 - 12:11 PM

It's preposterous to imagine the A&E triage personnel trying to ascertain exactly how an injury occurred and whether it amounted to self-inflicted negligence, and then proceeding to discover whether the patient had the means to pay. You can envisage the conversation;- "Well, we can give you a Paracetamol, but we refuse to set your broken leg. That'll be £2 please!" Here in UK, anyone and everyone who needs medical care, whether emergency or not, gets it. And no-one is asked to pay on a culpability basis. Habitual self-inflicted harm should be addressed with therapy, counselling and medication if required.

Subject: RE: BS: NHS treating drunks
From: DMcG
Date: 14 Jan 12 - 10:19 AM

I shouldn't be over-impressed by pleas of dire poverty from people who can afford to drink themselves legless every night with drink prices what they are

Doens't that depend on what the A&E costs, though? A quick search of the cost of fixing a broken arm came up with this:

It would depend on the bone and how bad it is broken. If it is a clean break and simply set, the cost would be minimal but, if it is a mulitple-break or a break that requires hardware (screws and pins) to set, then it will cost alot. At the very least, you will pay for the ER visist. You will have to pay for X-Rays. You will have to pay the Radiologists and probably an Ortho guy to set the bone. I would expect minimally pay $750-$1000.

XE Converter says that $1000 US is 652.80 pounds sterling.   Tesco online has one bottle of vodka at 9.82. I make that roughly 'minimally' 66 bottles of vodka per broken arm.   That's a heck of a lot of drunkedness!

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 14 Jan 12 - 08:44 AM

That would surely be a matter for intervention by the social services, Don. But, reverting to the main category this thread-title refers to: I shouldn't be over-impressed by pleas of dire poverty from people who can afford to drink themselves legless every night with drink prices what they are. For them then to plead they couldn't afford to pay for treatment to rescue them from the adverse consequences of their own over-indulgence would constitute the ultimate impertinence and snook-cock.

~M~

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 14 Jan 12 - 06:57 AM

I'm glad you mentioned medical morality Mike, because that is precisely what demands that any patient in need of treatment should get that treatment free at the point of need.

That means any patient, not just those who conform to your, or anybody else's, concept of acceptable behaviour.

And schemes like the one outlined above are refusal of treatment. Insisting that a patient suffer unnecessary pain while attempting to lose weight before being considered eligible for replacement surgery is just plain wrong.

Also, there is the question of whether the patient could even afford to pay, assuming he were billed for the treatment. What do you suggest doing about those wo couldn't?

Don T.

Subject: RE: BS: NHS treating drunks
From: MGM·Lion
Date: 14 Jan 12 - 01:35 AM

Nobody, surely, is advocating refusal of treatment. The point of this thread, from OP onwards, is the question of who should, arguably, be billed for treatment, and not receive it free, for what may be regarded as self-induced injuries or conditions. Binge drinkers it was suggested are one such category. Others have been suggested ~ the obese, smokers &c ... But I can find no evidence that anyone here thinks that no help should be afforded, and they should just be left to live with [or die from] the injuries or other adverse conditions they have brought on themselves. It is a matter of priorities in the allocation of resources; and perhaps also of medical morality.

~M~

Subject: RE: BS: NHS treating drunks
From: Don(Wyziwyg)T
Date: 13 Jan 12 - 06:32 PM

""(And yet... I wouldn't want a young lad or girl left paralytic in the snow, dying of hypothermia, alcohol poisoning or drug effects. Don't know what to think...!)""

What we think isn't really very important Eliza, but as the father of a grade E nurse, I can tell you that medical professionals are almost all adamantly opposed to refusal of treatment, and won't countenance for one second anything of the sort.

Don T.

Subject: RE: BS: NHS treating drunks
From: GUEST,Eliza
Date: 13 Jan 12 - 12:02 PM

I can well understand the reluctance of the general public to fund/assist habitual drunkards. In the club area of our city they've set up an 'SOS Post' ie a portacabin, which opens until the early hours and receives drunken and incapable youngsters. A taxi is called for them, to get them home safely, and trained first-aiders minister to their needs, calling an ambulance if necessary. One Saturday, people were rattling collecting tins to fund this SOS Post, but the remarks they were getting were not complimentary! I didn't contribute. I wondered if the parents of these bibulous youngsters would put anything in the tins? (And yet... I wouldn't want a young lad or girl left paralytic in the snow, dying of hypothermia, alcohol poisoning or drug effects. Don't know what to think...!)

Subject: RE: BS: NHS treating drunks
From: theleveller
Date: 13 Jan 12 - 09:48 AM

"A healthy BMI - a calculation of weight to height - for adults is 18.5 to 25."


BMI is not an accurate indication of whether someone is overweight. I spent 20 years weight-training and although I haven't done it for around 12 years still have a BMI in the 'overweight' category (27.1) despite having a waist measurement of 33 inches and very little body fat. Some of the bodybuilders I used to train with would have had a BMI off the scale.

My ex-father-in-law, who died a few weeks ago at the age of 96, was refused a hip replacement the age of 75 on the grounds that he exercised with weights and a exercise bike every day and so was considered too active.

Subject: RE: BS: NHS treating drunks
From: Nigel Parsons
Date: 13 Jan 12 - 09:47 AM

This isn't about drinking, but a very similar mentality is at work:

"In one of the first programmes of its kind in the country, Herts GPs have supported recommendations by NHS Hertfordshire, the county primary care trust (PCT), that force obese people to lose weight and encourage smokers to quit before they are allowed orthopaedic surgery.
[cut]...

...[/cut] Smokers needing routine orthopaedic surgery are now asked to go on at least one session with a trained advisor to receive advice on quitting before being they are added to a waiting list.

Sounds to me like a way to reduce waiting lists without treating patients!

Subject: RE: BS: NHS treating drunks
From: Keith A of Hertford
Date: 13 Jan 12 - 09:25 AM

From UK Liver Transplant Group Recommendations for Liver Transplant.


Assessment in the Context of Alcohol-related Liver DiseaseIt was agreed that there were several factors, each of which precluded listing
for a transplant because a poor outcome for the graft was likely.
1. Alcoholic hepatitis- clinical syndrome of jaundice, coagulopathy rather
than histological diagnosis
2. Repetitive episodes (more than 2) of non-compliance with medical care
where there was not a satisfactory explanation. This should not be
confined to management of their liver disease.
3. Return to drinking following full professional assessment and advice
(this includes permanent removal from the list if found to be drinking
while listed)
4. Concurrent or consecutive illicit drug use (except occasional cannabis
use)