Economy and NHS

Ladywriter1968

Wasnt sure what thread to place this under so its here. What happened.

A lady that I know, her daughter was walking in the park and fell over. her daughter broke her leg in 3 places and the bone was sticking out of her leg. It was raining hard as well so she was laying on the floor shivering and soaked and screaming. The ambulance was rang 5 times by passers by and was told that she was not a priority emergency, She lay there in the park on the floor for over an hour and a half screaming in agony. The local paper even printed her story. Then when she went to hospital after her operation she needed the toilet. They left her in her own crap for 2hrs on the bed she laid in it.

I think the NHS is in crisis and the care is very bad now. I can understand those wanting to go private but not everyone can afford this really. Cause people that work pay their stamp duties and all.

I wonder if the pitfalls of NHS out weight private treatment costs. Or private insurance cover costs. I also heard that the conservative want to rid the NHS. That would leave poorer people with nothing at all then. As I guess if that happened they would have to pay to visit their GP as well. Plus No more NHS dentist either.

Is there really any direction with any of it.

Loughton_Monkey

You are probably on the wrong board, as this is not directly an 'economic' matter.

However, this subject is close to my heart, and I would make the headline comment that the NHS is no longer 'fit for purpose'. This is not the fault of any one person working in the NHS. Some of them work hard and diligently.

They key issue is that given the ageing population, and the advances in medical science, it is impossible to provide a 'free' service anywhere near to matching expectations. Something has to 'give'. 80% of the time, what 'gives' is the time factor. In effect, it's 'rationed'. Your friend went through an awful experience, but was not going to die. The other 20% of the time, the quality gives.

As a secondary issues, rationing by time involves huge additional costs to manage a waiting list. On top of an archaic and inefficient process anyway, this means that a large proportion of 'health' spending is wasted on paperwork, management, idleness, and bureacracy.

The American system is arguably worse, but for totally different reasons. It is 100% privately delivered. Most working people have insurance. Those over 65 have 'state insurance' which is akin to our NHS, except the 'delivery' of treatment is usually (a) instant, (b) of high quality, and (c) largely paid by the government [although the person often has to pay a 20% contribution to some things].

I recently visited a friend of 50 years in Florida for 5 weeks and lived with him and his wife. He has kidney failure and is on a 'waiting list' for a transplant. Obviously in a case like this, he has to wait. But meanwhile, he has had other associated problems (circulation/heart, depression, muscle wastage...).

But here's the problem. There is simply no system (as in UK) for a GP to co-ordinate the whole thing. Hence, my friend is left to see 6 or 7 different 'specialists' for each issue. US doctors obtain commission for their prescriptions. We arrived to visit him, only to find that the day before, he had been prescribed drug number 16. 5 of these (including the new one) were for either depression, lack of sleep, or mood swings. In two days, he was literally 'away with the fairies'. His wife stopped the 5th pill straight away. At our instigation, his daughter checked his 4 other drugs on the Internet, only to find out that 2 taken together were an extremely dangerous cocktail, and the other 2 were even worse, with an extreme risk of death.

Rather perversely, there was no 'process' by which he (or his wife) could take any sort of advice, since each of the 5 doctors acted totally independently, without any reference whatsoever to what else he was taking. After 10 days of stopping two of the pills [based purely on Internet surfing!!] he was 'mentally' back to normal.

I could go on, but my point is that their system is also rubbish.

The best systems in the world (e.g. France) have a combination of state funding, plus co-payment for treatment, which allow them to fund for good quality treatment, at a reasonable cost, and most importantly more or less straight away [which happens to be the cheapest way anyway].

A._Badger

Loughton_Monkey wrote: »

But here's the problem. There is simply no system (as in UK) for a GP to co-ordinate the whole thing. Hence, my friend is left to see 6 or 7 different 'specialists' for each issue. US doctors obtain commission for their prescriptions. We arrived to visit him, only to find that the day before, he had been prescribed drug number 16. 5 of these (including the new one) were for either depression, lack of sleep, or mood swings. In two days, he was literally 'away with the fairies'. His wife stopped the 5th pill straight away. At our instigation, his daughter checked his 4 other drugs on the Internet, only to find out that 2 taken together were an extremely dangerous cocktail, and the other 2 were even worse, with an extreme risk of death.

Rather perversely, there was no 'process' by which he (or his wife) could take any sort of advice, since each of the 5 doctors acted totally independently, without any reference whatsoever to what else he was taking. After 10 days of stopping two of the pills [based purely on Internet surfing!!] he was 'mentally' back to normal.

I could go on, but my point is that their system is also rubbish.

To be strictly fair, I have encountered similar problems in the UK. Assuming a GP has much of a clue about what a specialist prescribes can be taking a risk too far.

grizzly1911

I think the quality of care is heavily dependent on your location in this country.

I have had cause to use the NHS as a real emergency myself for two separate reasons and fantastic care was received being handled sensitively and quickly both times.

We have a first class Medical Centre where we live, appointments are readily available and minor "ops" are undertaken and follow up care provided. The GPs are on the button.

I also know someone who works in major trauma and their position isn't helped by minor cases that present themselves when it should really be a GP visit.

Constant change doesn't help the NHS and there are far to many suited non clinically trained managers with clipboards shuffling the work to meet spurious moving targets.

The American system may get better treatment to a few some of the time but it it is massively more expensive, per head, and leaves millions with no "real" health care. A sad state of affairs for such a wealthy country.

Loughton_Monkey

All good points, and my comments in bold

grizzly1911 wrote: »

I think the quality of care is heavily dependent on your location in this country. True, but rather perversely makes 'National' helath service rather a contradiction in terms.

I have had cause to use the NHS as a real emergency myself for two separate reasons and fantastic care was received being handled sensitively and quickly both times. Agreed. Also personally experienced major issue. The operation itself and immediate [after] intensive care was probably world class. But why did I have to wait 7 months for it, when their published target (98.7% achieved! Joke!) is two months!

We have a first class Medical Centre where we live, appointments are readily available and minor "ops" are undertaken and follow up care provided. The GPs are on the button. Not around here

I also know someone who works in major trauma and their position isn't helped by minor cases that present themselves when it should really be a GP visit. I strongly advocate a £15 charge for every GP visit. Raised to £50 in A&E if classified as 'minor'.

Constant change doesn't help the NHS and there are far to many suited non clinically trained managers with clipboards shuffling the work to meet spurious moving targets. And fiddling them! I could write a book on this. Round here, every specialist's diary is released in "Three-month chunks". All those waiting are held... er... in paper form ... and then slotted into the next diary. Lo & behold, this magically creates 100% success rate in 'seeing' each patient within 3 months - except they don't count the 2 months you were just on paper....

The American system may get better treatment to a few some of the time but it it is massively more expensive, per head, and leaves millions with no "real" health care. A sad state of affairs for such a wealthy country.

Whilst true, your last point is interesting. Many Americans look on it in a different way. Health [or shall we say health insurance] is a commodity you buy just like you choose to buy a car, a mobile phone, or some house insurance... OK, a large proportion have it 'bought' by their employer as a perk, just as you might get a company car/mobile phone.....

So the argument would go that we [the US taxpayer] pay generous benefits to the unemployed, and if they choose to spend all that on cars, fags, and booze, rather than health insurance, then why should we care? In other words, it's valid to look at it in exactly the same way as, say, house insurance. In UK, we also pay generous benefits. Anyone who chooses not to buy contents insurance, and who gets all their stuff nicked, or has a fire, do we expect the tax payer to cough up? New for old even? I think not.

matbe

Ladywriter1968 wrote: »

Wasnt sure what thread to place this under so its here. What happened.

A lady that I know, her daughter was walking in the park and fell over. her daughter broke her leg in 3 places and the bone was sticking out of her leg. It was raining hard as well so she was laying on the floor shivering and soaked and screaming. The ambulance was rang 5 times by passers by and was told that she was not a priority emergency, She lay there in the park on the floor for over an hour and a half screaming in agony. The local paper even printed her story. Then when she went to hospital after her operation she needed the toilet. They left her in her own crap for 2hrs on the bed she laid in it.

I think the NHS is in crisis and the care is very bad now. I can understand those wanting to go private but not everyone can afford this really. Cause people that work pay their stamp duties and all.

I wonder if the pitfalls of NHS out weight private treatment costs. Or private insurance cover costs. I also heard that the conservative want to rid the NHS. That would leave poorer people with nothing at all then. As I guess if that happened they would have to pay to visit their GP as well. Plus No more NHS dentist either.

Is there really any direction with any of it.

I think you would have waited a lot longer for the private ambulance to have arrived. Private in this country does not include emergency service.

in a private hospital if something goes wrong you get bounced back to the nhs.

vivatifosi

This is nothing new, sadly and has nothing to do with cuts in healthcare. I was with a friend who broke her leg 10 years ago. It also took ages for the ambulance to arrive even though called in. When she was in the ambulance it was stuck in traffic because the ambulance driver said that it was classed as non-urgent and therefore they couldn't use their blues and twos and he wished drivers realised this so they got out of the way anyway. I know this because I was in the ambulance with her. It's nothing to do with cutbacks, but as Loughton says, has a lot to do with a system that's not fit for purpose.

grizzly1911

matbe wrote: »

I think you would have waited a lot longer for the private ambulance to have arrived. Private in this country does not include emergency service.

in a private hospital if something goes wrong you get bounced back to the nhs.

The other point to remember with the NHS is that a broken limb isn't , on it's own classed as life threatening.

Certainly where we live there is a lot of Motorway close by and there are regular major shunts often resulting on in death and major casualties. These will obviously have a priority call as that "Golden Hour" of recovery time could be the difference between life and death.

Ambulances services can't afford to be 100% available for every call they receive -it simply wouldn't be cost effective whether private or NHS.

Don't know the specifics of the OPs case but for a child that is alert with no other injuries couldn't they be scooped up and taken to A&E?

grizzly1911

Loughton_Monkey wrote: »

All good points, and my comments in bold



Whilst true, your last point is interesting. Many Americans look on it in a different way. Health [or shall we say health insurance] is a commodity you buy just like you choose to buy a car, a mobile phone, or some house insurance... OK, a large proportion have it 'bought' by their employer as a perk, just as you might get a company car/mobile phone.....

.

The difficulty in this country is that as we already have this as an embedded cost in our Government spending and tax regime the cynic in me doesn't believe taxation would be reduced sufficiently to compensate for the individual cost. It would be a layered up cost that only those with "surplus" disposable income could afford.

Funnily enough whenever I have been in A&E it doesn't ever seem to have many affluent people in there or hospital for that matter.

As the health insurance is brought as a perk by the employer at a cost then it it makes the competitive low "employer" tax regime of the likes of the USA a fallacy.

I have also used private hospitals under insurance arrangements and find them unnecessarily over the top adding to the expense to me/the employer.

For one of my urgent treatments it had gone undiagnosed by the "private" part of the NHS and once picked up by the NHS doctor I was referred that day to a consultant, at a different hospital, who flipped open his paper diary and offered me two dates , one in 36 hours the other in 72 hours.

I have a relative who required invasive neurosurgery, who was in a lot of discomfort, who was bumped a couple of times. The consultants also have to deal with more important cases and have Governmental guidelines for prioritising certain cases. The last time before he was operated on was due to a accident that resulted in the death of the patient.

We are often quick to criticise failure of individual cases but fail to acknowledge the thousands of cases that do work day in day out and the massive demands on the system.

princeofpounds

Healthcare is pretty much the biggest nightmare for any economist or policymaker. Most systems seem to have some huge problem.

In the USA they spend vast amounts (3x many other developed countries) on health compared to their GDP, but don't actually live longer or healthier than other countries despite the fact that many individual treatments are super high-quality.

In countries like France and Belgium they have great systems, partly funded by the state and partly through an insurance system which is typically employer-based. The quality of care and facilities is generally very good. But the indirect cost to the economy is huge as taxes are high and businesses find it hard to employ people.

The UK kinds of muddles around somewhere in the middle, achieving decent results, with some high quality and some poor quality care.

If there was an obviously easy option then I'd be all up for reforming the NHS dramatically, unfortuantely I've never been convinced of what that option is.

j.e.j.

Yes it is interesting that it's not necessarily the case that private = good, nhs = bad. I've found that with the nhs care varies a lot from place to place, and I have known people who've had an op done privately and something has gone wrong.

I think someone hit the nail on the head once, when they said that if you want a better healthcare system, you have to be prepared to pay for it (an extra penny in the pound, tax). And a lot of people, unfortunately, aren't.