NHS breaking point?

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lpm
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Re: NHS breaking point?

Post by lpm » Mon Jul 25, 2022 5:07 pm

The outcome of the last 4 General Elections says otherwise.
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Re: NHS breaking point?

Post by Little waster » Mon Jul 25, 2022 5:14 pm

lpm wrote:
Mon Jul 25, 2022 4:35 pm
One is fired, with his unpopular levy forming the backdrop to his disgrace. The other lost his reputation partly over it and won't win the leadership as a result.
“Johnson resigned because of the health care levy” said no future history book ever.

Presumably double digit inflation, a collapse in exports, a Non-Dom wife, latent Tory racism and Truss peddling fairytales will not feature in any future autopsy of Rishi’s leadership campaign either.

What an warm shade of gaslight.

What the f.ck is £8 a person per day going to fund? Just picking the massive UCLH as an example that has 665 beds. Assuming 100% occupancy that’s a whopping £5320 per day versus on an annual budget of £1.4bn (or nearly £4m per day).

I imagine that extra 0.00125% funding will make an earth-shattering difference to the NHS.
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Re: NHS breaking point?

Post by monkey » Mon Jul 25, 2022 5:19 pm

lpm wrote:
Mon Jul 25, 2022 5:07 pm
The outcome of the last 4 General Elections says otherwise.
People not complaining about the corporation tax rise suggests otherwise to you.

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Re: NHS breaking point?

Post by Opti » Mon Jul 25, 2022 5:19 pm

lpm wrote:
Mon Jul 25, 2022 5:07 pm
The outcome of the last 4 General Elections says otherwise.
The last 4 general elections haven't been contested on paying to reform the NHS. In fact, they haven't really been about taxation at all.
They've all been coloured by Brexit.
Time for a big fat one.

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Re: NHS breaking point?

Post by monkey » Mon Jul 25, 2022 5:20 pm

Little waster wrote:
Mon Jul 25, 2022 5:14 pm
lpm wrote:
Mon Jul 25, 2022 4:35 pm
One is fired, with his unpopular levy forming the backdrop to his disgrace. The other lost his reputation partly over it and won't win the leadership as a result.
“Johnson resigned because of the health care levy” said no future history book ever.

Presumably double digit inflation, a collapse in exports, a Non-Dom wife, latent Tory racism and Truss peddling fairytales will not feature in any future autopsy of Rishi’s leadership campaign either.

What an warm shade of gaslight.

What the f.ck is £8 a person per day going to fund? Just picking the massive UCLH as an example that has 665 beds. Assuming 100% occupancy that’s a whopping £5320 per day versus on an annual budget of £1.4bn (or nearly £4m per day).

I imagine that extra 0.00125% funding will make an earth-shattering difference to the NHS.
Less than that, if you assume it has the same exemptions as the prescription charge, e.g. the over 60.

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Re: NHS breaking point?

Post by Little waster » Mon Jul 25, 2022 5:24 pm

monkey wrote:
Mon Jul 25, 2022 5:20 pm
Little waster wrote:
Mon Jul 25, 2022 5:14 pm
lpm wrote:
Mon Jul 25, 2022 4:35 pm
One is fired, with his unpopular levy forming the backdrop to his disgrace. The other lost his reputation partly over it and won't win the leadership as a result.
“Johnson resigned because of the health care levy” said no future history book ever.

Presumably double digit inflation, a collapse in exports, a Non-Dom wife, latent Tory racism and Truss peddling fairytales will not feature in any future autopsy of Rishi’s leadership campaign either.

What an warm shade of gaslight.

What the f.ck is £8 a person per day going to fund? Just picking the massive UCLH as an example that has 665 beds. Assuming 100% occupancy that’s a whopping £5320 per day versus on an annual budget of £1.4bn (or nearly £4m per day).

I imagine that extra 0.00125% funding will make an earth-shattering difference to the NHS.
Less than that, if you assume it has the same exemptions as the prescription charge, e.g. the over 60.
Oops I forgot to carry the zeroes. It should be 0.125% (not including administration and exemptions).
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Re: NHS breaking point?

Post by nekomatic » Mon Jul 25, 2022 5:26 pm

I do understand the point being made here, which is that at some point insisting on the historic NHS funding model becomes perverse when the public have repeatedly declined to elect governments that would actually make it work, leaving us with a substandard service most of the time for the people who most need it.

I don’t agree that the only possible solution is direct charging and any potential difficulties with that can be handwaved away (yes of course we can dump the job of means testing and refunding on to the notoriously fair, efficient and compassionate benefits system, what could possibly go wrong?)
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Re: NHS breaking point?

Post by lpm » Mon Jul 25, 2022 5:37 pm

Woodchopper's figures for Norway's system of contributing charges gave a cap of £300 per annum.

Let's say the UK has 10 million non-paying users, 20 million paying users. The paying users are charged an average of £150 p.a. That's £3 billion a year.

f.ck off with your 0.00125% increase. That's 1.5% extra right there.

For Norway levels of charging. f.cking Norway, renowned for its nasty right wing governments controlled by foul tabloids like the Mail, what utter bastards, let's hope to god their policies don't migrate over here.
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Re: NHS breaking point?

Post by Millennie Al » Mon Jul 25, 2022 11:33 pm

EACLucifer wrote:
Mon Jul 25, 2022 3:21 pm
lpm wrote:
Mon Jul 25, 2022 1:50 pm
No, it would largely impact people with chronic health issues who repeatedly miss health appointments.
Which is frequently a consequence of having a chronic health condition you reactionary arse.

Booking a wheelchair taxi can be nearly impossible. Even if one can be booked, sometimes the taxi firm sends a conventional taxi, at which point you are f.cked. And yes, the NHS do hold it against you if you had a taxi booked and despite the booking clearly indicating a wheelchair cab - as acknowledged by the taxi firm after the inevitable complaint - the taxi firm sends a cab a wheelchair user can't get into.
Ideally, the NHS would get the penalty fee but it would be paid by the taxi firm whose negligence was the cause of the problem. Of course, in reality it might be very difficult to implement this. The best I can think of is for the NHS to provide the taxi on request and then, if a taxi firm made too many mistakes, they wouldn't get any more business from the NHS. That still leaves many situations unsatisfactory - for example, what if the problem is caused by a cancelled bus? The bus operator would be unlikely to be liable for penalty fees.

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Re: Who's next?

Post by Millennie Al » Mon Jul 25, 2022 11:39 pm

One of the ways to get more money per person for the NHS is to have it treat fewer people. If we could encourage those rich enough to pay for private treatment, it would leave the NHS with the money that would have been spent on them. This would require a major change in attitude in society - rich people would have to think that they shouldn't be getting free treatment if they could pay, or that private treatment was in some way superior.

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Re: Who's next?

Post by Martin_B » Tue Jul 26, 2022 12:14 am

Millennie Al wrote:
Mon Jul 25, 2022 11:39 pm
One of the ways to get more money per person for the NHS is to have it treat fewer people. If we could encourage those rich enough to pay for private treatment, it would leave the NHS with the money that would have been spent on them. This would require a major change in attitude in society - rich people would have to think that they shouldn't be getting free treatment if they could pay, or that private treatment was in some way superior.
That's spectacularly naïve.

a) You are essentially advocating for the NHS to deliberately provide inferior treatment to force rich people (who have already paid taxes to keep the NHS going) to go private.
b) You don't think that the Tories, as soon as significant numbers of people start having private treatment, won't reduce the NHS funding on the basis that "The NHS funding is X per patient and if they have fewer patients then they need less funding which can go towards my new car/wallpaper/duck island"?
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Re: NHS breaking point?

Post by lpm » Tue Jul 26, 2022 12:18 am

The NHS appointment is a valuable asset. Worth £100, say.

All this stuff about taxis and buses goes to prove my point: it's not valued as a valuable asset. Because the apparent cost is zero, it's treated as if it can be thrown away. Just another DNA.

If it was an envelope with £100 cash that people were trying to reach there'd be innovative solutions to help them grab it. There'd be an app.

The whole thing is a description of misaligned incentives.
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Re: Who's next?

Post by noggins » Tue Jul 26, 2022 12:21 am

Im sure the rich paying for private health will be every hit as beneficial to the common-wealth as the rich paying for private education.

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Re: NHS breaking point?

Post by Gfamily » Tue Jul 26, 2022 12:29 am

lpm wrote:
Mon Jul 25, 2022 5:37 pm
Woodchopper's figures for Norway's system of contributing charges gave a cap of £300 per annum.
Let's say the UK has 10 million non-paying users, 20 million paying users. The paying users are charged an average of £150 p.a. That's £3 billion a year.
Math - you need to triple the paying user amount to get to Norway levels on average.
If it's done on 'user charges' the majority of people make very little use (maybe once a year each at the dentist optician and health check up), so your charge has gone from £10 to ~ £70-150 per use, assuming you don't want to charge your 'non-paying users'
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Re: NHS breaking point?

Post by dyqik » Tue Jul 26, 2022 12:48 am

Gfamily wrote:
Tue Jul 26, 2022 12:29 am
lpm wrote:
Mon Jul 25, 2022 5:37 pm
Woodchopper's figures for Norway's system of contributing charges gave a cap of £300 per annum.
Let's say the UK has 10 million non-paying users, 20 million paying users. The paying users are charged an average of £150 p.a. That's £3 billion a year.
Math - you need to triple the paying user amount to get to Norway levels on average.
If it's done on 'user charges' the majority of people make very little use (maybe once a year each at the dentist optician and health check up), so your charge has gone from £10 to ~ £70-150 per use, assuming you don't want to charge your 'non-paying users'
And that's before the added cost of processing the billing, payments, exemptions and collections, which could easily make up 50% of the costs.

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Re: Who's next?

Post by bjn » Tue Jul 26, 2022 9:17 am

Also, there aren’t several thousand doctors and nurses sitting on their arses in the private health care system waiting for private patients to turn up. An increase in private healthcare will just strip staff from the already understaffed NHS.

It’s effectively queue jumping.

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Re: NHS breaking point?

Post by EACLucifer » Tue Jul 26, 2022 9:25 am

lpm wrote:
Tue Jul 26, 2022 12:18 am
The NHS appointment is a valuable asset. Worth £100, say.

All this stuff about taxis and buses goes to prove my point: it's not valued as a valuable asset. Because the apparent cost is zero, it's treated as if it can be thrown away. Just another DNA.

If it was an envelope with £100 cash that people were trying to reach there'd be innovative solutions to help them grab it. There'd be an app.

The whole thing is a description of misaligned incentives.
This just shows to go you either still don't get it, or are deliberately trolling. I reiterate that this is not an appropriate issue on which to do so.

Try to imagine for a moment what it is like to travel in a wheelchair. Streets are routinely blocked. Public transport routinely doesn't let you on, or sometimes, in the case of trains, doesn't let you off. For a manual chair user, the distance you can travel is limited by how far you can push. Operating a manual chair is quite hard work, certainly rather harder than walking. Electric wheelchairs make all kinds of far fetched claims about battery life, but these are downright fiction. In reality, a chair with 1.2kwh can do about four miles on one charge, but 1.2kwh is actually better than a normal chair carries. The most common battery bank size is about 0.8kwh.

Getting to a specialist appointment could involve travelling dozens of miles, and remember, the trains aren't accessible. Driving means using an adapted vehicle, but if you're on ESA, there's limits to how much money you can save before they decide to cut your benefits - and a decent adapted vehicle costs several times that limit, and remember, lots of people with mobility impairments can't drive anyway, due to the impairments.

The idea that people we could suddenly overcome these barriers for just £100 isn't just ignorant - it's extremely offensive. You are acting as if we aren't trying to overcome the barriers imposed by impairment and ableist society, but we f.cking well are, it's just the scope of those barriers is far greater than an arrogant, empathy free a..eh.le is willing to understand.

To put it in perspective, a decent wheelchair costs thousands, yet it doesn't overcome these barriers. I spent about £500 on my upgrades to my main chair, and that's enabled me to access the GP more reliably. The GP is two miles away, and I couldn't get there before the upgrades - both because of obstacles and battery life. The distances I've had to travel for specialist appointments have varied from ten to two hundred miles.

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Re: NHS breaking point?

Post by Woodchopper » Tue Jul 26, 2022 9:40 am

lpm wrote:
Mon Jul 25, 2022 5:37 pm
Woodchopper's figures for Norway's system of contributing charges gave a cap of £300 per annum.

Let's say the UK has 10 million non-paying users, 20 million paying users. The paying users are charged an average of £150 p.a. That's £3 billion a year.

f.ck off with your 0.00125% increase. That's 1.5% extra right there.

For Norway levels of charging. f.cking Norway, renowned for its nasty right wing governments controlled by foul tabloids like the Mail, what utter bastards, let's hope to god their policies don't migrate over here.
It’s not just Norway, payment for GP and hospital appointments via cash payment or private insurance is normal in many national healthcare systems in affluent countries. For example off the top of my head Finland, Germany, Ireland, Sweden, New Zealand, Japan, Switzerland. I assume that there are some other places that like the UK offer universal doctor or hospital care which is wholly funded from general taxation.

To be sure universal healthcare funded wholly from taxation would involve fewer administrative costs in terms of managing payment and is certainly more equitable.

Nevertheless use of user fees (with caps and exemptions) or mass private insurance (ie at much greater levels than in the UK) is a normal thing in affluent developed countries.

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Re: NHS breaking point?

Post by lpm » Tue Jul 26, 2022 10:37 am

EACLucifer wrote:
Tue Jul 26, 2022 9:25 am
lpm wrote:
Tue Jul 26, 2022 12:18 am
The NHS appointment is a valuable asset. Worth £100, say.

All this stuff about taxis and buses goes to prove my point: it's not valued as a valuable asset. Because the apparent cost is zero, it's treated as if it can be thrown away. Just another DNA.

If it was an envelope with £100 cash that people were trying to reach there'd be innovative solutions to help them grab it. There'd be an app.

The whole thing is a description of misaligned incentives.
This just shows to go you either still don't get it, or are deliberately trolling. I reiterate that this is not an appropriate issue on which to do so.

Try to imagine for a moment what it is like to travel in a wheelchair. Streets are routinely blocked. Public transport routinely doesn't let you on, or sometimes, in the case of trains, doesn't let you off. For a manual chair user, the distance you can travel is limited by how far you can push. Operating a manual chair is quite hard work, certainly rather harder than walking. Electric wheelchairs make all kinds of far fetched claims about battery life, but these are downright fiction. In reality, a chair with 1.2kwh can do about four miles on one charge, but 1.2kwh is actually better than a normal chair carries. The most common battery bank size is about 0.8kwh.

Getting to a specialist appointment could involve travelling dozens of miles, and remember, the trains aren't accessible. Driving means using an adapted vehicle, but if you're on ESA, there's limits to how much money you can save before they decide to cut your benefits - and a decent adapted vehicle costs several times that limit, and remember, lots of people with mobility impairments can't drive anyway, due to the impairments.

The idea that people we could suddenly overcome these barriers for just £100 isn't just ignorant - it's extremely offensive. You are acting as if we aren't trying to overcome the barriers imposed by impairment and ableist society, but we f.cking well are, it's just the scope of those barriers is far greater than an arrogant, empathy free a..eh.le is willing to understand.

To put it in perspective, a decent wheelchair costs thousands, yet it doesn't overcome these barriers. I spent about £500 on my upgrades to my main chair, and that's enabled me to access the GP more reliably. The GP is two miles away, and I couldn't get there before the upgrades - both because of obstacles and battery life. The distances I've had to travel for specialist appointments have varied from ten to two hundred miles.
I'm sorry, but you couldn't miss the point more. You don't even mention the NHS and its costs and the value of appointments and how it operates at a fundamental level.

All those barriers exist no matter the funding system. They don't suddenly pop up if there's a switch from tax to insurance, for example. The appointment at Outpatients doesn't become worth less when it's hard to get to. The cost of a GP appointment is not related to battery size.

The NHS is clearly failing in this, as well as other basics. You are describing how the system doesn't work, then refusing any hint of changing the system. Patient transport is trivially easy compared to cancer care. This is the age of frictionless transport and automated logistics. But the huge NHS bureaucracy can't even do this. Part of the reason is that appointments aren't valued sufficiently and DNAs are just stats on a spreadsheet. Valuable assets thrown away because we can't get proper transport? In 2022 that's an embarrassment.
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Re: NHS breaking point?

Post by EACLucifer » Tue Jul 26, 2022 10:53 am

lpm wrote:
Tue Jul 26, 2022 10:37 am
EACLucifer wrote:
Tue Jul 26, 2022 9:25 am
lpm wrote:
Tue Jul 26, 2022 12:18 am
The NHS appointment is a valuable asset. Worth £100, say.

All this stuff about taxis and buses goes to prove my point: it's not valued as a valuable asset. Because the apparent cost is zero, it's treated as if it can be thrown away. Just another DNA.

If it was an envelope with £100 cash that people were trying to reach there'd be innovative solutions to help them grab it. There'd be an app.

The whole thing is a description of misaligned incentives.
This just shows to go you either still don't get it, or are deliberately trolling. I reiterate that this is not an appropriate issue on which to do so.

Try to imagine for a moment what it is like to travel in a wheelchair. Streets are routinely blocked. Public transport routinely doesn't let you on, or sometimes, in the case of trains, doesn't let you off. For a manual chair user, the distance you can travel is limited by how far you can push. Operating a manual chair is quite hard work, certainly rather harder than walking. Electric wheelchairs make all kinds of far fetched claims about battery life, but these are downright fiction. In reality, a chair with 1.2kwh can do about four miles on one charge, but 1.2kwh is actually better than a normal chair carries. The most common battery bank size is about 0.8kwh.

Getting to a specialist appointment could involve travelling dozens of miles, and remember, the trains aren't accessible. Driving means using an adapted vehicle, but if you're on ESA, there's limits to how much money you can save before they decide to cut your benefits - and a decent adapted vehicle costs several times that limit, and remember, lots of people with mobility impairments can't drive anyway, due to the impairments.

The idea that people we could suddenly overcome these barriers for just £100 isn't just ignorant - it's extremely offensive. You are acting as if we aren't trying to overcome the barriers imposed by impairment and ableist society, but we f.cking well are, it's just the scope of those barriers is far greater than an arrogant, empathy free a..eh.le is willing to understand.

To put it in perspective, a decent wheelchair costs thousands, yet it doesn't overcome these barriers. I spent about £500 on my upgrades to my main chair, and that's enabled me to access the GP more reliably. The GP is two miles away, and I couldn't get there before the upgrades - both because of obstacles and battery life. The distances I've had to travel for specialist appointments have varied from ten to two hundred miles.
Yet More Idiotic b.llsh.t Snipped
I'm arguing against the exact points you made previously, you utter cretin. The nonsense that you pronounced. The idea that punishing those with chronic illnesses for missing appointments would be a good thing to do. The idea that people would somehow be able to find a way round those obstacles if it was to claim a hundred quid, but not to get to a vital appointment. I bolded one such example in the quote above. I don't think you are too stupid to remember you said that. I just think you'd rather change the subject, as you did in the drivel I snipped, rather than acknowledge just how deeply and callously and ignorantly wrong you are.

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Re: NHS breaking point?

Post by lpm » Tue Jul 26, 2022 12:05 pm

You are blatantly misreading that sentence. Why deliberately pretend the meaning's different then argue against something you've invented? What's the point?

For the avoidance of doubt, nobody ever suggests charging without exemptions. Universal Credit, children, state pensioners would all be exempt from charges.

A hypothetical person on UC with chronic conditions would still pay zero. The difference would be that appointments would be available instead of denied and basic NHS services like ambulances, hip operations and patient transport would no longer be in a state of collapse.
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Re: Who's next?

Post by Stephanie » Tue Jul 26, 2022 8:42 pm

Did you mean to continue the NHS discussion here?
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Re: NHS breaking point?

Post by Bird on a Fire » Tue Jul 26, 2022 10:39 pm

I can only see charging for missed appointments being fair if there was an option for reliable patient transport. Which might well end up costing quite a bit in itself.

I found a review of why people miss appointments:
Abstract

Background Missed GP appointments have considerable time and cost implications for healthcare services.

Aim This systematic review aims to explore the rate of missed primary care appointments, what the reported reasons are for appointments being missed, and which patients are more likely to miss appointments.

Design and setting This study reports the findings of a systematic review. The included studies report the rate or reasons of missed appointments in a primary care setting.

Method Databases were searched using a pre-defined search strategy. Eligible studies were selected for inclusion based on detailed inclusion criteria through title, abstract, and full text screening. Quality was assessed on all included studies, and findings were synthesised to answer the research questions.

Results A total of 26 studies met the inclusion criteria for the review. Of these, 19 reported a rate of missed appointments. The mean rate of missed appointments was 15.2%, with a median of 12.9%. Twelve studies reported a reason that appointments were missed, with work or family/childcare commitments, forgetting the appointment, and transportation difficulties most commonly reported. In all, 20 studies reported characteristics of people likely to miss appointments. Patients who were likely to miss appointments were those from minority ethnicity, low sociodemographic status, and younger patients (<21 years).

Conclusion Findings from this review have potential implications for targeted interventions to address missed appointments in primary care. This is the first step for clinicians to be able to target interventions to reduce the rate of missed appointments.
https://bjgp.org/content/71/707/e406

Haven't read the whole thing, but at least some of those reasons are things that charging a fee wouldn't solve. It's not just people with spare cash being feckless.

The worry with marketisation would be the risk of disproportionately harming people who are already at a disadvantage, which is probably the opposite of what a healthcare service (and, dare I say it, society in general) should consider acceptable.

But perhaps the risk could be mitigated by stipulating exemptions explicitly. Eg the NHS is responsible for getting people to and from appointments, with no penalty should eg the wrong contractor turn up. Employers and schools have to give leave for appointments or else they're on the hook for the fine. People with memory, attention or energy problems exempted. Etc. Target the fine towards actual abuse of the system, rather than hastily announced, poorly thought-through sanctions (cf the benefits system).
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Re: NHS breaking point?

Post by Bird on a Fire » Tue Jul 26, 2022 10:54 pm

Interestingly table 5 shows "Medicaid or self-pay" patients being more frequently reported as missing appointments than "publicly funded insurance", which doesn't seem to support the idea that patients forced to pay for healthcare are more likely to turn up.

The most commonly reported reasons were
  Minority/non-white patients
  Younger patients (<21 years)
in 8/12 studies each, then
Presence of mental health diagnosis
  Low sociodemographic status/deprived areas
in 5 each, and
Presence of at least one physical health condition
plus the payment my model on 4.

TLDR the people missing appointments tend to be chronically ill and/or socially disadvantaged (and obviously there's huge overlap). If they really are the most politically acceptable cash-cow to fund the NHS then the country needs a long hard look in the f.cking mirror.
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Re: Who's next?

Post by Millennie Al » Tue Jul 26, 2022 11:03 pm

Stephanie wrote:
Tue Jul 26, 2022 8:42 pm
Did you mean to continue the NHS discussion here?
No. Sorry. I intended to post that in the "NHS breaking point?" thread. Could any kind mod chop that bit off and graft it over there?

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