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Why the NHS is ruddy marvellous (and why we need to protect it)

August 14, 2013

Apologies for the title, I think I’ve been a bit affected by all the Alan Partridge mania of the last few weeks.

Why the NHS is ruddy marvellous

Over the last few months my husband and I have had occasion to use the NHS quite a lot more than we would have liked. We’ve been using primary care a fair bit, as I am 16 weeks pregnant, and unfortunately have had to use acute services three times in as many months.

To start on the primary care side, I have had two midwife appointments, with a further one tomorrow, and a 12 week scan. These appointments have allowed me to have a healthy pregnancy, both through the opportunity to screen for serious conditions and also the information given to me. As I have previously had mental health problems, the way this is asked about as standard is a great comfort to me. I feel that I can share any negative feelings I have and that I will be monitored for signs of pre-and post-natal depression. 

I am happily free of many of the other problems that the midwives talk to me about, but can see what a lifeline they must be to women living with domestic abuse and violence, or with drug and alcohol problems.

On the acute side, my husband and I have recently had 2 visits to A&E and an admission for surgery.

The first A&E visit came when I was 8 weeks pregnant and was having symptoms that could indicate a miscarriage. It was a Saturday night, so after speaking to a midwife I went to A&E. I had to wait to check in behind two idiots who apparently didn’t know what A&E stands for (one wanting to see doc there instead of his GP, and one who wanted to be seen there rather than make a fracture clinic appointment as advised by another hospital). They were, politely, given pretty short shrift by the receptionist. Apart from that, I was triaged pretty quickly and seen by a doctor after not too long a wait. He was able to reassure me that I probably wasn’t losing the pregnancy and arranged for me to have an ultrasound scan a couple of days later. I was given pretty much the first appointment available, and it turned out all was well.

The second A&E visit came two and a half weeks ago, after my husband was knocked off his bike by a careless driver. You can read his account here http://pixie359.wordpress.com/ (warning, very strong language!). The short version is that a driver cut across his right of way and he went into the side of the car. The driver then drove off, leaving him in a bloody heap in the middle of a junction. So an ambulance and the police were called by some good samaritans and he went to A&E, shortly followed by me. There he was seen by a doctor, nurses, and radiologists, his broken elbow and various cuts and bruises were patched up, and he was given an appointment for the Sunday morning fracture clinic (the existence of which tells you a lot about A&E on a Saturday night…) The time between the accident and getting home was only four hours. He was treated kindly at all times (even by the stern nurse, who I think they have in on a weekend specifically to deal with all the drunks).

As if husband wasn’t in enough pain, on Saturday night he began to experience some pretty unpleasant abdominal symptoms and spent the next 36 hours in bed. Yesterday he made an appointment with his GP, who promptly referred him to the surgical admissions unit of our local hospital with suspected appendicitis. After a bit of a slow start (he apparently looked a bit too well when he arrived, so wasn’t prioritised!) his condition got worse. I asked if someone could see him and the nurses got him some pain relief and were monitoring him whilst he waited to see the registrar. It was quite a long afternoon, and he had to wait in a side room as there were no beds, but as the amount of beds funded is hardly in the control of the ward staff, we didn’t complain. The staff have also noted this on his record and this will be passed on as they didn’t think it was acceptable. The staff were very busy but I think they gave him the attention needed, though I’m glad I was there to keep him company and to make sure he didn’t get worse between nursing visits. He got to see the consultant surgeon in the evening and was operated on in the middle of the night. The consultant surgeon gave us a clear idea of the risks and recovery time. He came round from the op safely.

I think anyone with an ounce of sense can see that all of the above, free at the point of use, is pretty ruddy marvellous.

[Since writing this he has returned home, it wasn’t fun but everything was fine, apart from the horrifically bad food]

Why we need to protect the NHS

All of the above was possible because we have a taxpayer funded, free at the point of use health service.

The first good reason to protect the NHS is what it provides to the people of this country, compared to the alternatives. In many other countries our options in each of the above situations would have been

  • Pay for treatment at point of use, i.e. paid up front for each treatment and investigation, or become indebted to the hospital and have to pay the bills
  • Claim for treatments on health insurance
  • Go without treatment

To start with the first option, who the heck has enough money swilling around to pay for expensive medical treatment up front? Not me. So, as often happens in the USA, we could have been bankrupted by the bills (or denied treatment). Out of 313 million US citizens, households containing 1.7 million people will be bankrupted by health care bills in 2013 (http://www.cnbc.com/id/100840148) and about 56 million adults, which is more than 20 percent of the population between the ages of 19 and 64, will have trouble paying their health bills (as above).

The second option is the way insurance based systems are presented to us. ‘It’s easy’ they say ‘you just pay your insurance premiums like you pay tax, and then claim against it when needed’. There’s so many problems with this premise, I don’t know where to begin! Perhaps with a story. A family member lives in Australia. He has a decently paid job and ‘good’ health insurance. Earlier this year he came off his mountain bike and broke his pelvis. His treatment has mainly been paid for by his ‘comprehensive’ health insurance. Oh yes, apart form the A$1000 (£590) for the ambulance which the insurers claim they don’t have to pay for, as his injuries weren’t ‘life threatening’. He is currently locked in a battle to try and get this cost reimbursed.

I myself have lived in a country with an insurance based system. Luckily I didn’t need acute treatment, but I did need to see a GP on more than one occasion. This cost the equivalent of 5 hours’ wages, plus the cost of any prescription medicines, and was not covered by insurance. I struggled with the cost and I knew plenty of people who didn’t go to the GP until they got desperate. 

I am now in the happy position of being relatively well off (well educated, job, good work history, two income household, smallish mortgage) and so I would be one of the people potentially least affected by losing the NHS (as long as I didn’t develop a serious long-term condition). However, unlike most of the people making decisions about the NHS, I have been poor and I have been unemployed, without many qualifications. I have struggled to pay bills and I can see where I would have been in an insurance based system. And anyway, the idea of ‘I’m alright Jack’ is a pretty poor way of forming your political views.

Another problem with the insurance based system is that, unlike income tax, it is not based on how much you can afford to pay. In fact, as we know from other sectors such as energy and banking, the poorer you are, generally the more you pay. And there are periods in most people’s lives when they simply do not have the money to pay for anything other than rent and food (if that). And if you don’t pay your premiums, you aren’t covered. Simples. 

The last option is to go without treatment. Do I need to spell out the implications of not being treated for appendicitis, or a broken arm, or having medical attention during pregnancy/childbirth? I think you can fill in this blank.

A second good reason to protect the NHS is that it is actually really good value for money. In 2011, the Commonwealth Fund found that the NHS was exceptionally good value for money compared to other developed countries, who mostly have insurance based systems (http://www.telegraph.co.uk/health/healthnews/8877412/NHS-among-best-health-care-systems-in-the-world.html). 

Another example of the value for money of the NHS is this: the average cost to the NHS of caring for a woman through pregnancy, childbirth and post-natal care is £2800 (http://www.england.nhs.uk/wp-content/uploads/2012/07/comm-maternity-services.pdf). The average cost of pregnancy care in the US being about $30,000 (£19,300) for a vaginal delivery and $50,000 (£32,200) for a caesarian section, with insurers paying out an average of $18,329 and $27,866 (http://www.washingtonpost.com/blogs/wonkblog/wp/2013/07/23/the-royal-birth-cost-15000-the-average-american-birth-is-billed-at-30000/). And the death-in-childbirth rate of the USA is worse than nearly every other industrialised country, which shows that a lot of women are not accessing good healthcare during childbirth (http://www.theguardian.com/world/2010/mar/12/amnesty-us-maternal-mortality-rates).

It’s a basic idea, and generally accepted, that economy of scale works. This is why beer in a Wetherspoons is cheaper than in your local independent pub. And this is why a national, tax-payer funded, system can deliver such good value for money. And yes, there are problems with large bureaucracies and vast organisations, but these are essentially an issue of how you arrange and manage an organisation. They are solvable problems.

I really don’t trust this government to do it’s best to maintain the NHS but a change of government wouldn’t necessarily signal that the service is safe. Constant rearrangement of how the NHS works is a danger in itself. The OECD (not exactly full of raving commies) wrote a report showing that the reform that seems to be the passion of every new government costs years in improvements in quality (http://www.theguardian.com/politics/2011/nov/23/health-bill-nhs-oecd-report). This isn’t to say that nothing should ever change, just that huge systemic changes aren’t necessarily going to improve anything and the impact of the fact of changing itself needs to be considered.

All of my arguments around the NHS of course assume that your end point is to make sure everyone has access to decent healthcare. I sometimes doubt that our current government really have that aim in mind. I could spend time arguing about why everyone should have access to good healthcare, but I’m assuming a basic level of decency from the reader.

I’m really worried about the future of the NHS. I see the next ten years being where the easy stuff is done by private providers for profit and the hard stuff, the stuff that’s complicated and unpredictable, and therefore unprofitable, being done by an increasingly underfunded NHS. I rather suspect that the long term idea is to starve the NHS of money and political support in order to make it so bad that the public will accept the insurance model, without actually knowing any of the pitfalls. The generation who remember life before the NHS is dying out, and with it their human stories of suffering which, for all the statistics I can throw out, is essentially what this is all about. Looking after our fellow human beings and stopping their suffering. Which is why we need an NHS.

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