The NHS, it’s the Wonder of the World it is

Another lovely little report out insisting that the NHS is the very finest health care system on the planet. A report that does have more than its fair share of problems it should be said. Vox on it here, the report itself here.

One problem:

Access: Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost. Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services. There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.

Well now, that is interesting, isn’t it? The NHS provides quick access to specialty services, does it?

The National Audit Office has highlighted the increasing challenge to the NHS of sustaining the 18-week waiting time standard for elective care and the importance for trusts of having reliable performance information and shared good practice.

The target for elective care is 18 weeks. The NHS might do quite well by that target. But note that this is a survey of patients and doctors that is being used to measure this “quick access”. So whether the access sis quick or not will be by the standards of the society in which the access is being offered. So, the NHS might offer quick access by UK standards but not, say, by US ones. And the report doesn’t take that into account.

Hands up everyone who thinks Americans would describe a four month wait to get a knee fixed as being “quick access”?

Or:

Cancer patients’ chances of survival are being put at risk by growing delays in carrying out vital tests on them on the NHS, experts in the disease warn today.

New official figures show that the number of people waiting more than six weeks for an MRI or CT scan has doubled in a year and reached its highest level since 2008.

6 fucking weeks for an MRI for a cancer patient? Is there anywhere at all other than the NHS where this is described as “quick“?

What are maximum waiting times?

You have the legal right to start your NHS consultant-led treatment within a maximum of 18 weeks from referral, unless you choose to wait longer or it is clinically appropriate that you wait longer.

“Quick” obviously has a variable meaning across countries.

And there’s another problem with that access thing. They measure when the patient doesn’t get treatment because the patient doesn’t have enough money. OK, obviously, this problem will be rather less in free at the point of use health care systems. However, they don’t measure people who cannot get a treatment because a free at the point of use health care system won’t pay for it. You know, the Nice and £30k per Qualy thing. So they do measure the meth dealer who doesn’t get the experimental lung cancer treatment because he can’t pay for it but they don’t mention the Brit equivalent who is sent home to die with some morphine because the NHS won’t pay for the same treatment.

They’re not really being all that impartial are they? And we shouldn’t expect them to be either. This is the Commonwealth Fund. They generally campaign against the current US health care system and in favour of something more like the NHS.

Oh, and one lovely part. They praise the NHS on its use of healthcare information technology. They do know the result of that program to computerise the NHS do they?

One final point. It would be absolutely fascinating to have the same people go over the Singapore system. A health care system at least as good as the US, UK, French or whatever but costing only 4% of GDP. One where routine care is out of pocket, catastrophic govt paid and providers compete in the market to attract custom. Couldn’t be that people don’t examine it just because it doesn’t fit their preconceptions of what ought to work, could it?

26 comments on “The NHS, it’s the Wonder of the World it is

  1. Couldn’t be that people don’t examine it just because it doesn’t fit their preconceptions of what ought to work, could it?

    The bad news is that Singapore is moving away from this model. There is even talk of an NHS-lite. The voters are, basically, stupid.

  2. “Couldn’t be that people don’t examine it just because it doesn’t fit their preconceptions of what ought to work, could it?”

    No, Tim. You seem to have a bit of a blind spot about this. The reason no-one looks at Singapore as an example of, well, anything, is that they fiddle the figures almost as badly as the old SovUnion. The ‘Singaporean Model’ is built on managing to exclude the lower-paid workers of the economy from the figures: only ‘Singaporean citizens’ are counted, but the economy relies on vast amounts of maltreated imported labour.

  3. As an anecdote, from my experience with supposedly one of the best hospitals in France, the price is expensive although mostly reimbursable, the standard of medical treatment and expertise superb (although you feel rushed), and the standard of administration and general organisation laughable.

  4. One thing’s for sure: whether in terms of elective lists or emergency care, the pisspoor NHS reforms are making things a whole lot worse.

  5. One thing I have learned over the years: when any notion of reform is rejected out of hand, any need to make the smallest reforms is decried, then a sacred cow has been created.

    The ‘three monkies’ advocates of the status quo – Richard Murphy, lost_nurse, etc – have nothing to offer any debate. They have never and will never learn anything new because they have closed their ears, eyes and minds to new ideas. Further, they believe the correct response to the Mid Staffs scandal is to say nothing. If one must speak, then deny the facts and try to intimidate the whistle-blowers into silence.

    If the fact doesn’t fit their prejudice then it is an abomination to be destroyed.

  6. When a dutch hospital apologised that I’d have to wait 4 weeks to see a specialist, I laughed out loud. They suggested I try a named other hospital, which I duly did.

    And the other Europeans I worked with thought the dutch system was crap compared to their home countries. They had no idea.

  7. An aquaintance of mine was told by a doctor in France that her son needed treatment by a particular specialist. She asked when they would be able to see this specialist. The doctor looked at his watch.

    Here, we’re still doing the “unofficial waiting list to get on the official waiting list” thing. Feh.

    Friend of mine, when his back was screwed and he needed a scan and was prettty much forced to go private, decided to look into why it takes so long to get an MRI scan in the UK. An MRI scanner costs something like quarter of a million (or did at the time). American hospitals, having spent so much, want to recoup it ASAP, so run their scanners round the clock: you might get an appointment at 2 in the morning. British hospitals don’t care about the money (which we’re constantly told is a wonderful thing), so run the scanners 9 to 5 to keep the unions happy.

  8. A truly wondrous thing the NHS does: our nation’s No.1 economics blogger tells us governments don’t actyually need to raise tax to fund their expenditure (word-for-word, though it coud be a heuristic logc). However, when the spending invovles three letters: N…H…S, well then economics flips on its head and it needs taxes now, penny-for-penny.

  9. Squander two – my wife last had an MRI at 9pm on a Thursday evening – a booked appointment we were notified of over a week in advance. My last MRI was on a Saturday morning at 7am in a mobile scanner – an HGV parked in the hospital car park!. Next MRI is on Sunday morning in the hospital itself.
    Maybe they are learning to keep the machine more in use? Even bringing one in to cope with a backlog.

  10. @Ironman.

    You’re right to suggest that I’m going to say nothing – but only in the sense that I’m going to (largely) restrain myself from responding to your asinine comment. Save that: you are very, very wide of the mark. Nurses are still having to fight the same battles as Graham Pink (google him), and a defining feature of the MidStaffs meltdown was management’s continued failure to listen (still less act upon) the concerns of frontline staff. And if you are going to bleat about resistance to current reforms, then perhaps you could outline how they are improving matters in areas such as elderly care. I’m all ears.

  11. *If you are lucky* A&E is pretty quick access: I was about to say that I had a fairly short wait last year when I tripped over a badly out-of-line kerbstone in shadow between street lights and crashed into a cast-iron fencepost hidden in the hedge (my friends escorted back to the clubhouse, someone located the first aid kit and, after I turned an offer to drive me to hospital, someone selected a good A&E to visit on my way home where they replaced the elastoplast with stitches). However my previous A&E visit – after the school ‘phoned me because they were not willing to sort out the mess they had permitted/caused through their stupid policies – I had to carry my son from the car park, then go back and move my car to an empty space on a small housing estate quarter of a mile away because I wasn’t carrying enough coins to satisfy the meter for the expected stay, then we waited for hours.

  12. @ lost_nurse
    My father-in-law, who was a pretty tough cookie, died as a result of an infection picked up in a NHS Hospital (because, like my family he believed in the NHS) when he went in for a minor ailment. NHS reforms make that worse – how?

  13. @ lost_nurse
    Elderly care is mostly carried out by social services despite the NHS spending millions of pounds trying to reallocate healthcare costs to local authority social service departments – with corresponding waste in hiring accountants by social service departments to refute false claims by the NHS.
    YES NHS reforms would improve elderly care if less time and money was wasted on squabbling by NHS accounts and county council accountants – treatment/services could be applied quicker before patients had deteriorated and more money could be used to help the elderly if it was not wasted on employing morally deficient accountants.
    Let those who have ears, hear – but since this is on the web, just read it.

  14. John77
    lost_nurse could be my stooge, provding exactly the sort of (no need for reform, nurses are to a man and woman angels etc) I hoped for an expected.

    However, I believe you and i share the opinion that tax provdies the most efficient and fairest method for arranging health insurance. I also believe we share the view that the NHS apologists (lost in nurse space) have lost the moral right to contribute to the debate.

    My father came home on Monday, meaning he has come home to die of prostate cancer. He will spend his last couple of weeks in a beautiful bedroom in a beautiful town in Somerset watching the birds in his garden. We finally managed to get him home for two reasons:
    1. A quite fantastic nurse from Ireland who has herded cats; the consultants, the pharmacy, the hospice (ha ha), the GP and most infuriating of all, social services.
    2. I carried in a business card from an exceptionally litigious firm of solicitors.

    I’m quite proud of the second.

  15. An elderly friend of mine, in generally good health, went into a local NHS hospital for a fairly routine op. She came out again in a box, thanks to the infections picked up inside.

    Another friend of mine, mid-30s, was in a local NHS hospital getting a wound in his foot seen too. That got infected, and the leg ended up being amputated.

    The NHS, it’s such a wonder of the world!

  16. The NHS is the wonder of the world! And the NHS in Wales is the wonder of the Universe!!

    Just where would Wales be today without those wise old men on committee to guide it?

  17. Interesting to note that Simon Stevens, Chief Exec of NHS England, is on the Foundation’s Board of Directors, and looks like being the only non-American on it.

    One might think there’s an agenda running round Obamacare.

  18. @ironman: I’m sorry to hear about your father. Whatever else, at least he is in the right place.

    I’ll refrain from further comment, except that you could not be more wrong regarding my attitude to MidStaffs. And the issue remains: what exactly are these reforms doing to prevent such situations re-occuring? Caring for patients (elderly patients especially) takes time, which is only ever possible with sufficient staff. That doesn’t excuse individual cases of neglect, of course (and, no, I do not hold to the bullshit line that all nurses are angels), but I see little evidence of DOH gripping the problem. Indeed, the current overload in acute care would strongly suggest that the ConDem’s expensive & convoluted re-org is making things worse. And fast.

  19. lost-nurse

    My problem with you and your like is you do not – will not! – accept the need for ANY fundamental reform. Nothing stays still and no system, no organisation remains fit for purpose unless harsh self-analysis is placed right at its heart. The NHS is now a religion; any criticism is met with a vicious response. The whistle blowers at Mid-Staffs, who had watched their own family members suffer, were forced from their home town for their crime of speaking out. This doesn’t, can’t, happen as isolated example; this can only happen if it is systemic.

    I started this morning by a statement in support of the principle of tax-funded health provision; my integrity in this is clear. I have never seen anything from you, however, that is anything other than knee-jerk defence of the status quo. So, until you speak up for the serious reforms YOU believe need to be made – and they really do! – then I am not interested in you or your opinions.

  20. So, until you speak up for the serious reforms YOU believe need to be made – and they really do!

    Above all else, there has to be an increased (and mandatory) level of nursing staff. I’d like to see a ratio of 1:4 (RN to patients) on general wards. At the moment (outside acute/specialist areas) it is generally 1:8 (& can be anything up to 1:12). These numbers are inadequate for the proper provision of care.

    I’m certainly not a defender of the status quo – but I will defend the NHS where I see it working well (most especially in acute settings – i.e. emergency/critical care). I’m not opposed to the kind of (better-invested – if we are to match the French/German stuff, it will cost us) social insurance models that are operational on the continent*… but I certainly wouldn’t trust the current lot to introduce the necessary (i.e. rigorous, nil-exclusive) reform. And I didn’t especially trust the last lot (after all, NuLav essentially paved the way for Lansley’s non-mandated blitzkrieg). It’s no accident that the management at MidStaffs took their eyes off the ball whilst attempting to implement the last batch of top-down diktat – with disastrous consequences (if you read the Francis Report, the staffing levels/skill-mix on the wards concerned were hopelessly inadequate – and warnings to this effect were repeatedly ignored). The current reforms, meanwhile, are making a difficult situation much worse. The resulting fragmentation is putting enormous stress on the frontline – most visible in the ongoing pile-up of A&E admissions & increased delays in elective lists. You’ll view this as simple producer interest, but I’m afraid I follow the NHA (e.g.http://nhap.org/nha-faqs/) in their analysis of why it’s a gathering clusterfeck. As widely predicted, the 2012 Act is proving to be a train-wreck – any move towards mixed-economy provision should be geared to the interests of patients, not Healthcare Inc… and we are moving in exactly the opposite direction! So, first off, I’d halt the bludy stupid reorg & focus on keeping keep ‘er steady – if only to protect services that would still be fairly centralised, even under a social-insurance system (cue arguments about hypothecated taxes…). And when it’s finally gone, even Tim might grasp why ye olde NHS was rather more cost-effective than the mess which is rapidly replacing it (albeit with an NHS kitemark).

    *Many of the issues that face the NHS are pretty much universal to all developed healthcare systems. In some respects, social-insurance merely swaps one set of problems for another…

  21. Oh really! So all the problem$s at Mid Staffs were as a result of Andrew Lansley’s reforms were, all post-2010 were they?

    You should go and talk to Richard Murphy instead of us, he shres your relationship with the truth.

    Those social models they have on the continent would mean the producer monopoly being broken up and the money being handed to patients. That is something you simply don’t say; I didn’t think you would. You ate quite right, I do see you as a defender of producer interest.

  22. Oh really! So all the problem$s at Mid Staffs were as a result of Andrew Lansley’s reforms were, all post-2010 were they?

    Er, no… where did I say that? I said NuLav paved the way for the current reforms (see, for example, their introduction of ISTCs, besides going overboard with PFI etc). The management at MidStaffs took their eye off the ball in large part due to pressure to achieve Foundation Trust status (requiring drastic cost savings, in turn affecting frontline staffing levels) – a key element of NuLav’s NHS policy. All this is in the Francis Report, but see here for a brief discussion: http://tinyurl.com/mwku9dk . The point being, the current reforms are proving to be the same kind of damagaing distraction, and – in my view – make the chances of a MidStaffs meltdown more, not less, likely.

    As for producer interest, blah blah, etc: a simple appeal to the “market” is just that – simple. Social-insurance models aren’t going to magically level out the asymmetrics, especially in acute care. The platitudes that get bandied about on here about “competition” in no way describe what is actually happening on the ground (which is why the Circle PR stuff is so laughable – they are simply sitting pretty, whilst avoiding the heavy lifting). The current reforms are a muddleheaded yard sale. I don’t oppose ’em because I worship the NHS as a sacred cow or because I’m resistant to change – I oppose them because they are an utter friggin’ disaster.

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