So the NHS is still shit then?

The charity said more than 24,000 people with diabetes die prematurely every year due to failures in accessing the best type of care.
This includes receiving eight annual checks in areas such as foot care and eyesight.
The checks – which only 60 per cent of people with diabetes currently receive – are designed to prevent complications which can lead to limb amputation, blindness, kidney failure and even death.

And don’t forget, it’s this sort of ongoing health care, the checks and tests, that a single payer health care system is supposed to be able to provide better than a fee for service system.

34 thoughts on “So the NHS is still shit then?”

  1. Why don’t they receive them?
    Is the answer going to be ‘staff shortages’?

    Or is it going to be ‘inability to get an appointment/seen quickly’..?

  2. These tests are mostly done at GPs offices. Most practices have a nurse or nurses –so it is hard to see why such checks don’t get done.

  3. Brilliant example of the fee system: Vets. Paid £80 for a few injections for cat. Nothing for winter flu and shingles injections for myself. While the private sector goes in for skimming existing money flows (or rent-seeking) Brits are going to stay loyal to NHS despite its faults.Subsequently paid hundreds of pounds for operation for cat (and the vets standard of care was exemplary) but for one second I did debate whether to let nature takes its course on sheer economic grounds.How much worse for Americans with operations on family members.

  4. “… I did debate whether to let nature takes its course on sheer economic grounds”

    The difference is that in the NHS it is doctors who are making these decisions and you don’t get any say in the matter.

  5. DBC- eh?

    I’m not sure the salient points in your posts are anything to do with rent seeking.

    I think that the interesting thing was the quality of care for the cat. You paid, and got exemplary service, and the patient didn’t die.

    The former is unlikely with the NHS (which isn’t free, but paid for in advance- so this isn’t even about cost vs Quality but competence), the latter sadly all too common. Especially for diabetes in the older person, as stated above.

    Or were you commenting positively on the private care system?

  6. There’s always pet insurance. That way, no nasty surprises.

    Besides, if the wife’s dog needs to see the vet, the dog sees the vet, immediately if the dog requires it.

    In Cyprus they have a similar system for humans.

  7. It could be that a lot of them are like me, with two letters from the optician reminding me to have a check up sitting on my book case for two years and another one from the GP offering me an approching-50 well-man checkup sitting there for three years. 😉

  8. It’s quite true that the NHS has an indifferent record of success in persuading patients to turn up for routine tests and to be lectured about smoking and body weight.

    I’ll put you down, Tim W, as being strongly in favour of more nagging and nannying from the NHS.

    “Who to believe: the NHS or “a charity”?”

    The figures are from the 2012-13 National Diabetes Audit, prepared by the Health and Social Care Information Centre. So you’d be trusting the DoH.

  9. @ SocialJusticeWarrior
    The NHS has a zero record for getting me to self-adminster their test on bowel cancer because it throws up more false positives than true positives and its false negatives are a higher %age of those with bowel cancer than sufferers are of the population. I do not want to pander to that sort of incompetent stupidity: they should find a test that is worth the cost and effort.
    As a life-long non-smoker who is still slimmer than my doctor despite my middle-age spread, the NHS’ failure to persuade me to be lectured about smoking and bodyweight is entirely due to its failure to try.

  10. john77: it’s entirely up to you whether you take the trouble to send off a FOBT sample, but your stated reasons for not doing so are stupid:

    “its false negatives are a higher %age of those with bowel cancer than sufferers are of the population”

    That comparison is meaningless? cf “Our goalkeeper failed to stop 40% of opponents’ shots on target. Only 30% of their shots were on target. So let’s replace him with an outfield player.”

  11. DBC Reed – vet fees are a great way of discovering what health care actually costs. I had a cat that needed a CT scan (I was so disappointed they didn’t call it a CAT scan, had the jokes all lined up) and it was done next day. Cost was $A1000. My partner at the time mentioned that she didn’t have to pay for CAT or MRI scans, and I pointed out that that was the reason the cat got in faster than her several month waiting list. So much for socialised medicine.

    I’m guessing you’ve never had to administer serious treatment for a cat. I have, twice daily chemo injections plus 5 daily tablets. Try doing that before you whine about vet bills. Especially the injections.

  12. The National Health Service is a massive insurance scheme with so many good risks that poor risks get treated for free .Not so pet insurance: our cat is a stray with a pre-existing condition ( thyroid) so ruling out pet insurance.Had he been a NHS patient he would have been treated for nothing. Considerably more humane.
    @ JS
    Please quote any definitions of rent seeking that does not include my criteria of skimming an existing revenue stream and not increasing national wealth .By definition all privatisations are rent seeking with most probably decreasing national wealth by “economising” on the wages of those involved.

  13. @ SJW
    Having been a wing-half who occasionally played in goal, when no goalie was available, I should say “Yes, let’s replace him with an outfield player” because I made a lot, lot more saves than goal kicks.
    You missed out the bit about false positives exceeding real positives – any referee who habitually awarded more goals when the goalie had saved it than when the forwards had put it into the net would be sacked if he was lucky. If he was refereeing a Millwall home match he might be unlucky.

  14. The idea of the FOBT is to look for blood in the stool, not to detect cancer. If you find it, you proceed with a colonoscopy, which is the real test, but is slightly risky and somewhat unpleasant.

    The alternative would be to do the colonoscopy straight away. Compared with that, a false positive leaves you no worse off.

    I forget what this has got to do with diabetes…

  15. @ SJW
    Not stupid – principled. Boycotts do sometimes work – Great Atlantic & Pacific Tea Company was the largest US food/grocery retailer for 60 years and for several years until 1965 the largest US retailer of any kind, but in the late 1960s/early 1970s, several churches organised a boycott of its supermarkets in protest against its practice of racial discrimination. Where is it now? More relevantly, when some NHS person asks I tell him/her/”them” why not – if there is anything between the two ears, then he/she/”them” is encouraged to ask why they use such a crappy test./

  16. @ SJW
    The thread title is “the NHS is still shit?” so it *is* relevant to the thread, albeit not to diabetes.
    The dud test means that more useless than useful colonoscopies take place. As you said risky and unpleasant. Weigh up the risks (and pain and other unpleasantness) to that majority against the net benefits to those few with bowel cancer who would not have been alerted by any other method.
    I did a quick cost/benefit analysis on the data sent to me by the NHS and, even without putting a price on general unpleasantness, came up with “cost>benefit”.
    What is needed is a screener test where benefit>cost. If I collude with the twits who administer this test, that might make the introductiuon of a decent test more remote. So I will not (for pendants, I do mean “will” not “shall”).

  17. John77: why blame the NHS? If you want to screen for bowel cancer, your choice is either to have a colonoscopy (or you could compromise on a sigmoidoscopy) or use the FOBT as a prescreen. That’s the state of medical science, it’s not the NHS’s fault.

    If I understand you right, you’re saying that if you had a positive FOBT test, you’d refuse the colonoscopy anyway, because for you the cost of it exceeds the benefit. Fair enough, but others feel differently. So we give people a choice. I see no reason at all for you to be insulting about it.

  18. @ SJW
    No, firstly it is not the state of medical science and secondly it is the NHS’ fault. If screening for bowel cancer is important, they should commission research to find a test that gets it right more often than it gets it wrong. I can understand that you don’t want to read the Daily Mail, but a Google search immediately turned up a Daily Mail article about a better test than the NHS one.
    No, you are not getting me right – I am not taking any test until the chance of getting right is better than evens.
    I have *not* insulted you. I have said that the test is not fit for purpose so I will not use it. Also that any NHS staffer who thinks can see it is is not fit for purpose. Which is more insulting – to say that they seem incapable of thinking or that they do think and choose a process that is – net – damaging to patients?

  19. Weighing in on the bowel cancer screening, multi-target stool DNA testing is the latest tech if anyone is interested. False positives are still an issue but it looks pretty sensitive.

  20. @DBC- I didn’t say that Rent seeking wasn’t present (I didn’t comment about rent seeking at all), I merely said that it wasn’t the salient (which is another word for ‘noteworthy’ or ‘most important’) part.

    I thought that was the fact your cat got excellent and prompt treatment and didn’t die, unlike the examples quoted above.

    Also- when the stuff about FOBT tests for colon cancer came up in the comments, I was reading FOBT as “Fixed Odds Betting Terminal”- which sounds a bit like the outcome of the test itself.

    Also- Also: I nominate this thread an example of Tim subtly leading the discussion- he puts “So, the NHS is still shit then?” as a title, and we end up with posts about multi target stool testing.

  21. Bloke not in Cymru

    NHS can’t even have a consistent quality of care for preganancy let alone anything else.
    When my wife was expecting our youngest the doctor strongly advised amnio to test for downs etc.
    My wife being a nurse asked for a fetal fold scan instead, no risk, but not as accurate. Our hospital didn’t have the requisite machine so she went private and we paid for it, had we lived 5 miles away she would have attended another hospital which did have a machine and we wouldn’t have to have paid.
    As for pets, questioning why were spending $300 on medical bills for a Guinea pig was most probably one of the stupider questions I’ve asked in my life.

  22. …any NHS staffer who thinks can see it is is not fit for purpose

    The purpose of the screening is to reduce colorectal cancer mortality. The Cochrane review found that it does in fact significantly reduce colorectal cancer mortality. Anyone, NHS staffer or not, can see that it is fit for purpose.

    …a Google search immediately turned up a Daily Mail article about a better test…
    Because of the way Google works, I’m much less likely to find that article than you are. If you care to post a link, or just tell me what the test is, I’ll approach with an open mind the remote possibility that a Daily Mail article on healthcare might have some slight grounding in fact.

  23. I participate in bowel cancer screening for the sheer joy of sending my poo in the post to Dundee.

    We have to make our own entertainment up here.

  24. @JS
    The question of rent seeking (which you confess you don’t understand) is highly relevant since Tim “The Oracle “Worstall is attacking the NHS as part of his dreary very unpopular campaign to replace it with private sector providers who will be rent-seeking since they are merely taking over an existing service and extracting profit from it.
    You are right about blog participants’ reaction to this thread: given the opportunity to talk about shit and their own arseholes , they would rather talk about these than the politics of health care.Much much too difficult.

  25. @ SJW
    http://www.dailymail.co.uk/news/article-2953112/The-35-DIY-test-spot-signs-bowel-cancer-Experts-say-discreet-kit-encourage-middle-aged-people-self-check.html
    That is better than the NHS test although not state-of-the-art as Noel C points out.
    The purpose of the NHS is to optimise the health of the population. The NHS test does not do that.
    Even if you were correct, a free test that is so unpleasant and unreliable that it is rejected by a majority of those invited to take it does *not* fulfil that aim when the available alternatives are (i) an improved version of FOBT that gets a higher take-up or (ii) a better test with fewer false positives and false negatives. So it is *not* fit for purpose.

  26. You missed my point completely DBC. I’ll put it bold for you.

    Girlfriend had prolapsed disc, ‘free’ MRI ordered by doctor took eight months. Cat needed CT scan, done next day cash on the barrel

    Note the quotes on free, or as you put it, ‘treated for nothing’. Medicare in Australia, very similar to the NHS if you don’t have private health insurance. Funded by taxes (in our case a very explicit % levy on top of income tax), so I would hardly call it free.

    Profit making by providing a better, cheaper, faster service is not rent-seeking.

    I’m not especially interested in the politics of health care. Efficacy though, that I care about. And not spending months in agony because your condition can’t get worse so you get marked down as non-urgent. Never mind you can’t work or live a normal life in the meantime.

    I understand you have your socialist barrow to push, but defending the NHS must be bloody hard work.

  27. Better not do your back in pushing that barrow DBC, or you’ll find out that nothing is so expensive as when it’s free.

    Another horror story. Friend of mine snapped a ligament in his knee when we were at uni. Knee reconstruction time. The health service offered to put him on the two year (really!) waiting list. He quite reasonably asked what would happen if it was in the middle of exam time. The answer was pretty much if you decline your slot you go to the back of the queue.

    He lived with it for four years and got it fixed when he started working instead. Years in his early twenties when he really didn’t need to be walking around on a knee that couldn’t take any loading to the side. He still walks carefully now, 15 years later. Ingrained habit.

  28. That is better than the NHS test…
    And your evidence for that is?

    It’s just a slightly different method for checking for haemoglobin in the stool. All your objections to the NHS test apply at least as strongly to this one.

    It really is better not to get your healthcare information from the Daily Mail’s combination of private-sector puff pieces and fantastic attacks on the NHS.

  29. @DBC

    “The question of rent seeking (which you confess you don’t understand) is highly relevant since Tim “The Oracle “Worstall is attacking the NHS as part of his dreary very unpopular campaign to replace it with private sector providers who will be rent-seeking since they are merely taking over an existing service and extracting profit from it.”

    First off: I understand rent seeking just fine, actually (well, what economists mean when they talk about it): I wasn’t talking about it at all. As I said before- the bit I found interesting in your post was the stuff about the quality of care and outcomes of the patient/cat under a private scheme. I was implicitly pointing out you’d missed the point in your desire to talk about rent seeking, I suppose.

    “You are right about blog participants’ reaction to this thread: given the opportunity to talk about shit and their own arseholes , they would rather talk about these than the politics of health care.Much much too difficult.”

    It was a wry comment, I had hoped. But the second part of your comment is interesting, about the politics of health care. I think most (sane) people hope that politics doesn’t intrude into health care at all. Perhaps that’s something to be aimed for, rather than discussed at length, or worse, celebrated.

    Either way, hope the cat’s better and life is treating you well. Or at least well enough as to not require health care, of any sort.

    Ps, I don’t know for sure what TW intends, but I doubt it’s to be an Oracle. I think he likes putting a counter-factual (or at least alternative view) on stuff that’s in the news, and provoking a bit of thought on the part of the reader- as with the post about cancer and HFCS a day or so back. You may disagree, but (being endlessly malleable in my view) that’s what I get from coming here.

  30. @ SJW
    Your visceral objection to the Daily Mail seems to resemble bigotry rather than prejudice. I am merely prejuduced and expect that, like a stopped clock, the Daily Mail will be right twice a day.

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