For many in the UK the National Health Service (NHS) plays a large part in defining who we are as a country. It would be political suicide for a politician to declare that it was irremediably broken and that it needed not to be upgraded (as is presently proposed although with enormous opposition) but dismantled.
I have some recent experience of the NHS. In August 2009 after a visit to my excellent General Practitioner (GP) I was sent to our local hospital and almost immediately informally diagnosed with colon cancer. From there the story becomes less favourable. It took an age for the CT scan to take place because one of the two available machines was out of service. I was then eventually told I also had secondary liver cancer but not that it was terminal. This I discovered on the Internet.
I started chemotherapy but after the first two weeks developed a severe reaction. The local Cancer Department told me it was not connected to the treatment and it was only when I was severely dehydrated and in some distress that my lovely GP told them to find me a bed. They fixed me up and sent me home after five days. My oncologist was on holiday and no one else took much interest in the cancer itself, a theme that was to become familiar.
I went private after that and my new Harley Street oncologist put me on a drug not available on the NHS. My insurance company AXA (the only name on offer in this article) have been excellent throughout by the way.
Things did not go well. I developed a blood clot between liver and small bowel and ended up in Accident and Emergency (A&E) where they carried out the tests that established the clot and told me I had days to live. I was admitted and further tests were carried out but although I was told nothing, my wife was given the option of taking me home to die or leaving me in the hospital. The following day they told her they were going to operate but that she should not expect a good outcome. We were never told the reason for the change of mind but cannot help but suspect it was budget-driven.
I was in hospital for nearly six weeks after the operation. There was little consistency save in the sheer number and variety of doctors who came to see me, some only once. They would arrive in a pack, the most senior would rip off the bandage over my wound and make some profound remark, and off they would troop. Sometimes the senior guy would prescribe some particular action or drug. Very often this would be countermanded by the following day’s legion. I progressed through Intensive Care and High Care to a room on the General ward. The standard of nursing in the latter was pretty average. I was often left with the dressing unchanged for 48 hours and routine checks on my “waste” bags were casual. I will spare you the horror stories that result from an over-active ileostomy bag in a busy NHS ward.
The food in the NHS is plain awful – reheated and inappropriate in many cases, certainly mine. There was nothing appetising and since my appetite was very poor my wife brought in treats she thought I might be able to eat. As it was I lost over three stone (42 pounds) in weight whilst in hospital.
I eventually persuaded them to let me out and my GP and the Community Nurses looked after my recovery. They were without exception efficient, punctual, charming and most important, effective. My wound started to heal and I was eventually able to go and see my oncologist. Just in time too. If I had not restarted the chemotherapy when I did I would not be writing this article. At no time had the NHS doctors expressed concern about restarting the treatment. Their focus was solely on the problem they could see.
I do not know much about the system in America so it is hard to compare. There are stories of greedy doctors who are keen to extract as much cash as they can from the insurance companies and harder stories of people who have no insurance and cannot afford to pay. In this sense at least the NHS with its “free at the point of delivery” service is pretty civilised. Apparently 17% of Americans have no insurance. Of course in the UK we are all obliged to pay for the NHS through general taxation which is high; there is no linkage any longer with National Insurance contributions which add 11% to the standard rate of tax.
The cost of healthcare in the States appears to be high but some indicators (life expectancy, infant mortality) lag behind other G20 countries and the lack of universal coverage causes thousands of deaths a year. Costs in the last year of life are very high, suggesting that a disproportionate amount of money is spent on some terminal cases. In the UK it is hard to avoid the impression that the NHS chooses to spend its money on cases where there is a greater chance of the patient surviving. There are some real horror stories of how badly elderly dying patients are cared for.
This image is a reminder of how a baby died when midwifes were too busy to stop her suffocating.
I assume (I cannot say with what accuracy) that the private sectors in the UK and the USA offer a similar standard of service. I would exempt from this statement those bits of the UK that are bolted on to an existing NHS hospital. My experience of those is that they suffer some of the same problems as the NHS does.
I would work very hard to stay out of an NHS facility in the future. I think I can discern an uncomfortable sense that too many staff have the attitude, “What do you expect, it’s free, isn’t it?”
“A lot more” is what I think.