Seen a lot of stuff written about the NHS lately and how it really isn’t the envy of the world, and I kind of agree, but only because they have got it all arse over tit. The NHS isn’t the envy of the world, that’s a handy slogan for those who want to keep it and a handy stick to beat us with by those who want it to fail. I mean, I’m sure it is if you are poor or on a low income and live in the half the world that doesn’t have a properly functioning healthcare system, like America or Syria. The fact that it’s free at the point of use and people, especially those with no or low incomes, don’t have to worry about getting sick and having to pay for it is enviable, deservedly. The left fetishises it a some kind of socialist utopia, whereas most people don’t care who does their scan as long as they don’t pay on the door. The right hates it because it is a little bit socialist and they can’t bear the thought that healthy people pay for sick people, until of course it’s one of THEIR sick people. Bear in mind that whatever your politics, the NHS is undeniably one of the most advanced, and comprehensive systems in the world, DESPITE being underfunded compared to a lot of our nearest neighbours.
Sure, the NHS has faults, but show me any system that doesn’t and I’ll show you someone who doesn’t understand the size and complexity of healthcare. We don’t have enough staff, we don’t have enough beds, we have a tendency to change too slowly, we are far too invested in a tick box culture, externally we have to deal with a completely disastrous care system. We are much better at acute care than we are at long term conditions, but I suspect that’s a global issue.
On the other hand, we have some incredible people working in the NHS, just look at how we responded to the pandemic and volunteered to vaccinate you all. We offer modern and comprehensive service that frankly, we tend to take for granted. In combination with our universities, we have some of the best and most innovative research in the world. The UK punches significantly above its weight in terms of citations for research papers, particularly health research, with the UK coming second only to the USA with it’s massive spending on healthcare.
That’s probably cold comfort if you’re trying to get an appointment with your GP or get a scan but the data tells us our waiting times aren’t actually that bad when compared to other countries. The OECD found that in 2014, UK waiting times for cataract, knee and hip replacement were below the average among the 14 countries for which they have data.
We do some things very well and quite importantly, don’t do things that other countries do that they really shouldn’t. In America harmful over treatment and testing is a massive problem, though for insurance companies, a very lucrative one. Many of us in the UK have serious reservations over often unevidenced mass health screening of the healthy population. Screening is not the same as early diagnosis.
“many of these screening programmes are not based on available scientific evidence, and policy-makers, health professionals and the public are often unaware of the potential harm of screening and its cost and burden” – WHO
Digressing slightly, still think we do too much screening, and as evidence guru Margaret McCartney says “Too much ineffective treatment for the well and not enough for the sick” Recommend her book The Patient Paradox and why sexed up medicine is bad for your health.
You still get patient advocates demanding screening programmes or demanding that programmes are extended to more age groups. PSA screening is a good example. Even the discoverer of the PSA antigen said the test is misused and unreliable and yet every so often you see some football stadium offering the test in a van in the car park to drum up public support for routine screening.
Trouble is patients often think they should be able to choose whatever they want on the NHS so if they want a brand spanking new drug that might extend their life by a week, but costs 5 million pounds per dose, they should have it. This isn’t good medicine, nor is it as simple as “rationing”. Nor is demanding CPR for those approaching natural death, nor is offering homeopathy just to placate Buckingham Palace. You can feel for individual patients but sometimes there is no justification for interventions, and yet the EU is once again threatening to introduce routine PSA screening. Some countries feel differently than the UK, but it still isn’t good medicine.
Where the NHS falls down is on outcomes, we are not doing as well as we should be, on mental health for a start. Trouble is the reasons for that are many and varied and just saying “because it’s publicly funded” is clearly nonsense. There are staffing, cultural, economic reasons, among other things. Manchester has some of the finest hospitals in the country, including regional heart, lung and cancer centres Whatever specialty you need, we probably have it and yet Greater Manchester has dreadful levels of cancer, cardiac and respiratory disease, driven in large part by cultural issues like poverty, smoking, air pollution etc. If everyone in Manchester lived in a nice warm suburban house, had enough money for food and fuel, didn’t smoke, drink, eat pies in barmcakes, we’d be quids in outcome wise. Harsh but true. So don’t put it all on the NHS, it’s doing a good job in difficult times, but it could do better. Demand better, don’t let politicians fool you that they’re doing all they can, but be realistic, there is no such thing as a perfect system.
(And it’s not being privatised you daft buggers.)