It’s the wonder of the world, isn’t it?

Thousands of people a year are dying unnecessarily after a heart attack because NHS follow-up care is so poor, a study says.

Six in seven of the 40,000 heart attack patients a year miss out on at least one of the treatments that have been proven to reduce their risk of having another one and dying, it found.

Those failures and an “unacceptable deficit in care” led to 33,000 avoidable deaths between 2003 and 2013 in England and Wales, according to researchers.

In those listings of how well health care systems do, Commonwealth Fund and so on, the NHS always comes out really rather badly from the “quality of treatment” and “deaths amenable to healthcare” sort of measurements. Yes, it’s very fair, funded progressively and so on. It’s just not a very good source of actual treatment.

29 thoughts on “It’s the wonder of the world, isn’t it?”

  1. 3,000 or so a year for ten years. Fuckng hell.

    To have the country believe this is “the envy of the world” in spite of the evidence to the contrary suggests a taboo on criticism so strong it probably dwarfs that on incest.

  2. “The most commonly missed interventions were dietary advice (68%), advice on stopping smoking (88%)…”

    So there you have it. If only we had a for-profit health service, heart attack patients would be properly advised to eat and smoke less. I look forward to reading this blog’s ringing endorsement of increased state nannying.

  3. “It’s just not a very good source of actual treatment.”

    Oh, come now. It’s clearly sub-optimal, but it’s still pretty good – that’s why we bumble along with it as it is instead of making big changes.

  4. If we had a for-profit health service that offed 3000 heart attack patients every year through neglect and mismanagement, we can be sure we’d be hearing about it every day from the BBC and the grauniad.

  5. BiW, if a for-profit health service offed 3000 heart attack patients per year, the CEO would be charged with Corporate Manslaughter. Not so Andy Burnham who was Health Minister during the Mid Staffs debacle. How Burnham can still show his face in public is beyond me.

  6. The difference between a for profit organisation and a not for profit one is simply whether those supplying money for set up or expansion cam hope to get their money back. With no need to pay back the suppliers of money a not for profit can pay it’s staff more and if well managed undercut any competitors, thus ensuring that no one can get any money back.
    I have an idea for a not for profit food supplier which would pay it’s staff more than the competition and offer cheaper food. All I need is for enough of those who decry the profit motive to ‘invest” their pension pot in my scheme.

  7. one of my favourite quotes from the Guardian ever was in its coverage of the WHO report that ranked the NHS as the world’s best health service (by giving a heavy weighting to equity and lack of charging at point of use). “The only black mark against the NHS was its rather poor track record of keeping people alive”

  8. Liberal Yank

    In terms of outcomes – the quality of healthcare I received in the US was as good as anywhere – the problem was the ludicrous number of intermediaries that seemed to bump up costs across the process – but to use that argument that people more thoughtful are advocating switching to the US system – as dearieme and the excellent Tim Newman have pointed out – it’s the ultimate in straw men

  9. I’ve always said that the NHS does emergencies brilliantly. Have a car crash, they all turn up and save your life. Your kid collapses from some unexpected life threatening problem, it kicks into gear and does brilliantly. All the people who go online to defend the NHS are inevitably ones who have had life threatening crises that the NHS has responded to.

    The problem with the NHS is (as this report rather makes clear), its the care to people who aren’t lying in a pool of blood or gasping on the floor that is the problem. Then its pot luck. The system just cannot function beyond the ‘this person is dying, we must do something’ mode. It can’t string together the bureaucratic chain of events necessary to treat a long term ill (but not immediately dying) person.

    And the reason for this is the way the NHS operates with no customer/health care supplier relationship. There is no negative outcome for the NHS to provide sub standard care to a person who isn’t dying. The patient can’t go elsewhere, the staff still get paid, there is no comeback on them. If its a life and death situation then its different, that would impact on the NHS – if people were dying in the streets because of NHS failures, patients families would sue, and heads would (eventually) roll.

    The NHS is not a universal health care system. Its an emergency health care system. It takes seriously injured and near death people and gets them back to a ‘not dying’ status, and thats about it. Some may make a complete recovery, some don’t, its pot luck on who happened to treat them and where and when.

    Until the parts of the NHS that are non-urgent are subjected to market forces in terms of ‘If this person isn’t happy with my service they can get it elsewhere and I will lose their money’ then nothing will change and indeed things will continue to get worse.

  10. ‘led to 33,000 avoidable deaths’

    Unless they can give you a list of the 33,000 names, they are lying.

  11. The U.S. health care system was the best in the world, until a few years ago when the government decided to fix it.

  12. Sorry for the troll but it is too easy. Healthcare locally is a complete cluster. I can’t blame ACA though as there were huge problems with insurance providers before it was passed. There is no reason a city the size of Pittsburgh should only have one and a half choices of medical providers.

  13. A) What Gamecock said. I want death certificates before I believe them.

    B) A for-profit healthcare system will give you the aftercare you paid for. That is, the cheapest option gets you a one-off lifestyle lecture, while the most expensive gets you a personal cardiac care team following you about as you live your life.

    According to this report, the NHS doesn’t even get you option A.

  14. Liberal Yank

    So it’s actually the absence of a functioning market that is the problem; not market – based medicine.

    Jim’s point is well made. The system pushes you through a series of tubes. At no point does the patient ever get to decide or even feel the system is in any way designed around him. There is no purchaser/ provider relationship. I would say, however thay a tax – based insurance system is as efficient as we are likely to find.

  15. The US healthcare system has been fucked since the unions forced the linkage of employment and health insurance, under FDR.

    I think Jim’s summary of the NHS is spot on.

  16. Bloke no Longer in Austria

    It’s all down to Tory cuts innit?
    The NHS can no longer afford decent leeches and has to make do with cheap Chinese imported ones whose blood capacity is severely reduced.
    Also a Report that I have just made up shows that not only are most NHS surgeons’ saws rusty, but they are also blunt

  17. So Much For Subtlety

    Matthew L – “The US healthcare system has been fucked since the unions forced the linkage of employment and health insurance, under FDR.”

    I am sitting here thinking of all the things that US healthcare has done since FDR. I mean, OK, they did not invent penicillin but they did make it cheaply and in massive amounts. And perhaps they did not come up with the final design of the iron lung, but the Drinker machine was still a breakthrough that saved FDR’s life. Speaking of which, they did cure polio. And got rid of Smallpox.

    In fact looking at the massive progress that has been made, and mainly made in the US by American doctors, I find it hard to believe anyone can say that the system has been a disaster. Compared to what? The Victorians? The middle ages?

  18. Liberal Yank

    Hat tip for the proper use of the word ‘troll’ to describe your first post – as opposed to the Muphyite use which roughly defines as ‘someone who disagrees with me and is able to argue me into a cocked hat’

  19. NHS is designed to pay for the people working in the system. The diagnose and care of the peons that have paid into it is just incidental. Look at it from that angle, 33k death per year is perfectly acceptable.

  20. The other problem with the NHS is that it’s just too damn big.

    For example there are local shortages of GPs, but the problem can’t be fixed quickly because any changes to contract T&Cs have to be agreed nationally.

  21. “What Gamecock said. I want death certificates before I believe them.”

    Hmm, that does rather fuck up epidemiology somewhat.

  22. “Hmm, that does rather fuck up epidemiology somewhat.”

    Good, the way epidemiology is practiced today, it could do with a good shake up.

  23. I have the misfortune to have an irregularly-recurrent condition, fixed by trivial surgical intervention which needs to happen within about a week of it showing up. So I’ve now had minor walk-in surgery in the US, the UK and Bali.

    The US were incompetent (did the wrong procedure under local anaesthetic the first time, sent me away with antibiotics that didn’t work, did a correct procedure the second time) and cost $2500, which travel insurance paid. They then sent me a bill claiming that the travel insurance hadn’t paid every month, until I got fed up with forwarding the bill to the travel insurers and moved house without giving a forwarding address.

    The Balinese hospital treated me under local anaesthetic; it took half an hour; they charged £200, which I didn’t bother claiming on travel insurance.

    The major UK teaching hospital admitted me overnight and did the operation under general anaesthetic at 3am. It was free.

    Post-operative results equivalent for all three, though the wound healed a bit slower after the UK intervention.

  24. @john77
    Since so many senior politicians attended Oxford, surely there’s a better case for bombing it to rubble, bulldozing the rubble & sewing the till with high level nuclear waste than maintaining its funding?

  25. Ironman,

    You are correct about the absence of a functioning local market. Regional consolidation first become noticeable to me in 1997 not long after UPMC started their own insurance plan. A healthcare version of Glass-Steagall could have prevented the lose of competition.


    I now recognize my observational bias relating to language. I will still be an American and use incorrect, made-up definitions despite my best efforts. In this case I was able to overcome one of my flaws and use troll correctly. Thank you for noticing. It is good to know someone else also cares about traditional meanings.

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