It has come to my attention that my blog posts so far could be misconstrued as ‘anti NHS’.
That in detailing my nightmarish three week hospital stay I am somehow attempting to provide evidence of why a government run National Health Service is a fundamentally flawed concept.
This couldn’t be further from the truth!
I am a passionate believer in the NHS, despite my recent negative experiences and in this blog I will attempt to set out why.
Firstly let me say that I believe a ‘bad’ medical experience could happen anywhere in the world and under any kind of healthcare system. I do not think poor practice is in anyway exclusive to the British NHS. The shoddy care I received was in the form of organisation/administration issues relating to my transfer between The Royal London and St Barts, staff shortage, resulting in ‘cover’ staff with no idea what was going on and arrogant doctors with poor people skills not communicating with me properly. However ANY ‘system’ be it public or private can end up badly run, short of money or short staffed. These things, more often than not, are caused by management decisions, regardless of whether that management is business or government led. In the end I got the correct surgery, performed by an excellent surgeon and while a private medical experience may have been more pleasant I am sure the surgical outcome would have been the same.
Unlike many other things in life, healthcare IS something we will all need. It’s a very rare (or non existent!) person who lives their whole life from birth to death without illness or accident and who passes quietly away in their own home without ever needing a doctor. Even if such a person were lucky enough to exist they would still have family, friends and loved ones around them who weren’t so fortunate. We are mortal beings. Not one of us are unaffected (directly and indirectly) by ill health at some stage in our short lives.
So, with this in mind, is the ability to access healthcare considered a basic human right?
Yes, it seems it so…
The UN Universal Declaration of Human Rights, Article 25, states: ‘Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services’. There is a certain ambiguity in this though; the right to medical care does not necessarily mean the right to FREE medical care.
Of course there is no such thing as free medical care. All medical treatment costs money and all medical staff need to be paid. The question then becomes how should the costs be met? Is it up to the individual himself to foot the bill or is it the responsibility of society as a whole?
Nye Bevan, grandfather of the British NHS and Labour Health Secretary during the 1940s, sums up the argument for me in this quote: ‘No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means’
I believe the way we care for our most vulnerable citizens is one of the most important differences between a just and unjust society. I want to live in a country that takes responsibility for the disadvantaged and does not turn its back on the elderly, sick and disabled.
I’m proud that the founding principle of the British NHS is that it is ‘free at the point of need.’
In order to meet this requirement it is entirely paid for by taxation and National Insurance – from the information I was able to access on the Internet it seems currently about 4% of tax taken from an average wage is spent on Health. There are now some small costs – in England some prescriptions cost around £8 (though not in the other UK nations where they are universally free) and NHS dentistry (which was partially privatised under Margaret Thatcher’s government) usually incurs a fee, but essentially the NHS overall still remains a free service.
I believe in its sixty seven year history, the British NHS has benefited this country immeasurably. From mass vaccination programmes, to cervical smear testing and the availability of the contraceptive pill, the Nation Health Service has prevented disease and suffering as well as treated the already sick and injured.
When I decided to write this article I posted various messages on social media asking for people’s personal thoughts and stories about the NHS. The general consensus from those who contacted me was that while there maybe issues in its current organisation or with individuals working within it, overall it is a fantastic and completely necessary institution that we in the U.K. are privileged to have and must fight to keep.
The main thing I believe the National Health Service has to its advantage is that is is ‘not for profit’. At the root of all private sector ‘competition’ is the drive to make money. Ultimately any private medical business has to make healthcare decisions based on both patient need AND financial gain in order to maintain its existence in a way that the public sector does not.
In order to illustrate this point I’d like to use two examples of friends of mine, one here in the UK under the NHS and one in the U.S.A., where there they have a private medical system.
My UK based friend, Amy, a self employed woman in her early thirties, was struck down with a stomach condition in 2009. Over the next two years she required hospitalisation for some nine operations, all kinds of scans, treatments and consultant appointments until she was finally discharged in 2011. All this treatment was given free at the point of delivery by the NHS.
Amy says ‘There is no way I could have had THAT much treatment if I’d had to pay for it. Obviously I’m a freelancer so had no insurance or anything. The care I received was amazing really. Yes the length of time you have to wait for consultant appointments can be ridiculous and not all of the ward nurses are as good as each other BUT overall I feel very lucky to live in a country where you don’t have to be rich to be properly cared for…’
Contrast Amy’s story with the experience of my U.S. based friend, Rob. He and his wife were already paying $850 a month on general medical insurance when they decided they wanted to try for a second child. Under their insurance system they had to add a ‘maternity rider’ to their existing policy for another $150 per month in order to be covered.
Rob says ‘We looked into adding the maternity rider, but you can only add it during the one month adjustment period in November. This was in February. Then we come to find out that after the maternity rider is added, there is a six month waiting period before a pregnancy is actually covered. In essence the insurance company was dictating that we had to wait fifteen months before we could even start trying to get pregnant if we wanted coverage. So we decided that we’d absorb the costs and go ahead without maternity coverage. When Luke was born, we had spent $3000 in pre natal care. The birth itself cost $19,000 and postnatal care was an additional $5000. Luke is 4 now. We just finished paying off his birth. And we have a six figure annual income.’
It’s worth bearing in mind that under the U.S. System if even someone on a good income can end up in difficulty owing thousands of dollars, where does that leave the poor and disadvantaged? I certainly can’t imagine how I would have felt, if after all the stress and pain of my pneumothorax, I was then presented with a bill for thousands of pounds for the cost of my treatment.
Presumably the Health Care insurance company that Rob uses in the U.S is a private company, with shareholders and is striving to make the biggest profit it legally can each year, as would be the case with a retail company or restaurant chain. In which case can it really be said that it has its clients health at the core of its practice?
The NHS, despite its many problems, is a service in the same way as libraries and schools. There is no profit to be made from a person’s illness in our system and I believe this is the way it should stay. Our country is unequal enough as it is without imagining the two tier society that would emerge were the rich and privileged to have insurance granting them access to state of the art treatment while the poorest members of the community had to rely on charity or face massive debts every time they became ill.
Thankfully the way our NHS is currently implemented there is not one person in this country who does not rely on it to some extent. Even if I was a billionaire and had the best insurance money could buy if I crashed my car in the UK tomorrow it would be an NHS paramedic who performed CPR on me and an NHS ambulance that would drive me to to an NHS A and E department. This means (hopefully) that everyone of us should have a vested interest in maintaining and supporting the NHS.
History shows us that the dismantling of previously state owned services does not always go well. British Rail may have had its problems but at least they were clearly accountable under state owner ship. Now it’s difficult to know who or which company is at fault when things go wrong. Punctuality was supposed to be improved under privatisation but this has not been the case and as someone who travels regularly I can vouch for the vast disparity in fare prices in different parts of the country.
Now while it maybe annoying if a train is delayed or a fare price inflated, it would be unthinkable if an appendectomy cost an individual £5,000 in Brighton but £2,000 in Glasgow because of a different service provider. I don’t think the public would accept this.
In fact the NHS is consistently voted the most beloved institution in the UK. I think it’s incredibly unlikely any government could conceivably pass a bill announcing its privatisation in the next few years. What I think is more likely (and dangerous) is the dismantling of it piece by piece. We’ve already seen some non medical services such as laundry and catering outsourced to private companies. This is both insidious and under reported. It’s also possible that under ‘austerity’ as the NHS budget gets squeezed the public become so dissatisfied with the service, lawmakers can justify suggesting privatisation as a way of ‘solving’ the problem. I think we must be aware of and rally against any attempts to privatise the NHS via the back door.
This is not to say the NHS is perfect the way it is and does not currently face a huge funding crisis. Jen, a Theatre Director friend of mine, who has had more than her fair share of hospital stays, summed it up perfectly, I think, when she said to me ‘The NHS is the victim of its own success – people live longer thanks to better medical care, long-term conditions can be managed for longer times, there are far more conditions that actually are treatable than when the NHS was founded… none of that is going to change, and treatments are going to continue to improve and be expensive……’
Interestingly everybody I spoke to said they would be willing to pay higher taxes if it meant a better funded and better run National Health Service, but throwing money at it alone is not the only answer. It’s clear there are deep flaws in the way things are currently run.
Sarah is a thirty- five year old Consultant Anaesthetist working within the NHS, she described to me some of the problems she faces:
‘On a daily basis we are short staffed, badly. Perhaps not quite so bad in theatre because someone, probably a cocky surgeon (or anaesthetist!), would stamp his foot and refuse to work in an unsafe environment, but the wards are appalling and it shows. Never a nurse to find to ask about patients, get medicines prepared, feedback to post op or to look after a sick patient – they are run off their feet and massively understaffed. ‘Sickies’ often get moved to high dependency when they could probably be managed in the ward, just because of staffing ratios (which is of course is better in HDU but should not be as bad as it is on the wards).’
This certainly seemed to be the case when I was a patient; many more ‘cover’ staff than permanent ones, very few nurses per bed, some nursing staff so overworked they were almost in tears in front of me.
Sarah explains ‘A lot of places have a restriction on employing permanent staff (nurses especially) so they function from a nurse bank. Historically, this was made up of staff who worked in the hospital anyway and were basically doing overtime. But various changes mean that some people (those with children, relatives to look after, often those from other countries) are permanent bank staff. Medicine needs continuity of care. It is so frustrating to turn up on a ward and ask a question about a patient, only to hear this is the nurse’s first day or she doesn’t usually work on this ward and doesn’t know.’
From what I’ve read in the last few days and from my own experience as a patient I’d say NHS managers have too much pressure on them to reach targets and stick to quotas rather than meeting the needs of patients at ward level. An example during my care was when I was still at The Royal London Hospital. My consultant told me that they could do nothing more for me there, I had to be transferred to the Chest ward at St Barts. Despite his request and that of the Surgeon at St Barts, management refused admit me on the basis of a nursing staff shortage over the bank holiday weekend. This was on the Thursday. Management initially said I couldn’t be moved till the Tuesday. The consultant and surgeon made repeated phone calls and even my ward Sister tried phoning the Sister at St Barts (who she was friends with) to see if anything could be done. I really got the impression the medical staff were fighting to get me moved. Eventually someone relented and I was moved on Easter Sunday.
I have no doubt that being a nurse or doctor in a modern hospital is stressful and emotionally draining enough without having to battle management at every corner too. My conversation with Sarah reminds me that the vast majority of doctors and nurses do go into the profession because they care about people and want to make a difference. Perhaps sometimes that gets lost a bit somewhere a long the way but there must be moments when even the toughest medical professional is affected by what they have to deal with…
‘Holding someone’s hand and telling them you will take good care of them as you put them off to sleep, knowing fairly well that they probably won’t ever wake up again (not due to my shoddy anaesthetic!) is something that sends a chill down my spine every time. And I have done that. Lots.’ Sarah tells me.
So despite the issues she faces on a daily basis does she still believe in the NHS?
‘If you are sick, no matter who you are, you should be able to turn up at a hospital and be treated, with the best medicine, doctors, nurses and ancillary staff. You shouldn’t have to foot a bill for this. You shouldn’t have to worry about whether you can afford to pay for your specialist diabetes appointment (which if badly controlled can lead to infections, gangrene and amputations and serious impact on function and quality of life) or whether it is actually a heart attack. I don’t know what the answer is. I’m not a health economist, but we need to keep the NHS…’
Whilst I feel incredibly unlucky to have had a pneumothorax at all (especially since it’s most common in tall, thin, male smokers – all of which I’m not!), I do feel I am fortunate that I live in a country with comprehensive, free, medical care. I cannot imagine the strain of living under the American system where the whole three week hospital stay could have left me in financial ruin worrying about my future.
However, worse even than that, I wonder what would have become of me if I had been somewhere like Sierra Leone or The Democratic Republic of Congo? I probably wouldn’t be writing blogs while recovering from surgery that’s for sure…
There are many many countries in the developing world where the population have barely any access to medical care at all. Women give birth on a daily basis with no midwife care, many die in the process. Children are born with HIV and receive no treatment. Diseases like malaria and even simple diarrhoea end lives and destroy communities.
We are so privileged in the UK to have The National Health Service. We grumble about it and we rightly point out its faults and debate ways to improve it, BUT we must never lose sight of how important it is. How many of us wouldn’t be here without it? How many of us were Caesarian births, or had our appendixes out, or have diabetes?
Nye Bevan, Clement Attlee and that post war Labour administration gifted us one of the most comprehensive National Health Services in the world. In these times of austerity and uncertainty we must not forget what we owe to those who fought to give us the NHS. We must preserve it ‘free at the point of need’ for all the generations to come…