Why do people think the NHS is so special?

[SnowBells]

There are always people around who proclaim the NHS is some sort of holy grail. It can't be touched, and don't even think about reforming it. The government may be offering free healthcare through the NHS, but nothing is really free, is it?!

My gripe with the NHS is that just like most institutions funded by the government, it becomes a big bureaucratic mess, where people are more concerned about ticking boxes than the actual patients. Most other developed countries have some sort of free healthcare that can actually be more effective than the NHS. I have lived in countries where, for example, health care insurances are mandatory, so that everyone has one (and a lot of times, employers contribute the bulk or the government subsidises it). Hospitals may be subsidised by the government, but GPs run their practice like a business, and rely on clients to earn their living (this means, they actually have to provide a bit of "client service" that's almost elusive here in Britain). You can make appointments with specialists directly - no need to waste time at the GP's practice when really, you needed to see, say, a gynaecologist.

Why is it that some hail is as the holy grail?

Molotov That you can even write this post demonstrates your privileged position (that is, to have unlimited access to good health care).

What do you mean?

THe NHS is amazing and frustrating but not in equal measure. I have two deaf children and they have received amazing care and the technology they need to listen and speak.

But, their aftercare in terms of therapy and support is not good, we have fought for best practice, which in the long term will save thousands as it has got my daughter to the point where she no longer needs therapy, as she has above average speech and language. But that therapy is rarely offered on the NHS.

Progressive Governments have short term views on NHS spending and equally, NICE has the horrific job of trying to restrict spending. We need to get back to an NHS that looks at the cost / benefit of every treatment and a country that understands that nothing is free (even if it is at the point of use).

But NI means National Insurance and was set up to cover all the mishaps in life - unemployment, sickness, and old age. We pay in while we are working and get the pension or benefit or treatment we need. Because it seems free lots of people think they can come here and use the facilities and so there is over demand. When I was young you only collected benefits when you were covered by NI - National Insurance. First child no payment, sickness benefit if you paid in. Too many people in other countries see ours as a way to get what theirs will not provide. NHS was splendid when it started as was OA pension. Before that It cost 2/6 (12.5 % of £) to visit a doctor when average wage was about £6.00.
There is also the fact that these days there are so many more costly treatments which private insurance would not cover.
We need the NHS.

Because when DD was born at 25 weeks gestation, the NHS provided her with world-class - very expensive - care, while allowing DH and me to concentrate on her, not on selling our house in to pay for her four months in intensive/special care, home oxygen, follow-up care, etc.
In almost any other country in the world, she would be dead, or we would be bankrupt.
The NHS is amazing.

Thanks, whatlifestylechoice! The NHS is a terrific idea overall but some areas work a lot better than others. Care of the elderly does appear from what I read in the media to be one of the less successful areas.

On the other hand, cardiac care appears to be utterly brilliant, in SE London anyway. My husband had a heart attack last year and had wonderful care. I dialled 999 at 8am and he was having an angiogram and a stent fitted at 2pm. Every single aspect of his care was fantastic, up to and including the cardiac rehab programme he was sent on afterwards. I dread to think how much it would all have cost in the US.

Balancing that out, I have often read that cancer care (some types, anyway) is better on the continent.

So it's swings and roundabouts.

Eostre, I hope your daughter is doing well now. I'm glad the NHS was there for you, but wouldn't any other Western European country have done the same for you through insurance cover? Genuine question, I don't know the answer.

...It can't be touched and don't even think about reforming it

Are you kidding?? I've worked in the nhs for 25 years and more recently have been a patient for a serious condition. I've lost count of the number of reforms and reorganisations me and my colleagues have had to endure whilst striving to keep our eye on the ball of providing good patient care.

As others have quite rightly pointed out, we are fantastically fortunate to have a health service, free at the point of care, which doesn't give up on you because the cover has run out.

Whilst it's not perfect, neither is any other system and i would rather have one which isn't going to shut the door on me because my insurance isn't right. The care I have received as a patient has been second to none, delivered by highly skilled and compassionate staff.

As for accessing specialists via gp, I think it's entirely sensible that someone should be headed off from seeing a specialist if the issue doesn't merit that level of input and can be dealt with at the gp surgery. This is just effective use of resources.

Op - posts such as yours make my blood boil. To say staff are more concerned about ticking boxes than about patient care is highly insulting.

Eostre any other country except the ones which also have excellent free health care? Of which there are many.

Why is everyone comparing it to the USA?

I am comparing it to healthcare systems of another European country where I received care that you would not be able to receive on the NHS.

There, it was normal to go to obgyns frequently, simply to monitor "women's health", e.g. scans, etc. (GPs don't do this here). You go to the dermatologist if you have an issue with skin. Yes, if you have a lump, they might tell you to go to the oncologist, but hey, that would just be the same as going to a GP and being referred, not worse.

Try living in a country with no NHS and then you'll appreciate it! I don't, but my relatives do, and my cousin (who is my closest living relative has been diagnosed with early onset dementia, he is only 54 ffs) not only have they the worry of how to cope with the dementia, the medical costs are crippling them.

I took DS1 to the doctor yesterday with his asthma, and I got chatting to the GP as she was examining him. She had 6 people not turn up for appointments yesterday. That's just one doctor!! It gives me the rage when people abuse it because it's "free" and that is costing the NHS so much money each year.

You know that there is private healthcare here too, you know? People moan about the NHS as if it is imposed on us here when there is outstanding private medical care available AS WELL.

I have had private and state healthcare in a number of countries in Europe, and each had its pros and cons, but I think the NHS has been the best so far.

There's something to be said for means tested free GP visits though, with people over a certain (reasonable - NOT 18k per household or something silly) threshold making a nominal or cost-covering contribution. Many of us could easily afford the £45 a GP appointment costs, and the difference it could make to the NHS's finances would be transformative, I suspect.

great post Marshy !

No the NHS isn't perfect but it is bloody good & employs some amazing people. If you should ever require the service they can provide you'll understand this.

I have linked you to an exhaustive comparison with other developed countries. If you like, you can do comparisons yourself. Like this:

Perception of Inefficient or Wasteful Care (2008)

I wholeheartedly disagree with "Most other developed countries have some sort of free healthcare that can actually be more effective than the NHS. "

Having lived overseas for 17 years or more, it is impossible to live without health insurance or you'd be burdened with the possibility of having to mortgage your house to pay for a broken leg.

I am proud to be British. Proud of our freedoms of speech & proud of the NHS (which I'm not entitled to use by-the-way as I live overseas.)

I used to work in an NHS children's hospital. I remember a student nurse asking me if I had ever been tempted to move to the Private Sector due to the higher pay. I pointed out that in one bed we had the child of a highly regarded Surgeon and a Solicitor and in the next bed we had a child from the most notoriously deprived estate in the city whose Mum had been forced to earn a living as a sex worker. Both children received the same (excellent) standard of care. I have absolutely no interest in working for a healthcare system where the choice of treatments these children recieved would be dependent on their parents ability to pay. That is what makes the NHS "special". No system is without it's problems, but I truly believe that most people won't fully appreciate the NHS until we have lost it.

Why on earth would you want to be having regular scans under the care of a gynaecologist when there is no indication that you need this? Ditto for dermatologist?

And just quickly to say. There is no, literally no, other healthcare system in the developed world that we could switch to and save money. NHS England is consistently the most efficient and low cost system when you examine OECD data. It absolutely IS conceviable that we could improve outcomes but probably not without spending an unelectably larger amount. Only New Zealand, of all the OECD countries, spends less per head than England, and its outcomes are distinctly worse in other metrics. I think it would be great to spend more.

There are measurable harms caused by overdiagnosis (your scans example). Here's a popsci article, or google "overdiagnosis of breast cancer by mammography" to access the scholarly discussion.

I think a lot of your opinion will depend on what, if anything, you and your family have needed treatment for. My experience is the NHS is excellent for acute issues and very good value overall but can be poor for chronic issues (whether these are common things like infertility or more unusual problems that don't fit neatly into anyone's box to tick) and it is stuck with some out of date practices because it doesn't have to respond to what patients want.

We ended up doing IVF in Greece due to not being able to access appropriate treatment in the UK (not because of the expense but because the legislation here is restrictive) and the Greek service was fantastic. It opened my eyes to the fact that a lot of what we hear about the NHS may be spin.

I do think that being covered for serious illness, even if you have no money, is worth a lot of other problems, however.

I don't know OP. I don't know. Have lived in the UK, Switzerland and Germany, DH has lived in the above plus Belgium, and the healthcare was better in all of them and only more expensive in Switzerland. People seem to compare the NHS with a) nothing or b) the US system and yes, by those standards of course it's great. Personally I hate it, the layer after layer of nasty unpleasant bureaucrats you have to get through before you get any treatment, and the fact that the NHS seems to collectively believe two things that contradict each other: that the NHS can't be expected to pay for x/y/z, just the essentials, and that at the same time the NHS is all anybody should ever need. My experience has been that when the NHS wouldn't pay for my treatment, NHS staff treated me as though I was being unreasonable in wanting treatment - privately, NHS, anywhere! I was supposed to just suffer on with my recurrent miscarriages.

I had a look at private health care, BUPA won't cover pre existing conditions.

You do know all that 'monitoring of women's health' was medically unnecessary don't you? I'm sure it felt lovely and supportive but who paid for it?

I've experience of the German system and the first thing to say is it's NOT free. Insurance is v expensive and there were lots of co-pays or investigations not covered.

In the UK, DH automatically gets seen by an ophthalmologist who specializes in glaucoma and sees hundreds of glaucoma patients a year.

In Germany we had to find the specialist ourselves, and because people self referred he saw whatever they came with - so although he was a highly rated glaucoma specialist in Germany, he actually had less experience than a jobbing glaucoma specialist at your local average UK hospital.

Of course we only realised this after DH's vision had deteriorated. DH's German GP said he wished he practised in the UK where the focus was on evidence based medicine, not 'how we've always done it'.

The waste in the insurance based system in Germany was mind-blowing.

I'm sure the Greek service was fantastic - because you were paying for it.

Currently there are thousands of Greeks with no access to healthcare - not so good for them, is it?

mimsy, whatlifestyle, yes, some other Western European countries would have given us the same level of (free, or at least mostly covered) care, hence "almost any other country" .
These countries generally have higher per-capita spend on healthcare, though, and similar or higher taxation levels. Given what we pay for it, I stick by my original assertion - the NHS is amazing. Why would we want to move to a system which costs more for care which is either of similar, or poorer quality (depending on which study you look at)?

I think that the NHS is fantastic in the specialised areas but sadly the " care", in my experience, is dire in the bog standard areas, e.g elderly people ill on a general ward, post natal maternity , birth.
I have had nothing but bad experiences of general care, from the sloppy and disinterested, to the downright dangerous.
And yet when I have experience the way the HDU, or Oncology work, I have been awed by the efficiency and standard of care.
I really blame the endless box ticking and quotas that seems to take up all the time of the staff, to the detriment of the patient. I don't know what's gone wrong on the general wards, but something has, very wrong, when old people are starving on wards, or medication being forgotten.
Having said that, I passionately believe in the NHS, and that is must be free at the point of delivery. I have had times when I literally could not find a tenner for a doctor's visit, and I can't be alone in that.