The Politics Thread

[Worthy4England]

Alright, but what if you're skint and don't have a credit card with funds available?

I'm not fishing for anything - I genuinely don;t know.. Especially outside EU

If you do have Insurance, then you'd ring them and get them to cover the cost (assuming your insurance covers it). Not sure what happens in the event you have neither.

[bedwetter2]

^^ Utter drivel. Why don't they all go and demonstrate in Tiananmen Square - ever the voice of reason - are you suggesting they all rocked up in Washington recently? No, they didn't.

People are entitled to protest against what the feck they want to. You're entitled to call 'em names. Nothing to see here.

You are suggesting the politically motivated left do not choose their campaigns to generally target western leaders rather than eastern authoritarian ones? Did I once say that people are not entitled to protest? No, I would defend everyone's right to protest or campaign against injustice. It's just that the semi-professional agitators of the left are myopic at best or ignore inconvenient truths as it doesn't fit with their world view. Apparently, and according to the Washington demonstrators own bs 1 million of them turned out; quite a lot rocking up...and for what, eh? Not getting their own way when Clinton was bounced?

It's you who is talking utter drivel.

Of course the right (and businesses) often don't bother with semi-professional agitators, they generally use fully professional lobbyists behind the scenes where they're much less visible to the naked eye.

If you support and defend everyone's right to protest, why do you have issue with 100,00 or 1,000,000 turning out in Washington (or London)? Sure in the US, they lost an election, but they won the national vote - has the protest got to fit in with your myopic view of right and wrong, in some sort of elitist sense?

I don't recall a shit load of protests aimed at Western heads of state addressing parliament - can you help me out on any?

I don't have an issue with however many turned up at a particular demonstration apart from any ensuing public disorder which can create damage to property, injury to persons and disruption to services.

Was Trump elected or not? And if he was, why is the overwhelming sense of bitterness by the losers continuing?
The protests I was talking about had bugger all to do with addressing parliament. Compare and contrast the ire shown towards the USA and the lack of comments re the military junta in Myanmar.

There is one thing which I can agree with you on and that is the use of lobbyists to buy influence. It is corrupt and should be stopped entirely. That should apply whether it is large political donations from companies, the contacts between PR companies and ministers, the employment of ministers or MPs by organisations, which had a previous relationship with that company, once they leave politics and, of course, the sponsoring of MPs by unions, the donations from unions and so on and on and on.

[bedwetter2]

^^ Utter drivel. Why don't they all go and demonstrate in Tiananmen Square - ever the voice of reason - are you suggesting they all rocked up in Washington recently? No, they didn't.

People are entitled to protest against what the feck they want to. You're entitled to call 'em names. Nothing to see here.

You are suggesting the politically motivated left do not choose their campaigns to generally target western leaders rather than eastern authoritarian ones? Did I once say that people are not entitled to protest? No, I would defend everyone's right to protest or campaign against injustice. It's just that the semi-professional agitators of the left are myopic at best or ignore inconvenient truths as it doesn't fit with their world view. Apparently, and according to the Washington demonstrators own bs 1 million of them turned out; quite a lot rocking up...and for what, eh? Not getting their own way when Clinton was bounced?

It's you who is talking utter drivel.

Of course the right (and businesses) often don't bother with semi-professional agitators, they generally use fully professional lobbyists behind the scenes where they're much less visible to the naked eye.

If you support and defend everyone's right to protest, why do you have issue with 100,00 or 1,000,000 turning out in Washington (or London)? Sure in the US, they lost an election, but they won the national vote - has the protest got to fit in with your myopic view of right and wrong, in some sort of elitist sense?

I don't recall a shit load of protests aimed at Western heads of state addressing parliament - can you help me out on any?

Or just go for straight up lynchings/shootings/violence.

I find it laughable that people who bang on about immigration and choose isolated news stories to attach to their campaign, accuse anyone of being myopic.

I would only accuse you of being myopic if you are genuinely short-sighted.

[Abdoulaye's Twin]

Alright, but what if you're skint and don't have a credit card with funds available?

I'm not fishing for anything - I genuinely don;t know.. Especially outside EU

It will vary according to where you are and will range from leave you on the side of the road to do the minimum to keep you alive and do the rest once they've sorted payment/insurance.

It isn't unreasonable to to make suitable insurance as part of the visa process and we should take all reasonable efforts to recoup money. That said, I fear the problem is being made to be bigger than it probably is to suit the bloody foreigners coming over here taking our jobs/welfare/houses/GP appointments rhetoric.

So yes, I'd like it sorting along with the PFI contracts and a little joined up common sense on social care and the NHS. 2 of those 3 will make a far more significant contribution to sorting out the NHS but sadly heard nothing that indicates anyone will do anything.

[BWFC_Insane]

Don't talk bullshit, you are making excuse after excuse, 'it's too hard to tell if someone qualifies or not and not everyone carries id', if you look young and try to buy booze in a supermarket they ask for id, no id no booze.
It has been stated over and over again that emergency treatment there would not be a problem, so where is the problem going for routine treatment and carrying id?
What the fcuk is wrong with personal responsibilities in your book? You own nursery schools?
No one should be allowed entry into the UK without valid medical insurance and airlines should be fined for carrying clearly well due expectant mothers.
All this goes to show we should just tighten up control over who floats into our country despite what dickheads who are happy to right off £300 million or whatever because it's only small change and doesn't matter.

As for Corbyn?

Well if he occupies the liberal leftie chattering classes and stops them interfering in other matters,

long may he reign!

No, I've explained the actual situation. To save a drop in the ocean, you have to invest a significant amount first up front, then on an ongoing basis.

The gain isn't actually going to make a difference. If we sort out the bigger issue of the health and social care funding crisis first, then by all means consider tackling health tourism. But don't divert from the major issue. We've spent 20 years doing that and it has got us nowhere.

And by the way, I'm not interested in your "alternative facts/common sense" view on this. I spent 3 years of my life looking into payment and insurance solutions in the NHS for this exact sort of thing. Try and construct a business case for it, and the numbers do not stack up.

I was talking about collecting information in order to bill foreigners, not developing payment and insurance solutions for foreigners. God knows what you are talking about.

Ill/injured foreign person turns up at GP practice or maybe walk-in centre or maybe A&E department. Receptionist asks for name, address, date of birth and method of payment to be tendered. If it's basic treatment by a GP or practice nurse, a streamline card terminal will take payment or insurance cover details taken for invoicing. If the patient needs in-patient treatment, the department administrator creates a unique job number on the software and again takes payment details, johnny foreigner is repaired (hopefully), the computer job record updated with details of treatment and final accumulated cost and sent on his way rejoicing having signed a billing consent form for the insurer or paid by card. Billing all done simply from a menu of treatments which have a fixed cost per annum.

You don't have to spend a significant amount up front. The computers already exist, multiple software licences are very cheap per user and streamline terminals are virtually free from the card companies. There are many low-cost off the shelf pieces of software which accumulate costs against a project or job and then bill the client, or in this case the patient or their insurer. Not beyond the capacity of even the most blustering unionised half-wit to operate. And before you say many more people will need to be employed to operate such a system, I will call bullsh*t. Having seen the slow speed that most administrators in hospitals carry around bloody great sheaves of paper in files, existing employees could more than cope.

1) How do you identify that they are an "ill/injured foreign person" in the first place - sadly for you they don't come with a symbol sewn into their clothing.
2) How are you planning on handling information governance and data protection laws associated with NHS patient details in such a system? Especially a "low-cost" off the shelf piece.
3) You clearly don't understand NHS staffing models. Lets take A&E, whilst receptionist Sarah is sat on reception trying to take a, lets say, Russian man's details, (he doesn't speak English), 3 mum's from Bolton are stood behind with young kids all with nasty cuts or illnesses. But Sarah can't move past Mr Russian man because she needs his full name, address and insurance details. Mr Russian man has insurance but doesn't have any documentation with him. He also cannot remember his home address. A&E/Walk in centres aren't overstaffed. If someone is taking time doing all that, then something else, somewhere isn't happening. FACT. IF that thing that isn't happening exacerbates or causes a further health issue in any patient, you have a complete shitstorm on your hands. And it will. Trust me. The ONLY way around it, and again, unless you've personally spent three years modelling this, please don't come back with some uninformed, anecdotal nonsense, the ONLY way around it is to employ extra staff. Work out your staff costs there across every NHS A&E, hospital department, walk in centre and GP surgery. Dentists may be more able to cope as they generally, rarely have the emergency or critical cases other departments handle.
4) Once you've taken your insurance/address what sort of back office do you need to process them. Lets take HMRC as an example, they have to recruit whole new offices to pursue non-payment cases. This WOULD be exactly the same. Some function would have to spend the time processing the claims/invoices, sending them out, monitoring payments. And again all this has to be IG and data protection compliant. Otherwise if anything goes wrong, you have another shitstorm on your hands. The same office would have to deal with the many FoI requests such NHS functions receive almost daily. Alongside, reporting to local and national government. Further, given that, the NHS isn't one entity and is in fact a collection of service commissioners and providers who run in parallel but in pseudo competition with each other, this back office function would also need to ensure that payments received and then charged back against the correct commissioning or provider budget. In effect it would mean either each commissioner would need this function, or would at least need a role dedicated to the processing of these charges (if you setup a central function). Alternatively each commissioning unit could record their "foreign person" cases and claim back out of a central pot. This though adds even further complexity and extra steps into the process. Clearly there will be under payment, so you'll end up with over claiming. Someone has to sort that out. It gets even more complex when you consider many treatments straddle providers and sometimes even commissioners.
5) Who decides whether someone can pay on the spot or if it requires further follow up? Cases aren't always, often aren't straightforward. So someone comes in with a basic issue that then uncovers something else. How is that handled? Are you saying as an additional piece of work, doctors and nurses will need to create invoices for every treatment/procedure/examination and then these will need following up, but that lets call it a "billing function".

[Worthy4England]

^^ Utter drivel. Why don't they all go and demonstrate in Tiananmen Square - ever the voice of reason - are you suggesting they all rocked up in Washington recently? No, they didn't.

People are entitled to protest against what the feck they want to. You're entitled to call 'em names. Nothing to see here.

You are suggesting the politically motivated left do not choose their campaigns to generally target western leaders rather than eastern authoritarian ones? Did I once say that people are not entitled to protest? No, I would defend everyone's right to protest or campaign against injustice. It's just that the semi-professional agitators of the left are myopic at best or ignore inconvenient truths as it doesn't fit with their world view. Apparently, and according to the Washington demonstrators own bs 1 million of them turned out; quite a lot rocking up...and for what, eh? Not getting their own way when Clinton was bounced?

It's you who is talking utter drivel.

Of course the right (and businesses) often don't bother with semi-professional agitators, they generally use fully professional lobbyists behind the scenes where they're much less visible to the naked eye.

If you support and defend everyone's right to protest, why do you have issue with 100,00 or 1,000,000 turning out in Washington (or London)? Sure in the US, they lost an election, but they won the national vote - has the protest got to fit in with your myopic view of right and wrong, in some sort of elitist sense?

I don't recall a shit load of protests aimed at Western heads of state addressing parliament - can you help me out on any?

I don't have an issue with however many turned up at a particular demonstration apart from any ensuing public disorder which can create damage to property, injury to persons and disruption to services.

Was Trump elected or not? And if he was, why is the overwhelming sense of bitterness by the losers continuing?
The protests I was talking about had bugger all to do with addressing parliament. Compare and contrast the ire shown towards the USA and the lack of comments re the military junta in Myanmar.

There is one thing which I can agree with you on and that is the use of lobbyists to buy influence. It is corrupt and should be stopped entirely. That should apply whether it is large political donations from companies, the contacts between PR companies and ministers, the employment of ministers or MPs by organisations, which had a previous relationship with that company, once they leave politics and, of course, the sponsoring of MPs by unions, the donations from unions and so on and on and on.

Agree around the damage thing, disruption to services if it's genuinely caused by "volume of people" trying to get to said protest - tough.

Trump was elected, yes, think the final figures for the popular vote were 51.11% Clinton - 48.89% Trump - a difference of somewhere near 2.6m voters. Compare that to our referendum vote. 51.9% leave, 48.1% remain. How would you have reacted if it had been pointed out (and I'm not suggesting it should have been) that the result was non-binding (which legally it wasn't, despite parliament having the power to have made it so), so it was too close to call and we're ignoring it (something I don't agree we should do)...I reckon you'd have been a bit pissed. I think you might have expressed some bitterness and I think it would still be continuing.

I'm more than happy to do all over the above in relation to unions, lobbyists and donations.

[Worthy4England]

Don't talk bullshit, you are making excuse after excuse, 'it's too hard to tell if someone qualifies or not and not everyone carries id', if you look young and try to buy booze in a supermarket they ask for id, no id no booze.
It has been stated over and over again that emergency treatment there would not be a problem, so where is the problem going for routine treatment and carrying id?
What the fcuk is wrong with personal responsibilities in your book? You own nursery schools?
No one should be allowed entry into the UK without valid medical insurance and airlines should be fined for carrying clearly well due expectant mothers.
All this goes to show we should just tighten up control over who floats into our country despite what dickheads who are happy to right off £300 million or whatever because it's only small change and doesn't matter.

As for Corbyn?

Well if he occupies the liberal leftie chattering classes and stops them interfering in other matters,

long may he reign!

No, I've explained the actual situation. To save a drop in the ocean, you have to invest a significant amount first up front, then on an ongoing basis.

The gain isn't actually going to make a difference. If we sort out the bigger issue of the health and social care funding crisis first, then by all means consider tackling health tourism. But don't divert from the major issue. We've spent 20 years doing that and it has got us nowhere.

And by the way, I'm not interested in your "alternative facts/common sense" view on this. I spent 3 years of my life looking into payment and insurance solutions in the NHS for this exact sort of thing. Try and construct a business case for it, and the numbers do not stack up.

I was talking about collecting information in order to bill foreigners, not developing payment and insurance solutions for foreigners. God knows what you are talking about.

Ill/injured foreign person turns up at GP practice or maybe walk-in centre or maybe A&E department. Receptionist asks for name, address, date of birth and method of payment to be tendered. If it's basic treatment by a GP or practice nurse, a streamline card terminal will take payment or insurance cover details taken for invoicing. If the patient needs in-patient treatment, the department administrator creates a unique job number on the software and again takes payment details, johnny foreigner is repaired (hopefully), the computer job record updated with details of treatment and final accumulated cost and sent on his way rejoicing having signed a billing consent form for the insurer or paid by card. Billing all done simply from a menu of treatments which have a fixed cost per annum.

You don't have to spend a significant amount up front. The computers already exist, multiple software licences are very cheap per user and streamline terminals are virtually free from the card companies. There are many low-cost off the shelf pieces of software which accumulate costs against a project or job and then bill the client, or in this case the patient or their insurer. Not beyond the capacity of even the most blustering unionised half-wit to operate. And before you say many more people will need to be employed to operate such a system, I will call bullsh*t. Having seen the slow speed that most administrators in hospitals carry around bloody great sheaves of paper in files, existing employees could more than cope.

1) How do you identify that they are an "ill/injured foreign person" in the first place - sadly for you they don't come with a symbol sewn into their clothing.
2) How are you planning on handling information governance and data protection laws associated with NHS patient details in such a system? Especially a "low-cost" off the shelf piece.
3) You clearly don't understand NHS staffing models. Lets take A&E, whilst receptionist Sarah is sat on reception trying to take a, lets say, Russian man's details, (he doesn't speak English), 3 mum's from Bolton are stood behind with young kids all with nasty cuts or illnesses. But Sarah can't move past Mr Russian man because she needs his full name, address and insurance details. Mr Russian man has insurance but doesn't have any documentation with him. He also cannot remember his home address. A&E/Walk in centres aren't overstaffed. If someone is taking time doing all that, then something else, somewhere isn't happening. FACT. IF that thing that isn't happening exacerbates or causes a further health issue in any patient, you have a complete shitstorm on your hands. And it will. Trust me. The ONLY way around it, and again, unless you've personally spent three years modelling this, please don't come back with some uninformed, anecdotal nonsense, the ONLY way around it is to employ extra staff. Work out your staff costs there across every NHS A&E, hospital department, walk in centre and GP surgery. Dentists may be more able to cope as they generally, rarely have the emergency or critical cases other departments handle.
4) Once you've taken your insurance/address what sort of back office do you need to process them. Lets take HMRC as an example, they have to recruit whole new offices to pursue non-payment cases. This WOULD be exactly the same. Some function would have to spend the time processing the claims/invoices, sending them out, monitoring payments. And again all this has to be IG and data protection compliant. Otherwise if anything goes wrong, you have another shitstorm on your hands. The same office would have to deal with the many FoI requests such NHS functions receive almost daily. Alongside, reporting to local and national government. Further, given that, the NHS isn't one entity and is in fact a collection of service commissioners and providers who run in parallel but in pseudo competition with each other, this back office function would also need to ensure that payments received and then charged back against the correct commissioning or provider budget. In effect it would mean either each commissioner would need this function, or would at least need a role dedicated to the processing of these charges (if you setup a central function). Alternatively each commissioning unit could record their "foreign person" cases and claim back out of a central pot. This though adds even further complexity and extra steps into the process. Clearly there will be under payment, so you'll end up with over claiming. Someone has to sort that out. It gets even more complex when you consider many treatments straddle providers and sometimes even commissioners.
5) Who decides whether someone can pay on the spot or if it requires further follow up? Cases aren't always, often aren't straightforward. So someone comes in with a basic issue that then uncovers something else. How is that handled? Are you saying as an additional piece of work, doctors and nurses will need to create invoices for every treatment/procedure/examination and then these will need following up, but that lets call it a "billing function".

No, no and just no. Everything wring with the NHS organisation neatly encapsulated into one half paragraph - well done.

1) There's a thing called a passport. I'm happy to take mine to prove where I'm from.
2) The issue around patient data is just complete bollocks - they'd need to store the same data in relation to the treatment in any event whether it was paid for or not. You might need some tokenisation of PCI-DSS data in relation to Credit Card details but that's easy solved.
3) More problems than answers - it took significantly less then 10 minutes for my insurance to resolve with a service in Mexico - I'm fairly sure they covered the cost of their time in the bill, after which maybe they could afford two of them, to reduce the queue.
4) You generally need no "back-office" to process payments - it's usually sorted out through PoS/EFT etc.
5) You don't have to decide at the first point of contact how much it will cost - surely the medical need will outweigh that.

[bedwetter2]

I was surprised yesterday, that during the latest talks around the NHS falling down around our ears (or being allowed to) there was talk that so called health tourists would now be charged for non urgent treatment. My first reaction was "You mean they don't already?" - When the care for many elderly in this country is nothing short of a national scandal - What took them?

The estimate is this costs the NHS somewhere between £100M and £280M.

The cost of social care, just on the social care non health side is upwards of £17billion annually.

So how much would it cost to tackle health tourism? You'd need whole systems in place to do it. And you'll never save the full amount anyway. Imagine someone from Australia rocking up to a hospital with a badly infected ingrowing toenail. They'd be a health tourist. Is that emergency or not? Who makes that call. Then who works out they are a "health tourist", who determines what they pay? What is the mechanism for payment? Also in such a system does that mean I have to take my passport to every outpatient appt and someone has to scan it as a record?

I think it'd be far more effective to discuss why we aren't as a country prepared to fund the NHS and social care properly. Why are we such a selfish society? That would be a better place to start than thinking that introducing more and more systems that all cost a significant amount in staff time, resources and salaries to solve a problem that is not even going to trouble the tip of a very large iceberg. Mind its popular cos nobody likes foreigners no more.

I agree that social care in general is in a very poor state. The local authorities have cut budgets each of the last 3 years or diverted money in some cases to more pressing demands. There is insufficient money in the system to meet the needs as they exist at the moment, let alone the demographics of the future.

My wife has worked in the sector for some time, currently as a residential nursing and care home manager, and so I know quite a bit about it. Unusually, the place she is responsible for is both a care home and nursing home also with a high dependency unit for dementia patients. The home has had significant money invested in it by new owners over the last 12 months and the quality of the place is second to none being more like a 4 or 5 star hotel than a run down institution. Nevertheless, it is in crisis. The majority of carers are on the minimum wage and the staff retention rate is very low. They are constantly trying to recruit but there are better paid jobs in the area which are less demanding and so they are increasingly reliant on agencies to provide short term staff. They cost a lot more. The owners cannot just up the staff pay as the home barely breaks even with a high occupancy rate. The clients are a mix of private and local authority funded, probably more private. Even so they cannot up their charges to private individuals as they are in competition with other care homes. The local authorities have reduced the weekly rates they pay for the last two years. The home now has started to turn down further local authority funded clients because each contributes to losses. I guess that most of the persons who are turned away contribute to the NHS bed-blocking statistics.

So, what is to be done? There is no magic money tree but Government policy will need to change to bring about an improvement. There has been talk about integrating NHS and social services to better anticipate needs and find solutions. That, in my opinion will only lead to a bigger, less efficient entity. The NHS is too big to manage effectively now and despite what supporters say, it truly is inefficient. Not helped, of course, by regular Government "initiatives".

Care needs to go back to basics. The best place to care for people is in their own homes or the home of a family member. I would introduce grants/loans to adapt homes or extend them if I were in Government but in addition compensate family members if they are involved in caring, not with the current miserable carers allowance but something which makes it worthwhile for a family member to give up full time work. The average cost of keeping someone in a residential home is £900 per week, so we could afford to be rather more generous that is currently the case. The carers who are employed to make home visits need to be paid better and professionalism introduced by the use of a compulsory qualification to eliminate the less desirable types. It wouldn't improve matters overnight but a augmented non box-ticking CQC making unannounced visits to all sectors would start to see results.

[bedwetter2]

Don't talk bullshit, you are making excuse after excuse, 'it's too hard to tell if someone qualifies or not and not everyone carries id', if you look young and try to buy booze in a supermarket they ask for id, no id no booze.
It has been stated over and over again that emergency treatment there would not be a problem, so where is the problem going for routine treatment and carrying id?
What the fcuk is wrong with personal responsibilities in your book? You own nursery schools?
No one should be allowed entry into the UK without valid medical insurance and airlines should be fined for carrying clearly well due expectant mothers.
All this goes to show we should just tighten up control over who floats into our country despite what dickheads who are happy to right off £300 million or whatever because it's only small change and doesn't matter.

As for Corbyn?

Well if he occupies the liberal leftie chattering classes and stops them interfering in other matters,

long may he reign!

No, I've explained the actual situation. To save a drop in the ocean, you have to invest a significant amount first up front, then on an ongoing basis.

The gain isn't actually going to make a difference. If we sort out the bigger issue of the health and social care funding crisis first, then by all means consider tackling health tourism. But don't divert from the major issue. We've spent 20 years doing that and it has got us nowhere.

And by the way, I'm not interested in your "alternative facts/common sense" view on this. I spent 3 years of my life looking into payment and insurance solutions in the NHS for this exact sort of thing. Try and construct a business case for it, and the numbers do not stack up.

I was talking about collecting information in order to bill foreigners, not developing payment and insurance solutions for foreigners. God knows what you are talking about.

Ill/injured foreign person turns up at GP practice or maybe walk-in centre or maybe A&E department. Receptionist asks for name, address, date of birth and method of payment to be tendered. If it's basic treatment by a GP or practice nurse, a streamline card terminal will take payment or insurance cover details taken for invoicing. If the patient needs in-patient treatment, the department administrator creates a unique job number on the software and again takes payment details, johnny foreigner is repaired (hopefully), the computer job record updated with details of treatment and final accumulated cost and sent on his way rejoicing having signed a billing consent form for the insurer or paid by card. Billing all done simply from a menu of treatments which have a fixed cost per annum.

You don't have to spend a significant amount up front. The computers already exist, multiple software licences are very cheap per user and streamline terminals are virtually free from the card companies. There are many low-cost off the shelf pieces of software which accumulate costs against a project or job and then bill the client, or in this case the patient or their insurer. Not beyond the capacity of even the most blustering unionised half-wit to operate. And before you say many more people will need to be employed to operate such a system, I will call bullsh*t. Having seen the slow speed that most administrators in hospitals carry around bloody great sheaves of paper in files, existing employees could more than cope.

1) How do you identify that they are an "ill/injured foreign person" in the first place - sadly for you they don't come with a symbol sewn into their clothing.
2) How are you planning on handling information governance and data protection laws associated with NHS patient details in such a system? Especially a "low-cost" off the shelf piece.
3) You clearly don't understand NHS staffing models. Lets take A&E, whilst receptionist Sarah is sat on reception trying to take a, lets say, Russian man's details, (he doesn't speak English), 3 mum's from Bolton are stood behind with young kids all with nasty cuts or illnesses. But Sarah can't move past Mr Russian man because she needs his full name, address and insurance details. Mr Russian man has insurance but doesn't have any documentation with him. He also cannot remember his home address. A&E/Walk in centres aren't overstaffed. If someone is taking time doing all that, then something else, somewhere isn't happening. FACT. IF that thing that isn't happening exacerbates or causes a further health issue in any patient, you have a complete shitstorm on your hands. And it will. Trust me. The ONLY way around it, and again, unless you've personally spent three years modelling this, please don't come back with some uninformed, anecdotal nonsense, the ONLY way around it is to employ extra staff. Work out your staff costs there across every NHS A&E, hospital department, walk in centre and GP surgery. Dentists may be more able to cope as they generally, rarely have the emergency or critical cases other departments handle.
4) Once you've taken your insurance/address what sort of back office do you need to process them. Lets take HMRC as an example, they have to recruit whole new offices to pursue non-payment cases. This WOULD be exactly the same. Some function would have to spend the time processing the claims/invoices, sending them out, monitoring payments. And again all this has to be IG and data protection compliant. Otherwise if anything goes wrong, you have another shitstorm on your hands. The same office would have to deal with the many FoI requests such NHS functions receive almost daily. Alongside, reporting to local and national government. Further, given that, the NHS isn't one entity and is in fact a collection of service commissioners and providers who run in parallel but in pseudo competition with each other, this back office function would also need to ensure that payments received and then charged back against the correct commissioning or provider budget. In effect it would mean either each commissioner would need this function, or would at least need a role dedicated to the processing of these charges (if you setup a central function). Alternatively each commissioning unit could record their "foreign person" cases and claim back out of a central pot. This though adds even further complexity and extra steps into the process. Clearly there will be under payment, so you'll end up with over claiming. Someone has to sort that out. It gets even more complex when you consider many treatments straddle providers and sometimes even commissioners.
5) Who decides whether someone can pay on the spot or if it requires further follow up? Cases aren't always, often aren't straightforward. So someone comes in with a basic issue that then uncovers something else. How is that handled? Are you saying as an additional piece of work, doctors and nurses will need to create invoices for every treatment/procedure/examination and then these will need following up, but that lets call it a "billing function".

No, no and just no. Everything wring with the NHS organisation neatly encapsulated into one half paragraph - well done.

1) There's a thing called a passport. I'm happy to take mine to prove where I'm from.
2) The issue around patient data is just complete bollocks - they'd need to store the same data in relation to the treatment in any event whether it was paid for or not. You might need some tokenisation of PCI-DSS data in relation to Credit Card details but that's easy solved.
3) More problems than answers - it took significantly less then 10 minutes for my insurance to resolve with a service in Mexico - I'm fairly sure they covered the cost of their time in the bill, after which maybe they could afford two of them, to reduce the queue.
4) You generally need no "back-office" to process payments - it's usually sorted out through PoS/EFT etc.
5) You don't have to decide at the first point of contact how much it will cost - surely the medical need will outweigh that.

Couldn't have put it better myself.

[BWFC_Insane]

No, no and just no. Everything wring with the NHS organisation neatly encapsulated into one half paragraph - well done.

1) There's a thing called a passport. I'm happy to take mine to prove where I'm from.
2) The issue around patient data is just complete bollocks - they'd need to store the same data in relation to the treatment in any event whether it was paid for or not. You might need some tokenisation of PCI-DSS data in relation to Credit Card details but that's easy solved.
3) More problems than answers - it took significantly less then 10 minutes for my insurance to resolve with a service in Mexico - I'm fairly sure they covered the cost of their time in the bill, after which maybe they could afford two of them, to reduce the queue.
4) You generally need no "back-office" to process payments - it's usually sorted out through PoS/EFT etc.
5) You don't have to decide at the first point of contact how much it will cost - surely the medical need will outweigh that.

I'll bow out here, because otherwise it will get boring for everyone. I will add there is a "how it should be" and "how it actually is" situation going on here. However, agree to disagree here I think.

[bedwetter2]

Don't talk bullshit, you are making excuse after excuse, 'it's too hard to tell if someone qualifies or not and not everyone carries id', if you look young and try to buy booze in a supermarket they ask for id, no id no booze.
It has been stated over and over again that emergency treatment there would not be a problem, so where is the problem going for routine treatment and carrying id?
What the fcuk is wrong with personal responsibilities in your book? You own nursery schools?
No one should be allowed entry into the UK without valid medical insurance and airlines should be fined for carrying clearly well due expectant mothers.
All this goes to show we should just tighten up control over who floats into our country despite what dickheads who are happy to right off £300 million or whatever because it's only small change and doesn't matter.

As for Corbyn?

Well if he occupies the liberal leftie chattering classes and stops them interfering in other matters,

long may he reign!

No, I've explained the actual situation. To save a drop in the ocean, you have to invest a significant amount first up front, then on an ongoing basis.

The gain isn't actually going to make a difference. If we sort out the bigger issue of the health and social care funding crisis first, then by all means consider tackling health tourism. But don't divert from the major issue. We've spent 20 years doing that and it has got us nowhere.

And by the way, I'm not interested in your "alternative facts/common sense" view on this. I spent 3 years of my life looking into payment and insurance solutions in the NHS for this exact sort of thing. Try and construct a business case for it, and the numbers do not stack up.

I was talking about collecting information in order to bill foreigners, not developing payment and insurance solutions for foreigners. God knows what you are talking about.

Ill/injured foreign person turns up at GP practice or maybe walk-in centre or maybe A&E department. Receptionist asks for name, address, date of birth and method of payment to be tendered. If it's basic treatment by a GP or practice nurse, a streamline card terminal will take payment or insurance cover details taken for invoicing. If the patient needs in-patient treatment, the department administrator creates a unique job number on the software and again takes payment details, johnny foreigner is repaired (hopefully), the computer job record updated with details of treatment and final accumulated cost and sent on his way rejoicing having signed a billing consent form for the insurer or paid by card. Billing all done simply from a menu of treatments which have a fixed cost per annum.

You don't have to spend a significant amount up front. The computers already exist, multiple software licences are very cheap per user and streamline terminals are virtually free from the card companies. There are many low-cost off the shelf pieces of software which accumulate costs against a project or job and then bill the client, or in this case the patient or their insurer. Not beyond the capacity of even the most blustering unionised half-wit to operate. And before you say many more people will need to be employed to operate such a system, I will call bullsh*t. Having seen the slow speed that most administrators in hospitals carry around bloody great sheaves of paper in files, existing employees could more than cope.

1) How do you identify that they are an "ill/injured foreign person" in the first place - sadly for you they don't come with a symbol sewn into their clothing.
2) How are you planning on handling information governance and data protection laws associated with NHS patient details in such a system? Especially a "low-cost" off the shelf piece.
3) You clearly don't understand NHS staffing models. Lets take A&E, whilst receptionist Sarah is sat on reception trying to take a, lets say, Russian man's details, (he doesn't speak English), 3 mum's from Bolton are stood behind with young kids all with nasty cuts or illnesses. But Sarah can't move past Mr Russian man because she needs his full name, address and insurance details. Mr Russian man has insurance but doesn't have any documentation with him. He also cannot remember his home address. A&E/Walk in centres aren't overstaffed. If someone is taking time doing all that, then something else, somewhere isn't happening. FACT. IF that thing that isn't happening exacerbates or causes a further health issue in any patient, you have a complete shitstorm on your hands. And it will. Trust me. The ONLY way around it, and again, unless you've personally spent three years modelling this, please don't come back with some uninformed, anecdotal nonsense, the ONLY way around it is to employ extra staff. Work out your staff costs there across every NHS A&E, hospital department, walk in centre and GP surgery. Dentists may be more able to cope as they generally, rarely have the emergency or critical cases other departments handle.
4) Once you've taken your insurance/address what sort of back office do you need to process them. Lets take HMRC as an example, they have to recruit whole new offices to pursue non-payment cases. This WOULD be exactly the same. Some function would have to spend the time processing the claims/invoices, sending them out, monitoring payments. And again all this has to be IG and data protection compliant. Otherwise if anything goes wrong, you have another shitstorm on your hands. The same office would have to deal with the many FoI requests such NHS functions receive almost daily. Alongside, reporting to local and national government. Further, given that, the NHS isn't one entity and is in fact a collection of service commissioners and providers who run in parallel but in pseudo competition with each other, this back office function would also need to ensure that payments received and then charged back against the correct commissioning or provider budget. In effect it would mean either each commissioner would need this function, or would at least need a role dedicated to the processing of these charges (if you setup a central function). Alternatively each commissioning unit could record their "foreign person" cases and claim back out of a central pot. This though adds even further complexity and extra steps into the process. Clearly there will be under payment, so you'll end up with over claiming. Someone has to sort that out. It gets even more complex when you consider many treatments straddle providers and sometimes even commissioners.
5) Who decides whether someone can pay on the spot or if it requires further follow up? Cases aren't always, often aren't straightforward. So someone comes in with a basic issue that then uncovers something else. How is that handled? Are you saying as an additional piece of work, doctors and nurses will need to create invoices for every treatment/procedure/examination and then these will need following up, but that lets call it a "billing function".

Just for the sake of clarity, the software "job" function accumulates all relevant costs and can be closed off at anytime, say 2 weeks, a month or a year after the first input. Once the job is closed an invoice is created which may include various costs from different departments on different days, but critically it is up to the operator to close off the job at the point where it appears treatment is complete. There is you answer to point 5.

As you appeared to suggest earlier that health tourism is small beer compared to larger problems and more trouble than it is worth, how much time do you think that the average hospital would need an administrator to work on providing invoices and taking payments? It would appear that there are 168 acute hospital trusts but the majority operate more than one hospital so let's say 300 hospitals as an estimate. So taking your £280m tourism figure that would mean that a 365 day year would mean the average foreign inpatient costing £5000 per time as an estimate leading to 0.5 invoices per day per hospital. Some will be busier, many less so and some patients may only incur bills measured in hundreds while others may be in tens or hundreds of thousands. I haven't even included GPs, dentists, etc in that. If I did, the figure may well come down to 0.05 invoices per outlet per day. It would appear to be overkill to employ anyone additional for this function. There is your answer to points 3 &4.

As to points 1 & 2 how do you think the French, Germans, Spanish, Dutch etc deal with this?

[Worthy4England]

^^ The French sold me your patient details saying it was "just a rash".

[bedwetter2]

^^ The French sold me your patient details saying it was "just a rash".

It was more than a rash, at least I don't think crabs can be called a rash. I may write a stiff letter to Marine le Pen.

[Worthy4England]

^^ The French sold me your patient details saying it was "just a rash".

It was more than a rash, at least I don't think crabs can be called a rash. I may write a stiff letter to Marine le Pen.

She looks like she could use a stiff one.

[Lord Kangana]

I don't know why you lot are wasting terrabytes on pointlessly arguing what should be done with the NHS. Its going to be privatised like everything else.

Boris's hypothetical question about abroad is about the only meaningful contribution. And yes, i've been in a non-EU country with a serious injury. I wouldn't wish it on anyone, even if they were brown, foreign and probably muslim.

[bedwetter2]

I don't know why you lot are wasting terrabytes on pointlessly arguing what should be done with the NHS. Its going to be privatised like everything else.

Really? I've heard that you have crystal balls. Ooer missus.

Boris's hypothetical question about abroad is about the only meaningful contribution. And yes, i've been in a non-EU country with a serious injury. I wouldn't wish it on anyone, even if they were brown, foreign and probably muslim.

Yes, but what about the crabs?

[Hoboh]

I don't know why you lot are wasting terrabytes on pointlessly arguing what should be done with the NHS. Its going to be privatised like everything else.

Boris's hypothetical question about abroad is about the only meaningful contribution. And yes, i've been in a non-EU country with a serious injury. I wouldn't wish it on anyone, even if they were brown, foreign and probably muslim.

All boris asked was how medical matters overseas got resolved?

You didn't explain. Did you pay by card, via insurance or what?

T'other half once needed a doctor to come out to her in Spain, rather than mess about I stumped up cash, was about £70, reception at the hotel arranged the visit.
Bloody peanuts she'd bought at a local market was the problem, food poisoning.

Worthy you need the EHIC card, free, get one here
http://www.nhs.uk/NHSEngland/Healthcare ... -ehic.aspx" onclick="window.open(this.href);return false;
I'm surprised you don't have one I thought you travelled a bit.

[Hoboh]

Theresa May crushes Brexit rebels as the Government defeats EVERY amendment to Article 50 bill (and even Diane Abbott manages to vote) - but the Lib Dem Remoaners STILL aren't giving up 

Gosh! she must have found the Paracetamol.

[Worthy4England]

I don't know why you lot are wasting terrabytes on pointlessly arguing what should be done with the NHS. Its going to be privatised like everything else.

Boris's hypothetical question about abroad is about the only meaningful contribution. And yes, i've been in a non-EU country with a serious injury. I wouldn't wish it on anyone, even if they were brown, foreign and probably muslim.

All boris asked was how medical matters overseas got resolved?

You didn't explain. Did you pay by card, via insurance or what?

T'other half once needed a doctor to come out to her in Spain, rather than mess about I stumped up cash, was about £70, reception at the hotel arranged the visit.
Bloody peanuts she'd bought at a local market was the problem, food poisoning.

Worthy you need the EHIC card, free, get one here
http://www.nhs.uk/NHSEngland/Healthcare ... -ehic.aspx" onclick="window.open(this.href);return false;
I'm surprised you don't have one I thought you travelled a bit.

I do - I incorrectly referred to it as E111.

With work, I'm covered under their insurance which usually provides a higher quality of overnight hospital stop than the hotel rate.

The incidents I was referring to were either outside of Europe or, like you where you just take the £70-£100 whatever it is hit, for the sake of a bit of peace and quiet on yer jollies.

[Hoboh]

And there's me thinking Nick 'sell out my principles' Clegg was bad.

"Tonight's vote isn't the end of the process. Over the next few weeks, Liberal Democrats in the House of Lords will seek to make changes to the government's plans," Liberal Democrat leader Tim Farron told his supporters via email.
"Our goal will be to protect Britain's membership of the single market, protect the rights of EU citizens in the UK and to give the people the final say on Theresa May's deal."

This bloke takes the biscuit.

The Liberal Democrats will stand at the next general election on a platform of derailing Brexit and keeping Britain in the European Union, the party has announced.
Leader Tim Farron said on Saturday night that he would be “clear and unequivocal” with voters that if elected it would set aside the referendum result and keep Britain in the EU.

PMSL next election? sorry Tim we will be gone

LOSER