I was reading this BBC article on Trump’s recent tweets (apparently sparked by some Fox and Friends show he watched with Nigel Farage (who I understand isn’t that popular with most UK 'dopers…or many in the UK as far as I know). It was amusing to see how Trump can spin something to be exactly the opposite of what people are saying. From the link:
So, got a chuckle. It seems most of those in the UK love their NHS. But…also linked on that same page was this article.
Overall and from the outside, it seems to me as if even with the above, it’s a good solid system that just needs some tweaks. What I’m wanting in this thread is input from UK 'dopers…what do you think of your system? What I DON’T want (though I’m sure this will fall on deaf ears) is the standard comparison to the US mainly from US 'dopers pining for that sweet, sweet NHS here in the states. Please…PLEASE…don’t mention the US in this thread, don’t compare it to our system, don’t tell me how much better it is. I don’t even want it compared to other EU systems. What I want is…how do you like it? What do you like about it? What do you wish it improved on or what do you think needs to be fixed and what do you think should be done to do so. Or, do you think it’s basically a good solid system already and maybe only needs a few tweaks here or there to make it perfect?
Today’s Fresh Air is an interview with a British woman who has written a book about her 17 brushes with death. One of them involved the NHS. She had had encephalitis as a child, and was warned about her ability to have natural childbirth. When she gets pregnant anyway, she asks her NHS doctor for a caesarean section because she won’t be able to give birth naturally.
But NHS has a lot of problems and they have established a maximum quota of surgeries to be performed per month, and her doctor basically told her she was lying and had no medical reason for such a procedure, without examining her or looking at her medical history. So she almost died during childbirth, and they had to do the caesarean anyway.
This was a very uncomfortable story to listen to, for those who think that other countries with single payer health systems are doing fine and have few or no problems. She said several times how much she loves the NHS and is sad to see it in such a difficult condition as it currently is. How many of us would stand for that kind of treatment and still come back and say afterwards that it’s “sad” and not “outrageous?”
I severely doubt that is how or why it happened (if it happened)
To the OP.
It is a great system with pretty damn great outcomes but it suffers from the challenges of all universal healthcare systems. Rising costs of many more advanced treatments for an ageing population.
The biggest problem is that because it is seen as untouchable it is very hard to introduce any major improvements either in treatment or funding models and there is no doubt that something rather radical will be needed at some point in the near future.
That’s one of the things mentioned in the BBC article…what’s the optimal model:
This SEEMS like it would be a relatively easily fixable issue, though it might cost a bit up front to shift to a different model. It seems like it would save money though in the long run if you got rid of large centralized hospitals where it makes sense and go to smaller, community centers.
Doctors make mistakes everywhere in the world and the UK is no exception. An organisation the size of the NHS is bound to have some incompetents; both medical and managerial. By the same token, there will also be a large number of brilliant doctors, nurses and managers doing an excellent job.
We have what is known as a ‘postcode lottery’ which means that the quality of care and, importantly, the procedures and services that are available, can vary from place to place; regional management is supposed to react to local needs. On the C section question, it is not long ago that we were seeing headlines “Too Posh to Push” and there was a drive to reduce the numbers. In the NHS generally, c-sections aren’t performed through ‘choice’ or for non-medical reasons. This is due to the fact a c-section is a large surgical procedure with many risks and potentially post-surgical complications compared to pushing the baby out through the birth canal.
The important fact is that whoever you are you will get a relatively high standard of medical care. Yes, for sure the NHS could be better, but it could be a whole lot worse. This has given rise to a problem in A&E departments where people go with what are often very minor injuries or medical problems. Each one has to be seen and it seems that even a four hour wait is no deterrent. Add on the drunks, druggies and people who just want somewhere warm to hang out, and you have a problem that no one seemingly has a solution for.
When I worked for the NHS twenty years ago, I went to a seminar on recruitment and retention. We were told, that to fill all the current vacancies that year, every school leaver would have to start work with the NHS. For years, the NHS, like many other organisations, has relied on immigrant labour to fill the junior and the more menial posts. That supply is drying up and this creates a huge headache. Add in the amazing medical advances like transplants etc which cost huge amounts of money and you create imbalances. A country like the USA with an insurance-based system solves that problem by only making those procedures available to those who have the means to pay.
I’m not going to repeat all the good points already made. The NHS is not perfect, but it’s pretty damn good. One of the problems is that as medical technology and expertise has advanced, people want the NHS to do more and more. Scope creep has become rampant. This also affects entry-level staff, particularly nurses. Nurses used to be pretty much trained on the job. Now they require lengthy courses. All this requires money, and the money has to come from somewhere.
Someone needs to sit down and think about what we want the NHS to do but to do so would be political suicide. So we have the classic British fudge. But it’s pretty damn tasty fudge, and good enough. And for those for whom it is not good enough, there is private medical insurance.
The book is described as a novel. I think that it’s safe to assume that many of the events (which are impossible to verify) are, at the very least, exaggerated.
I liked the NHS better than the current system I’m under, in the Netherlands. Here, I pay about €150 a month but the system is much worse. (Ooops, sorry, I compared.) I think that’s largely a local systems-thing, rather than the overall system. Because I only experience the local system. I read about the whole system, but so does the OP and he’s asking for experiences.
On the NHS, you could just get care. Anywhere, for anything. Just like that. Now, I need all sorts of paperwork and my local providers are rubbish. The GP, the chemist, the hospital: they don’t play well together. Plus the system funds homeopathy, which is frankly enraging. I never had these problems on the NHS, my GP was wonderful and efficient, so was the hospital, so was the chemist. But again, that’s a local experience and doesn’t say much about the functioning of the whole system.
One thing that really bothers me is spending time on trying to get care, spending time on paperwork, spending time on your insurance, spending time on your medical costs - all this useless time spent. There was none of that on the NHS. Care was just there.
Sorry OP, I know you didn’t want comparisons but it doesn’t really work. Without a comparison it’s just “the NHS was great” but that’s not very interesting.
Well, I am not currently in the UK, but I have lived there for many years and used the NHS on occasion.
Superficially, the NHS is fast and responsive. I’ve never had any significant waits or problems. My girlfriend who is from the UK was unsatisfied and changed her doctor and surgery. He later lost his licence. The NHS does not look as shiny as many European systems, the buildings are dingy, the chairs worn etc, but the UK in general has an issue with a large mass of legacy architecture and infrastructure that is just about good enough for purpose.
When you look at the numbers, the NHS is exceptionally cheap. If you compare it to OECD peer nations with roughly the same price level, it is 25 to 50 % cheaper. New Zealand does even better here. What is more interesting is, comparing it to nations with systems explicitly based on the NHS -Beveridge type systems- Denmark, Sweden etc. it is still very cheap. If you compare it to other large developed nations such as Germany and France it remains cheap. (Although Germany runs a Bismarck model, generally more expensive).
If we look at some generally acknowledged (and quick to check) measures for health care system performance, lifespan, infant mortality, maternal mortality, the UK tends to score towards the bottom of the comparable nations. Generally, the claim that it is effective but underfunded compared to similar systems in peer nations seem strong.
The OP did not want comparisons with the US system. That is sensible, because the US does not really have a system in the sense that other nations do, it has a large range of systems. I think there could be some merit in comparing the NHS to other European systems.
The NHS, overall, is awesome. Yes, it needs more money and more resources (and I could go into a lengthy rant here about the Conservatives starving it of funds in order to drive down results and justify creeping privatisation - again - but that’s a separate issue) and more people (not helped by impending Brexit driving away lots of qualified medical staff), and yes, like every medical system everywhere it has its share of incompetents and errors and excessively needy patients wasting time and resources unnecessarily, and of course a growing and aging population is putting considerable additional strain on the system.
But I can usually ring my doctor’s office first thing in the morning and get an appointment on the same day if I need one (although that may be a factor of where I live - see the “postcode lottery” point above). There is no paperwork involved at all - I literally just turn up and give them my name and DOB and that’s it. My doctor’s surgery is in a local medical center - not a hospital but a place that does all sorts of outpatient services and testing and also has an urgent care clinic for non-emergencies. And there’s an NHS helpline (at least I think there still is - they keep messing with it) for non-emergency medical concerns like when your child suddenly gets sick at 2am and you need to know whether to take them to the hospital or just give them paracetamol and put them back to bed.
The hospitals are maybe not as nice as those in private systems, including the UK private system (okay - they’re rundown) but all the ones I’ve been in have been fine and functional and filled with skilled and helpful staff. I’ve been relatively lucky enough not to need too much in the way of emergency care, but last year when an infected tooth went very bad very quickly the dental A&E got me in for an emergency root canal first thing in the morning which literally may have saved my life. When my daughter was born she and my wife had to stay in hospital for a week due to medical issues, including a stay in the NICU; it wasn’t much fun (in part because the maternity ward didn’t have any air conditioning - in midsummer) but the medical care was excellent. On the few occasions I’ve had to take my daughter into the hospital for emergencies they’ve had separate children’s A&E departments and a separate triage process. I’ve also had follow-up cancer checks (this, despite the fact that the cancer and initial treatment happened before I moved to the UK) and a non-emergency operation (which was rescheduled once on the day due to the ERs being needed for emergency surgeries) and both were fine if not fancy.
And again - virtually no paperwork. I do get private insurance as part of my job but to be honest I’ve never needed to use it although I know people who have. And that requires paperwork.
Oh, and prescriptions are all currently £8.60 per item. That’s about, what, $10-11?
That’s max copay, I’m guessing. If the med happens to cost less, does the patient pay for it in full or is there a %? One of the current issues in Spain’s healthcare puzzle is that different regions do it differently for “pensioners” (retirement, disability, etc.), who used to get full medication coverage for scrips; for active workers having a scrip means the system pays a fixed % and the patient the rest.
The experience of my coworkers going to an ER in Glasgow was the same as going in Spain, other than being a bit miffed that the patient got checked for pregnancy (we would have had to call the Vatican, but the medics said it was part of the protocol for a woman her age). They went, they showed her EU-SS card, they waited for a short time, they were attended to, she was given some medication that worked fine, no need for admission and got sent home with instructions.
It’s a one-price-fits-all approach - the patient pays £8.60, full stop. I can’t imagine very many medications fall below that price for a full course but who knows?
There are also various exemptions:
and there are likewise adjustments for those unable to pay full costs.
Details hereif you’re interested.
ETA: I attend a private dentist. Note that the one time he gave me a prescription, I had to pay full whack (about £28 IIRC) because it wasn’t from an NHS doctor or dentist.
One can discount Nigel “Gissajob” Farage’s view on the impact of immigration on the NHS, not only in relation to the service’s dependency on staff from overseas, but also because the most problematic demands on the service are not from immigrants or “health tourists” but by the extension of lifespans and the needs of older people. Because of that, immigration of younger people potentially increases the tax base and funding pool (or would if we had a government that seriously tackled low pay and abuses in the labour market).
As several times before in my lifetime (only a few months older than the NHS itself), problems have surfaced when there have been long periods of government policies of austerity squeezing the finances. Comparing it to other areas of government expenditure is almost irrelevant since that too reflects government priorities - the NHS is the one thing the electorate would not let them slash away at. This has an unfortunate side-effect in that they are squeezing local government funding (from which the social care support that would help older people more at home and forestall calls on hospital services) even more.
