The NHS

[clovehitched]

Word of this is getting around - apparently in order to discredit the, as I understand it ,somewhat limited reforms that President Obama is proposing for the US's very expensive, and not all that effective health care system, right wing pundits in the US have been using the NHS as a scare story about all the bad things that can happen under "socialised medicine". The problem is, they're not being overly accurate about their claims, with perhaps the most priceless example being this massive goof about Stephen Hawking, where it was claimed, by one publication, that he would have had no chance for survival had he been British.

Apparently the writer of the article in question didn't realise that Stephen Hawking is, in fact, British, and has been the recipient of quite a lot of NHS care. The article was hastily rewritten to remove any mention of Professor Hawking, but the Internet noticed and the epic LULZ are now spreading.

The Guardian (yes, I know) has noticed too, and if you feel like grabbing some popcorn the comments thread here makes for a wonderful piece of "can't stop looking at the car crash" style Internet browsing.

Anyway, I want to make a personal point. When I was eight years old I was walking home from school one day. I was crossing the road at the centre of this Google Maps page from north to south, to walk into the lane running south, which was part of my walk home. The school gates had those zig zag yellow "School, No Parking" lines on them, which were being duly ignored by the parents picking up my schoolmates. There was no pavement on the south side, so I had no choice but to cross there, and an illegally parked truck (I even remember whose parent it was parked there) was blocking my view along the road.

I edged out to look round, and at that moment I'm told someone stepped out from one of the garden gates on the opposite side. A car which was travelling along the road swerved to avoid them, and narrowly missed the truck I was peering out from round.

I experienced this as a screeching of brakes, at which point I guess I must have had a ton of adrenaline dumped into my system. Time slowed down, and I turned to face the sound. The world streaked across my vision, as if shot with a poor quality video camera with too much persistence, and I heard a bang. The lateral streaks of the world became a swirl, and in slow motion I watched the swirl as I turned upside down, and then felt a sharp pain as my left knee struck the asphalt. The swirl continued as I came to rest on my back, pretty much back where I'd started crossing the road, and then time returned to normal speed.

As it did, I felt a pain more intense than anything I've ever experienced in my stomach - far more pain than an eight year old should have to deal with. I looked up to see a circle of faces looking down at me. The events of the next 15 minutes are confused in my memory - someone ran home to get my mother, someone else came from across the street saying, "I've called an ambulance". Others were exclaiming that I was alive. Someone, perhaps the car driver, got me a blanket and laid me on it. My mother arrived in tears - I found myself consoling her (ah, irony). One of my teachers arrived and with my mother picked me up to move me back inside the school (I don't think this is recommended practice). As they did, the weight of my legs hanging below me made the pain intolerably worse, and I'm not quite sure how I managed to avoid passing out.

In due course an ambulance arrived. It took my to the Chesterfield Royal Hospital where I spent a week on the Nightingale Children's ward in a lot of pain, being fed through an IV line in my arm, feeling deeply sorry for myself. When it was clear that I didn't need to be hospitalised any longer, a week later (when I was able to eat food again and get out of bed), they allowed my parents to take me home. I spent several more weeks off school before returning, having made a full recovery. By some miracle I had "escaped" the impact of the car with "only" haemorrhaging into my stomach, despite the initial fears that my ribcage was smashed, that my lungs were punctured, that I might die. I guess I would have done without medical attention.

The car driver sent me a jigsaw in hospital - I understand he was really cut up about what had happened. It wasn't his fault - it was just one of those things.

Through all of this there were no insurance companies involved, nobody ever asked how the x-rays, the doctors, the medicine, the bed, etc. were to be paid for, no questions were ever asked about whether we had "coverage", they just sent an ambulance, took me into hospital, looked after me for a week, and got me back in a fit state to be sent home. When I was eight years old the system the US right wing wants to portray as some kind of socialist dystopian disaster simply did its job and saved my life.

So yeah, thanks for that NHS, and don't believe everything you see on the television, especially if there are political lobbyists involved.

Originally posted at http://auntysarah.dreamwidth.org/207629.html - you can comment here or there.

Comments

[auntysarah.livejournal.com]

When I was fighting Cambridgeshire PCT about funding my surgery, I got the prices they paid to the West London Mental Health Trust for appointments at Charing Cross GIC.

They were *three times* what the private sector was charging for equivalent services.

Cambridgeshire PCT apparently didn't care.

[juggzy.livejournal.com]

OK. I'm obviously not privvy to that information. My first reaction is to ask about economies of scale - whatever it was that affected location, numbers of people wanting similar surgery (which would affect cost of consultants). In your case it was specialised surgery which might well cost less if done in one centre, as opposed to distributed around non specialist centres (costs being expenses for consultants as well as consultant and specialist fees). I'm also fairly certain that the surgery you underwent would have involved a long period of consultation with you in the first place to ensure that this was what you really wanted to do. Do the private places factor in these costs?

If it was like for like then that's shocking. My experience is that private clinics for whatever pick people up after profiling and consultation is done by the NHS, thus raising costs for the NHS. However, you say equivalent, so maybe it was like for like.

In which case, how could the NHS costs have been reduced?

[auntysarah.livejournal.com]

My first reaction is to ask about economies of scale - whatever it was that affected location

NHS clinic is in Hammersmith. Private clinic operates out of premises in the West End.

numbers of people wanting similar surgery

This was for assessment appointments prior to surgery (i.e. seeing the consultant). The price for the actual surgery was within about 10%.

Do the private places factor in these costs?

Yes. That's the difference I'm referring to - appointments with consultants. At the time, the private sector was charging about 200 pounds an hour, the NHS around 600 pounds an hour.

If it was like for like then that's shocking

It was definitely like for like. Walk in the door to see a gender specialist and if you go private (in 2006), you'll pay 200 quid. Use the NHS, and your PCT would have had to pay around 600 quid for a first assessment.

Norfolk PCT is wise to this - they subcontract to the private sector. I pointed this out to Cambs as well, and furnished them with a copy of Norfolk's policy, as an example of better practice. To go with their figures provided to me under FOI, I pointed them at the online price list for seeing a private consultant for exactly the same service at around a third of the cost per appointment.

Their response made it clear that they hadn't even bothered to look.

In which case, how could the NHS costs have been reduced?

Some PCTs have seized the initiative and subcontract to the private sector for these services. I mentioned Norfolk, I understand there are others. Over the course of a typical treatment this would save them thousands of pounds per patient, and because waiting times are shorter in the private sector, patients would be expected to spend less time on very expensive chemical castration drugs (100 pounds a month - the NHS did fund that bit in my case, possibly because my GP never actually told the PCT).

The Scottish PCTs have their heads screwed on properly in this regard too - they offer services inhouse where it makes sense, and subcontract where that makes sense. Most of the English PCTs seem happy to pay vastly over the odds to subsidise the West London Mental Health Trust. Were I a betting woman, I'd put money on most of that price differential not actually reaching the Charing Cross GIC, so god only knows where it goes.

[juggzy.livejournal.com]

That does appear to be ridiculous. The Scottish model is the one that I had assumed that the NHS used universally.

Still, let's keep the pressure on the NHS to be more efficient, rather than assuming that no NHS is the solution to this.

[auntysarah.livejournal.com]

That does appear to be ridiculous. The Scottish model is the one that I had assumed that the NHS used universally.

When it comes to gender services, there appears to be some resistance. There are some of us actively engaging to try and make some of these points, but we're not numerous or interesting enough for NICE to take the time to have a proper look, it seems.

Still, let's keep the pressure on the NHS to be more efficient, rather than assuming that no NHS is the solution to this.

Quite. As creaky as the system is in this regard, things are far worse in general in the US.

[phonemonkey.livejournal.com]

There are some of us actively engaging to try and make some of these points, but we're not numerous or interesting enough for NICE to take the time to have a proper look, it seems.

Sad to say, I think NICE is afraid of the tabloid factor when it comes to gender services, because it'll be easy for the papers to demonstrate what they consider "worthy" and "unworthy" patients by digging up somebody who wanted to use a very expensive cancer drug that NICE rejected. Especially because it'll take about five minutes before a sub-editor realises that you can rhyme "grannies" with "trannies".

[auntysarah.livejournal.com]

Especially because it'll take about five minutes before a sub-editor realises that you can rhyme "grannies" with "trannies".

I find your cynicism to be a thing of beauty, and probably absolutely spot-on.

[phonemonkey.livejournal.com]

You cannot hope to bribe or twist
(Thank God!) the British journalist
But seeing what the man will do
Unbribed, there's no occasion to.

- Hilaire Belloc

[auntysarah.livejournal.com]

I should add, I think the root of the problem with the gender stuff is because they're trying to run a central service (London handles much of the country's work) as if it were a local service, and the way the disconnect gets managed ends up being rather Byzantine.

If a GP could just refer someone to the specialists in London, a lot of the problems might be cut, but as it is a GP can't make that referral - it has to come from local MH services, who quite often haven't got a clue what they're actually doing, and then the PCT have to agree funding. My view is that a lot of this stuff is just pointless obfuscation, and not only would the system work better if the middlemen (local MH services - do you *really* need a consultant psychiatrist to write a letter saying, "this person says they're transsexual, will you have a look at them please?" and the PCT) were removed from the equation, it would probably cost less too.

not exactly true

[auslanderin01.livejournal.com]

My GP referred me directly. He said that there'd been yet another change in the rules.

[darkwaterfairy.livejournal.com]

*nod*

At the heart of it, it's the self-serving misdeeds of the doctors and managers inside the NHS (and politicians outside) that are the only problem with the NHS. And like they've never suffered professional bastardry in the U.S. *rolls eyes*