Wednesday, 8 January 2014

Those pesky international treaties

Remember the hooha, the kerfuffle and the keich about all the international treaties that Scotland would have to renegotiate after independence?  Was it 14,000 or so that was claimed?  Treaties that included those about navigating the Rhine last century and addressing some issue that was important when Victoria was busy being unamused, leaving less than a quarter having any relevance today, most of which Scotland could accede to without having to do much more than say "aye, we agree to that"?

Well, they include an awful lot that are about reciprocal medical treatment.  How do I know?  Well, I was standing at a bus-stop and a chap sidled up and whispered "pssssst, you'll be interested in these" and he handed me a couple of links.  I rushed home and shoved them in the back of the computer, wound up the key and had a look.  The first one is a terribly interesting agreement between the UK and New Zealand about being decent people to each other's people in that if I pop over to NZ for a wee look round and get sick the health service in that fine country will treat me and bear the cost.  Similarly, if one of the All-Blacks forwards gets mown down by a Scottish scrum half and ends up in hospital then the poor fella will get treated in one of our hospitals and we'll bear the cost.  That's what decent people do, isn't it?  Interesting that this agreement was signed by Thatcher's Government.

The other link - well, the other link shows that this wee treaty is not alone.  Medical treatment resulting from bad boogying in Barbados, crap karaoke in Kyrgyzstan or a misbehaving molar in Moldova will be supplied free or awfy cheap.  Armenia, Azerbaijan,  Belarus, Bosnia and Herzegovina, Georgia, Gibraltar, Serbia, Montenegro, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan and others have agreements with the UK - as well as, of course, the 31 EEA countries and Switzerland.

So what?  Well, under the charging plans that the London Government (Lib Dems and Tories) is planning for Accident and Emergency departments (are they still called A&E?  It didn't get changed while I wasn't looking?) are nurses and doctors expected to check whether the person in front of them and in desperate need of medical help happens to come from one of the many states with which the UK Government has a reciprocal medical assistance treaty in place?  Will m'learned friend hanging around saying "I know she's slipping in and out of consciousness but you can't treat her until we find out whether she is from a country with a treaty or not"?

I don't think that I'll be terribly off-target if I assume that the current Scottish Government has decided that it doesn't consider this to be a very good idea so I'm just assuming that it won't be happening in Scotland.  Having a wee ask about, though, I came upon a friend of mine who turns out to know a thing or two about medical things and they said "GMC rules mean that Doctors have to treat the sick or injured person in front of them.  If they refused on grounds of charging or failure to pay or any such nonsense there is a good chance they'd find themselves struck off - and quite rightly so."  I think GMC is the General Medical Council and they regulate medical types.  That would create an interesting tension - the Government which is the paymaster for NHS salaries saying "don't treat this person" while the regulatory body is saying "if you don't treat this person you won't be a doctor any longer."  Well, the tension is interesting for me in an abstract kind of a way; I'm sure it wouldn't be very interesting for the doctors so much as an inexcusable Catch 22 and a ridiculous position for any employer to put its employees in, never mind the lack of decency inherent in thinking that it's fine to leave a sick or injured person suffering while we have a health service perfectly capable of treating them.

Seeking a reasoned and considered opinion, I turned to The Ranter (so called for the measured and mellow tones with which opinions are delivered) and received something like this in response:

"You've got to look at what the endgame is here for the Tories and the Lib Dems, they want to effectively remove wholly socialised medicine and replace it with partially socialised medicine and then a market on top while at the same time portraying their position as protecting the NHS.  Being upfront about completely marketising the NHS would be a PR disaster and political suicide so to get their way without becoming utterly unmentionable everywhere outside of their own houses they are salami slicing it away.

"Think about it - and really think about this time you lazy sods - to introduce any form of upfront charging regimes for these terrible foreign types would require some mechanism to determine what the charge should be for each kind of procedure or treatment or assessment or suchlike.  You've got to assume with this lot that the charges will be based on full cost recovery (materials, staff costs, accommodation, food while on the premises, and so on).

"That's not going to be easy, is it?  It's going to need a bureaucracy - and those costs will get added in as well.  It will probably need to be an organisation doing something similar to NICE, so that charges can be refreshed regularly and kept at arms length from government for appearances' sakes.  Charges would need to be consistent across England, of course, otherwise you'd create a perverse incentive for the foreign types to shop around.

"So to deal with these foreigners you now have an apparatus in place which establishes charges for treatment on the NHS - and they can even introduce 'extras' and 'luxuries' that can be added on like you might do in a good hotel.  Hey, seeing as that charging system is place anyway why don't we make sure our glorious NHS isn't being abused by scroungers, so you still get free healthcare folks but shouldn't the cash going to the hospitals reflect the patients they get?  So let's have the money follow the patient, let's have real national insurance where if you're in work then sure your treatment is free because you deserve it; and pensioners, well they've contributed all their lives, and kids as well, just because we're nice.

"But see these benefits scrounging types, well, they're just taking the piss aren't they?  So obviously they'd get emergency treatment if they really needed it but maybe if they don't take that job or do that workfare scheme or we assess them as scroungers then they should get restricted free primary care and so on.  I mean, if they're not contributing to the pot why should they get to take out of it?

"And hey, since we're on the subject, do you want treated faster, or with a particular doctor, dentist, hospital, clinic?  Well, you can wait or, if you want, pay the small top up charge that we promise won't go up the way that tuition fees went up.  And that wee charge, well that's good for everybody because the additional profits made from that will go into the pot to pay for general patient care...

"That's my read of the long term goals but I'm doubtless just being paranoid because it's not like following the recent health legislation in England that certain treatments are no longer freely available in NHS England, is it?"

Sometimes I think The Ranter needs to get out more, sometimes I think the opposite, but I nearly always find myself thinking "yeah, I can see that coming to pass" and it often does.  Maybe it's keeping chickens that gives you that insight.

Anyway, given that the London Government seems determined to head down this road, who'd want to be a medic in England in the next few years?  Scotland, I hope, will keep our NHS as a public good and for the public good.

The question is how do we protect it and ensure we keep it?  The answer - well, make up your own mind but have a read of this while you're doing it.

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