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"?

I'm interested to know what paying more for our healthcare will achieve, in terms of quality? Having worked for the NHS, it's poorly run and has far too many middle managers who don't work clinically, and runs largely on goodwill and staff doing more than they should. Me paying £5 when I see the GP wouldn't bother me (would some, for whom £5 is out of their budget) if it meant I got an appointment when I wanted one. But it wouldn't - us as taxpayers wont make more GPs/nurses/midwives magically appear out of thin air. It won't stop the service having demands placed on it it just can't meet.

I love that we have an NHS, and have seen it firsthand save lives and do extraordinary things. It saved my Dad's life twice, for example. But I do think it can do and be better, and still be free at the point of use. And if we're criticising it, we need to look at whose funding it, whose in charge of it, and who we have in power.

Interesting point Togaandsandals however I've just looked it up and the country I live in which comparably has much better healthcare than the UK spends less than the UK in terms of GDP and per capita.

Oops, above I meant to tag you @Togaandsandals

having ended up in A&E in Hong Kong and the states and in HK in particular not being transferred out of a&e till a colleague had got hold of my insurance documents was ridiculous. I was on a drip and barely conscious.

This is surprising but possibly as you were a non resident (I assume) or visited a private hospital. HK actually has an excellent public health system with very low co-pay costs (eg you only get charged around ten pounds to give birth)

I work for the NHS, it’s badly run, inefficient, abused and hero worshipped. It also relies too much on the goodwill of staff lower down the pecking order.
There is so much that needs to change.

My husband had a heart attack in Belgium last week and the care he had in a public hospital was wonderful and free!
We only had to show his passport and his EHiC card.
We will be forever grateful!

Sorry I haven't been able to get back sooner. I am still reading the thread. I am happy to see that at least some people are open to criticising the healthcare system.

The country I mentioned is Israel. I do think that the healthcare system there is vastly better and vastly cheaper (they spend 7.5% of GDP or in absolute terms $2428 per person versus UK's around 9% or $4125 ). But I need to be honest here - I don't think it is entirely fair to compare the two, because UK is much bigger and less homogeneous, and possibly with large segments of population having health problems caused by differences in lifestyle that necessitate bigger spending. However both from examples in this thread and from friends who lived in other countries that are comparable to the UK (Italy, Spain and Portugal, perhaps less so Germany, Austria and Switzerland) it seems that the UK healthcare system can be improved.

My point is that you shouldn't just accept what is handed to you and sheepishly green in acknowledgement. Because you purchased it with your own money, and it can be made better!

Also I don't follow the UK politics, but if you suspect the tories want to kill the universal healthcare, how come they are in power for the last 10 or so years? I mean, this is literally the life or death issue. You or your loved one can die next year because the GP thought the spot on his skin doesn't justify referral to dermatologist and it turned out to be melanoma. Or because the breast cancer drug you need isn't approved in the UK. Or because your chid developed an allergy but wasn't prescribed EpiPen because a wait for the allergist is half a year long. (All real cases that happened to me and close friends, luckily all still alive but could have ended badly, and I could go on).

It seems to me also that the social impact from abolishing the free healthcare in the UK would be so dramatic that no government will be stupid enough to actually do it. I suspect they are just doing it as a way to stifle criticism.

I agree with you, OP. All public services, to a large extent, are funded by the taxpayers' money and the taxpayer, therefore, has the right to expect a reasonable service. NHS does a lot of great things and, in many instances, delivers even a great service but it's not consistent and there are also many appalling failures. The taxpayers should certainly be well within their rights to expect and even demand an improvement in the service.

A couple of months ago, my ex colleague ended up in a hospital with gallstones. She was in total agony and yet still had to wait well over 4 hours to be seen by a doctor in our local A&E. I do not consider that even an acceptable service, let alone a good one. While A&E may not have considered her situation to be life or death and may have thought there were other priorities, I find it horrific that someone, who is literally crying from pain while also vomiting should be left waiting for over 4 hours without ANY assistance to ease the pain AT ALL.

A lot of people say there are countries that have worse services BUT Britain considers itself a developed and civilised economy. One of the most developed countries in the world. Therefore, comparing this country to anything that may be even more substandard is not really adequate.

Christ I was hospitalised briefly in Italy and it was like being in a third world country. It was awful.

I agree with you OP. I think the expectation that patients behave with simpering gratitude and believe themselves lucky to have received NHS treatment, has contributed to the public's lack of sense of ownership of the service, and subsequent lack of motivation to demand it be run and funded better.

Another thing I wanted to say that’s often forgotten is the ADMIN. I have helped friends in Australia and South Africa sort out family healthcare following major operations and it was an utter eye opener.

Australia- government paid 1/3, insurance paid 1/3, the patient paid 1/3 (£7,000!) all the separate bills came to the patient to farm out, reclaim, batch up and fill out additional claim forms and submit.

South Africa- the insurance company weren’t concerned about whether treatment was covered or not so trust broke down and my friend ended up directly ordering the “parts” for want of better word (joint replacement) he also booked the anestatist, surgeon, hospital and blood tests etc. They had no money to pay for anything uninsured and made it clear. The hospital still did a load of uninsured tests, getting the patient to agree immediately after coming round from GA*

Again, all the invoices came to him so he could fight for payment from insurance, fill out the additional claim forms etc.

• the procedure is also something rarely performed in the U.K. because it doesn’t improve quality of life (mainly affecting the elderly and sick) however, at £28k, it was very much recommended there. Said patient has now had 2 of these replacements.

Contrast it to here, where my entire pregnancy was planned for me, all appointments made on my behalf and aftercare booked for me.

I don't Agree with opening post at all.
I think she's talking rubbish.

we are perfectly capable of criticising the NHS and appreciating its failings.
you know we're not stupid.

however it is free, it caters for a lot, and you know it will pick up anyone in an ambulance irrespective of their nationality or if they can't speak English : everyone gets treated equally, by ambulance crew, when there is a car crash or life-threatening incident.

it could do a lot better. But it's better than many other countries and you simply can't dispute that.

possibility for a GP telephone appointment the same day as being a good thing. So, I've got a massively sore throat and a fever - how does my GP check that out over the phone?

I don't know, I've never rung for anything like that! He might want you to come in, I guess. Actually, whenever I've rung, I've always had whatever I need prescribed for me without me going to the surgery.
It suits me, it means I don't have to cancel work appointments just to get meds prescribed. They will see patients the same day if it's medically urgent, especially if it's children.

When my friend had an excruciating headache, and mentioned a family history of cerebral bleeds, the doc didn't piss about, told him to go straight to A&E (having first checked that his wife was able to drive him) at the hospital that also has the dedicated neuro unit for the area, and rang to let them know he was on the way. He was in surgery having a leaky aneurysm fixed within 90 minutes of speaking to the doctor.

AlwaysCrashing - how much is the insurance in aus? Did you have to pay for ambulance upfront and then reclaim from insurance?

Charolais I'm assuming you have until now been in employment in USA and able to afford insurance?

TooMuchTooOld - it's precisely because I'm not making assumptions that I ASKED if op meant English or was using English to mean British. Maybe they did mean English and not British? No way of knowing at the time I and others queried this. The fact is there is a difference between English and british.

TheStoic - I'm scots and asked the same question.

"The only systems anyone really knows much about in the UK are ones from other English" not true. There's a significant number of mners who are or who have lived in other non-English speaking countries and experienced the healthcare there myself included.

Those discussing Australian system - how does it REALLY work regarding those who can't work (who are actually more likely to be sick/disabled and therefore need more healthcare)? And/or the mentally ill?

"Apart from those people who pay for private healthcare!" To be fair private healthcare in uk doesn't cover that much. Certainly doesn't cover emergency situations.

Madeline88 are you able to say roughly what percentage of benefit income a Drs visit is?

PenguinSaidEverything - I agree. I've had mixed experiences with nhs. Excellent in most emergency situations but dreadful when trying to get the right treatment via primary healthcare. Personally it's the power that GP's hold I think needs addressed. I think GP's reluctance to admit when they don't know the cause of your problem, to refer to specialists, to properly ascertain if the treatment is correct COSTS the nhs a bloody fortune in the long term.

OpinionCat - not necessarily short waiting times in USA system for emergencies either

www.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sexism/410515/

"When you've had years of not being able to get a GP appointment you end up thinking you wouldn't mind paying for it and it can go on from there.." See attached pic

SofieAmes - what does "close to" free at the point of use mean in reality? I've asked several USA based mners on similar threads how their system would work for someone like me (unable to work due to my health which includes serious mental health issues) - they never answer. Some have been honest enough to admit they don't know, others who previously in the dialogue were lauding the USA system suddenly fell silent 🤔

"so that the system isn't overburdened with minor complaints." Many times dealing with "minor" complaints prevents them developing into major ones. An issue within the nhs too. Cheaper and better for the patient long term to address "minor" complaints early on, keep people healthy than wait until they're major complaints.

"Of course it could do better. Its massively underfunded right now." Deliberately so - again see pic.

I have to say though I think the biggest indicator of the nhs - despite its many issues - being better than how most other countries operate their healthcare is the number of "expats" who return to the uk as soon as they reach a point where they're needing a lot of healthcare, whether that be due to being elderly or otherwise.

"For a government to suggest switching to an insurance model would be political suicide though." I fear if the current Tory govt are re-elected they'll do this without warning the electorate whatsoever, quite possibly in the first year of their term, at most with a heavily disguised reference to it in their manifesto.

"Tbf to OP, the NHS can be regarded as English. NHS Scotland is a separate entity devolved to the Scottish Parliament." Not entirely. It's still subject to Westminster funding and guidelines on many issues.

"Cutting resources when we have an ageing population with a high level of complex need is just madness." Not really when you're voters are usually older folk and you want people to think it's not working and possibly vote for at least partial privatisation based on this fallacy.

LakieLady I'm glad you've had a good experience with primary healthcare - sadly many of us have had many problems over the years with this. It can take weeks to get an appointment - Even if the matter is urgent - with my surgery, rarely with the same dr twice so precious time is taken up with getting the dr up to date with whatever the appointment is for (my main conditions are all long term with complex histories attached) AND in my case I'm allergic to or have major problems with side effects with many medications and so before they can even prescribe an antibiotic I have to give the list of what I can't take - actually been told on more than one occasion it's quicker for me to that than for dr to look it up on what is clearly an unfit IT system. On similar threads other mners have often cited similar issues.

"Making nursing a graduate-only profession and abolishing the nursing bursary was a stupid move." As an ex nurse I heartily agree. Both under Tory govts too. (Mind you not that I consider blairites true labour). I have a friend/ex-colleague who now is also responsible for mentoring trainee nurses. She says most are ok but a significant number due to nursing now being a graduate profession, consider certain tasks "beneath them".

"Add into the worse outcomes things like alcohol, obesity, inactivity, smoking and one can see an entirely different reason for the U.K. to have worse outcomes than many other nations." Do you SERIOUSLY think those issues are only a problem in the uk?!

Personally I'd rather if there's a spare £84 mn going begging in the budget I'd much rather it went on nhs than bloody grouse shooting!

Biker47 - considering what I mentioned upthread re our CURRENT politicians having VESTED INTERESTS in American healthcare companies - no it's not a huge stretch to fear a USA style system at all!

Those stating "under X system in y country it doesn't cost THAT much" do you know how that system works for unemployed, very sick people who need healthcare frequently?

"But I do think it can do and be better, and still be free at the point of use. And if we're criticising it, we need to look at whose funding it, whose in charge of it, and who we have in power." Very well put!

"My husband had a heart attack in Belgium last week and the care he had in a public hospital was wonderful and free!
We only had to show his passport and his EHiC card.
We will be forever grateful!" Do you understand that will largely have been because the Belgians will have known U.K. Govt will pay the costs no problem?

"if you suspect the tories want to kill the universal healthcare, how come they are in power for the last 10 or so years? I mean, this is literally the life or death issue." I agree but then I don't understand why anyone but the wealthy vote Tory anyway! Voter turnout was better but still too many not voting and it tends to be younger ones who don't vote and they're less likely to vote Tory.

"everyone gets treated equally, by ambulance crew, when there is a car crash or life-threatening incident." Hmm you sure about that?

www.telegraph.co.uk/news/2017/07/31/mother-died-paramedics-accused-faking-symptoms-attention-inquest/

Op I'll ask you the same as others re non-British healthcare - how does it work where you are for the unemployed sick/disabled - who need more healthcare generally than those well enough to work?

In short, I think the nhs is better than most other systems BUT that doesn't mean it couldn't and shouldn't be better!

Less fat cats with manager titles

Proportion of staff on the NHS who are managers: 4%
Proportion of staff in the private sector who are managers: 16%

Seriously, it astounds me that people can understand that the NHS is a massive and unbelievably complex organisation and not understand that it therefore needs many people to manage it administratively: buy the drugs, manage the buildings, recruit the clinical staff, plan the appointments, make sure premises are clean, ensure the right services will exist for future populations, etc etc etc. Or do you think doctors and nurses should do all this?

@graphista This article you linked is horrible. Unfortunately I recognize this condescending attitude that the paramedics displayed, and as a foreigner myself I have no idea how to stop such behavior if it occurs. I must say that specifically the paramedics I encountered here were all excellent and extremely professional.

How are the disadvantaged treated in Israel - formally there is no distinction. Practically I am sure someone who can articulate themselves and demand things gets treated better than someone who don’t.

In my personal experience I gave birth on the same ward with many refugees from Africa who come to Israel through the border with Egypt. They aren’t citizens but are entitled to free healthcare. We were treated absolutely the same as far as I could tell.

Thank you for your honest reply regarding how the less well off are treated.

I think often and this is not peculiar to uk, people who've never been one of the less well off don't know how the less well off are REALLY treated within their society and certainly not in others societies. We get glimpses but it's not the whole story.

That article is indeed shocking - and sadly such incidents aren't as rare as some may think. Try asking anyone with mental illness how they're treated when admitted to a&e, even with physical ailments.

Christ I was hospitalised briefly in Italy and it was like being in a third world country. It was awful.
In Italy things can be excellent or terrible unfortunately. Generally the medical treatment is excellent but the bedside manner and facilities leave a LOT to be desired.

"My husband had a heart attack in Belgium last week and the care he had in a public hospital was wonderful and free!
We only had to show his passport and his EHiC card."

But you got that free treatment because they have a reciprocal agreement with the NHS as members of the EU/EEA. It's still paid for via your taxes, just indirectly.

"It seems to me also that the social impact from abolishing the free healthcare in the UK would be so dramatic that no government will be stupid enough to actually do it. "

Not in one go, no, but they can do it bit by bit. There has already been some privatisation.

If I had been sent to a private hospital the. I would have had to pay something before my travel insurance kicked in.
Perhaps I am ignorant as to how it works but I was so glad I didn't have to worry about it when I thought my husband may die.

"I think GP's reluctance to admit when they don't know the cause of your problem, to refer to specialists, to properly ascertain if the treatment is correct COSTS the nhs a bloody fortune in the long term. "

You make it sound like it's the GPs' fault though. They're told not to refer people unless they've tried everything they can themselves first. That's why they're called GATEKEEPERS.
I personally think GPs should be able to provide holistic care and not confine you to only talking about one problem at a time, but the NHS sees them as a way of keeping patients away from specialists.

"Mutuelle contributions are hardly expensive - €35 twice a year for the whole family! Outside of Brussels, seeing a GP (after reimbursement) costs about €5. Again, hardly expensive. "

Well, I lived in Brussels so the cost of a GP outside Brussels is big news for me. I think I paid 30E and got ten back.
I'm sure my mutuelle was more than 35 twice a year as well. I paid every month and I seem to remember it being about 13E a month. That was Partena and just for me.
I also paid taxes, which were much, much higher than here and a part goes from taxes as well.

I agree with you that a telephone appointment is not an appropriate way to make a diagnosis.

"I've started another related thread:
AIBU To ask you to tell me about healthcare systems in other countries?www.mumsnet.com/Talk/amii_being_unreasonable/3415646-to-ask-you-to-tell-me-about-healthcare-systems-in-other-countries"

This was done a while ago.