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Should smokers, drinkers, drug users and obese people be charged to see the doctor?

It seems reasonable to me, after all, they consume a very large chunk of the NHS budget, so I think it's entirely appropriate that they stump up for their treatment. What do you think?


Created By on 27/06/2016

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duckkers
8th Jul 2016 10:35:03 (Last activity: 5th Aug 2016 10:57:08)
-1
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I've just thought of another group to join the NHS budget guzzlers -
Eating Disorders - Anorexia/Bulimia and so on ......
Response from celtwitch Original Poster made on 5th Aug 2016 10:57:08
Interestingly, there are NO eating disorders in countries where food is scarce, so are these acquired disorders genuine?
serenitywoman
2nd Aug 2016 11:17:38
2
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I think this is a diffult question to answer, we cant put all these people in the same box as they are indivisuals right?
people who go into hospital time after time, need help from other bodies, they need support and to find out what the cause is. someone who drinks may have been abused as a child,so we cannot judge everyone the same some people cannot deal with loss a lot of people need after support to help yes some people don't want help and are beyond help.. drinkers and drug users wont care about paying because its an adiction .. some may turn to crime to feed their addiction or to pay for treatment and so crime goes up .. if we don't find the cause we cannot find the cure..

we use money to fight senseless wars to send bombs and guns to other countries to kill each other we build rockets to send to the moon , when we cannot even help people living on this plannet, think of all the many billions that are waisted just in this country alone .. all this money can be used better..
in so many ways to support many people overcome addictions and support many people..
i don't have any figures of the zillions that are waisted on wars, weapons, rockets and many more things .
perhaps those who condemn others for their adictions could help by training to be a counillor and help in their own way ..

love and peace 🙂
duckkers
2nd Aug 2016 09:05:29
2
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Have we mentioned mental health problems?
I think it's easy to "judge" if you are lucky enough to enjoy good health. If you are not that lucky and have problems that are not your fault perhaps we could wind our necks in and be a tad less judgemental.
celtwitch Original Poster
29th Jul 2016 18:29:31
0
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If people insist on damaging their personal health, should the NHS simply refuse to treat them? It seems reasonable to me.
Mollflanders
1st Jul 2016 17:52:23 (Last activity: 7th Jul 2016 16:00:52)
2
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The NHS was created out of the ideal that good healthcare should be available to all, regardless of wealth. When it was launched by the then minister of health, Aneurin Bevan, on July 5 1948, it was based on three core principles:
that it meet the needs of everyone
that it be free at the point of delivery
that it be based on clinical need, not ability to pay
These three principles have guided the development of the NHS over more than 60 years and remain at its core.

If you want to start changing all of this in bits and pieces then get rid of the NHS altogether. Let's go back to the Dark Ages.
Response from celtwitch Original Poster made on 3rd Jul 2016 19:19:08
The architects of the welfare state believed that sick people would recover and return to work. It was never envisaged that some people would opt for a lifetime on the sick.
Response from lagarto made on 4th Jul 2016 14:28:13
that is a cruel thing to say. People don't "OPT" for being sick, they just are. Would you like to be judged about your lifestyle and whether or not you 'deserve' help? The hypocratic oath prohibits doctors from choosing who to help and who not to.
The NHS was never envisaged, though, for the world of medicine to become so wonderful it can save lives that previously would have been beyond the realms of medicine. That part is true. But don't make judgements of people based on your narrow opinion of the tiny bit of their lives you maybe can see.
Response from celtwitch Original Poster made on 5th Jul 2016 10:05:30
I know a few people who are 'on the sick' and have been for many years, one woman has been 'depressed' for 20 years. Depression is self limiting, so how she has managed to get herself signed off for so long is a mystery.
Foreigners are particularly adept at milking our welfare system and many of them top up their benefits with sickness benefits as well.
Response from jeanmark made on 5th Jul 2016 13:50:13
Whilst agreeing there are a number of people who have been found 'on the sick' when they are indeed healthy and able to work, it is not completely accurate to state depression is self limiting. For a number of people it becomes a chronic condition that may be outside of their control even when on medication leaving them unable to work or maintain a job for long periods. As for foreigners, why are some people so xenophobic particularly when talking about the health service. I worked in the NHS for 47 years and rarely found it was 'foreigners' abusing the system.
Response from SoundFlyer made on 7th Jul 2016 14:52:50
I found this a very interesting and topical debate.

I've had more than my fair share of NHS treatment and find it difficult to be unbiased in their favour but my last visit late last year made me think. There was so much waste of time and resources, not to mention abilities, so much discord in and between NHS staff, that I realised "that it be based on clinical need, not ability to pay" was a double edged sword:

Taking an overview, the country's ability to pay is now in question. There must be a cut off point that balances the individual patient's needs with the individual taxpayers needs, not to mention the individual NHS employee's needs.

Satisfying the needs of unavoidable and or unexpected illness and disability for everyone is a marvellous idea but achieving it without attracting, encouraging and perpetuating would-be abuse is the real-world reality and task in hand. NHS staff have face this reality all the time, they can't afford politician's ideologies.

Like it or not, every need has to be evaluated against every other and resources allotted fairly and affordably. We all take risks with our everyday life choices, we have to face up to risk management and who foots the bill for it. So, for me, the debate is not should needs be assessed against costs but how to do it fairly down to the last penny. Personally, I'm looking after myself a lot more, physically and mentally, and enjoying it.
Response from jeanmark made on 7th Jul 2016 16:00:52
I wish I could have put it so eloquently SoundFlyer. Like you I find it difficult to put an unbiased argument across having worked in the NHS all my working life and used its services many times. The NHS I started working in in 1965 was nothing like the NHS I retired from in 2012 and certainly not in cost!
[deleted]
2nd Jul 2016 15:47:38 (Last activity: 7th Jul 2016 15:12:05)
4
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[deleted]
Response from jeanmark made on 2nd Jul 2016 16:07:48
I can't argue with that although I'm sure someone will!
Response from celtwitch Original Poster made on 6th Jul 2016 19:42:14
The goose may die sooner than the average, but while they linger on in pain for years before finally shuffling off, their treatment can cost many thousands of pounds. There is chemo therapy, oxygen therapy, nurse visits, carers and the loss of the taxes they would have paid had they not played Russian roulette with their chosen vice.
The nett value of the unholy quartets contribution is probably minimal, and in some cases negative.
Response from celtwitch Original Poster made on 7th Jul 2016 11:38:38
I simply tell the truth...don't shoot the messenger!
Response from jeanmark made on 7th Jul 2016 13:25:39
No, you're telling only part of the truth. Yes, the quartet you have fixated on do cost the NHS a great deal of money but you are failing to acknowledge there are other life style choices that affect health, including certain cancers that can and indeed are costing the NHS a great deal of tax payers money. The point being made by a number of comments is why discriminate against some and not others?
Response from celtwitch Original Poster made on 7th Jul 2016 14:43:23
The point of debate is to argue a point with opponents, amicably and politely, I think that I have done that, and there is nothing to be gained by sticking pins into my effigy.
Most cancers are indeed costing the NHS a fortune, but almost all cancers are preventable!
My question can be broadened out to include all risky behaviours, from smoking, which is the height of stupidity, to sky diving. If there is even a small chance that it will cause you serious injury, or ill health the risk taker should buy appropriate insurance.
I am not discriminating against anyone, I'm merely asking pertinent questions in the best spirit of debate.
Response from jeanmark made on 7th Jul 2016 15:12:05
Discrimination may not have been intended but unfortunately that is my perception as you only mentioned certain risks. We take a risk by just living, in which case I interpret your suggestion of appropriate insurance as applying to everyone. Not all people are in a position to be able to buy health insurance which is why Bevin believed in a service free at the point of delivery. Like you I am arguing a point and had hoped it was both amicable and polite, I apologise if you interpreted that as 'sticking pins into your effigy' that was not my intention.
Sandy 58
6th Jul 2016 15:48:56 (Last activity: 7th Jul 2016 13:46:05)
0
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I think over the last 10 to 15 years people are becoming better educated on how smoking, drinking, drugs, over eating affects your health and that is having some impact. If you consider the number of your friends and family who are non-smokers in comparison to the eighties and nineties there have been changes. Doctors can refuse to give a patient treatment if they are not conforming to advice to support their treatment. e.g. if someone who is a heavy smoker refuses to stop, a doctor may refuse to carry out an amputation which would be a complete waste of time if the patient continues to block their arteries with smoking: there would be no point placing an alcoholic on the list for a liver transplant if they continue to consume alcohol. I don't think there is anything to be achieved by refusing free treatment to people with addictions, as most of them are already suffering financially due to their addiction. If we concentrate more on the treatment of the mental health of those with addictions, dependencies, then hopefully we will have less demand on the health service in years to come.
Response from Wilf made on 6th Jul 2016 16:12:18
I agree with you and think there is so much advice given about stopping smoking and drinking etc that we all have to stop or cut down. I must say I do drink every weekend and worry that over the years it will all mount up but its not excellive maybe half a bottle of wine a night at weekends and a few beers-we have to enjoy life don't we!
Response from jeanmark made on 6th Jul 2016 16:13:14
Well put although we don't put sufficient resource in to services for mental health as a whole. There is funding to help people with addictions, they just have to be motivated to take the help offered and that can often be very difficult.
Response from lagarto made on 6th Jul 2016 17:00:53
I do not think we should interfere with other people's life decisions. We can offer advice and should. We do not have sufficient availability for counselling and mentoring and general mental health care and yet seem to be fine with judging people based on the thinnest of evidence about lifestyles or situations. I think ALL healthcare must continue to be free at point of service and if we had better access to psychological counselling services and mental health care (and good quality social services) - that would cut the costs of the NHS emergency and purely medical interventions right down by a massive amount.

But being self - righteous when judging whether someone else makes poor decisions is not where I want to go, and not a country I want to live in.
There will always be people who take advantage, and people who despite help offered, continue to make poor decisions, but that is true no matter what we do, and it is true on all levels of life, social status or income, yet somehow it is deemed ok to interfere with those on the lower ends of social strata. Leave people alone to decide how to run their own lives and free to make their own errors but have a system that helps when it can.
Response from jeanmark made on 7th Jul 2016 13:46:05
Well said lagarto but I have to say that there is very strong evidence, gathered over many years that identify the quartet that celtwitch has fixated on causing a great deal of ill health and cost to the NHS. What she hasn't done is identify how many other life styles also have a high human and financial cost to the NHS.
Pam1960
6th Jul 2016 20:53:29 (Last activity: 7th Jul 2016 10:19:35)
1
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If you want to target smokers, drinkers and drug to pay for healthcare what about the people who participate in sports and other outdoor activities. As a child my son broke his leg playing football. He played a sport where there is a likelihood of injury should he have to pay for treatment. Extreme sports including bmx and mountain biking have a high injury rate. Should these people have to take out insurance to cover treatment. Maybe Celtwitch you think we should all take out private medical insurance and do away with the NHS
Response from celtwitch Original Poster made on 7th Jul 2016 10:19:35
No Pam, I don't want to see the end of the NHS, though I think that it will happen sometime in the near future. However, if someone does something stupid, like smoking 40 gaspers a day, or participates in high risk activities, shouldn't they pay towards their treatment when they need it?
When I was a climber and caver I took out critical injury insurance.
celtwitch Original Poster
5th Jul 2016 17:29:58 (Last activity: 6th Jul 2016 14:59:00)
0
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Perhaps the smoking, drinking and drug using community could take out compulsory health insurance, just in case they are struck down as a result of their cavalier attitude to their personal health?
Response from celtwitch Original Poster made on 6th Jul 2016 09:39:08
There is something called 'learned helplessness' and one of its many symptoms is the belief that the state is responsible for supporting the individual if they become sick, even when the sickness is self induced.
'I have paid my taxes, therefore I'm entitled' (to treatment that might span decades and cost hundreds of thousands) they wail, like petulant school children.
I don't smoke, I have never done drugs and the amount of alcohol that I consume annually is unlikely to do me any harm.
Many years ago I earned my crust as an outdoor pursuits instructor, I was vary aware that a fall could either kill me, or disable me for life, so I took out critical injury insurance.
Shouldn't people who take risks with their health do the same?
Response from jeanmark made on 6th Jul 2016 14:13:36
Well celtwitch for many years I earned my crust as a nurse and am well aware of the term 'learned helplessness' but I am a little confused by your statement implying that people who take risks with their health should take out health insurance. For many years my specialists field of nursing was Infectious Diseases, Tropical Medicine and HIV, should I have taken out private health insurance as I understood there could be a risk to my health? You also appear to make an assumption that everyone has the capacity to understand there may be health risks to their life style and have the ability to pay for health insurance. Yes, there are life styles that can lead to ill health but why pick on only certain types of these? Would you include Special Needs adults into your belief who may themselves take risks without fully understanding the consequences? When I read what you have written the word 'arrogance' sprang to mind although I am sure that isn't your intention as I'm aware you like to stimulate debate.
Response from celtwitch Original Poster made on 6th Jul 2016 14:35:05
Are you suggesting that the unholy quartet of smokers, drinkers, druggies and porkies don't know that they are risking their lives?
If they can afford cigarettes, liquor, drugs or take-aways, surely a few quid for insurance would be money well spent.
I think that perhaps you have spent too many years molly-coddling people who are responsible for the hell they have made for themselves?
Response from jeanmark made on 6th Jul 2016 14:59:00
No, I'm suggesting that there are other life styles that can also cause health related problems, people only pick on the quartet. Even if they cut down on their habit they probably still couldn't afford insurance as it would cost much more than if they were clean living virgins. I have 'molly-coddled' many people through a hell they may have caused themselves but would never have dreamed of blaming them, I believed they deserved my support not condemnation. My first ward sister post was on a care of the elderly ward, I never once considered blaming them for getting old and dependent even though a number of them drank alcohol, smoked and survived WW1!
celtwitch Original Poster
1st Jul 2016 09:36:27 (Last activity: 5th Jul 2016 14:59:11)
4
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I think that we should all pay, say, £5.00 to see the doctor, £10.00 to be treated at A&E, and pay for our food while in hospital.
It would reduce the number of unnecessary visits to the GP and also lessen the load on A&E staff. We pay for our food at home, so why not in hospital, and it might improve if we are paying for it?
Okay, start shouting me down!
Response from celtwitch Original Poster made on 1st Jul 2016 11:28:16
It was just a suggestion, to get a debate going.
Response from BungalowBel made on 5th Jul 2016 12:17:03
First post, so be gentle!!

I certainly think we should pay for our food while in hospital, we would have to pay for it if we were at home. They could have menus like a restaurant. Or, the choice for a relative to bring food in if you didn't want to pay for the hospital food. The hospital catering should offer more choice than it does at present.

I do not think we should pay to visit the Doctor. However, I do think we should be charged £5 if we miss an appointment without cancelling it first.
Response from jeanmark made on 5th Jul 2016 13:59:45
I'm all for people being charged when they miss appointments with no explanation but one has to be wary of the circumstances before charging. I was with my step mother-in-law when she received a phone call from a doctor berating her for my father-in-law missing an appointment even when she pointed out that he had signed the death certificate!
Response from celtwitch Original Poster made on 5th Jul 2016 14:43:19
I have twice travelled to hospitals for appointments with consultants, only to discover on arriving that they were on sick leave.
Should they be charged for wasting our time?
Response from jeanmark made on 5th Jul 2016 14:59:11
Did they know it was you being seen? I would hope you were seen by another, albeit junior doctor as even consultants don't always know when they are going to be too ill to attend work. I think it depends on the reason someone misses an appointment, I've heard such reasons as I managed to get a last minute hair/nail appointment, I was invited out to lunch by a old friend. Surely these people should be charged!
lagarto
4th Jul 2016 14:23:58
2
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no. It is a slippery slope to start judging people as if you are some great lord and have a right to see into people's lives and decide who gets treatment and who not. After all, would you like for someone like me to judge that you should not get heart treatment because your lifestyle is dubious by in the way you exercise or not?
Joan Fraser
3rd Jul 2016 10:38:21
5
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Hi - I have just advised my Oral Surgeon that if the biopsies recently undertaken prove to be malignant, that I will not be taking the option of treatment. I have paid into 'the system' for 46 years, yet cannot get the pension I believed was my right at 60, I use over the counter meds where possible - and basically try to pay my way. My son has a chronic health condition and I have paid thousands to find alternative treatments and regimes that may help him rather than use the NHS 'pill for every ill' when other options may work better.
However, I have smoked for 40 years and paid 35% (at least) in tax to the Treasury from each packet........and I still say 'hell mend me - I have known the dangers of smoking for years and still kept at it' (I also took and still take a drink and pay tax on every bottle of alcohol too) - so despite a lifetime of multiple contributions I won't penalise others or use fragile NHS budgets for something I might have avoided.
Sad to say I find celtwitch comment rather judgemental and cloistered ....... many cases of addiction/dependence I have come across could actually be defined as 'coping mechanisms' eg The lady who has 2 disabled children and very little assistance, choses not to take the tranquilizer meds prescribed - but depends on a bottle of wine to help her sleep; or the lonely widower who goes for a pub lunch and stays on for the sake of company - but keeps drinking to be 'social'.
But for the grace of God.......
jeanmark
2nd Jul 2016 14:59:24
2
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Well Mollflanders, if you read all that I have written I never suggested that smokers, alcoholics, drug misusers and obese people be charged for their care, in fact I said the opposite. I was strongly against blaming certain sections of society as where would the blame stop when a number of life styles contribute to health related issues occurring. However, you appear to have a very distorted view of smokers, alcoholics, drug misusers and obese people. Many are productive members of society and not all live off the state. I accept some do become destitute but surely they deserve our support rather than a hypocritical display of virtue!
Mollflanders
2nd Jul 2016 14:20:03
-5
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Should smokers, drinkers, drug users and obese people be charged. Well, in my opinion, the smokers and drinkers couldn't afford to pay because all their money is going on ciggies and alchohol. Same with the druggies and fat people. Most drug users and alchoholics don't work anyway so any money paid would have already been given them by the taxpayer. So, what do we do with them Jeanmark? Leave them to stew in their own juice because it's their own fault?
jeanmark
1st Jul 2016 18:48:43 (Last activity: 2nd Jul 2016 08:20:09)
2
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Mollflanders, I would hope most people are aware these core principles remain at the centre of the NHS but Aneurin Bevan could never have envisaged how quickly health care would progress. How do we ensure those core principles are met when there is an increasing demand on the service at an increasingly high cost? Taxes alone cannot meet the financial needs and the private health sector can not meet all of the health needs with the latter going against the core principles set out by Aneurin Bevan.
Response from anf1408 made on 2nd Jul 2016 08:20:09
I agree. At the time of the birth of the NHS nobody would have foreseen the extent to which life expectancy would have risen nor the advances in the ability to treat certain illnesses and injuries. Both these factors have and will continue to put an increasing strain on the budget. You could use either a 'carrot' or a 'stick' approach to try to relieve this burden. Celtwitch has suggested charging people, which would be one possibility, but I prefer encouraging those who can afford it to opt out of the system as this would help to maintain one of the core values mentioned, keeping the NHS free at the point of entry. Whatever is done, it is important something is done quickly. Otherwise maintaining the NHS will become increasingly difficult and it is possible that we will get a repeat of what happened to the state pension, where ignoring the problem over time led to the eventual actual taken by government being far more damaging to individuals than it should have been.
anf1408
1st Jul 2016 15:54:33
0
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If there were a guarantee that NHS spending was protected an alternative may be to offer greater tax incentives to those who can afford it to take out private health plans. In this way the burden would be reduced by removing these people from the NHS system, allowing greater spending per head of the population. But, as I say, such a plan would only have a chance of succeeding if there was a cross-party commitment to protection of the NHS budget in the future. There would also need to be a sufficient number of trained doctors and nurses so that expansion of the private health sector would not cause skill shortages in the NHS. Unfortunately, such a surplus of doctors and nurses is not a luxury we currently possess.
jeanmark
1st Jul 2016 13:26:10
1
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Dollie I can understand where you are coming from but Celtwitch made a suggestion that shouldn't just be dismissed as unfair. Yes we pay taxes but not sufficient to fund todays NHS and all the services it is expected to provide. The system will always be abused because the mentality of some users is 'it's free and I'm entitled'. I lost count of the number of times I had that shouted at me over the years. No one appears to have the answer to the problem of funding and before anyone jumps in to 'blame' immigrants, they are not the problem. Medical science has advanced far more than was ever envisaged successfully treating many conditions which was never thought possible. To carry on the debate Celtwitch has started, what is your suggestion?

.

Celtwitch, I still wouldn't target specific people because of their lifestyle!
ginntonic
29th Jun 2016 22:47:31
2
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Whether I agree or not doesn't really matter as it will never happen here. But when you don't show up for a dental appointment you get billed so I think it should be the same for a GP or hospital appointment. More people then might call to cancel if they no longer require the appointment so someone else can have the slot, if they don't the money charged could go to the NHS.
MrsH.
28th Jun 2016 06:12:06 (Last activity: 29th Jun 2016 15:54:35)
8
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I agree with "jeanmark". These health-related problems are illnesses, too. And, if you charge people to get health-care Only for certain 'conditions', then where does that line of thinking Stop. Unfortunately, something has gone wrong in people's lives, for their conditions to become their crutch. Why would anyone pick on the more vulnerable in society, as even the person who has Chosen this type of lifestyle, has done so for a reason. I believe more psychologists would be useful, in assisting people with habits or addictions, to overcome their inner problems, and then to help them quit these dangerous addictions. To charge someone for wanting/needing help at their most ill points would be cruel. It could quite easily slide to involve people with hormonal problems, or attitude behaviours, or ADHD, or going further down the line, could include people with mental-illness. None of us would wish to "contract" some of these horrendous illnesses, and for someone with an eating disorder, an addictive personality disorder, a behaviour disorder or the like, would be the downfall of a compassionate system where asking for help is met with care and dignity, appropriate support and generous appreciation of The Person.
Response from celtwitch Original Poster made on 28th Jun 2016 10:28:48
I have only two words to say in answer to your comments. PERSONAL RESPONSIBILITY
Response from jeanmark made on 28th Jun 2016 13:32:09
I understand the concept of personal responsibility but my point was why pick on certain health related issues when it is well understood that a number of life styles can cause ill health and can also be very expensive to treat in the long term. Where would you stop? Such issues are rarely so simplistic that you can apportion blame.
Response from jeanmark made on 29th Jun 2016 15:18:15
And what about those people who may develop a smoke related disease because they live with a smoker, they had a choice to leave their husband/wife/partner but remained so should they be discriminated against as well?
.

By 'take drugs' I assume you mean those people who use illegal substances? If not a large number of us are going to have to pay for treatment because we 'take drugs' a number of which can cause side effects that require treatment. We do have a choice of course, we don't have to take a prescribed drug!
Response from jeanmark made on 29th Jun 2016 15:54:35
That's a relief but my question remains one of where do you stop? Why discriminate against certain people when it is well recognised that a number of health related problems are life style related.
Sheila Mc
29th Jun 2016 15:06:15
3
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No! Look what happened after they started charging for prescriptions. At first they charged 10p an item then increased the cost with future budgets, now even with the yearly prepaid system it is expensive. They would do the same with health treatment until it was too expensive for the average person.

Smokers and drinkers pay the tax on what they use which should be put towards the NHS.

I do agree that people who book appointments and then do not turn up should pay a fine for stopping someone else from having the appointment and wasting the time of the medical profession.
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