AIBU to not understand the english attitude towards the NHS?

[EggplantsForever]

Every time someone criticises the NHS, every time someone asks for better health service, or to have some not absolutely vital procedure (like IVF) covered, or to be referred to a specialist there is a barrage of voices here calling them "ungrateful", proclaiming that "the NHS is on it's knees", etc.

I just find it so peculiarly English and I have very hard time understanding it! Perhaps you can explain?

I mean, it is almost as if people feel that someone very nice and kind has given the English people the free health service, and they should be eternally grateful and not mention its shortcomings or it will be taken away. But the NHS is in fact paid by your own taxes! It belongs to you. And you have full right to criticise it and expect it to work just as well as other free healthcare systems in the world. Which it doesn't. It actually compares pretty badly even to the countries that spend less money per capita on health. I have a feeling it is actually badly mismanaged.

For example, look at this table en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare
UK is at the bottom at most of them, below Portugal/Spain, Israel, and Slovenia who spend significantly less money on healthcare.

From my personal experience, having lived in a country with free healthcare, you could go to a gynaecologist without referral (and women were advised to see one for a yearly check up). Skin specialist did not require referral either. Referral to any other specialist took me on average two weeks. IVF was available to everyone for free. The list of cancer drugs included drugs that are not funded in the UK. etc And people still routinely complained about their healthcare. Which they had full right to do, because it was funded by their own taxes.

So I am just not sure why is everyone so afraid to criticise the NHS? It is actually one of UK's biggest problems. And why does everyone eternally fear that it will be "taken away"?

"Abroad" is a big place! Compared to many many other countries the NHS is amazing.

Like which countries, for example, @Printerneedsink?

Kazzyhoward. I’m afraid you are wrong. The cause of many pancreatic cancers is known - or at least triggers are known.
pancreaticcanceraction.org/about-pancreatic-cancer/medical-professionals/stats-facts/causes-and-risks/
Don’t smoke and reduce obesity and you significantly reduce the risk of pancreatic cancer in the young.

We need to get over the idea of victim blaming and simply tell the truth that if you want to hugely reduce the risk of cancers whilst young you need to make lifestyle choices that prevent you developing the diseases rather than focus on treatment.

Smoking, alcohol consumption, obesity, hpv virus, excess sun exposure are all triggers and if these are reduced then there will be less cancers in the relatively young and less cost to NHS. If people chose better lifestyles and stopped smoking, reduced alcohol consumption to a moderate level, used factor 50 and the shade and walked more we’d also save on hip and knee replacements, COPD management, diabetes care, gall stones, back problems, trauma costs, bronchitis, peripheral vascular disease, VTE management, depression, ME, CFS, pressure damage and leg ulcers, ophthalmology costs, glue ear in children, varicose veins and even incontinence. We need to make people take responsibility rather than expect the easier option of treatment through medication or surgery.

I cannot understand why so many people compare the US model either.

I think it's because the US model is painted as a post apocalyptic medical system where if you're not Bill Gates or Jeff Bezos you're performing your own appendectomies by torch with a butter knife. So the NHS can say that any structural reform (which they don't want) will result in an immediate devolution to what those poor Yanks are stuck with.

Great Post Cherry. If only people could start to hear the message but I think we are still a long way from it. Much easier in every way to blame a system than our bad habits that give us immediate gratification.

theredjellybean is the UK awash with hypochondriacs? Is the UK population significantly more stupid than in other countries? Because I suspect not and wonder why these are non-issues elsewhere yet so feared by medical professionals in the UK.

CherryPavlova

It is too simplistic to say that if people looked after themselves better, they would not suffer lifestyle induced conditions, thereby saving the NHS money.

Fertility in Western Europe and East Asia is below replacement rate. We are heading towards an ageing population, where the number of workers having to support children and the elderly, is decreasing - there will be a drop in labour productivity (hence a lowering of GDP and fall in living standards) and tax receipts, just as costs for education, child benefit, old age pensions, social security, social care and health are increasing. It is difficult to envisage manual labourers, the emergency services, teachers and nurses for example being able to work beyond 60. A retirement age beyond 70 for the rest of the population may not be realistic. If people, who are no longer dying in their 50s and 60s live instead to 90 - 100, they are likely to be frail and forgetful in old age - needing more social care. Pensions costs going on for 30 - 40 years in the whole retired population may be difficult to fund, given many people have not put anywhere near enough into their pensions. Social care costs are being held down by local authorities, but social care providers cannot operate at a loss indefinitely. We may face instead 1 in 4 of far more very elderly in residential care at a cost of £50,000 pa for 4 years, or nursing care for 18 months. (I cannot recall the cost of nursing care homes). Brexit may curtail immigration.

Evolution is only concerned that we live long enough to reproduce. It may be what even if we all lived healthily, and avoided cancer in our 50s and 60s, those same people may have a genetic disposition to cancer or other chronic conditions and suffer them instead in the last 6 months of their old age; or air and water pollution have carcinogenic effects we cannot avoid or foresee as yet.

Helena - even an agreed phrase or code to write on prescriptions would be SOMETHING it's a ridiculous state of affairs that people are avoiding filling necessary prescriptions due to fear of costs/fines.

Glad your dh's treatment was too notch but unfortunately it isn't for everyone. Women having heart attacks are often misdx/untreated.

"Eggplants...that was an incredibly patronising post" pot? Meet kettle.

"On this thread many posters have clearly had bad experiences and if they feel their gp was negligent then I'd suggest they complain" many of us have/did complain! Only to find that results in being labelled a "difficult patient" or even left without a GP. Yes it's illegal and it's not supposed to happen but it does. And for patients with conditions that require continuity of care just to stay alive - diabetes, serious mh issues, asthma, heart conditions... They daren't risk that. So they put up with crap even illegal behaviour. These patients are also rarely mentally/physically strong enough to pursue a complaint - they are too busy dealing with the results of the cock up! Something I think the worst GP's rely on.

I'm also aware of GP's who've had several complaints made against them, who's own colleagues think they should

"GPS spend years training, have a wide range of experience and often nowadays come from a different specialty first. I was an orthopedic consultant before becoming a gp for example so yes actually I do know a thing or two about patients knee pain or back pain."

A - how is a patient supposed to know that? I mean for definite?

B - how long is it since you practiced in orthopaedics? Medicine is a fast moving field, knowledge & ideal treatment schedules change constantly.

I'm interested that you claim obs & gynae are part of GP training. On another thread (think it was an ama one) another GP was saying obs & gynae isn't required for GP training now. So which is it?

How long would you consider acceptable to not refer to specialist if you can't figure out/don't know what's wrong with a patient?

"OK so you think it's OK to make specialists stay in fields they don't enjoy, doesn't work for their families etc..." That's an emotive and manipulative response to a practical argument. If we need more specialists - in whatever area then we should be training more and learning what's necessary to retain them in those roles. Yes, sometimes shit happens and people are unable to continue in those roles, that's indeed true of any profession as you pointed out.

But I think it very unlikely that's the reason the majority leave to become GP's. In most cases I think it's because the hours are far less and less anti-social hours and the pay bloody good! It's why women tend to go into general practice it's generally more family friendly than other roles.

But then I genuinely also think GP recruitment criteria & training needs to change as there are too many who are dismissive, don't listen to patients, don't refer to specialists appropriately.

The focus should be on patients needs far less on the Drs desire to have a job that suits their needs.

I'm still frequently shocked at how GP's won't work any Ooh, these roles often filled by locum services (how much is that costing?), won't do house calls to the point patients are then having to call or have called for them, ambulances and go to a&e (which MUST be far more expensive to nhs - I note you answered none of my queries on cost comparisons btw).

"You talk about doctors as if we are a commodity owned by the public." Rubbish! We talk as if it's a service role - which it is! And which many Drs seem to forget.

Instead arrogantly assuming we should be grateful for ANY attention we get from them, and should never DARE to call them out when they cock up! Even though those cock ups have seriously negatively, even in some cases fatally, affected patients.

You doubt that patients would know correctly when to see a specialist. Generally I don't. Instead my experience and the experiences of others I'm aware of both in real life and online is that GP's have actively prevented patients who DID need specialist care from getting that care.

MissConductUS While I understand you were using hyperbole, certainly our perception is that the USA healthcare system is largely profit motivated and that is what we don't want. I've seen some horrific things on both factual and fictional narratives based on the USA system. I've asked my friends and relatives how accurate these are and most of the time the frightening thing is they say it's either likely, possible or even they've actually experienced something similar.

Stevie77 absolutely the uk population is no more or less stupid than any other!

Saltpans - we're also no responsible/irresponsible than other populations. Personal responsibility is a FACTOR in in many conditions but it is very rarely the only cause - not even a dr would say that as it's simply not true. As I said if it were then there wouldn't be heavy smokers/drinkers/overweight people who are essentially ailment free and live well into 90's/100's. There's more to disease than that. Plus there's the fact that we are often unaware of causes at certain points and only through research etc they become apparent. And then you have to convince people of this new knowledge. Eg I grew up in a home with both parents heavy smokers. They genuinely believed that they were not doing us significant harm. Hell when they started smoking there wasn't even clear public knowledge it was harmful, it was still being allowed in hospitals! The link between certain red meats and cancer has only recently been discovered. The effects of things like asbestos are relatively recent discoveries.

Personally I believe we've yet to learn the true impact of mobile phone use, vaping, certain types of modern insulation that's supposedly better than asbestos, artificial sweeteners etc

And I'm afraid also "nature finds a way" everyone has to die of something and people have to live their lives and get pleasure from something. It's like the old joke

"My dr says I need to quit smoking, drinking and only eat an organic vegan diet, and exercise for at least an hour daily, move out of the city away from pollutants and stop driving. I asked if this would help me live longer? "No but it'll feel bloody like it"

When we "eliminate" certain conditions/diseases others occur to replace them as we need some form of population control.

I know someone who firmly believe that's the existential reason we had the AIDS crisis - we'd not had a major war for almost 2 generations, vaccination programmes were working extremely well so population particularly in the developed countries was rising. So nature "stepped in" to reduce it.

YY Graphista Agreed i mentioned DHs treatment as i felt it only fair.

But totally agree about women and heart disease Most studies have been based on males from what ive read.

YY Graphista DH is 68 and used to smoke He gave up in 2006 when he had a heart attack He was 10 when he started smoking

this tv advert was around in his childhood

"more doctors smoke Camels than any other cigarette"

Many older people are now living with ailments caused by smoking but grew up in a time when it was normalized and people smoked everywhere. buses trains cinemas even hospitals and they were told (or at the very least given the message ) that it was safe.

"Eg I grew up in a home with both parents heavy smokers. They genuinely believed that they were not doing us significant harm. Hell when they started smoking there wasn't even clear public knowledge it was harmful, it was still being allowed in hospitals"

Exactly. i think many people much younger than us dont realize how normalized it was.

Exactly. i think many people much younger than us dont realize how normalized it was.

Definitely! It comes up frequently on "what life was like in 60's/70's/80's" threads just how really hugely prevalent it was! Even when I started work in the 90's people still smoked at work and it was seen as perfectly normal.

We're also still learning about tertiary smoking and I wonder about old buildings especially residential ones if certain materials are still exuding harmful chemicals due to the building having been smoked in.

That may seem excessive but as an army brat we used to have to help clean our houses before we handed them back to army (called a march out they had to be left spotless), the layers of yellow that came off the walls, doors, window frames! You could clearly see a cleaned space versus a not yet cleaned bit and the water in the bucket you were using to clean turned a horrible brown/yellow colour really quickly.

I just thought to google and the pic attached is a really good illustration.

It is too simplistic to say that if people looked after themselves better, they would not suffer lifestyle induced conditions, thereby saving the NHS money
It is too simplistic at all. The population is indeed aging, but that's not what causes the NHS to struggle most, what does is the increase number of people living longer with a long term condition, which I think is now close to 20 years on average, and it's this stagecof life that is costing the NHS a fortune.

The highest cost to the NHS is not foreign travellers or whatever else the DM love to spout! It's our own lack of self care, diabetes, which cost the NHS not million butt billion. That's diabetes type 2 which is a direct outcome of poor lifestyle and obesity.

If the UK population started to focus on themselves and what they do for themselves to stay healthy, the NHS would cope with illnesses and conditions that can't be easily prevented.

Our society has reached an amazing achievement at reducing the rate of smoking, its now time to really tackle obesity and alcohol consumption so that people can realise the damage it does to their health the way smokers realised the impact of smoking on their lungs.

It is too simplistic to say that if people looked after themselves better, they would not suffer lifestyle induced conditions, thereby saving the NHS money
What he was trying to tell you is that statistically, you'll spend the last 10 to 20 years must likely to enjoy your life if you are healthy younger than if you are not. The hs can keep you from dying, but they can't take away your pain, lack of mobility, mental decline.

Considering we now have to work until 68, what a depressing state to think that one would go from working to a limited life until dying, watching the healthy pensioners having a blast doing all the things they wanted to do when working.

My mum is 70, single and having the time of her life, travelling, volunteering, meeting up with friends doing sporting activities, even dating! She is healthier than many people 10 years younger. My friends dad is 100 and still active, even regularly baby sitting his 3 yo great great grand son!

Considering the likelihood of living older, I know that I much prefer facing these years healthy than not!

It is simplistic but then the best solutions often are. It’s one of those messages litigation and gutter press have prevented NHSE giving out for fear of offending.
Much quicker and easier to offer antidepressants than exercise, talk therapy and social contact for mild depression. Much easier to refer to a one stop breast clinic with breast cancer (easier in terms of time and acceptance by patients) than telling postnatal women (easy point to catch them at) that they need to lose weight, walk more and reduce drinking.

Someone above said it’s not about an ageing population- it is to an extent but it is also about ensuring people stay healthy and mobile into old age instead of making excuses.

Cigarettes were advertised on television until 1965 with sports sponsorship stopping a decade later, give or take. Cigarettes were linked to lung cancer in the 1940s/50s when suddenly huge numbers developed the disease. That’s an awfully long time until now for people to realise the danger and give up. People saying they used to advertise and didn’t understand the risks are reducing people to empty vessels to be filled with nonsense. Of course people understand the risks in the U.K.

Smokers actively choose lung cancer, heart disease, mouth and throat cancer, stomach cancer, cancer of kidneys and liver, leukaemia, VTEs, poor wound healing, peripheral vascular disease, ocular degeneration, strokes, COPD, emphysema heart failure; They want their children to develop bronchitis and glue ear. It creases the risk of prematurity and stillbirth, reduces male fertility and increases SIDS. It also increases risk of cleft palates and cataracts. The NHS bears the financial cost of that choice. It is an unpalatable truth for some but there should probably be a total ban on the sale of cigarettes in the U.K. Certainly a total ban in all public spaces. It would save the NHS a fortune five years hence and prevent an awful lot of pain and misery.

Aging population is an issue to some extent but could be managed if people didn't live older with long term preventable conditions. People used to live younger but died more likely from an infectious desease.

The NHS has increased its funding and will continue to do so above inflation in the next 5 years. This should tackle to an extent the additional activity that results from an increase number of older people but it can't tackle the increase cost of managing long-term conditions, copd, diabetes, heart disease, etc...

The cause of many pancreatic cancers is known - or at least triggers are known.

People still get pancreatic cancer who don't have the causes/triggers! My father didn't smoke nor drink, wasn't overweight, and was generally fit. Not the "risk profile" at all, which is why it took his GPs months to even think about a cancer diagnosis despite him presenting with obvious signs (with the benefit of hindsight).

My OH has Myeloma - again, another cancer without known causes/triggers - same story, 3 years of going to the GPs with various symptoms. Again, not a smoker nor drinker and generally good health. Again, very late diagnosis after multiple chances for the GP to think about it being a cancer.

I think all this "blaming" is actually counter productive. It's making people think that they're only going to get a cancer if they're overweight, smoker, drinker, or whatever other unhealthy lifestyle. That causes people who "behave" and healthy to think they're not going to get cancer, and clearly it makes GPs think the same (hence late diagnoses!). 60% of cancers AREN'T caused by lifestyle/behaviour choices - that's a statistic that needs to be shouted from the rooftops to get it across to people (and GPs) that it's not only those with unhealthy lifestyles that get cancer. Unhealthy lifestyles only increase the risks - there's no guarantee you'll get cancer and no guarantee those with healthy lifestyles won't get cancer - it's just a probability/risk game.

Kazzyhoward, of course there are plenty of diseases where the cause in unknown but that doesn’t mean we should ignore the huge incidence of diseases (including but not exclusively cancers) where the cause is known. A reduction of 40-50% of disease would bring huge benefits. Including more time to investigate those rarer diseases.
We need people to take responsibility - it doesn’t mean nobody will get ill but shouting ‘you can’t help yourself’ is not an appropriate message.

We need people to take responsibility

Indeed we do, but we also need to be VERY careful about what message is being sent out to those who don't indulge in poor lifestyle choices and the doctors treating them. Far too many people I am close to have been badly let down by GPs who initially ignored signs of cancer etc because the risk factors/causes weren't present.

"That's diabetes type 2 which is a direct outcome of poor lifestyle and obesity." If that were true then why isn't EVERYONE who's obese & has a poor lifestyle got t2?

Even the nhs acknowledges there are other factors.

https://www.nhs.uk/conditions/type-2-diabetes/symptoms/

Even the Mayo clinic acknowledges we don't really know

Exactly why this happens is unknown, although genetics and environmental factors, such as excess weight and inactivity, seem to be contributing factors.

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

Indeed there are some who are researching if diabetes is caused BY being overweight or whether actually it's a case of being diabetic /pre-diabetic makes you gain weight.

"Our society has reached an amazing achievement at reducing the rate of smoking, its now time to really tackle obesity and alcohol consumption so that people can realise the damage it does to their health the way smokers realised the impact of smoking on their lungs." And as with smoking it wasn't necessarily the individual that caused the societal problems we now have with alcohol and poor eating habits. There are mothers on this site who remember being encouraged to drink stout while pregnant, to "eat for 2", I personally am far too familiar with the pro-alcohol culture within the armed forces in particular and male culture generally, as for the obesity issues I and many others think various govt policies have contributed to our convenience food reliant culture.

Again, just my personal belief but we've also yet to acknowledge the true effects/dangers of caffeine. Doesn't surprise me that as yet not much research on this as the biggest soft drink manufacturer in the WORLD'S best selling product is caffeine laden, as is the second biggest soft drink manufacturer! Then add to that the huge coffee & tea production around the world.

"Much quicker and easier to offer antidepressants than exercise, talk therapy and social contact for mild depression." I suspect many cases of mild depression are down to vitamin deficiency or undx/underdx conditions like anaemia, hypothyroidism etc. Dx and treating them would make more sense.

I hate smoking and have never smoked myself BUT I also understand that for those who are smokers especially those who've been smokers for decades, it's an addiction and not just a psychological one either, it's a physical addiction too. So it isn't as simple as "just quit" nor do I think a blanket ban would work, it would just result in smokers buying on the black market (which they already do to a degree) which brings a whole raft of problems not just health ones. Also it wasn't "just" advertising - it was culturally prevalent, Drs and nurses telling patients it "wasn't that bad", geez I remember early 90's an older sister of a friend being sympathetically told that cutting down while pregnant was fine if she couldn't face quitting altogether.

I do think there's a discussion to be had on preventing new smokers buying tobacco. I really don't understand those who've taken it up who are of my generation (I'm 46) and younger because we KNEW it was a killer. That makes no sense to me. But then I don't at all understand the appeal of street drugs either, I mean I know the attraction is getting high & that's a pleasant feeling but I don't understand taking the risk when you've no idea what's in it, how strong it is and how it will affect you.

There's also cognitive dissonance/denial so no most smokers aren't actively choosing to be ill. They choose not to think it will happen to them. They focus on their mum who smoked till she was almost 90 and never had a day sick their whole life, while ignoring their dad who died at 60 from a heart attack, due to smoking induced congestion!

"I think all this "blaming" is actually counter productive. It's making people think that they're only going to get a cancer if they're overweight, smoker, drinker, or whatever other unhealthy lifestyle." Worse - as you say, and clear in your cases it's making DOCTORS think only patients with risk factors get those diseases.

I too have known people get pancreatic cancer who weren't in the high risk groups, I've nursed patients with heart disease, cancers, lung & gastro conditions who weren't high risk groups for the conditions they had.

Cherry there are VERY few conditions aside from genetic ones where the cause is KNOWN. We know what increases the risks but that isn't the same thing at all.

And as Kazzy Says, Drs going in with that attitude and ignoring clear symptoms of cancer or other serious conditions because the patient doesn't fit the profile of a typical sufferer of that condition are not performing their duties properly, and are letting patients down.

"I think all this "blaming" is actually counter productive. It's making people think that they're only going to get a cancer if they're overweight, smoker, drinker, or whatever other unhealthy lifestyle." Worse - as you say, and clear in your cases it's making DOCTORS think only patients with risk factors get those diseases.

Have to agree with all that. Certainly my experience too! GPs seem to take one look at you and "judge" - i.e. if you're fat, all your problems are down to overeating and lack of exercise. If you're thin, there's nothing wrong with you, you're just a hypercondriac. Time after time, I've had various GPs start a mini rant about cutting down alcohol - I've been teetotal all my life - it's in their notes, they ask at least yearly and I see them tick a box - why don't they look at their sodding notes? If they're not going to bother looking at the history, why bother asking the questions and filling in their checklists every time you go?

Badbadbunny They get paid CQUIN funding based on giving alcohol reduction advice hence the need to ask the question. Not the GPs fault - blame NHSE.
Nobody is suggesting blaming but I am suggesting telling people the truth. No use saying giving up smoking is hard and then complaining about the huge number of disease processes you’ve triggered in yourself and your children. If you’re not to blame for choosing to make yourself ill, who is? Much easier to criticise the NHS than take responsibility for improving our own health outcomes.

They get paid CQUIN funding based on giving alcohol reduction advice hence the need to ask the question

So as if a 10 minute appointment isn't short enough, they spend some of it filling in a questionnaire of no benefit to the patient, so they can earn more. Nice!

Not so,they can earn more but to ensure they receive their full funding. They lose money if they don’t ask rather than gaining if they do. They’re hands are tied, I’m afraid.

Some posters above have mentioned NZ a a comparison to the NHS.

My comments...

A medic friend who has worked in both systems says the NHS allowed him to prescribe a much wider range of medications. This has been so for years

Also, the NZ system has been starved of funds over the last decades. DW and my DCs have all had hospital visits in recent years. They have been notably quick to get them out the door, in one case way before the proper time, which resulted in a second, longer stay. They made mistakes with treatment because the staff were rushed. The nurses recently went on strike because they'd not had a pay rise in years and one hospital has been found to be infected with black mould.

It's become normal to wait ages for treatment and GPs have become really leery of making referrals.

We now carry private insurance because we believe we will no longer get adequate treatment otherwise.

Injuries caused by accident are paid by compulsory insurance. In practice, this means no difference in the quality of care.

The reality is that all developed countries are spending much more on healthcare for a variety of reasons, and it doesn't matter how you organise things: the money will be stretched.