Who Should Pay?

So the NHS is in crisis, A&E is fit to burst, there are no beds for those who need them. Plenty of opinion-givers have waded in on how to fix the problem, some qualified, some obviously not, and one of the solutions I keep seeing (from both sides) is, honestly quite disturbing.

Patients who turn up to A&E suffering injury or illness due to alcohol or drugs should pay for their treatment.

I know a few people who agree with this and genuinely believe it to be an acceptable way to deal with NHS overcrowding, and I’ve also seen comments to this effect beneath nearly every article about A&E online. I’ve even had people say to me “as someone who doesn’t drink, doesn’t it really piss you off having to deal with drunks at work?” which is something I find quite astonishing, because you wouldn’t say “as someone who doesn’t drive a car, doesn’t it really piss you off having to deal with injured car drivers?”.

Yes, it’s unpleasant being verbally and physically assaulted by intoxicated patients, but I’ve been punched and spat at by sober patients, and I’ve had drunk patients treat me with respect and decency whilst being incredibly apologetic for their state.

Plus “drunk patients” is an incredibly broad term, some recent examples that I can remember:
The woman who was beaten by her partner, who then spent the entire night drinking vodka to numb the pain as he wouldn’t let her leave the house until he had gone to work;
The hen party who’s taxi collided with a lorry, killing one of the occupants and seriously injuring the others;
The young child who had been bullied and beaten at school, so he snuck into his parent’s drinks cabinet and drank a bottle of liqueur, becoming violently ill;
The teenager who had been out celebrating his birthday and was assaulted by a group of men at the taxi rank putting him into a coma.

So which one would you send an invoice to? Fair enough we get plenty of people who get drunk, fall over and injure themselves as well, that’s pretty standard, but where do you draw the line? Some people say “if it’s self inflicted, they should pay” but again, what counts as self inflicted? The 70 year old lady who falls over her own slippers and breaks her hip- that’s entirely self inflicted, no one else could be blamed for that, but would you charge her for her treatment? How about mentally ill patients who attempt suicide because our woeful mental health services have failed them? Sports injuries- that 17 year old didn’t have to play rugby, he could have stayed indoors playing Xbox, but now he’s broken his leg, should he be paying? Motorbikes are dangerous, should all injured bikers receive a bill at the door?

Ultimately, no one wants to be injured, and it’s horrible when patients repeatedly apologise for taking up our time (that happens a lot on Christmas and New Year shifts), but the entire ethos of the NHS is to provide healthcare to the public, free of charge at the point of use. There is abuse of this system, yes, but it is minute in comparison to the amount of patients in genuine need of help. All this talk of putting patients off coming to A&E hurts even more when a patient (usually elderly, usually with a chronic injury or illness) tells me that they’ve been in pain for a while but “didn’t want to be a bother”.

The recent idea of sending an invoice showing “this is how much your treatment was worth” but without actually asking for payment would only put such patients off even more, and will undoubtably lead to the most vulnerable members of society dying long and unpleasant deaths so as “not to cause a fuss”.

I wonder whether the attitude towards users of the NHS has recently worsened due to the government’s swing towards privatisation; perhaps encouraging these opinions in the media and online will lead to more of an acceptance of the American way of “providing” healthcare, so that when it begins sneaking in subtley, people will welcome it, rather than abhor it.

“Well obviously I shouldn’t have to pay to have my appendix removed, but that alcoholic in bed 6 should be handed a bill on his way out.”

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