Is this a completely bonkers U-turn by the NHS?

[HappySecret]

My faster is well and truly flabbered. Can this be in any way reasonable? Justifiable?

From today's Times:

The evidence supports screening for women over 25. The risks of a false positive, which are common in young women, outweigh the benefits of screening at a young age. However, a younger woman with symptoms of cervical cancer should undergo cervical screening.

If one was cynical one might think that doctors in the US encouraged unnecessary testing to earn more money.

I have a rare, chronic condition and under Labour govt was seeing an amazing consultant in london on the nhs, very out of local area. Two years ago that hospital decided to close the clinic and im sure finance was a huge part of that decision. The local commissioners arent happy as 95% of patients are out of area. Some of us employed a barrister and actually took the hospital to the high court and won. Hospital is having to treat us again, high court awarded us our costs. Hospital are appealing this and are now taking us to court to try and make us liable for paying our barrister which will be tens of thousands. Money is everything.

I have a myriad of chronic mental and physical health issues. Under Labour I waited nearly 2 years on a mental health waiting list as a crisis patient. Under the Tories I was seen within the week. Under Labour I waited months for physiotherapy and could only be referred via my GP under the Tories i have been seen in a fortnight and self referred. The physio has access to a musculoskeletal pathway and there is no need to see anyone who isn't specialist in the care I need. Under Labour I had difficulty accessing my GP who were 9-5 Monday to Friday only. Under Tories I'm with a surgery that runs 7am -10pm 7 days a week. Under Labour I couldn't claim DLA - I didn't meet the criteria. Under Tories my PIP claim went straight through without issue.

My anecdotal experience is the Tories have been better for me and my health.

I'd forgotten about physio - I've just self referred and was seen within a week. Previously I had to see my GP (which was a nightmare as to meet the targets, all appointments had to be made on the day only) and then wait 6 weeks for an appointment.

If one was cynical one might think that doctors in the US encouraged unnecessary testing to earn more money.

As someone who was diagnosed with CIN3 before I was 25 I'm just very relieved my doctor decided to earn the extra money by running the test.

The doctors here have never overtested me. It's a myth that they overtest. The insurance companies won't pay for medical that isn't needed or can't be justified. If we go to the emergency room we always call the doctor first and have them tell us to go. If we don't do this our medical insurance will further investigate our claim. We rarely go to the emergency room but when we have it's been because it's needed and the medical team at the hospital are told we are coming in by our doctor so have the basics in place for us. Or medical records are on a network the hospital has access to. There is no such joint up care that I know if the UK like this.

I speak with a group of people online from round the world who have one of the conditions I have, it's relatively rare so we are a small bunch. There are 2 striking differences between here and there: 1) the difficulty they have accessing pain relief, They're all treated like drug seekers if they go to a&e 2) their medication is limited in volume due to insurance. We have "rescue" medication which here once I've used mine I simply order a repeat ad nauseam and can have one a day if necessary over there their insurers limit them to 4 or 6 a month. It's disgusting.

Medical care is rationed by different bodies depending on where you live. In the UK it's done somewhat randomly by postcode and condition. In the US it's done by a combination of insurance companies and random factors like what state you live in or what kind of insurance available to you.

I'm curious to know how it's rationed in Switzerland, France, other countries. Anyone know?

I know we can't afford it because we have our spare money. We have zero savings. We couldn't afford an extra £50 a month if we had to.

We couldn't afford any of the other examples being explained on this thread.

If one was cynical one might think that doctors in the US encouraged unnecessary testing to earn more money.

They would only say that if they didn't know that the in the US the lab gets paid for running the test and the doctor does not get paid for ordering it.

bumpowder you MUST be aware that your experience is not typical? I can only assume that your condition has worsened since your DLA application, since through work I've spoken to literally hundreds of people who had longterm / lifetime DLA awards who've been refused PIPs. Don't think I've ever spoken to anyone who gets PIPs and couldn't get DLA, since the criteria have become so much stricter and that was the entire point of the change, unless their condition has significantly worsened.

As for your experiences of healthcare, I'm glad you're getting help more quickly, I suspect that has more to do with changing practices than anything. Last year I moved three miles and went from a practice where it took weeks on end to get an appointment, now I'm somewhere that will see me same day, has a physio, phlebotomist and pharmacist in house etc. That improvement has nothing to do with the tories, it's in spite of them.

User14 '... thats not my experience of the nhs with melanoma at all. No way we were told by letter! Thats awful. And regular check ups for min 5 years, which I really think your sis should be getting as standard - has she followed that up? We have had two different health authority experiences of melanoma, and also worth saying, immunotherapy at hundreds of thousands of pounds cost to the nhs, resulting in no more cancer visible.

Perhaps it is also an example of how the uk system is flawed in the local model, so each area has different standards? We all pay the same rate of tax and ni, why should we get different treatment? Someone upthread suggested that a new health insurance model would be regional - can you imagine?? South east, rich, north east, poor ..... it's already terrible
Re melanoma check ups, we all get nhs yearly checks as we have a family member with melanoma ... bizarre that your sisters area dont even check her yearly...

Bumpowder it’s great that you have seen an improvement in the services you receive from the nhs.
It is also true that there are things the NHS is good at. Palliative care is one of them, mainly because it has no issue prescribing very string drugs that other countries will not.

However, I have very big doubts that not sending am ambulance for a susoectvthat ted heart attack is giving a good service to patients. Esp when we know that early intervention is key to recovery.
I doubt that not being told that something has been found on a scan, that present as cancer, is helpful. Because it delays further investigations and treatment by months and months and yes means the chances of reciver are slashed again.
I doubt that being told no further investigations of a lump over a lump node area will be done because you have no other symptoms is helpful. (Said lump was then found to be cancer again after going private)
As for the access to MH services by teenagers.....

So yes great to see that you think your situation is great. But please do not reject other people’s experiences as nit existing just because yours is so different.
Most people experience huge delays in being treated, end up in great pain (because actually not everyone has access to such strong painkiller and it can take years for people to be actually treated properly, eg for back pain or hip pain). Some of them are nit treated and end up dying (see the 6 months old baby whose surgery was cancelled three times and subsequently died - what a waste of a whole life!!)

Sadly I think experience helps one get a better service.

The MH service dd gets due to her ADHD was eventually secured because I sought protocol clarity from the director of children's service at the MH Trust and the Director of Commissioning at the COG and took their written confirmation to the GP who had advised the service wouldn't be available. Even then the ADHD service only saw dd because because I reiterated their time frame and offer back to them in writing and said if that wasn't the correct understanding they were to notify me within 10 working days. They didn't. They tried to wriggle out of it. "What we write isn't always what we mean because demand changes".

Similarly when I broke my back GP said she'd refer to a neurologist and physio after 10 weeks if I was still in pain then. I asked what the waiting was and it was 10 weeks. I noted that I worked full time and it was better for society if the NHS helped people stay in work to fund it. She responded all patients were treated equally. So I asked her make an entry in my notes to the effect that she had refused a specialist referral at my specific request. I walked out with a referral.

I saw a neurologist within two weeks. She was fab. The fracture was greater than 50% collapsed and she considered kyphoplasty to help keep my spine aligned long term and this would have been done on the NHS. However the CT scan showed the tip of the vertebrae just touching the spinal canal and she'd have had to screw and rod it too. Fortunately the pain was resolving and we left well alone and two years in I just have to be cautious. She did however facilitate the best possible care for my osteoporosis with the best rheumatologist available and recommended via letter to GP. Otherwise my GP would have referred to the local trust not a neighbouring one and the local one has a shocking rep and doesn't offer the treatment I'm having.

The NHS clearly still has the backing of the general public:
www.independent.co.uk/news/uk/politics/budget-nhs-chancellor-philip-hammond-waiting-lists-theresa-may-housing-survey-a8062816.html

I personally don't have an issue with the introduction of small charges in certain cases but I suspect that the mistrust of the government is such that people may think that it will end up just being the tip of the iceberg.

The problem with the French system is that you have to pay unpredictable amounts of money upfront for appointments/treatments, and its always very unclear how much you will get back from social security and your mutuelle, the system is ridiculously complicated. I ended up with a mutuelle which cost me more in monthly payments than I got back from it, even in a year where I ended up needing more medical treatment than usual. You generally get seen quickly and efficiently, but you do pay for that. Not as much as in America, but still.

Oh I agree lostmy. Our MP tells me he and his family have always had fantastic care from our local hospital when I've raised it. DH has at least snorted "you would, wouldn't you. When CAMHS backtracked over dd's counselling and argued that they hadn't said it would be provided within 2/3 weeks, it was extraordinary how a quick email from our MP on his return from holiday resulted in it being delivered in 24 hours.

So it isn't quite such an equal access system.

I really believe we need to move away from the free at the point of delivery model. It is the only way to deal with the doing you a favour attitude.

I became very aware of this when my aunty was having to advocate for my great aunt (who had no children herself) We both said to each other then that it made us fear for all those who had no family to get answers and persist until things were resolved. I do think this is partly the impact of an over-stretched system and partly that some healthcare workers can't/won't see the wider implications of not doing everything properly. They are a stark contrast to the ones who constantly go above and beyond.

lost that has been our experience too. Back in the late 80s and early 90s my family funded the HIV and AIDS charity provision wholly for about 5 years because there were so many people (mainly gay men) dying in Manchester and Liverpool with next to no support. When this was raised by our MP all of a sudden they remembered who my father was and we get treatment. If this isn't pay to play I don't know what is. The whole premise of the NHS is that everyone should be able to access help. It should not matter what your creed is or where you live.

I'd also put a stop to any UK medical school place going to non British citizen until we don't have a shortage of doctors. It's insane that we have so many apply for medical school every year and they are turned down with a place going to a foreign student who has zero expectation to remain in the UK beyond qualification.

After I made a formal complaint about dd's experience in ED 're CAMHS and NHS protocols, and to be fair he did meet me, and that service has been sharpened up, I was assured that if a member of my family attended his hospital again we would receive exemplary care. I said we would never willingly set foot there again but I suppose It's not that hard a promise when like you we have an exceedingly unusual family name. And DH was at uni with the MP, etc, etc. And is a leading QC...........

Well this is hardly going to lessen the pressure on A+E.

www.newstatesman.com/politics/welfare/2017/11/universal-credit-flaw-forcing-patients-risk-50-prescription-fine