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NHS not so good

To understand this you have to understand what is being measured:

The NHS has lost its prestigious ranking as the best health system in a study of 11 rich countries by an influential US thinktank.

The UK has fallen from first to fourth in the Commonwealth Fund’s latest analysis of the performance of the healthcare systems in the nations it studied.

Also, why it is being measured. The Commonwealth Fund desires that the American health care system be replaced with something much more like the NHS. Thus their measurement system is created to make something like the NHS look good:

Analysis of 71 performance measures across five domains — access to care, care process, administrative efficiency, equity, and health care outcomes

The actual health care bit is only that last. Any and every system that has equality of access will do well by such measures whatever the excellence – or not – at treating people.

Access to Care. The access to care domain encompasses two subdomains: affordability and timeliness. The five measures of affordability include patient reports of avoiding medical care or dental care because of cost, having high out-of-pocket expenses, facing insurance shortfalls, or having problems paying medical bills.
Equity. The equity domain compares performance for higher- and lower-income individuals within each country, using 11 selected survey measures from the care process and access to care domains. The analysis stratifies the surveyed populations based on reported income (above-average vs. below-average, relative to the country’s median income) and calculates a percentage-point difference in performance between the two groups.

The entire measurement system is biased towards equality rather than actual health care.

11 thoughts on “NHS not so good”

  1. If they’re measuring timeliness then the NHS should come bottom.
    It sucks. Astonishingly slow and inefficient.
    I had to get a referral one Friday from the GP, which was a saga in itself, and then I went private.
    GP: “I’ll send it to the NHS hospital as well.”
    Me: “erm, why?”
    GP: “they will probably be quicker.”
    Me (barely holding back tears of laughter): “ok”

    Got an appointment with private specialist the following Thursday. Who said I needed an op, which could have been booked in the following week, but as I had scheduling conflict, was booked three weeks later.

    Came home from the op to find a letter from the NHS department acknowledging my referral, informing me that they would send me another letter letting me know when my initial consultation with specialist would be. And I could look forward to receiving this letter in six months.


    Once you’ve had experience of a country with a good medical system, the utter shittiness of the NHS becomes painfully apparent.

  2. “Access to Care”

    Lol. Its virtually impossible to access any care at all in the NHS right now, unless you’re ambulance ready.

  3. “The entire measurement system is biased towards equality rather than actual health care.“

    And the National Elf is still sliding down the table.

    “Once you’ve had experience of a country with a good medical system, the utter shittiness of the NHS becomes painfully apparent.”

    That’s how they get away with it, of course. Most people don’t, and so are fertile ground for the propaganda.

  4. Reminds me of this gem from the Graun’s report on a Commonwealth Fund survey some years back – ‘The only serious black mark against the NHS was its poor record on keeping people alive’.

  5. @Chernyy Drakon…

    My brother had a similar (but much closer shave) with NHS scheduling a couple of years ago (even “Before Covid” it was not exactly quick)… He’d been having stomach pains that were getting worse, his GP finally referred him to hospital, where he was eventually seen by a “specialist” and sent-away with pain-killers and a further referral for 3 months time…

    A couple of days later he played golf with a friend who brought along one of his mates, who happened to be a surgeon. Part-way through the round bro’ doubled-up in pain for a few moments and was asked by said surgeon what was the matter. Bro’ explained and was told “come and see me in my rooms tomorrow afternoon and I’ll have a look at you”. This he did, was examined carefully, sent down the hall for tests, X-Rays, etc. Surgeon looked at them and and said “I’ll operate on you the day after tomorrow”… Bro’ asked why, and was told “because if I don’t you’ll probably be dead within a couple of weeks”.

    Suffice it to say that bro’ was very ill for a while but is now OK, but would probably not have reached his 3-month referral.

    Thanks NHS.

  6. “The timeliness subdomain includes six measures (one reported by primary care clinicians) summarizing how quickly patients can obtain information, make appointments, and obtain urgent care after hours. The 2021 report includes a new measure of the percentage of respondents who received counseling or treatment for mental health issues if they wanted or needed it. The wording of two survey-based measures was modified since 2017. Five 2017 measures were not included. Two were not available from a recent survey. Three other measures of wait times were excluded because they were asked early in the 2020 COVID-19 pandemic and results were thought to be unreliable.”

    Can see how the NHS might score ok on that basis – can generally call 111 or visit A&E whenever – might be a miserable experience, but it’s do-able. Bit of persistance and you can get a GP appointment too. Just handy how they’ve excluded the measures of wait times (although if I go to my GP with something does that count as being treated for that even if I don’t see a specialist for 6 months?).

    For my own anecdote, Mrs Yeoman has been suffering with a relatively severe ENT issue that has required 3 A&E trips amongst other stuff. Over the course of a month or so she’s had a CT scan, an MRI, discussions with 3 different specialists, a couple of private prescriptions, and is now scheduled for surgery next week. All pretty much zero-fuss through the insurer. The earliest the NHS could have seen her for an initial specialist consultation was October (and who knows when treatment would have actually started).

  7. The entire measurement system is biased towards equality rather than actual health care.

    I was talking to a couple of lefty Yanks recently, who both reckoned the NHS was better. Setting aside that they’d never had to use the NHS, their argument was that the US health system is great, except for the bottom 10%, while the NHS is bang average (as I say, they’ve never had to rely on it), except for the richest 10%, who go private. They both reckoned the latter state of affairs is better, because it is more equitable.

    Now I think their view is not just incorrect, but fucking mental. Yet that’s the mindset that runs Yankistan now. Which means it will be the mindset running Britain in a few years.

  8. In Oz at the moment. One of the great things here is freedom of choice on GP’s.

    Call your GP for an urgent appointment: Too busy to see you? Call another one or fire up the app and ask “Who around here has free appointments?”. The GP you see is the one that gets the money from Medicare, the one who was too busy misses out.

    It’s funny how easy it can be to see a GP when they are incentivised to actually see patients

  9. Bloke in North Dorset

    Baron Jackfield,

    Similar thing with my brother, but without the chance encounter. He’d been complaining about stomach pains for months but was told by his GP it was just colic.

    By the time the go to see a specialist and was opened up they zipped him up again and sent him home to die. They tried treating him but it was fairly obvious they were going through the motions and he died not long after that, 6 weeks before his 40th birthday.

    His cancer was something more likely in older people and his GP didn’t recognise the signs, I think if he’d lived down here where they deal with more older people he might have had a chance.

  10. Bob Downe, it is the free market in action, but, though not getting your money, the GP with the full appointment book is clearly not missing out. It is common to find practices with 4-6 GPs. Phoning the practice often goes something like this: “can I see Dr X, please?”, “Dr X has nothing until next Wednesday, but you can see Dr Y and Dr Z today.”

    It’s a bit like wandering along a street full of restaurants in a town that you are unfamiliar with. Do you go for the empty restaurant that can seat you now or go off and have a drink for an hour while waiting for a table at the restaurant that is heaving? Those suffering from pandemic paranoia may choose the empty restaurant, but most of us assume that there is a good reason why the locals are flocking to the one rather than the other.

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