Having spent a bit of time up close and personal with the NHS recently, it’s given me some time to reflect on its nature.
Firstly, most people’s perceptions of it are I suspect coloured by their personal experience. Anecdote looms large whenever talk turns to doctors and hospitals – how could it not? I was seen, diagnosed and operated on within the space of a month. I was diagnosed by a top neurologist in a huge, clean, modern hospital and operated on by a team using groundbreaking ‘gamma knife’ technology in the same ward where Richard Hammond was treated following his near-fatal crash, despite having neither great wealth or fame. I’ve paid my dues through the tax system and been handsomely treated by a service blind to status or personal background.
But yet. My story is just that: a story. In the bed next to me was David B of Pontefract. For 7 years he struggled to find treatment for leg pains that left him unable to walk – and therefore unable to work. So knowledgeable was he about his own condition after long years of pain that he had to correct the nurses’ medication charts for himself. Despite his erudition and knowledge and despite his articulacy it had taken 7 years to negotiate the system and get onto a neurology ward. His own brand of gallows humour certainly had a different colour to my own and when I left he remained undiagnosed, marking time on a cocktail of pain killers.
You pays your money, you choose your anecdote. On this basis the NHS could be either miracle or nightmare.
There’s definitely a problem associated with size. I think regardless of the source of funding – whether you’re a fully signed-up Tractor Production Operative straight outta 1940s Ukraine or a foaming Friedmanite free market fundamentalist – any organisation with 1.6 million employees and over 60 million ‘customers’ can’t be efficient.
Returning to anecdotes, I have sat through probably 12 – 15 different mini interviews with various medical personnel over the last few months. Every single one, without exception, asked me about allergies or existing medical conditions. Without exception every single one diligently noted my allergies (Penicillin, peanuts, cats) and medical conditions (asthma, recurrent oesaphageal bolus). I’ve been telling NHS personnel this for decades – shit, they diagnosed these things – and yet on every visit their collective memory is blank. Maybe Tommy Lee Jones and Will Smith turn up after I leave with a little memory-wiping light pen.
Where does this paper go? How come, in 2011, with all the wonders of technology and the sheer ubiquity of database systems does this information not follow me around with my NHS number?
It’s a small thing in my case, but returning to Dave B of Pontefract for a second the details of his daily medication were wrong. 3 different nurses did the rounds to deliver his pills. 3 times he patiently explained to each of them that their notes were wrong and that the 50mg dosage on their charts was insufficient. The information couldn’t even survive the end of a shift, much less the passage of years.
Another, less trivial anecdote. As I lay in my bed, near the nurse station, the ward sister/matron/overlord was engaged in a frantic paperchase with another ward. A 73 year old stroke patient had been sent from the Neurology ward to a different department for a scan. He never returned. Instead, this department had discharged him. Literally sent him out of the building: 73 years old, undiagnosed, suffering the after-effects of a stroke, onto the streets. Responsibility, communication and responsive action seemed notable by their absence – despite the best efforts of the person on the end of the phone.
So, you can read the runes of the anecdotes any way you like. But pull out to the wider picture, and the NHS fails by many measurable metrics. On the huge scale of things, the matter becomes one of aggregated statistics. And there the truth comes out. Survival rates for cancer are pitiably low – down there with the likes the Poland, despite the almost incalculable extra billions spent. For heart disease, witness our 20% greater death rate than nearby Germany. We have fewer hospital beds per head of population than poor, bankrupt Greece – despite spending 25% more per head of population.
The NHS is also deeply politicised – and this is because of the way it is funded. Some elements of the medical profession are militant. One of my nurses was on her last couple of days and was very vocal about leaving the NHS because of the changes coming up. The stupid, sci-fi dystopia TV screens attached by mechanical arms to the beds had Andrew Lansley’s stupid mug playing on rotation. All the nurses seemed to see him as some kind of Voldemort figure. Maybe he is. I don’t know. But politics have no place at the bedside.
Likewise, a friend of mine – a nurse – sprays her Facebook wall daily with polemic about ‘cuts’ and union activism. She is a believer in the NHS. It is often said that the NHS is the closest thing to a religion left in the country and this is both true and unpalatable. The goal of any health system is to save lives – not waste them in the name of “equality of access”.
Instead of looking rationally at what systems deliver the best health outcomes, we’ve spent 60 years exploring a cul-de-sac with apparently scarcely a glance at a map book.
Of course if any politician dares to speak of ‘reform’ the land trembles to the sound of marching feet and the refrain of “we don’t want to end up like America!” as if there were only a binary choice between our system and theirs.
Now I’m no expert in the provision of healthcare, but it seems pretty obvious that Specsavers do a better job of eye care than the NHS did or could manage on its own. I get regular, cheap eye tests and have dabbled with various styles of glasses and contact lenses down the years – always at friendly price points and with a convenience it’s hard to imagine anyone a GP ever delivering.
It also seems pretty clear that with even relatively small subscription fees that schemes like the Leeds Hospital Fund (now sadly subsumed into some conglomerate in the modish fashion of the age) have managed to offer superior levels of service than the NHS can by itself.
The answer would appear therefore to lie in the model adopted by most of the world: compulsory health insurance, with a minimum guaranteed contribution by the state and top-ups according to each individuals needs, wants and financial circumstances. That such a suggestion is beyond the pale in polite conversation tells you what you need to know about the mythic status of the NHS. In its current form, it has been a heroic failure.