Questions about the NHS

From a US blogger. Given the changes that are about to happen in US health care, what do we think about the NHS?

1. What do you like about the government ran health care system?
2. What don\’t you like about the government ran health care system?
3. What would you change about the government ran health care system?
4. How long does a normal visit to the doctor take?
5. How has the system affected you or your family positively?
6. How has the system affected you or your family negatively?
As I\’ve not had much interaction with the health care system of any country (dentistry and a few stitches here and there excepted) I\’m probably not the right person to ask. So I throw it open to you to answer in the comments.
Note that he\’s looking for personal experiences, not policy wonkishness.

15 comments on “Questions about the NHS

  1. 1) Can walk into A&E without worrying about payment
    2) Endless queues, or redefined “not queues” that are, really, queues
    Lack of choice when it comes to treatment
    3) Government should not own or operate the hospitals
    4) To get an appointment usually takes three days, unless you turn up and ask.
    5) My children were born reasonably safely
    Mordens eye hospital A&E is excellent
    6) Following has occurred:-
    – wife given eye drops contra-indicated for pregnant women despite being 6 months pregnant
    – wife ignored for 2 hours after birth of daughter despite requiring attention (next midwife shift did what was required instead)
    – torn muscle in leg caused a visit to A&E. Was X rayed and ignored on trolley for 2.5 hours until wife arrived and made a fuss
    – Dislocated right shoulder was ignored in A&E for 3 hours. Finally treated and asked to discharge myself 6 hours after arriving despite having right ankle in cast…no wheelchair or crutches offered
    etc etc

  2. 1) It is free at the point of service, so I don’t need to worry about whether I have any documents on me if I need to visit A&E.
    2) It feels like there are too many Chiefs and not enough Indians (can we still say that?) and the appointment system for hospital outpatients is diabolical. Oh, and the car parking fees are outrageous.
    3) Not entirely sure as I don’t work in Government or the NHS, but the target mentality which has pervaded many Government provided services (like education) seems to cause unintended consequences.
    4) At our local surgery, appointments are often the same day, if not, definitely the next. Although I have previously had a surgery where you needed to book an appointment four days in advance.
    5) I’m not dead. The partners of two friends of mine are similarly not dead, despite being diagnosed with cancer in their early 30s
    6) My girlfriend was mis-diagnosed by our local NHS Trust for two years and – having recently been diagnosed correctly by a neighbouring area hospital – is now too far gone in terms of her illness to be able to fully recover. One of the original hospital’s neurologists told her outright that her illness was mental, not neurological, and refused to answer questions.
    A friend from University was similarly mis-diagnosed by the NHS. She was told she had epilepsy after one fit in her mid-30s (despite no history) and was only diagnosed with brain tumours some six months later. She was then given treatment which worsened the condition (as predicted by medical textbooks) and died 18months later.

  3. A gallstone made its presence felt in my gall bladder one night five years ago. I didn’t at that stage know it was what it was, and my NHS practice agreed to see me more or less immediately when I called the next morning, and referred me immediately to the nearest major hospital (one of London’s big teaching hospitals).

    I had to wait about six hours to be checked, after which I was told to go and get a an electro-magnetic scan, in the same hospital.

    That’s when the fun started. I’d naively assumed the scan would be done on the spot, but I had to make an appointment: six weeks later was the earliest date available.

    Following the scan, I was then instructed to make another appointment with the specialist: the earliest this could be done was several weeks later, at which time I was due to be working on an assignment overseas.

    I complained to my doctor, who then arranged for me to go to another major hospital where he personally knew the consultant. I suggested that my scan might be sent from one hospital to the other, to save time: too complicated.

    So through the same procedure again – check, scan etc, altogether about 9 months, and repeated time-consuming visits, from my first diagnosis until I came face to face with the surgeon.

    Then it was straightforward advice (removal not critical but advisable), out with the diary, what day would suit you, and appointment fixed, all in about 15 mins.

    The operation itself, once a major event, involved keyhole surgery, the plucking out of an apparently non-vital bit of my interior with a disappointingly miniscule piece of gravel, full recovery from the anaesthetic within a couple of hours, and just one night in hospital.

    So great medical service, but hidden behind soul-destroying bureaucracy.

  4. My overall impression is that they are good at the mass products . Our children were born under circumstances that amazed me , so good was the support.
    If it does not fit the box however forget it and if you are not up to complaining and writing letters doubly so

  5. 1. Nothing.

    2. the lack of health or care generated by the system.
    3. I would change everything about the government ran treatment rationing system.
    4. Two weeks wait to see the doctor for 5 minutes
    5. A relative got good service (but they worked for the NHS and knew all the consultants personally)
    6. It almost killed me. So I started http://nationaldeathservice.blogspot.com/

    Compared to my private Dentist, the NHS is dismal.

  6. 1. Free at the point of service; no payment or documents required.
    2. Parking charges, waiting times, organ and surgery shortages, “top up” payments, public-private mixed systems, bureaucratic wrangling, prescription charges (the few ailments I am afflicted with are treated with cheap mass-produced ancient drugs. I don’t like overpaying to subsidise old people’s aricept)
    3. Essentially the major thing I object to is the government-run element, not the government-funded element. I’d like to see like a “john lewis list” for healthcare products that’s the amount that the state will subsidise you. I’d also like to see tax-free healthcare savings accounts, and tax-free personal medical insurance.
    4. Well, actually seeing the doctor: 5mins. But it’ll take a couple of hours out of your day; booking the appointment, travelling to the clinic you’re registered with, waiting to see the doctor…

    I’ve neglected to answer the last two questions, because I don’t use the NHS enough to comment

    An interesting psychological element: the NHS is free in monetary terms, but using it is costly in terms of opportunity costs. I wouldn’t mind 10 GBP copayment if i only had to take half an hour out of my job to see the doctor — it works out cheaper.

  7. All I can say is that if it was down to the NHS my father would probably be dead, fortunately he is wealthy enough to afford to have his heart op done privately. As a aside, he is also now pretty much blind, caused by a botched cataract operation on the NHS 20 years ago – he was coming round from anasthetic and was nil by mouth. Some stupid nurse arrived and fed him, he promptly spewed it all up and the retching affected his eyes, which never healed properly.

    I could continue with horror stories of other friends and acquaintances – the utter inefficiency, downright negligence, the entire ‘do as we say, you have no say in your own treatment’ attitude. (My fathers eye consultant is a woman who hates private medicine, and refuses to refer him to a private doctor for a second opinion).

    The best man at my fathers wedding was our family doctor, now retired for over 15 years. He recently paid for an op he needed privately, he is so disgusted by the state of the local hospital. He wouldn’t set foot in the place for any treatment, he says there’s a good chance they’ll kill him. And he worked in the NHS all his working life.

    Overall the NHS should be razed to the ground and rebuilt as a goverment funded, but privately run insurance type system. Monolithic State providers went out with Stalin.

  8. 1. What do you like about the government ran health care system?

    Free at point of use. If you strip out one-third of NHS budget that they spend on quangos and anti-smoking and multi-lingual crap, it is very good value for money.

    2. What don’t you like about the government ran health care system?

    The one-third of budget spent on crap. The layers of bureaucracy between walking through the front door with a bleeding finger and actually seeing a doctor (about four or five layers).

    The jobsworth attitude of many employees and the smoking ban on hospital grounds.

    3. What would you change about the government ran health care system?

    See above.

    4. How long does a normal visit to the doctor take?

    Far too long.

    5. How has the system affected you or your family positively?
    6. How has the system affected you or your family negatively?

    Like I said, healthcare in the UK isn’t that bad. There are hundreds or thousands of shocking examples of appalling patient care every year (largely down to their snotty attitude and incompetence and bureacracy) such as MRSA and so on, but out of tens of millions of patients, it’s not that terrible.

  9. Re 5. and 6., as Jim says a good place to start would be a basic health system which is a “goverment funded, but privately run insurance type system.” like most European countries.

  10. After my experiences with the NHS I now pay about 1k per year for premium health insurance (expacare) which means I can walk into any medical establishment anywhere in the world and be assured that the bill will be met in full (ok there’s a £50 excess). I always go private and am treated like royalty. In the uk I avoid the NHS like the plague.
    It would cost £60b p.a. to give this to every person in the UK. Current NHS cost is £90-100b.

    1. What do you like about the government ran health care system?
    Absolutely nothing. Even if you want the government making sure everyone gets health cover, you don’t want them running it. It would be cheaper, by 30-40 billion a year to give the entire country the premier healthcare that I have than to pay for the NHS. It is slow, painful and often fatal.

    2. What don’t you like about the government ran health care system?
    The fact that it’s government run. Having it run by government means it is run poorly, understaffed, overworked and trying to meet all the wrong goals. Imagine the US healthcare system run by the people currently running Homeland security (the only US bureaucrats I have personally encountered). Bureaucrats get to decide, based on budgets and poor management, what treatments I can or cant have. You’re not a customer, or even a patient, you’re a nuisance who stops them from reaching whatever silly goal has been set for this quarter.
    If you die, problem solved.

    3. What would you change about the government ran health care system?
    Make it non government. Introduce some competition. Get rid of most of the management.
    More doctors and Nurses, more equipment and drugs. i.e. more things that actually save lives and less things that waste money (which ultimately costs lives).

    4. How long does a normal visit to the doctor take?
    About 3 minutes if you’re lucky (less time if you’re not). That’s for the first misdiagnosis. Three times is generally the trick to get a handle on what’s actually wrong. But this is not the right question. The right question is how long does it take you to get to see the doctor or specialist in the first place. Unless you are actually in the act of dying when you show up, it will usually be
    A&E – hours, sometimes into double digits
    GP – weeks to months
    specialist – months, and you have to have gone through the GP bit first.

    5. How has the system affected you or your family positively?
    My family are not in this country. But for me, the last time I used them cost me three weeks off work (circa 10k – self employed) and I was verging on serious complications (pneumonia)for a simple chest infection, which was misdiagnosed and then mis-prescribed for. After three weeks I bit the bullet and went to see someone private and paid for it out of my own pocket. I was better and back at work two days after that. That’s why I have private medical insurance

    6. How has the system affected you or your family negatively? See above. They’re no longer afforded the chance to affect me. The only way I’ll end up in the NHS is if I collapse on the street and that will get rectified as soon as I wake up or my next of kin are contacted. Hopefully they wont have been able to kill me by then.

    Hope that’s useful

  11. Interesting to note the strong consensus for “it works for serious stuff, but the queues are a pain” among all but a couple of insane ideologues. For me:

    1) no financial worries about anything at any point; excellent critical/emergency care.
    2) non-critical care slow and bureaucratic
    3) possibly nothing, possibly more private contracting of NHS-commissioned work – while other systems can be faster, they can also be much more expensive
    4) if an emergency: seen within an hour, 10-15 minute slot. If a non-emergency: seen within a week, 5-15 minute slot.
    5) last week, provided excellent care for emergency operation for me (with surgery scheduled within 10 hours of the diagnosis), plus decent after-care. Is catering for two dying grandparents with all the necessary palliatives, life-prolonging drugs and equipment, etc. Provided another, non-dying, grandparent with a replacement cornea at age 85 which he reckons has given his best vision in 40 years.
    6) has involved a lot of timewasting, waitlisting and physical queueing for all concerned.

  12. (ooh, meant to add – the reason private medical insurance is so cheap in the UK, Canada, Australia is that the basics are covered by national healthcare, so there’s a giant hidden subsidy. This means that sums based on the cost of private insurance *with the NHS in place* can’t be used to show what it’d cost without the NHS in place).

  13. 1. Can get a professor out of the bed at 04.00 to treat a heart attack taking place on his ward
    2. Takes too long to get a neurological appointment.
    3. See 2.
    4. GP appointments are on a 10-minute slot in the practice I go to.
    5. Yes, as the professor who came to see my mother saved her life.
    6. Not particularly – while one can grumble about being prescribed medications with unpleasant side effects, I don’t possess either the training or resources required to treat my illness on my own.

  14. Tim, you should also emphasize something to your contact. Every job I have worked in during the last 15 years has offered private medical insurance as part of the package. For professional jobs, it’s practically standard, and you see it even in non-professional ones too. As john b says, it’s not that much money for a company to provide, but if “our NHS” is so wonderful, you wonder why anyone bothers…

  15. If I feel ill, I phone the surgery. Within an hour or so, my GP rings back. We discuss the problem. If he feels he needs to see me he gives me an appointment. Usually the time between that decision and my seeing him is governed by my travelling time, which is about 20 minutes. Seems to work fine.

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