Coming to America

The National Health Service of Great Britain costs the taxpayers about $200 billion per year. And by the way, that is more than double what it cost ten years ago … but that is beside the point. The NHS is getting to the point where it must choose between buying expensive drugs for terminally ill patients or providing more care to more people.

Is that really a choice that you want anyone to make about your healthcare? Even worse, why should the government be the one making that choice for you? Because you’ve virtually begged for it. Americans now think that their health care is someone else’s responsibility: either their employer or the government. We’re asking for it and begging for but the truth is that we’re not going to be pleased with it at all. Politicians will love it though. Just think of the power! How powerful you must feel when you tell an elderly American that they can’t have a specific drug or medical procedure because someone younger needs it more. Sorry people, but that’s the truth.

In Great Britain, 800 out of every 3,000 cancer patients lose their chance at getting life-saving drugs because it would cost too much for the NHS budget. And that number is only going to get bigger and bigger. In fact, the UK is now considering making a permanent ruling that certain medications that are “too expensive” should be excluded from government-funded treatment. So even if there are better treatments out there, you can’t have them because the government doesn’t want to pay for it.

Of course though, Americans have been taught all their lives that government is the answer for everything. That government is supposed to make all our problems go away and that we don’t need to take any responsibility for ourselves or our children. I just can’t believe how many pathetic people live in this country that are willing to sacrafice their childs future just so government can support their lazy fat ass.

The NHS has frequently been the target of criticism over the years. Examples of such criticism include:

Access controls

Treatments determined by NICE to be ineffective (e.g. homeopathy) or relatively cost-ineffective (i.e. drugs that have only minor effect at great cost) are simply not offered by the NHS though may be available privately. These controls have been labelled “rationing” though others argue that these are a sensible cost-control mechanism to fund only cost-effective^,evidence-based medicine although this argument is controversial as many drugs with proven efficacy (e.g. anticholinesterase for Alzheimer’s Disease^, are not fully funded.

In the NHS, GP referrals are needed to access specialist care and one of the original roles of general practitioner was to act as ‘the gatekeeper’. This role as gatekeeper has become more prominent in the 1990s with the introduction of the ‘internal market’ with GPs managing funds to buy clinical services. In 2000s, the role of gatekeeper has been increasingly moved to primary care trusts (PCTs) that issue guidelines to limit referrals to secondary care. ‘Referral management centres’ are also another recent innovation to divert referrals from GPs to cheaper nursing or therapy-led alternatives.

It has been argued that a nominal charge for an appointment with a GP could be introduced to prevent patients consulting their GP for frivolous reasons. To date, this has never been introduced to avoid the danger of patients avoiding consultations (for financial reasons) for conditions which might be potentially serious.

Politicisation

Over time, increased demand leads to continual political pressures to increase spending and widen the range of treatments available.

Supporters of the NHS would point out that the NHS has wide public support and the English population has as good a health outcome as many other similar countries, and often at much lower cost. Political pressure could work both ways, but the Blair government was elected in 1997 largely on a promise to invest more taxpayers money in health to bring spending closer to the European average. Most peoplewould prefer to see gradual improvements within the current framework and be able to hold politicians to account for the service. This is the position of all the major political parties, none of which has an agenda to replace or make a wholesale reform to the system. The Conservative Party says its policies are aimed at “Protecting and improving our health service by putting patients back at the heart of the NHS, and trusting the professionals to ensure that they are able to use their skills to make the fullest possible contribution to patient care.”

“Paying twice”

Taxpayers who choose to pay for private healthcare must nonetheless still contribute to the NHS via taxation, and in effect “pay twice”, although the vast majority of emergency medical treatment is carried out by the NHS. This is not an effect specific to the NHS, and occurs whenever a choice between a publicly-funded and privately-funded service exists.

Some patients with complex illnesses pay for some medical services privately, while turning to the NHS for the rest of their care. In one recent case a cancer patient was told that if she paid privately for a drug that was not covered by the NHS she would have to pay for the rest of her care. NHS officials argue that allowing the practice would give wealthy patients an unfair advantage and undermine the philosophy of the system.

Waiting lists and the 18 week target

Rationing is a part of all health care systems because resources are necessarily finite. In purely private systems, health care is rationed via the price mechanism, with those being able to or wanting to pay for care getting it immediately and those not able waiting indefinitely (until they can afford it, which may be never). In the NHS, which aims to give a broad coverage of care to all without charging, health care is rationed on the grounds of clinical need, meaning that emergency cases (e.g. heart attacks) get instant access where those with less urgent needs (e.g. cataract surgery) are given lower priority and so wait longer.

Although there are obvious arguments in favour of prioritising by clinical need rather than ability to pay, it can mean that waiting lists vary widely between regions. Patients waiting can choose to have a procedure done outside their local NHS district in order to be seen more quickly, and if the waiting time is long can often get private treatment at public expense, either in the UK or abroad. A major programme is underway in the NHS to reduce all wait times to 18 weeks by December 2008. This new target starts at the point the time the patient’s own doctor writes to the hospital specialist and ends when treatment begins. It therefore includes the time to make the first appointment, and the time for all diagnostic tests to be completed, evaluated, and discussed with the patient, which were not in the previous target. It has been widely criticised by doctors, healthcare professionals, and think-tanks as diverting resources from more serious conditions to achieve politically-motivated goals, and doubts persist over its achievability.

The term bed-blockers is often used to refer to patients still receiving care, even though their acute ailment has been treated and they are fit for discharge. This strains hospital resources, through both increased costs and longer waiting times for other patients. In the UK, bed-blockers are frequently geriatric patients awaiting a placement in a nursing or residential facility.

“Superbugs”

Fatal outbreaks of antibiotic-resistant bacteria (”superbugs”), such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, in NHS hospitalshas led to criticism of standards of hygiene across the NHS.

Both C. difficile and MRSA are, however, not exclusive to the NHS, existing in British private hospitals and throughout other western healthcare systems; for instance, cases doubled in the USA’s private healthcare system between 1999 and 2005, and the UK’s death rate is half that of the USA’s. The introduction of Private Finance Initiative cleaning contractors into the NHS and the associated “cutting corners on cleaning” have been blamed for the problem, as has increased drug resistance due to inappropriate prescribing of antibiotics and patients failing to complete courses of antibiotics.

Another viewpoint is that the spread of communicable diseases in hospitals is facilitated by the overcrowding in NHS hospitals with high bed occupancy rates (as the NHS has a low bed:population ratio produced by hospital bed closures and the increasing emphasis on increasing bed ‘turnaround time’).

Computerisation

The NHS has been criticised over the implementation of its National Programme for IT which is designed to provide the infrastructure for electronic prescribing, booking appointments and elective surgery, and a national care records service. The programme has run into delays and overspends, with the initial budget of £2.3 billion over three years officially revised to £12.4bn over 10 years and some sources putting it as high as £20bn. Critics including the House of Commons Public Accounts Committee and the National Audit Office claim the project is falling behind schedule. In addition, 93% of doctors within the NHS are not confident their patients’ data will be secure, some GP practices have begun to advise all their patients to opt-out of the scheme, and privacy campaigners have claimed the national care records system breaches patients’ privacy rights.

The Government and NHS national leadership have consistently argued that major capital investment in IT is necessary to transform services. Fragmented information systems, as in the US, prevent health services providing consistent dataand can damage patient care where doctors may not have an overview of patients records held by another NHS body.

Dentistry

There has been a decreasing availability of NHS dentistry following the new government contract and a trend towards dentists accepting private patients only, with 10% of dentists having rejected the contract offered.

Coverage

The lack of availability of some treatments due to their perceived poor cost-effectiveness sometimes leads to what some call a “postcode lottery”.

NHS supporters would argue that the NHS has a duty to ensure that taxpayers money is used wisely and such denials are effective controls. People can always choose to go private, if they can afford it, if the treatment is legally available in the UK or elsewhere.

Deficits

Some hospitals and trusts were running a financial deficit and getting into debt.

Scandals

Several high-profile scandals have occurred within the NHS over the years such as the Alder Hey organs scandal, Harold Shipman and the Bristol Royal Infirmary inquiry.

Supporters would argue that there is nothing endemic about such issues which might equally have occurred in other types of health care establishments. They might also point out that the detection of such issues leads to better controls being established throughout the NHS for the benefit of all.

An October 14, 2008 article in The Daily Telegraph stated, “An NHS trust has spent more than £12,000 on private treatment for hospital staff because its own waiting times are too long.”

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