[Closed] NHS - where should it stop paying for services

[i]"But what I would question is why I was sent to a hospital so far away when there was one nearer"

Probably because the centre you were taken to had more specialist experience in your type of injury. Or it could be that the local hospital had no spare beds...[/i]

This is what I was on about.
The centralisation of services can improve outcomes, but essentially places a greter amount of the problem of transport onto the patient.

As far as beds being available....well now... If you accept that the NHS has to make savings, become more 'efficient', then the first thing you could look at is spare capacity. We used to be able to deal with surges in admissions because we had spare beds, but this is not the case anymore and this winter will prove to be an interesting one in terms of capacity, certainly in critical care, but also in other hospital departments.

TJ
its not a stupid statement, just a reflection of what I see in other countries around the world.
The question is where do we draw the line, or should we not draw the line and provide everything free.
Its a difficult topic.
Again you are talking about discrimnation, and I dont follow your argument.
Ethnicity and knowledge of a language are not the same.

do you not understand the differnce between going on holiday to a county and emigration?

Yes - I emigrated and lived overseas and accepted that [b]it was my responsibility to fit in, not the other way round.[/b] Plus it would have been very arrogant to have argued otherwise. I was also educated in Scotland but fear that discrimination will prevent my children doing the same.

BTW - how would a centralised, planned NHS avoid political interference. How do you ensure economies of scale > diseconomies and watse?

Legally staff are not allowed to use friends or relatives as translators, even if the patient gives consent, its a big no no.

I have no reason to doubt that what you say is correct, but going back to the original point, there just isn't the money in the local healthcare trust to pay for translators in the numbers that would be required, staff have to make do with what they have available to them and sometimes that is a relative of the patient.

Oh look you've got a little gang, bless. Judean People's Front or those other guys?

A few observations about translators, from my experience:
1. It is the Police who spend more on translators than anyone else - should victims of crime foot the bill for their own translators too?

2. In mental health, where I work, I would argue that it is much, much better to have an appropriately trained and competent translator than not. Apart from anything else, sorting out a translator might not be at the top of your priority list when you're suicidal or having a psychotic episode. Either way, for all concerned, I’d rather each party knew what the other was saying.

3. In some cases translators actually help integrate people who have been very isolated in their communities. Surely access to the services and facilities in the wider community are essential if we want people to integrate?

[i]I have no reason to doubt that what you say is correct, but going back to the original point, there just isn't the money in the local healthcare trust to pay for translators in the numbers that would be required, staff have to make do with what they have available to them and sometimes that is a relative of the patient.[/i]

For things like 'Are you warm enough?', 'have you got pain?', 'Do you know where you are?' relatives can be a godsend, but for things like confidential medical information, consent for operations, anything with a medico-legal implication, relatives should not be used.

I have been in a situation where an 8 year old girl was expected to translate for her mum who was about to have complex gynaecological surgery; I had to say that this was not acceptable and delay things by a few hours... just not right.

Similarly, husbands cannot give consent for their wives surgery and so on.

Sorry I haven't read though the above, but have we established if Andrew Lansley is racist yet?
[url] http://www.bbc.co.uk/news/uk-politics-15164373 [/url]

Surely [s]access to the services and facilities in the wider community are[/s] learning the local language is essential if we want people to integrate?

So McBoo - being shown up as racist, being unable to answer any points being put to you, altering your stance to an even more ridiculous one when the ridiculousness of your position is pointed out to you and childish insults to those who disagree with you.

well done!

Maybe if the service were provided at a cost and there were circumstances where the cost could be waived in the case of poverty.

Its tricky and similar to the taxi thing.

Some people on here have had need of a taxi to get to/from hospital and that service is available but have chosen to pay themselves.
What if translation was a service that could be provided for a fee, then some people would take up the service others may make arrangements themselves.

My point is would this save money to the NHS without compromising service. and not be considered racist.

Sancho - its still racist because its disadvantaging people on grounds of their ethnic background.

It must be equal access to all

Crikey, I think you've cleared that up better than I could have hoped to. Mrs mW's role is in aftercare so the language difficulties she is likely to face would generally fall into the former description rather then the latter example of the 8 year old girl.

Is he always like this?

Yep Mcboo, I think it's good if people learn English. I guess it's a bit of a chicken and egg thing isn't it?

Interestingly, I know a number of translators locally who decided to become a translator haing previously been on the receiving end of the service. They learned English and trained as translators.

Fact is, we can look at it in a black and white Daily Mail vs Guardian type way, or we can accept that there is a massive amount of grey in the middle. In this instance I think that TJ is more right than you are though.

Yes, seems so.

Perhaps you might want to re-post the latest instalment cutting out the words - "So McBoo - being shown up as racist". It would be most appropriate 😉

Bol - I actually think that many people have sympathy with TJ's view (I certainly do) but not with the absurd extremities that he takes to try to convince people (the "racist" cop out card, endless repetition etc)

"What if translation was a service that could be provided for a fee, then some people would take up the service others may make arrangements themselves"

Its too complicated. You would have to means test people which would cost time and money in administration. The there is dealing with the complaints when you turn round and say sorry you dont qualify etc etc.

Also and this may be a sweeping statement on my part, but those who could afford to pay would probably already speak English. Those who could not afford to pay would be probably be the ones who can not speak English, and I'm sure Human Rights would unfortunately come in to it as basically you would be restricting access to health care.

This is why the NHS is so difficult. IMO it should be either pay for all or pay for none, personally I'm in favour of pay for all as I think its cheaper and more efficient in the long term.

Oh and with regards to provided at cost. The prices I quoted earlier are at cost. The NHS doesnt add margin to the costs it recharges to other parts of the NHS.

The social integration bit ie learning English isnt really an NHS issue, I guess its shared by the Council and Education Department.

Wait a sec

bol - Member
Eight pages? Nine? This ones going to run a bit isn't it?

I love a bit of (not very) thinly veiled racism in the morning.

Don't come on being all matey fella......you're the one that shouted RACIST to begin with. Care to elaborate? Let's see if you can be any more convincing than Mrs Doubtfire up there.

TJ
I dont see how race is a factor for not learning the language of the country you live in.
I can understand where foreign nationals who are visiting dont speak English, and often people who are not UK born citizens will not be fluent.
But a UK born citizen I would expect to know English.

So maybe its not a racist issue, more a matter of nationality and that then I dont think the NHS should foot the bill in all circumstances.

Were it a simple matter, we could offer translation as an added extra. As it stands, communication is an integral part of healthcare and we try to offer the best healthcare that we can, therefore.....we need to provide a service to help some people access healthcare.

I don't see it as a big issue really.

Incidentally, has anyone seen the introductory talks that junior doctors get?

The ones where bright shiny young doctors are helped to translate dialect sayings when they go to work in such foreign lands as Yorkshire or Newcastle?

http://news.bbc.co.uk/1/hi/england/4688120.stm

So give over with the 'You should all speak perfect English' stuff, Eh?

Sancho

If you take an ation that disadvantages one group more than others then that action is prejudicial. If this group is defined by their ethnicity / nationality then its racist.

TJ - I fail to see the association between [b]race[/b] and [b]language[/b]

I know lots of black people who can speak English, I know brown people who can speak English too, and yellow ones, and a whole load of mixes inbetween...

Funnily enough I know shed loads of white people who can only speak French, and some who can only speak Polish, I even know some white people from Scotlandshire who could probably do with a translator too.

I even know Black French people who can speak English, shock horror!

No correlation between ethnicity and english speaking Zulu?

how many inuit translators does the NHS have?

if the answer is none, then are we racist against the inuit?

should the NHS provide a translator in every hospital for every language?

Can we stop with the race thing now?

Everyone has had a say, no one is going to change their minds, why not leave it there?

If you take an ation that disadvantages one group more than others then that action is prejudicial. If this group is defined by their ethnicity / nationality then its racist.

So are Scottish Universities racist?

The New Statesman:

The Scottish fees policy is often wrongly perceived as anti-English (the Daily Mail refers to it as "the fees apartheid") but it's simply aimed at maximising revenue for universities....For the left, Scotland should serve as a reminder that tuition fees are a political (racist?) choice, not an economic necessity.

Can we stop with the race thing now?

Everyone has had a say, no one is going to change their minds, why not leave it there?

Sure, soon as TJ and bol back off and acknowledge that screaming racist at me was a little over the top I will be happy to move on.

I mean you guys should meet me.....I'm really quite nice.

No correlation between ethnicity and english speaking Zulu?

No, there really isn't when you think about it is there TJ.

Last time I looked, Germany had both white and black people there, some of whom are unable to speak English, and some can 🙄

Mcboo, do you accept that there is a place for translation services within the NHS?

crikey - Member
Mcboo, do you accept that there is a place for translation services within the NHS?

Yessir

mcboo - Member

Can we stop with the race thing now?

Everyone has had a say, no one is going to change their minds, why not leave it there?

Sure, soon as TJ and bol back off and acknowledge that screaming racist at me was a little over the top I will be happy to move on.

Perhaps you should back off and apologise.
1) I did not "scream racist at you"
2) you clearly were being racist and many of us agree

its the unthinking insidious racism not the overt intended racism as I clearly stated and spent some time explaining to you.

and as for the childish insults thrown my way?

crikey - I will take your advice

Edit - changed your view completely now have you? seems like it

Nice one, now TJ and bol, any chance of a reconciliatory post?

Edit: not quite what I was thinking of...

Going back to the issue raised in the OP ... 🙂

Maybe the question isn't 'how can the NHS save money / what services should it cut', but rather 'does the NHS require greater funding to support a comprehensive, equitable health care service for all'? It seems to be a societal given that we now need to cut services to address the deficit, rather than consider what we should pay / contribute to support public services.

We are living longer (but often with chronic conditions), and medical advances now mean that treatments are available for illnesses and conditions that previously would have killed someone. I guess from my ethical POV, if we (as in the medical / care professions) are able to do something that can aleviate suffering, then we should. And if that costs more money, then we increase what we contribute to the cost of that, especially from those that can afford to (and frankly that includes most of us who have a disposable income to spend on bike bits!)

I think the NHS requires a change in focus. As Z-11 suggested a while ago, primary care is the place to spend money, not in hospitals, try to keep people well rather than fix them.

The tricky bit is that it requires a level of social input and prescriptive influence on lifestyles and life choices that is verging on the 1984ish...

I didnt know I was a Kulak until TJ pointed it out to me.

You mean you're bald and suck lollies all day?

Oh....

I see what you are saying.
But disagree with you on this

crikey - I agree completely: one of the most effective ways of reducing costs and simultaneously minimising human suffering is through keeping people well in the first place.

But as individuals and as a society, along with a lot of the emphasis in the medical sector, we are hugely resistant to this. I work on research related to the health benefits of physical activity / active lifestyles, and I do verge on dispair at some points.

I meant TJ
I just dont feel it should be a blanket free service.
As I dont see it as the role of the NHS.
They stick to fixing people, we use their services.
If I dont understand what the doctor is saying then I arrange a translator, if I cant afford one, or dont have a relative/friend who can help, then I ask for help. Then the NHS can provide one.

Certainly not a race issue.
Same with a Taxi, I have a broken leg and need to get to hospital, I cant get a friend to take me and cant afford a taxi, should the NHS provide that service?

I dont think it should be a free service in all cases.

But its just a view point

Yes, sorry. I was just pre-empting what I anticipated would follow. I didn't mean to get into a big "you're a racist" thing, and clearly didn't choose my words very well.

I don't think people are usually intentionally racist, but I feel quite close to translation services, see the benefit they provide to the NHS (and wider society), and get a bit riled when I feel they're being dismissed.

bump

bump

Ok a few simple points

1) Just because it is [b]TJ[/b] doesn't mean he is wrong.
2) I do however dislike the labelling of posters and posts as Rascist or Bullying because they are allegations which are both damaging and impossible to effectively refute.
3) Having said which - I definitely inferred a whiff of probably unconscious racism in [b]McBoo's[/b] first post when I saw it - my interpretation - may be wrong - I'm a Guardianista after all.

4) Lastly - the important one. As a doc working in the NHS (and not needing translation services often) I have a duty to do the best I can to diagnose and treat patients correctly. Sometimes I need a stethoscope to listen to their heart, sometimes I need a translator to listen to their story. Take either away and I cannot do the job properly, and will miss diagnoses and waste money and time. Pragmatically it makes sense to have access to free-to-patient translation services

I like the pragmatic approach.
but the question is should the NHS pay for the external services of a minority of people who cant speak the language of the doctor.

Maybe its a race issue, or a nationalist point of view, but its a lot of money being spent on a service.

Sancho - its integral and important then communication is as good as possible

[b]Sancho[/b] as the bloke who will get sued if I get it wrong... Yes...

And having used translation services a lot more when I worked in Australia, I know we are not the only country who sees this as important.

TJ - totally agree

Im not disagreeing with the need for translation, but question whether the onus should be on the individual to pay/provide when in a country that you dont speak the language.

If I dont understand what the doctor is saying then I arrange a translator, if I cant afford one, or dont have a relative/friend who can help, then I ask for help

I beleive the total cost to the public secctor of translation servces is around £8BILLION 9maybe someone slse has mentioned it, but I haven't read the whil thread). Anyway, and specifically with regard to the NHS, shouldn't that be the reponsibility of the service user? if I go abroad, I take health insurance to cover my costs in the event of an unexpected trip to hospital, and I expect translation to eb a cost met by the insurance co. If we're talking about someone who lives here, then isn't he onus on them to meet the simple expecattion of making themselves understood, not the other way round?

Also, FWIW

1) Just because it is TJ doesn't mean he is wrong.

Sancho - Member

Im not disagreeing with the need for translation, but question whether the onus should be on the individual to pay/provide when in a country that you dont speak the language.

No - because its discriminatory! Its meaning those who are non native english speakers are getting a lessor service

Big but slimmer bloke - where did you get that figure from - it looks totally absurd so I'd love to see some real data to back it up

Sancho - one of the principles of the NHS is that it is free at the point of use.

The NHS is about providing health care, if in order to do that you need to communicate, then the NHS pays.

The way to save money/solve the problem is to get people learning English, and this is the job of the council and education department.

TJ just had a thought is the NHS racist in trying to get certain Ethnic minorities to change their diet or change their tobacco habits? In fact I can think of many NHS health intiatives that are aimed at Ethnic minorities which change their culture etc etc

[img] [/img]

Big but slimmer bloke - where did you get that figure from - it looks totally absurd so I'd love to see some real data to back it up

Getting back to the topic:

If certain things like sex-change operations (according to The Daily [s]Liar[/s] Mail) are to be condemned because they are not an acute need then IVF should also go the same way. There are far too many people on the planet as it is. If someone is so desperate for a child via IVF they should stump up the money themselves.

I'd reallocate money to preventative medicine.

Oh and get rid of that stupid water scam known as homeopathy, unless they can produce double-blind trials showing it works. Or at least give them something labelled as 'arnica 30C' which was filled up at the kitchen sink!

My wife has used the translation services on occasion and they've been very useful. She does speak reasonable english generally but medical situations can be both complex and highly specialised so I think it's unfair to equate the need for translators to someone being unable to speak the language. As a UK taxpayer I'd say she deserves the same standard of care as the rest of us and commend the NHS for making great effort in these areas.

TJ
Fair point and yes its free at the point of service.

But does it also cover foreign nationals.
I remember a report about the hospital nearest to Heathrow charging foreign nationals for treatment as there was a problem with I cant remember the correct term, something like sickness tourists.

I dont want to drift too far off track, but is there a limit to the service?

If people are not entitled to free NHS treatment then there is a mechanism to charge. That includes such people as those who have not paid NI, non UK / EC nationals

You can get homeopathy on the NHS?

mcboo - Member

You can get homeopathy on the NHS?

In some areas yes - and yo know what - its actually cost effective 😯 - yes I know its pure bullshine but the money it costs is tiny and it stops a lot of repeat referrals as the placebo effect is so effective

Is it basically up to the hospital to decide what services are available and how to implement the charging mechanisms?

no

http://www.****/news/article-562980/Foreigners-asked-produce-cash-hospital-beds-crackdown-health-tourists.html

here is an article on the health tourists.
I know its the Daily Mail and Im taking it at face value, but does it suggest the the Trusts decide how to apply charges etc, not a common policy on charging etc.

I've deliberately avoided this thread. Could someone summarise the [s]achingly predictable, entrenched[/s] opinions of the [s]usual suspects[/s] main protagonists please? fank you muchly

Sancho - sorry - I meant the thing most recently discussed in the thread... homeopathy.

Trusts application of charges to non eu patients is uneven.

In some areas yes - and yo know what - its actually cost effective - yes I know its pure bullshine but the money it costs is tiny and it stops a lot of repeat referrals as the placebo effect is so effective

Then my last bit stands. Fill it from the tap when the patient isn't looking and stick a label on it. None of this hideously expensive hitting with a leather strap rubbish! Save a little bit more! They can't exactly use spectroscopy to find the 'active' ingredient if there isn't any!

(someone might have already said this, I couldn't be bothered to wade through all the absolute crap)

It takes time to learn a foreign language to even a basic conversational standard, but to discuss medical treatment you need a grasp far beyond that.

I speak reasonable german but I haven't a clue what the german for "You've broken your hip- if the next bit goes right you'll walk normally again, if it doesn't you won't, so listen carefully- we're going to perform keyhole surgery tomorrow and fit a load of bolts, then sew you back up and give you a course of painkillers which trust me you do not want to get the dosage wrong for, and some critical physio which you will have to do carefully, diligently and correctly or your leg will explode, and some information on exactly what you can and can't do with that leg for the next 3 months, so that you don't cripple yourself. Please sign here to say you understand the procedure and you give your consent. PS this button here gives you morphine directly into your bloodstream, don't **** that up".

Pretending translators are only for people who don't speak english at all or can't be bothered to learn is either dishonest or plain ignorant. Frankly, from what I saw when I was inside, a lot of native english speakers struggled to understand what they were being told- it's sometimes complex, and alien, and you're hearing about it at a time when you're stressed to the max and possibly in pain to boot. That's just exactly when you want to be having trouble understanding.

Does seem to me that in circumstances where charges are being levied, it's reasonable to include translation fees as part of that. No idea if this happens or not.

Northwind - said exactly that on page 1 🙂

Used to be a voluntary TEFL teacher for non-english speaking women who were pregnant and trying to learn to speak English so that they could understand enough for when they go into hospital. But as you say, it takes a while to learn a new language fluently.

Nah, you used [i]way [/i]less words than I did. 😳

Real quick one..

When i was going back to hospital a couple of weeks after my 3 week stay, i was told this.. We can organise an ambulance taxi if you are stuck for a lift to your appointment, but we only ask you to do this if you cannot get here otherwise.

I was in a spine brace then, and on crutches, so i couldn't get the bus, couldn't get the train, and could only get a lift. Luckily i have relatives that were able to take me.

A taxi service is offered as part of the treatment to those who cannot get to the hospital to continue with their care. Obviously the ambulance buses are preferred which pick you up from your home.

Anything that prevents access to an interpreter just makes the clinicians job harder.
Who ever thinks that is a good idea really hasn't thought it through.
(We don't want this thread dropping off the front page after only 4 pages do we?)