Funding medial treatment from pre-tax income

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 james wardle 02 Dec 2021

Hello Climbers. 

On the basis that UKC always knows everything I thought I would ask you a bit of an unrelated to climbing question.

One of our friends' needs an operation to treat their chronic illness   If they were in Scotland it would be funded on the NHS but in England, it is not (who knew that was a thing).   They have applied for a funding exception from NICE but this has never been approved for this condition.

A group of us are planning to fund this for them,  but it's not a small number. About £30k.

If we could somehow find a way to do this via a charity then we could fund this from pre-tax income and it would cost us 40% less.  But this does not seem to be possible as, in the end, it benefits an individual.

Any suggestions on how we can do this in the most cost-effective way?

Thanks

James

In reply to james wardle:

I recognise you are approaching this with the very best of intentions.

You are in effect asking the taxpayer to fund private health care, which is quite a difficult political issue. It is the reason why Nice review funding exceptions.

I am sure many tory mps would delight in your cause as its precedence could be used to funnel tax revenue to their cronies in private health care and further privatise the NHS.

I wish you and your friend all the best but I find your methodology questionable. 

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 henwardian 02 Dec 2021
In reply to james wardle:

Move to Scotland?
How urgent is this treatment? It sounds like you are planning to raise the funds over a period of time and that the treatment can wait for some time?

It would be a hell of a lot cheaper just to rent a house in Scotland for a little while and get whatever it is done on the NHS.

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 neilh 02 Dec 2021
In reply to james wardle:

If that was possible then everyone find raising for private mediacl treatment  would be doing it.......for example setting up a charity means registering it with the charity commission..so suggesting its a bit more complicated than you think.

Most cost effective way-- get as many financial donors as possible...

I would just bite the bullet and get on with the medical tratement and negotiate like hell to get the best price.

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 stubbed 02 Dec 2021
In reply to james wardle:

A friend of a friend wanted some specific treatment that was not available on the NHS in England. They fundraised £50k with events and donations, raffles, etc. and went for treatment in the US. Although initially this looked like it was working, to be honest it had insignificant impact on the progression of her disease. I was glad in the end, though, that her husband didn't sell his house to fund it because that was his original plan.

In reply to henwardian:

> It would be a hell of a lot cheaper just to rent a house in Scotland for a little while and get whatever it is done on the NHS.

The actual solution is for the English to stop voting Tory and get NHS England running properly, not export the most expensive patients from a 60 million person country into a 5.5 million person one. If that starts to happen to any significant extent Scotland is going to be forced to follow the English Tory NHS model because there will be no alternative to having the exact same rules.

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 Spidermonkee 03 Dec 2021
In reply to james wardle:

I'm sorry that your friend is in this situation. It must be very upsetting for you. What fantastic friends he has, willing to put their own hard earned cash to helping them.

I don't think this is the right thread for people to be sharing their thoughts on political situations so I will refrain from that topic.

I am afraid I don't know the answer to your question regarding making your donations go as far as possible. There are so many tax free schemes for things such as cycle to work, charity donations, and even on washing work uniforms it feels like there must be some options to explore.

There are some examples on tax relief at www.thefriendlyaccountants.co.uk/medical-expenses

Good luck and best wishes

1
 henwardian 03 Dec 2021
In reply to tom_in_edinburgh:

> The actual solution is for the English to stop voting Tory and get NHS England running properly, not export the most expensive patients from a 60 million person country into a 5.5 million person one. If that starts to happen to any significant extent Scotland is going to be forced to follow the English Tory NHS model because there will be no alternative to having the exact same rules.

The politics sub-forum is that way [gesticulates]

I'm sure there's a debate to be had about this but I really can't be arsed right now and I'm only here to give a practical suggestion.

7
In reply to henwardian:

> The politics sub-forum is that way [gesticulates]

Your suggestion was that they jump from England to Scotland just long enough to get treatment for an expensive existing condition and then jump back and to defeat the system by renting a house so it looked like you'd moved to Scotland.

> I'm sure there's a debate to be had about this but I really can't be arsed right now and I'm only here to give a practical suggestion.

That's not a practical suggestion it is an unethical one.

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 summo 03 Dec 2021
In reply to tom_in_edinburgh:

> The actual solution is for the English to stop voting Tory and get NHS England running properly, not export the most expensive patients from a 60 million person country into a 5.5 million person one. If that starts to happen to any significant extent Scotland is going to be forced to follow the English Tory NHS model because there will be no alternative to having the exact same rules.

If only there was some formula where English services could receive 10% more, then they'd be able fund things like this treatment. Maybe they could call the funding calculation the Barnett2.0 Formula, after the existing formula that sees Scottish services receive 10% more per capita from the treasury than England. 

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 Rob Exile Ward 03 Dec 2021
In reply to james wardle:

It's a terrible predicament but if NICE don't approve something there will be a good reason for it - and it won't just be money, despite what the press say and US Republicans say. NICE primarily try to look objectively at how effective any given treatment is; they review the published papers and their recommendations are based on whether treatments actually work or not; plenty don't. 

It's easy for me to say, I'm not currently faced with life threatening illnesses apart from age; but if/when I am faced with something NICE don't agree to fund, I hope I have the courage to accept that they probably know best.

1
In reply to summo:

> If only there was some formula where English services could receive 10% more, then they'd be able fund things like this treatment. Maybe they could call the funding calculation the Barnett2.0 Formula, after the existing formula that sees Scottish services receive 10% more per capita from the treasury than England. 

I'm not going to get into why your Barnett argument is bollocks on this thread.

The point I will make is that if there was 10% extra to spend in England it wouldn't go on the NHS. When Tories have money to spend they spend it on contracts for their pals, foreign wars or tax cuts.  The Tories want to privatise the NHS so healthcare expenditure goes through insurance companies and financial services make money on it, that would be their plan no matter how much extra money they found.

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 henwardian 04 Dec 2021
In reply to tom_in_edinburgh:

> That's not a practical suggestion it is an unethical one.

I think you might need to use a dictionary. "practical" and "unethical" are not mutually exclusive.

Also, how's the view from that high horse? Obscured by clouds at all?
You do realise that all of the worlds tourism, migration, globalisation and probably pretty much everything else are based on moving to a new place or doing something in a new place to get something you couldn't in the old place, right?

I mean any time anyone moves house to get a better school for their kid or goes on holiday to get a better suntan or buys good made in China or crosses the border to buy cheaper booze, they are being unethical by this measure. If this is where you want to set the bar then by all means, go for it, I just think you'll find it rather depressing to discover that you've probably been personally unethical every single day of your life.

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 Smelly Fox 04 Dec 2021
In reply to henwardian:

That’s all just bollocks though isn’t it…

Not one of your examples are paid for by the local tax payer.

”Come to Scotland, we will pay for you expensive medical treatment” is hardly the same as going to Spain to buy cheap wine

Post edited at 05:41
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 Dax H 04 Dec 2021
In reply to james wardle:

Start a just giving page and push it across social media. I raised 10k plus with next to zero effort for a mates funeral and to help out his widow a bit. Strangers can be very generous 

 summo 04 Dec 2021
In reply to tom_in_edinburgh:

> That's not a practical suggestion it is an unethical one.

The funding policies of England and Scotland are just political bullocks.

If you can move house, anywhere, to potentially save a life, that's the ethical thing to do. 

Post edited at 06:46
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In reply to summo:

> The funding policies of England and Scotland are just political bullocks.

The political bollocks is that England won't fund it.

A country of 5 million people cannot take on health care (or education) costs for a country of 50 million people.  If this happens to any appreciable extent the 5 million person country will be forced to have the exact same criteria for what is funded as the 50 million person country, no matter how stupid they are, in order to prevent jurisdiction arbitrage.  

Scotland is doing university education and the NHS better than England at the moment. The solution is for England to stop voting Tory and do the same things as Scotland, not for Scotland to be forced to do the same crazy Tory things as England.

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 Graeme G 04 Dec 2021
In reply to summo:

> The funding policies of England and Scotland are just political bullocks.

Eh?

> If you can move house, anywhere, to potentially save a life, that's the ethical thing to do. 

Def stretching the definition a bit…. 

“relating to moral principles or the branch of knowledge dealing with these”

1
 DaveHK 04 Dec 2021
In reply to Spidermonkee:

> I don't think this is the right thread for people to be sharing their thoughts on political situations 

It's hard to see how that could be avoided given that the op is talking about healthcare and taxation and that suggestions involve relocation to a place with a different government!

Once you throw in the simmering sexual tension between summo and TiE then it is inevitable.

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 DaveHK 04 Dec 2021
In reply to summo:

> If you can move house, anywhere, to potentially save a life, that's the ethical thing to do. 

That's not an ethical decision it's an economic one. 

 DaveHK 04 Dec 2021
In reply to summo:

> If you can move house, anywhere, to potentially save a life, that's the ethical thing to do. 

Let's just unpick this a bit... Those who can afford it relocating to a different area for healthcare not available in their own area is the ethical thing to do?

It might be the needful thing but don't dress it up as the right thing. 

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In reply to james wardle:

> Hello Climbers. 

> Any suggestions on how we can do this in the most cost-effective way?

> Thanks

> James

Would they be up for medical tourism? I'm guessing it would be a lot cheaper in India or Turkey or somewhere.

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 summo 04 Dec 2021
In reply to tom_in_edinburgh:

> The political bollocks is that England won't fund it.

> A country of 5 million people cannot take on health care (or education) costs for a country of 50 million people.

> Scotland is doing university education and the NHS better than England at the moment. 

Maybe rather than Scottish services receive 10% more than England, the money should be spread from the treasury per capita across the uk? Then we can judge who is spending or managing funds more wisely?

Scottish universities aren't doing better, free places for Scots are simply being paid for those attending who aren't Scottish. 

Are Scottish NHS outcomes better? What are Scotland's average mortality rate and age? 

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 summo 04 Dec 2021
In reply to DaveHK:

> Let's just unpick this a bit... Those who can afford it relocating to a different area for healthcare not available in their own area is the ethical thing to do?

> It might be the needful thing but don't dress it up as the right thing. 

Would you rent a house elsewhere in the uk if a relatives life could be saved, or would you let them die? 

The politics of why it's like this is different from what you might do personally. 

Post edited at 10:58
 DaveHK 04 Dec 2021
In reply to summo:

> Would you rent a house elsewhere in the uk if a relatives life could be saved, or would you let them die? 

Maybe and maybe not, the fact is that such a black and white decision is highly unlikely.

But you've missed my point, which was not that it would necessarily be wrong for people to do this but that it is wrong to say doing so is the ethical thing. Unless of course your ethics are of the 'I'm all right Jack' school.

Post edited at 11:40
 Timmd 04 Dec 2021
In reply to james wardle:

The best I can think of is having a fund raising campaign for the 40%, and framing it as 'Help us to help our friend by helping raise under half of the cost' without going into detail about it being the tax you want to avoid paying.

I'm not entirely sure how I'd feel about that ethically (I don't really think this is an ethics thread), it's from the ideas part of my brain...

Post edited at 12:02
 summo 04 Dec 2021
In reply to DaveHK:

It's not a matter of I'm alright Jack..  I agree healthcare shouldn't be a postcode lottery. But if renting a house for a year, spending less than £10k saves a family member then it's worth it. The belief on the fact folk shouldn't have to travel for better care hasn't changed, people are just doing what they can under existing conditions beyond their control to survive. 

The solution in the uks case is increase tax and spend more on the nhs. It's one of the lowest funded in Europe per capita. 

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 DaveHK 04 Dec 2021
In reply to summo:

> It's not a matter of I'm alright Jack..  I agree healthcare shouldn't be a postcode lottery. But if renting a house for a year, spending less than £10k saves a family member then it's worth it. The belief on the fact folk shouldn't have to travel for better care hasn't changed, people are just doing what they can under existing conditions beyond their control to survive. 

This is the tragedy of the commons. In this scenario you'd be using your economic status to extract greater value from a communal resource (the NHS) than you would otherwise be able to and you'd be doing this at the expense of the others using that communal resource.

There's nothing intrinsically wrong with using your economic status to achieve better outcomes for you and yours but if you want to do it ethically then you need to step out of the communal system entirely and go private.

 summo 04 Dec 2021
In reply to DaveHK:

> There's nothing intrinsically wrong with using your economic status to achieve better outcomes for you and yours but if you want to do it ethically then you need to step out of the communal system entirely and go private.

In our case we moved to Sweden... whilst the tax on occasion makes the eyes water, I feel we get value. If I was in the uk then yes, we'd feel we would need to suffer the financial cost of private health and probably schools for the kids, because the nearest to us waxed and waned from satisfactory to special measures. Paying into the collective pot where everyone has better services is the way, not just the wealthy in England or those in Scotland with their 10% extra, having improved services. 

 Timmd 04 Dec 2021
In reply to DaveHK:

> This is the tragedy of the commons. In this scenario you'd be using your economic status to extract greater value from a communal resource (the NHS) than you would otherwise be able to and you'd be doing this at the expense of the others using that communal resource.

> There's nothing intrinsically wrong with using your economic status to achieve better outcomes for you and yours but if you want to do it ethically then you need to step out of the communal system entirely and go private.

I guess this applies, even if Westminster 'does' channel money Scotland's way, and the OP's friend could plausible rationalise it as them simply moving to a place where they could get what they see as 'something in return' for their taxes paid.

So it's clear where I'm coming from, if I was Scottish I'd vote for independence following it's Remain vote, and I'm a lefty/greenie/liberal type (given certain studies on brain structure, we seem to be born as where we end up on the political spectrum, or seem to have no control over it). 

Post edited at 18:04
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 Graeme G 04 Dec 2021
In reply to henwardian:

> It would be a hell of a lot cheaper just to rent a house in Scotland for a little while and get whatever it is done on the NHS.

Unless you’re resident in Scotland, you’d likely pay a fee. Just as Scottish patients do, when they access treatments in England.

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 Baz P 04 Dec 2021
In reply to Graeme G:

Maybe going to France and returning by rubber boat would be the answer. 

5
 Graeme G 04 Dec 2021
In reply to Baz P:

A UK resident claiming asylum in the UK? That would be a laugh!

 Dr.S at work 04 Dec 2021
In reply to Graeme G:

Is that not paid for by the Scottish NHS rather than individuals? 

 Toerag 04 Dec 2021
In reply to Dax H:

> Start a just giving page and push it across social media. I raised 10k plus with next to zero effort for a mates funeral and to help out his widow a bit. Strangers can be very generous 


Someone did one a week or so ago for a family whose 4 yr old daughter has been diagnosed with something nasty. Target was £5k to help pay for the family to go over to Southampton to be with her whilst she had treatment, the appeal hit £33k in 3 days and is over £40k now I believe.

 Graeme G 04 Dec 2021
In reply to Dr.S at work:

> Is that not paid for by the Scottish NHS rather than individuals? 

No. There are instances where Scottish patients pay for treatment same as any other ‘foreign’ national does.

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 Dr.S at work 04 Dec 2021
In reply to Graeme G:

Interesting - in what circumstances? I lived on the English/Welsh border for a long time and it was really common for people to access services both sides of the border - I’ve never heard of charging before.

 Graeme G 04 Dec 2021
In reply to Dr.S at work:

Sorry, I can’t. But is it because NHS England and Wales are the same financial entity. Whereas NHS Scotland is separate?

1
 Dr.S at work 04 Dec 2021
In reply to Graeme G:

Don’t think so - Welsh NHS separate, and Barnet based funding for Wales. 
free prescriptions in Wales ( where I lived) and not in England ( where I went to hospital and accessed NHS physio services afterwards).

This

https://www.england.nhs.uk/wp-content/uploads/2014/05/who-pays.pdf

suggests that patients treated in another U.K. nation would be paid for by their local bit of healthcare (pg17).

land the Scottish NHS contributes to some U.K. level specialist stuff.

https://www.nss.nhs.scot/specialist-healthcare/specialist-services/speciali...

It seems that Scots might need to go to Russia rather than England?
 

https://www.dailyrecord.co.uk/news/scottish-news/abandoned-discarded-scots-...
 

My google search failed to find examples  of Scots having to personally pay the English NHS - I guess some might access private services at NHS hospitals in England?

 Graeme G 05 Dec 2021
In reply to Dr.S at work:

Don’t have personal experience so happy to be proven wrong. But I asked a medical secretary who said that this happened when they worked in a GP practice.

 Wimlands 05 Dec 2021
In reply to Graeme G:

This in the news today,

Treatment not available in Wales but you can get it in England…

https://www.bbc.co.uk/news/uk-wales-59525446

 Dr.S at work 05 Dec 2021
In reply to Wimlands:

That, the OP and the daily record story all seem to have the same root - NICE and the Scottish and Welsh bodies with similar jobs coming to differing conclusions on the cost/benefit of treatments. No doubt with time those things get resolved as data becomes clearer but I can imagine it’s very distressing if you live in Connahs Quay and have a treatment denied which would be allowed in Oxton.

living in Connahs Quay being distressing enough in the first place.

In reply to summo:

> Maybe rather than Scottish services receive 10% more than England, the money should be spread from the treasury per capita across the uk? Then we can judge who is spending or managing funds more wisely?

If you design a system where all the power and money is concentrated in SE England you can expect to have to partially compensate with increased public spending in the regions furthest from the centre of economic power.

The accounting system, just like the accounting system which showed England was subsidising India, is designed to conceal indirect costs and make it look like the exploited regions are getting a good deal.

> Scottish universities aren't doing better, free places for Scots are simply being paid for those attending who aren't Scottish. 

The Scottish system of funded places and rationing is better than the English system of loans for any sh*t. Even in terms of cost to the taxpayer once you consider loans not getting paid back. 

> Are Scottish NHS outcomes better? What are Scotland's average mortality rate and age? 

NHS outcomes are only one of many factors which affect mortality.

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 CantClimbTom 05 Dec 2021
In reply to Rob Exile Ward:

> It's a terrible predicament but if NICE don't approve something there will be a good reason for it - and it won't just be money, despite what the press say and US Republicans say. NICE primarily try to look objectively at how effective any given treatment is; they review the published papers and their recommendations are based on whether treatments actually work or not; plenty don't. 

> It's easy for me to say, I'm not currently faced with life threatening illnesses apart from age; but if/when I am faced with something NICE don't agree to fund, I hope I have the courage to accept that they probably know best.

Well, NICE do say treating many hernias or people who can't breathe through their nose (and so sleep apnea and high blood pressure) is not cost effective, or that bone spurs shouldn't be removed from hips instead let them get so bad after years of suffering people need a full hip replacement and triple the expense and pain.

Seriously.... As much as I respect their clinical expertise, NICE are under a lot of pressure to recommend against stuff to short-term save cash even if long term it costs way more money and suffering long term. 

2
 Dax H 05 Dec 2021
In reply to CantClimbTom:

> Seriously.... As much as I respect their clinical expertise, NICE are under a lot of pressure to recommend against stuff to short-term save cash even if long term it costs way more money and suffering long term. 

Unfortunately that attitude is endemic in all aspects of public and private business and rewarded as well. Anyone who protects today's budget is well thought of and often promoted. Short term is everything, forget tomorrow because I will have moved on by the time my decision today makes a difference tomorrow. 

1
 Rob Parsons 05 Dec 2021
In reply to james wardle:

What is the actual treatment you're talking about?

 Moacs 05 Dec 2021
In reply to tom_in_edinburgh:

> The political bollocks is that England won't fund it.

> Scotland is doing ... the NHS better than England at the moment.

I like you. You make me laugh.

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 Rob Exile Ward 05 Dec 2021
In reply to Dax H:

Do we know that? Does anyone have any links, references? 

 Graeme G 05 Dec 2021
In reply to Moacs:

Do you have experience of the NHS in Scotland? Most English people, now resident in Scotland, I speak to tell me that’s their experience.

 duncan 05 Dec 2021
In reply to Rob Exile Ward:

> It's a terrible predicament but if NICE don't approve something there will be a good reason for it - and it won't just be money, despite what the press say and US Republicans say. NICE primarily try to look objectively at how effective any given treatment is; they review the published papers and their recommendations are based on whether treatments actually work or not; plenty don't. 

Up to a point. NICE is about getting value for money, the best 'bang for your buck', so they consider both effectiveness and cost. As healthcare resources are finite, irrespective of source of funding, it has to be this way: paying for hyperexpensive new treatments means less money for existing less 'sexy' care which would lead to an overall reduction in the quality of care. NICE, or a health insurer, has to make a decision about which new treatments to fund and which not, leading to the headline grabbing scenarios where very costly and unproven or marginal benefit treatments are not supported.

In reply to CantClimbTom:

You are wrong about NICE guidelines on acetabular impingement. NICE supports the use of both arthroscopic and open surgery: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-co...

I don't know what you mean about NICE not recommending hernia operations. The only relevant guidelines I can find is Laparoscopic repair of inguinal hernias which is supported: https://www.nice.org.uk/guidance/ta83/chapter/1-Guidance

Other hernia repairs have no guidelines; this is not the same as NICE not supporting them.

Your point about sleep apnea is too vague to be answerable. Some treatments are supported as they are cost-effective and others are not, which is as it should be. Perhaps you could clarify what you mean here?

You are wrong about the effect of pressure to recommend short-term savings. It may be true that NICEs recommendations are not implemented in order to make short-term cost savings but this is a different question.

  

 Sir Chasm 05 Dec 2021
In reply to Graeme G:

> Do you have experience of the NHS in Scotland? Most English people, now resident in Scotland, I speak to tell me that’s their experience.

But you don't talk to many people, and those people generally don't experience both versions of the NHS for the same condition. My mum had botched cancer surgery in Raigmore, but the aftercare wasn't bad, would she have done better in England? Who knows. Individual stories are meaningless, you have to look at an overall picture. 

 Graeme G 06 Dec 2021
In reply to Sir Chasm:

> Individual stories are meaningless, you have to look at an overall picture. 

The overall picture is made up of millions of individual stories. 

 summo 06 Dec 2021
In reply to Graeme G:

> The overall picture is made up of millions of individual stories. 

But perspective is based on individual failures or successes, most people will say Scottish police do their best, but not the family of those in the car crash left for days to die slowly. Everyone's view of healthcare is relative to their own experience and isn't going to directly mirror the national picture. 

 Graeme G 06 Dec 2021
In reply to summo:

> Everyone's view of healthcare is relative to their own experience and isn't going to directly mirror the national picture. 

Did you read my OP? My post merely stated that those who I talk to, albeit a very small number of people, who have moved from England to Scotland say their experience of the NHS in Scotland is better. 
Make of that what you will.

 Moacs 06 Dec 2021
In reply to Graeme G:

Some. Pre-covid:

Outcomes worse.

Statutory performance measures worse.

Constitutional standards worse.

But sure, free scrips.

 Graeme G 06 Dec 2021
In reply to Moacs:

> But sure, free scrips.

You forgot to mention customer satisfaction.

 Moacs 06 Dec 2021
In reply to Graeme G:

> You forgot to mention customer satisfaction.

I did.  Customer satisfaction in healthcare is a strange thing. Personally I prefer outcome but some people prefer coffee.

 Rob Exile Ward 06 Dec 2021
In reply to duncan:

I'm pleased you posted that; that was my understanding several years ago, and I found it hard to believe that the leads involved would sacrifice their academic reputations for reasons of political expediency.

Evidence based medicine is the way forward, and Nice has an important role to play.

 Timmd 06 Dec 2021
In reply to Baz P:

> Maybe going to France and returning by rubber boat would be the answer. 

It's an easy life to seek asylum huh?

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